Treat the cause, not the symptom
The biggest mistake I see therapists make is to just treat areas of pain. Most therapists (and owners) are good at identifying where a horse is sore and effectively treating the area, but if you never address the cause of the pain, it will never stop coming back.
As a physiotherapist, we have extensive training in completing functional assessments - looking at gait patterns, individual joint range of movements, areas of weakness, hoof angles, saddle fit and piecing together the puzzle to identify why your horse is getting recurrent soreness. When we identify and treat the why, we can create a treatment plan which doesn’t involve seeing a therapist every 2-4 weeks for the rest of your horse’s life.
Often we do require input from a veterinarian, as only veterinarian’s can provide a diagnosis and provide a lameness work up with imaging to rule in or out pathology. Whilst many people are apprehensive at the cost of a vet bill, it is far easier to get the diagnosis right from the start rather than wasting time treating or rehabbing the wrong area or making an educated guess at what is going on.
Lets look at an example. The most common condition I treat as a physio is back pain in horses. Here are the most common causes of back pain that i find!
Poor posture due to weak core muscles and lack of topline: Many horses (even some that competed at the Olympics 🫣) are ‘dipped’ through their back with atrophy over their topline. This usually results in overactive gluteal muscles (at the top of the hindquarters) and overactive lower neck muscles. This posture creates narrowing of the space between the dorsal spinous processes of the spine and creates changes to the interspinous ligament, causing back pain in horses. How to resolve back pain: Completing an exercise program (usually including 4-6 weeks of in-hand work) to strengthen the horses core and spinal musculature to improve posture. Pain management throughout is usually required throughout the rehab program, in the form of either medication or physiotherapy treatment.
Poor saddle fit: Seems obvious, but poor saddle fit is very common cause of back pain. The saddle is the bridge between you and the horse, so high areas of pressure are magnified when the rider sits in the saddle. Be aware that horse’s back shapes are unique, and not every saddle will fit every horse. Unfortunately, not all saddle fitters are trained equally - make sure your fitter looks at how the saddle sits on the horse when they are moving and when you’re in the saddle to ensure the saddle is suitable for both you and the horse. How to resolve back pain: Get your saddle fit checked by a well trained professional.
Hindlimb lameness: Now, this isn’t one that I can diagnose (obviously) so a trip to the vets is required. Often, low grade hindlimb lameness can cause secondary back pain due to compensation strategies the horse uses to move. The back pain and poor performance is usually picked up, but often the lameness is missed (particularly if it is bilateral). A thorough lameness work up by a veterinarian is required, using nerve blocks to accurately diagnose where the problem is. How to resolve back pain: Treat the hindlimb lameness and the back pain usually resolves.
As you can see, the ‘treatment’ to solve back pain is rarely centred around the hands on or electrotherapy modalities used by therapists. Whilst these are great tools to reduce pain, inflammation and improve range of movement and performance, these treatments assist in the short term but rarely solve the horses problem without a rehab plan or intervention from a vet or saddle fitter. So if you’re stuck in a never ending treatment cycle with no plan to solve the underlying problem, reach out for help HERE.