Posture problems
I have treated many horses with fractures and I’ve found that the way you bring them back into work is critical for their long-term recovery. Once the fracture has healed, there are other equally difficult issues to deal with that relate to injury-induced posture problems. If a horse has a fracture and is forced to stand for several weeks, it’s obvious that he is not going to put much, if any, weight on the injured limb. So in this case, the horse will have been taking most of his weight on his right hind leg for several weeks, if not months. This is one of the reasons why he built up muscle on the right side, and lost it on the left.

Take a look at the picture on the left. Note how the horse is standing with his right foot turned out and the hock turned in. This is a lameness induced posture problem caused by standing primarily on the right hind. If I was to bring the horse back into full work without correcting this problem . .

a I suspect that he would not remain sound for very long and would most likely strain the hock.
b Or as a National Hunt chaser, his jumping would be affected and his performance would be diminished.

Having lavished so much care and attention on his recovery from the fracture, it would be foolish to try to bring him back into work too quickly only to have him break down again. In this particular case he was actually owned by his trainer, and so cherished that nothing was too much trouble when it came to his recovery! This is why you must have a rehabilitation programme specifically designed to correct these problems. Don’t forget that these photographs were taken three months after we started his rehab, and his right-hind problems were considerably worse than this when we started.

Post-box-rest rehab
If a horse has been on box rest for several weeks, or even months, keeping him calm for the first few outings can be difficult, and sometimes a small amount of sedative is needed. With this horse, for the first week he was simply led out of the stable and walked around the manège for five minutes, increasing to 15 minutes. To this routine, we added some poles to walk over. After this, when he was relaxed and calm, we long reined him, and created an equine gymnasium with some poles on the ground, some raised poles and some different types of surface. For example, he would do some pole work in the school, then walk onto the gravel in the car park and around a few cars, up and down the grass bank, then back onto the school etc. This is to help with his balance and ‘proprioception’ – his ability to know where his legs are in relation to the rest of his body and the ground, without looking. After a few weeks of this work, we could start to introduce trot work and bring him onto a circle, still with poles.

Remedial riding and lungeing
By October we decided that he could start ridden work, and he has now done six weeks walking under saddle. Now we can introduce work on the Pessoa lungeing device. I like the Pessoa for this type of rehabilitation work because the lines keep the horse straight, make him use his hind legs, and stretch and supple his topline. In the photo (right) is a horse from the same racing yard being worked in what I consider to be the correct outline, with the head lower than the withers and the lines of the Pessoa clipped to the underside of the roller.

In our rehabilitation programme this horse will work at trot on the Pessoa, starting with five minutes on each rein, working up to 15 minutes on each rein. He will do this every other day, alternating with ridden trotting work. When we introduce faster work will depend on how he copes with this portion of his rehabilitation work, but if all goes well I would expect the horse to be completely rehabilitated by spring of 2008 and ready to go back into racing. You can appreciate that his rehab programme took longer than the time it took for him to recover from the fractured pelvis, but by taking that time with him, we have given him the best possible chance of a full recovery.

H-wave therapy
One further electro-therapy technique I used with this horse was H-wave neuromuscular stimulation. I started it when he was ready to come out of the box and start his rehab programme.

What does H wave do?

1. It stimulates the small, smooth muscle fibres within the lymphatic system, which is responsible for elimination of inflammatory products from the body.
   
2. It produces optimal muscle contraction for ‘slow twitch’ muscle fibres (the type that utilise oxygen more efficiently for endurance work), using lowfrequency and low-intensity electronic pulses, which have nonfatiguing qualities and pump inflammatory products into the lymphatic system. Each time a tissue is compressed by muscle contraction, small amounts of protein-enriched fluid (inflammation) move into the lymphatic system from the area of inflammation. By using H-wave over the horse’s pelvic area as we brought him back into work, I could ensure that any residual inflammation was removed and that muscles that had not worked for several months could be ‘nursed’ back into action.