b'SPORTS MEDICINEfactors) and treated the area with extra- perfect example of what a good diagnosis,and included physical therapy, aquatic corporeal shock wave therapy (believed togood treatment, compliant owners, and aexercise, cryotherapy (cold therapy), and improve new blood vessel growth, recruitwell-behaved horse can do. controlled exercise. mesenchymal stem cells, and have pain- Cryotherapy was initially utilized as a relieving effects). JR means of reducing inflammation to the Schlachter also recommended forMelissa King, DVM, PhD, Dipl.DDFT region, King explains. Underwa-Chanel a controlled exercise program,ACVSMR, is an associate professor at theter treadmill exercise was incorporated as which she modifies to meet the needs ofColorado State University (CSU) Veteri- a means of providing buoyancy and, thus, different injuries and disciplines but typi- nary Teaching Hospital, in Fort Collins,decreasing the loading on the forelimbs cally involves: where she specializes in equine sportswhile increasing joint range of motion, Eight weeks of stall rest with hand- medicine and rehabilitation. King treatedstride length, and muscle strength.walking multiple times each day; JR, a 16-year-old Thoroughbred whoJRs rehabilitative workload increasedEight weeks of walking under saddle; had shown as a four-star eventer. Fromto incorporate the use of weightedEight weeks of walking and trottingrepetitive use in his job, JR developed ansurcingles, surface changes, backing under saddle; insertional lesion in his deep digital flexorexercises, ground poles at various heights, Six to eight weeks of walk-trot-cantertendon (DDFT, which runs from the kneeand eccentric loading exercises aimed at (or lope, as it were) under saddle withdown the back of the leg and around theincreasing soft tissue extensibility in a sport-specific additions (such as jumps)navicular bone, attaching to the coffincontrolled manner, she adds. added at the end of this stage. bone) and a second, discrete tear at theIn addition to his forelimb injuries, Two months post-diagnosis, Schlachterpastern level.JR had significant back pain and muscle reevaluated Chanel. At that point sheDiagnosing the injury was challengingsoreness caused by severe overriding was 80-90% better, so we allowed her todue to its location. A portion of the lesiondorsal spinous processes (kissing spines) be walked under saddle for the next twowas at the insertion of the DDF tendonthat were evident on radiographs. The months, she says. When we looked atonto the coffin bone, says King. SinceCSU team treated these areas with her again at the four-month mark, shewe were unable to image the soft tissueacupuncture, laser, mesotherapy (corti-was 100% sound, so we started her onstructures in the foot with ultrasound, thecosteroid and local anesthetic injections some trot work. only path to diagnosis was through MRI. into the middle layer of skin on the back Once she was sound at the canter,Once King made a diagnosis, however,to help relax the muscles), and daily core Chanel began working back into training.she performed a contrast CT scan and aexercises. JR was hand-walked twice daily Eight months post-diagnosis she was stillbursoscopy (using a fiberoptic endoscopeusing a resistance band to improve hind-sound and back in the show ring. Sheto guide her debriding of the lesion),limb strength and stability and encourage is now free of bar shoes, and her onlyfollowed by an intra-arterial perfusionlumbosacral (where the lumbar vertebrae maintenance since recovering has been aof bone-marrow-derived stem cellsmeet the sacrum at the croup) flexion.round of hock and sacroiliac joint injec- (which have anti-inflammatory proper- Sixteen months post-surgery, JR made tions to manage normal wear and tear.ties and help coordinate tissue healing).a full recovery, returning to training and, Chanel was a wonderful patient,JRs postoperative care took place ateventually, eventing at the three-star level. Schlachter says. She is the picture- the CSU Equine Rehabilitation CenterThe only maintenance he receives now is regular farrier care to maintain appropri-Eight months after her collat- ate hoof angles and reduce stress and eral ligament injury diagnosis,pressure on his hooves and legs.Chanel is sound and back inThe ultimate goal of any rehabilitation the Western pleasure ring. program is to return an injured equine athlete to a fully functioning, pain-free state, says King. In order to accom-plish this, therapeutic programs must be customized to each individual, addressing mechanisms to modulate pain, restore joint range of motion, enhance neuromo-tor control, improve muscle strength, and increase flexibility.IzzyIn 2019 Schlachter was called out to a nearby show to treat Izzy, a 12-year-old Warmblood mare. Izzy had been per-forming well in the 1.40- meter jumpers until the middle of the summer, when she walked out of her stall with a very swollen 30August 2020The Horse|TheHorse.com'