b'SPORTS MEDICINEspaces and improve total spinal flexibil-ity, ensuring the horse continues travel-ing in straight lines. Striking a balance between spinal stability and flexibility is essential to overall spinal health, Schils says. For example, if they are a jumper, we work on canter pirouette-type turns to keep the horse straight, she says. In addition, before any turn or change of direction, three strides of a straight line should be performed. This comes from human research on the number of strides it takes for an athlete to rebalance.ISABELLE BEAU DE LOMENIE COURTESY DR. SHEILA SCHILSSupraspinous DesmitisThe supraspinous ligament lies above the dorsal spinal processes, running the length of the vertebral tract from the seventh cervical vertebra to the sacrum One of the many therapies veterinarians might recommend to ease discomfort associated with(pelvis). Direct trauma can damage this intervertebral facet joint osteoarthritis is mesotherapy. ligament, as can overstretching during exercise, particularly jumping, causing horse with intervertebral facet joint OA,by providing stability to the spine, andinflammation (desmitis). Injuries to the he or she might recommend a variety ofsome limited equine research supportssupraspinous ligament are similar to therapies to ease that discomfort: that, she says. For horses with OA ofthose that occur with other important (to target thethe facets, movement in straight lines isligaments, such as the suspensory liga-Corticosteroid injectionsinflammation), with or without hyal- always preferable in the early stages ofment at the back of the cannon bone. As uronic acid (similar to treating jointrehabilitation. When turns are necessary,with most soft tissue injuries, ultraso-pain elsewhere in the body), guided bythey should look more like octagons, notnography is the diagnostic tool of choice, ultrasonography.circles.and the location to focus on appears to be (injecting pharmaceu- Once the horse seems comfortable atthe region spanning the thoracolumbar Mesotherapyticals into the middle layer of thethe trot, add canter sets into the reha- junction.skinthe mesodermon either side ofbilitation protocol to help open the jointSchils says she typically sees supra-the spine to block sensory-pain fibers)spinous desmitis occur as a result of using, per Allens recommendation,overextension of the ligament and/ora combination of a local anesthetic,pathological (involving disease or dam-corticosteroid anti-inflammatory drug,age) spinal rotation. She says rehabilita-and Traumeel (a homeopathic combi- tion of supraspinous desmitis problems nation drug) diluted in saline. must focus on improved weight-bearingof the limbs, so the spine isnt solely Extracorporeal shock wave therapy(ESWT) using an 80-millimeterresponsible for movement. probe to apply 1,000-2,000 pulses atSupraspinous desmitis is typically a the highest setting, says Allen. Yourself-limiting injury (it heals on its own) veterinarian can repeat ESWT at four-in horses, and the lesion should scar in to 12-month intervals, based on theafter a few weeks, says Allen. If there horses response.is significant pain or swelling associated (drugs thatwith the injury, the horse will likely ben-Off-label bisphosphonatesinhibit bone resorption, FDA-approvedefit from shock wave therapy and/or the for managing navicular pain), evenadministration of NSAIDs (non-steroidal though little evidence supports theiranti-inflammatory drugs) while they have use for back issues. time off from ridden work. Schils says you then need to rehabili- Schils says stabilizing the back during tate the arthritic facets to address incor- Horses compensating for thoracolumbar backthe initial stages of supraspinous desmitis rect joint spacing in concert with thepain often begin moving asymmetrically. Thisthrough trot work can help. existing muscle asymmetry.horse places one hind limb toward the center ofHow long this process takes depends I have found the diagonal move- his body during movement on straight lines andon how long things have been wrong ment at the trot seems to bring reliefcurves, as well as when standing. and the degree of the asymmetry and the 48February 2020The Horse|TheHorse.comSportsMed_Feb.indd 48 1/3/20 11:45 AM'