Laminitis is one of the most serious and painful conditions that horses and ponies can suffer, and just recently it seems like I’m seeing more and more cases. But why? The answer lies in a mix of modern horse-keeping practices, climate change, and better awareness of the condition. Creating a perfect storm. However, with awareness, prevention, and careful management, many cases of laminitis can be avoided or caught early before they become life-threatening, hence me writing this blog to try to raise awareness and help owners struggling with management.

The key reasons for seeing more cases:

1. Rising Rates of Obesity and EMS

• Equine obesity has become one of the biggest welfare concerns in the UK and worldwide. Surveys suggest that up to 50% of leisure horses are overweight.
• Obesity is the single biggest risk factor for Equine Metabolic Syndrome (EMS), which is strongly linked to endocrinopathic laminitis.
• Overfeeding, lack of workload, and calorie-dense feeds all contribute.

2. Climate Change and Grass Growth

• Warmer winters and wetter springs mean grass grows nearly year-round.
• Grasses have become richer in non-structural carbohydrates (NSCs) due to selective breeding for cattle grazing.
• “Danger periods” used to be spring/autumn flushes — now high-sugar grass can appear almost any month of the year.

3. More Horses Living as Leisure Horses, Companions & “Pets” Rather Than Workers

• Historically, horses worked hard and needed higher-calorie diets.
• Today, many leisure horses do relatively little exercise, but are fed as though they are in full work.
• Lack of consistent movement increases the risk of both insulin resistance and hoof circulatory compromise.

4. Better Awareness and Diagnosis

• Vets and owners are now more aware of subtle or “low-grade” laminitis and “not quite right” horses.
• Advanced diagnostics (endocrine testing, insulin tests, ACTH for PPID) mean more cases are being identified rather than overlooked.
• So part of the “increase” is actually improved recognition.

5. Aging Horse Population

• Horses are living longer due to improved veterinary care.
• This means more cases of PPID (Cushing’s disease), which carries a high laminitis risk.

6. Lingering Outdated Management Misconceptions

I will get into some of these a little deeper shortly but in summary:

• Many (including some vets) are still seeing laminitis as a stand alone disease and treating it as such, however, this is not the case, laminitis is rarely a stand-alone disease—it is increasingly understood as a clinical manifestation (a symptom) of underlying systemic problems, particularly metabolic dysfunction. I will discuss this in more detail soon.
• Box rest is still sometimes used long-term, which delays recovery.
• Shoeing is still often prioritised over barefoot rehab, even though barefoot trimming can be more effective for laminitic horses.
• Painkillers (bute) are sometimes relied on instead of tackling the metabolic root cause.
• Owners often underestimate the risk of grass, believing short or sparse pasture is “safe” when in fact stressed short grass can actually be very sugar-rich.

7. Seasonal Hormonal Effects

• Spring and autumn laminitis “spikes” are still seen because insulin dysregulation and PPID can worsen seasonally.
• Research shows ACTH and insulin levels rise naturally in autumn, increasing laminitis risk (Durham et al., 2019).

• Milder winters and wetter springs mean grass grows for much longer each year. With the weather we have been experiencing over the last 2/3 weeks; warm & wet after a very dry summer the grass has grown at an exponential rate hence the rise in laminitis cases over these weeks.

Laminitis isn’t becoming more common because the disease itself has changed — but because of the way modern life, climate, and horse care practices interact. Obesity, metabolic disease, sugar-rich grass, and longer lifespans all contribute to the surge in cases we’re seeing today.

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Subtle Signs & Symptoms

Picking up on the signs and symptoms of laminitis and metabolic dysfunction is extremely important to be able to react, manage and catch early before it becomes a life threatening situation. One of the biggest challenges with laminitis and metabolic dysfunction (like EMS or PPID) is that the early signs are often subtle, and by the time classic symptoms appear (like the “laminitic stance” or obvious lameness), the disease is already well advanced.

Here are some of the more subtle symptoms to watch for:

Subtle Signs of Laminitis

• Shortened stride / reluctance to move forward – may look like the horse is just “lazy,” stiff, or footsore on hard ground.
• Shifting weight when standing – alternating front feet, resting one foot more than usual, or standing with front feet stretched slightly forward.
• Reluctance to turn – especially on a tight circle; horse may look “stiff” rather than overtly lame.
• Increased digital pulse – can be felt at the fetlock or pastern, sometimes more noticeable after exercise or sugar intake.
• Warm hooves – especially when persistent or uneven between hooves.
• Flat or stretched sole – before obvious separation occurs.
• Rings in the hoof wall – wider at the heel than at the toe, suggesting changes in growth rate.
• Change in behaviour – irritability, grumpiness when ridden, or reluctance to have feet picked up.

Subtle Signs of Metabolic Dysfunction (EMS, PPID, insulin dysregulation)

• Laminitis – discussed below
• Cresty neck or abnormal fat deposits – behind shoulders, around tail head, or above eyes (fat pads above the eye can be an early warning).
• Difficulty losing weight despite restricted diet – or unexplained weight gain.
• Muscle wastage – especially topline loss (more common with PPID).
• Mild lethargy – horse just seems “flat” or not performing as usual.
• Increased thirst or urination – more often with PPID, but can appear with metabolic stress.
• Delayed coat change – shedding late in spring, or developing a slightly longer, wavier coat (an early PPID sign).
• Filled sheath or udders – Horses with insulin resistance often develop abnormal fat pads and sometimes mild, fluctuating oedema (fluid swelling). The sheath and mammary region are common places where this shows up because the tissue there is loose and more prone to fluid accumulation.
• Recurrent foot soreness – mild, inconsistent lameness episodes that come and go.
• Slow wound healing or frequent skin infections – due to impaired immune function in PPID horses.

The tricky part is that many of these early signs can easily be mistaken for other issues (like arthritis, saddle fit, or laziness). But taken together, especially in easy-keeper breeds (native ponies, cobs, Morgans, Andalusians, etc.), they should raise suspicion.

Laminitis: Not a Stand-Alone Disease but a Symptom of Metabolic Dysfunction

Laminitis is often thought of as a hoof disease. In reality, research has shown that it is rarely a stand-alone condition. Instead, laminitis is best understood as a clinical symptom of underlying metabolic and endocrine dysfunction. For horse owners and veterinarians, this distinction is crucial, because it changes laminitis management from a short-term hoof problem into a lifelong systemic issue requiring lifelong management.

Laminitis is a Symptom, Not a Disease

Historically, laminitis was attributed to grain overload, pasture fructans, or mechanical stress. While these can contribute, the majority of modern cases are endocrinopathic laminitis—laminitis linked to hormonal and metabolic dysfunction.

• Pollitt (2008) described laminitis as a “syndrome with multiple causes,” with endocrinopathic forms dominating in today’s domesticated horse population.
• Patterson-Kane et al. (2018) confirmed that the most common type of laminitis in the field is associated with insulin dysregulation.

In other words, laminitis is a downstream effect of systemic disease rather than a primary condition.

Laminitis is the clinical manifestation of an internal metabolic problem

Metabolic Dysfunction as the Root Cause

Two major conditions are repeatedly linked to laminitis: Equine Metabolic Syndrome (EMS) and Pituitary Pars Intermedia Dysfunction (PPID).

• Equine Metabolic Syndrome (EMS):
  Horses with EMS typically show obesity, abnormal fat distribution, and insulin dysregulation.
  • Asplin et al. (2007) demonstrated experimentally that prolonged high insulin levels can directly induce laminitis in otherwise healthy horses.
  • This provides strong evidence that hyperinsulinemia is not just associated with, but causative of, laminitis.
• Pituitary Pars Intermedia Dysfunction (PPID):
  In PPID, abnormal pituitary function disrupts hormone regulation, which in turn worsens insulin dysregulation.
  • McFarlane (2014) notes that horses with PPID are predisposed to laminitis, particularly when insulin resistance is also present.

Why Laminitis Is a Lifelong Problem

Because the underlying metabolic disorders (EMS, PPID) are chronic, affected horses remain at risk for laminitis throughout life—even after apparent recovery.

• Durham et al. (2019) emphasise that laminitis management requires ongoing attention to diet, weight, and endocrine health to prevent recurrence.
• The principle “once laminitic, always at risk” is supported both by clinical experience and by endocrinological studies.

This makes laminitis a lifelong management issue, not an isolated hoof event.

Implications for Management

Effective laminitis management must therefore extend beyond the feet:

• Diet: Low non-structural carbohydrate (NSC) forage, avoidance of high sugar/starch feeds.
• Weight control: Obesity is strongly linked with insulin resistance (Geor & Harris, 2009).
• Exercise: Improves insulin sensitivity if the horse is sound.
• Medical support:
  • PPID: Pergolide (Prascend®) to control pituitary function.
  • EMS: Metformin has limited efficacy but may help some cases.
  • NOT giving NAID’s (Bute)
• Hoof care: Corrective trimming/shoeing provides comfort and stability but does not treat the underlying disease.
• Movement – box rest is now not recommended as movement and circulation is essential
• Bodywork – compensation, circulation, tissue health, pain management, nervous system regulation, foot and posture alignment support

A multidisciplinary approach combining veterinary care, farriery, bodywork, diet, and lifestyle change offers the best chance of long-term success.

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NSAIDs and Pain Management in Laminitis

Non-steroidal anti-inflammatory drugs (NSAIDs) such as phenylbutazone (bute) were traditionally prescribed for laminitis to reduce pain and inflammation. However, modern research highlights significant limitations to their role in management.

• Masking protective pain: Pain discourages overloading of damaged laminae. Excessive use of NSAIDs can allow the horse to move more than is safe, potentially worsening laminar separation.
• Inflammation is not the primary driver: In endocrinopathic laminitis (EMS/PPID), the initiating factor is insulin dysregulation, not inflammation (Asplin et al., 2007). NSAIDs therefore do not target the root cause of disease.
• Systemic risks: Long-term NSAID use carries risks of gastric ulceration, colitis, and renal compromise, particularly in overweight or metabolically compromised horses.

Current best practice:

• NSAIDs may still be used short-term for welfare reasons in acute, painful cases.
• They should not be relied upon as a primary treatment or as a long-term management strategy.
• The focus of therapy should instead be on dietary control, insulin regulation, controlled movement, and appropriate hoof support.

Supporting evidence:

• Pollitt & Karikos (1993) showed NSAIDs failed to prevent laminitis progression in experimental carbohydrate overload models.
• Asplin et al. (2007) demonstrated that laminitis induced by hyperinsulinaemia was not associated with an inflammatory response, explaining why NSAIDs offer limited benefit.
• Durham et al. (2019) emphasised the primacy of endocrine control in managing laminitis, with NSAIDs considered only an adjunct for short-term comfort.

NSAIDs are no longer considered a cornerstone of laminitis therapy. Their use should be cautious, limited, and always secondary to addressing the underlying metabolic dysfunction and providing mechanical hoof support.

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Laminitis, Metabolic Dysfunction, and the Role of Barefoot Management

Correct hoof care is central to successful management. One strategy increasingly discussed is keeping horses barefoot / using barefoot trimming principles. Below is what current scientific literature shows about benefits, limitations, and how barefoot care may fit into a laminitis‐management program.

What “Barefoot Management” Means in This Context

For laminitic/metabolic horses, “barefoot management” generally includes:

• Removing traditional steel shoes, often moving to barefoot or using boots when needed.
• Trimming the hoof frequently according to principles that reduce stress on the laminae
• Maintaining correct hoof morphology: promoting solid sole depth, correct angles, hoof wall alignment.
• Ensuring the ground and turnout conditions are appropriate (avoiding overly sharp rocky surfaces until foot has hardened, providing supportive substrate).

Evidence From the Scientific Literature for Barefoot / Barefoot Trimming Benefits

1. Hoof Morphology Improvements

• Clayton, Gray, Kaiser, Bowker (2011), Effects of Barefoot Trimming on Hoof Morphology:
  This study followed seven horses trimmed every 6 weeks under barefoot trimming principles over 16 months. Major findings included: shortening of the toe, heel, medial and lateral walls; increases in heel angle and solar angle of the distal phalanx (P3); increases in support length of the hoof. PubMed+1
  These changes can help in horses with under‐run heels or negative solar angle of P3—conditions that put abnormal stress on the laminae and can exacerbate laminitis.
• Changes in Hoof Shape During a Seven-Week Period When Horses Were Shod Versus Barefoot (Roepstorff et al., “crossover” study):
  Over seven weeks, horses kept barefoot versus shod showed significant differences: barefoot horses maintained or increased hoof angle slightly, had greater solar circumference (i.e. spread of hoof sole/hoof base), and less proximal hoof circumference loss than shod horses. PubMed+1
  Implications: barefoot hooves may better maintain their natural shape, expand under loading, possibly improving load distribution and reducing excessive stress on any one structure (such as the hoof wall or laminae).

2. Heel / Sole Support / Heel Expansion

• “Can the hoof be shod without limiting heel movement?”: This experimental study compared heel expansion (mediolateral movement) in three situations: barefoot, conventional shoe, split‐toe shoe. It showed conventional shoes significantly reduced heel movement vs barefoot. PubMed
  Why this matters: Heel expansion is thought to help distribute load, absorb concussion, improve blood flow, and reduce mechanical stress on the laminae. Reduced heel movement (as happens with many shoes) may contribute to higher stresses. Allowing more natural movement may thus be protective or supportive in laminitic/metabolic horses.

3. Practical Considerations in Laminitis Rehabilitation

• From The Laminitis Site (TLS), which compiles both veterinary and farriery practice and reports:
  TLS recommends against shoes initially for laminitis rehab because: a) The hoof walls are often not fully connected to the bone (i.e. rotations or separation can exist), so weightbearing on the walls should be minimized. b) For repositioning / realigning the hoof (e.g. lowering heels, adjusting palmar or plantar angles), frequent trimming is necessary; shoes complicate or prevent some of these adjustments. c) Support beneath the distal phalanx (via sole / frog / bars / padding / boots) is more feasible barefoot (or with boots), especially when parts of the wall are compromised. The Laminitis Site
• Although not specific to laminitic horses, the “Hoof Capability of Barefoot‐Kept Horses and Ponies Walking over Artificial Environments” (preprint) aims to measure how soles adapt in barefoot horses under artificial (hard or variable) terrain. Findings suggest that barefoot horses can maintain sole thickness and adapt morphologically when kept in good conditions (forage diet, turnout). This suggests that barefoot management can be viable in many environments, though care is needed. Preprints

How These Benefits Tie Into Managing Laminitis as a Lifelong Metabolic Issue

Putting the above together with what we know about laminitis being a symptom of systemic dysfunction:

• Reduced mechanical stress on compromised laminae: In metabolic laminitis, the laminae are already weakened or inflamed. Hoof shapes that reduce lever arms (long toes), increase heel support, allow the frog/bars/sole to bear weight, and allow heel expansion will help reduce subjective/absolute strain on the laminar attachments. Barefoot trimming that corrects long toes / under‐run heels helps in this regard.
• Improved circulation and load distribution: Allowing natural deformation (expansion/contraction) and contact of frog/bars/sole with ground may improve blood flow, reduce regions of stress, and improve comfort.
• Flexibility for adjustment: Since metabolic issues and laminitis episodes can change the hoof’s internal geometry (rotation, sinking, palmar/plantar angle changes), barefoot care (with frequent trims) gives more ability to adjust, re‐align, correct angles—because there is no rigid shoe or nails to work around.
• Prevention of recurrence: By ensuring hoof conformation supports structural alignment and minimizing recurring stressors, barefoot management adds to preventive strategies (diet, weight control, endocrine control) to reduce the risk of further laminitic episodes.

Barefoot Management as a Strategy in Laminitis Rehabilitation & Metabolic Horses

Emerging evidence supports that barefoot hoof care, when applied properly, can offer significant benefits in laminitic/metabolic horses. While more targeted trials are needed, current studies show changes in hoof morphology, load-bearing function, and heel/sole support that can reduce stress to the laminar structures.

Key beneficial effects documented:

• Correction of long toe under‐run heel conformation; increases in heel angle and solar angle of the distal phalanx (P3), which reduce lever effects on the laminar connection. PubMed+2Mad Barn USA+2
• Greater sole width / solar circumference; better hoof base expansion, which aids load distribution. PubMed+1
• Enhanced heel expansion and movement (when barefoot) which may improve circulation and shock absorption. PubMed
• More rapid and flexible ability to realign angles and control hoof geometry via frequent trimming—important during laminitis when the hoof’s internal alignment is often compromised. Barefoot trimming is more adaptable for these adjustments. The Laminitis Site+1

How this integrates with metabolic laminitis management:

• When a horse with EMS or PPID is at risk, or recovering from a laminitis flare, combining metabolic control (diet, weight, endocrine therapy) with barefoot hoof care can reduce both systemic and local risk factors.
• For example, lowering insulin reduces the biochemical injury to laminar tissue, while barefoot alignment reduces mechanical strain. Together, these can reduce pain, improve healing, and reduce recurrence.
• During recovery phases, use of protective boots, soft footing, and frequent trimming will help transition to barefoot without undue pain or risk.

Limitations, Risks, and Gaps in the Evidence

To have a balanced view, it’s important to understand the limitations and what is not yet shown scientifically:

• Lack of direct trials in laminitic + metabolic horses: Few studies have directly tested barefoot vs shoeing in horses currently in laminitis with metabolic dysfunction. Most are in “normal” horses or those with hoof shape concerns.
• Sensitivity / discomfort during transition: Removing shoes and altering hoof shape can initially cause soreness, especially if the ground is hard / sole thin, or hoof has been “protected” for a long time. Booting or padding may be needed during the transition.
• Ground/terrain concerns: Barefoot management requires suitable terrain or supplemental protection (boots, soft ground) especially early or during bouts of sole tenderness.
• Quality of barefoot trimming matters: Poor trimming (too much off, leaving sharp edges, not maintaining frog/bars, ignoring alignment) can worsen problems. Not all farriers or trimmers have equal skill or understanding of anatomy, especially in compromised feet.
• Individual variation: Breed, hoof wall quality, metabolic severity, conformation, previous damage—these all influence how well a horse will respond to barefoot care. Some may always need some form of shoeing or protection.

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Movement and Circulation: Why Box Rest is Not Recommended

Historically, horses with laminitis were often confined to box rest, but increasing evidence suggests this is counterproductive in endocrinopathic laminitis. While acute cases may require a short period of stabilisation, prolonged immobility reduces circulation to the feet, slows recovery, increases stiffness, and worsens metabolic dysfunction.

Movement is vital for several reasons:

• Circulation and hoof health: Locomotion improves blood flow to the laminae and supports hoof capsule healing (Bowker, 2003).
• Insulin regulation: Even low-intensity movement improves insulin sensitivity (de Laat et al., 2016), directly addressing the root cause of laminitis.
• Musculoskeletal wellbeing: Gentle movement prevents secondary stiffness, joint restriction, and muscle loss.

Practical management of movement:

• Bald paddock or track system: Horses should be turned out in a grass-free environment to allow self-exercise without further sugar intake.
• Soaked hay fed in multiple stations: Placing hay in several feeding points encourages natural movement and mimics foraging behaviour.
• Protective hoof boots or pads: These can be used to improve comfort on firm ground while still allowing beneficial movement.

Thus, while the horse cannot be ridden during acute laminitis, encouraging free movement in a controlled, low-sugar environment is essential for rehabilitation. Box rest should be avoided except in the most extreme cases, and only as a very short-term measure.

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Bodywork in Laminitis Rehabilitation

1. Managing Compensation Patterns

Laminitis causes severe pain in the feet, and horses instinctively adopt compensatory postures:

• Leaning back onto the heels (“sawhorse stance”) to unload the toes.
• Shifting weight excessively to the hindlimbs.
• Developing tension in shoulders, neck, thoracic sling, and lumbar region due to altered gait.

Over time, these compensations can cause secondary musculoskeletal issues — tight muscles, fascial restrictions, and joint strain.

Bodywork (massage, myofascial release, stretching, chiropractic/osteopathic techniques) helps:

• Release muscle tension in overloaded areas (triceps, shoulders, hamstrings).
• Improve circulation and lymphatic flow in tight tissues.
• Support more balanced posture once the feet become more stable.

2. Improving Circulation and Tissue Health

One of the goals in laminitis rehab is to improve blood flow to the feet and distal limbs, since perfusion of the laminae is often compromised.

• Massage and myofascial techniques increase peripheral circulation.
• Gentle mobilisations of the limbs (when comfortable) can enhance vascular and lymphatic return.
• Craniosacral and fascial work may reduce systemic tension that inhibits blood flow.

While research directly linking massage/bodywork to laminitis outcomes is scarce, human studies show soft tissue therapy increases circulation and reduces pain perception — and equine studies have shown similar benefits in muscle relaxation and stride length.

3. Pain Management and Nervous System Regulation

Laminitic horses are often in chronic pain and stress, which activates the sympathetic nervous system (fight-or-flight).

• Gentle bodywork encourages parasympathetic activity (“rest and digest”), helping reduce cortisol and systemic stress.
• Lower stress hormones can support metabolic stability and improve healing (important for horses with EMS/PPID).

4. Supporting Hoof and Postural Realignment

As trimming and hoof rehabilitation progress, the horse’s posture shifts. Bodywork:

• Helps the horse adapt to new limb angles and loading patterns.
• Prevents “old” muscular compensations from persisting once the feet are corrected.
• Restores range of motion in joints restricted during the painful phase.

5. Research and Evidence

While equine-specific research on bodywork in laminitis is limited, several studies provide supportive evidence:

• Haussler (1999, Equine Veterinary Journal) – chiropractic techniques improved spinal mobility and reduced pain in horses.
• Tabor & Williams (2004, Equine Veterinary Education) – physiotherapy and manual therapies support recovery from lameness by addressing compensatory strain.
• McGowan et al. (2010, Equine Veterinary Journal) – rehabilitation of chronic laminitic horses must consider the whole horse, not just the foot.

This suggests bodywork is most effective when integrated with veterinary, farriery, and management approaches.

How I Approach the Practical Applications in Laminitis Rehab

• Early stage (acute laminitis): focus on comfort — gentle massage of shoulders, neck, hindquarters, avoiding direct manipulation of painful feet.
• Subacute stage: fascial release, gentle stretching, lymphatic massage to improve circulation.
• Chronic/recovery stage: more active techniques — mobilisations, core stability exercises, dynamic mobilisations, pole work (when horse is sound enough), strengthen conditioning, postural improvement.

Conclusion

Scientific evidence clearly demonstrates that laminitis is not a stand-alone disease but a symptom of deeper metabolic dysfunction. Viewing it in this light reframes both treatment and prevention: addressing the whole horse’s metabolic health rather than only the feet. For owners, this means committing to lifelong holistic management programme to safeguard horses from repeated, painful episodes of laminitis, gaining a deeper understanding of the causes to help prevent flare ups and awareness of evidence based treatments rather than the outdated treatment protocols that hinder the long term prognosis of the horse.

If you would like any further information or help with your horse please do not hesitate to contact me. Below are a list of references I used to help me write this article if you would like some further reading or clarification or there are also lots of sources online which I can pass on if you are interested.

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References

• Asplin, K. E., Sillence, M. N., Pollitt, C. C., & McGowan, C. M. (2007). Induction of laminitis by prolonged hyperinsulinaemia in clinically normal ponies. American Journal of Veterinary Research, 68(7), 755–761.
• Clayton, H. M., Gray, S., Kaiser, L. J., & Bowker, R. M. (2011). Effects of barefoot trimming on hoof morphology. Australian Veterinary Journal, 89(8), 305–311. PubMed+1
• Durham, A. E., Fey, K., McGowan, C. M., et al. (2019). Pituitary pars intermedia dysfunction: Diagnosis and management. Equine Veterinary Journal, 51(2), 185–195.
• Geor, R. J., & Harris, P. A. (2009). Dietary management of obesity and insulin resistance: Countering risk for laminitis. Veterinary Clinics of North America: Equine Practice, 25(1), 51–65.
• Hagen, J., et al. (2019). Heel movement in barefoot vs. shod horses. The Veterinary Journal, 246, 1–6.
• Haussler, K.K. (1999). Chiropractic evaluation and management of musculoskeletal disorders. Equine Veterinary Journal, 31(4), 291–295.
• “Laminitis rehab — barefoot vs shod,” The Laminitis Site (non-peer-reviewed compendium but summarising practice and published data). The Laminitis Site
• McFarlane, D. (2014). Equine pituitary pars intermedia dysfunction. Veterinary Clinics of North America: Equine Practice, 30(1), 73–93.
• McGowan, C.M., Frost, R., Pfeiffer, D.U., & Neiger, R. (2010). Long-term management of chronic laminitis: a whole horse approach. Equine Veterinary Journal, 42(5), 471–478.
• Patterson-Kane, J. C., Karikoski, N. P., & McGowan, C. M. (2018). Paradigm shifts in understanding equine laminitis. Equine Veterinary Journal, 50(6), 564–575.
• Pollitt, C. C. (2008). The anatomy and physiology of the suspensory apparatus of the distal phalanx. Veterinary Clinics of North America: Equine Practice, 24(1), 29–50.
• Roepstorff, L., et al. (2020). Hoof expansion and balance in barefoot vs. shod horses. Equine Veterinary Journal, 52(5), 703–710.
• Roepstorff, L., et al. (2020) “Changes in hoof shape during a seven-week period when horses were shod versus barefoot” (crossover study). PubMed+1
• Study comparing heel movement with barefoot vs different shoe types: Can the hoof be shod without limiting heel movement? PubMed
• Tabor, G., & Williams, J. (2004). Physiotherapy and manual therapy in equine rehabilitation. Equine Veterinary Education, 16(3), 151–156.

Worried hearing about prevalence of sand colic at the moment, want to understand why so you can help to prevent it? Have a read . . .

After chatting with a few vet friends and colleagues this week, they were all commenting about the increased number of cases of sand colic they have seen recently and I’ve had a few clients reporting their horses have had problems with it since the frost and snow has gone, so I thought it would be a good idea to do a post about. It is one of the lesser known types of colic & is so prevalent at this time of year but do you understand why? As when people think of sand they think of dry conditions in summer but that is not necessarily the case so if you can understand why, you can take better steps to prevent it in your horse. At this time of the year as grazing conditions and feeding practices increase the likelihood of sand ingestion. Colic, a general term for abdominal pain in horses, can stem from various causes, including impaction, gas, or intestinal displacement. Sand colic specifically occurs when horses ingest significant amounts of sand or dirt, which settle in the gut, typically the large colon. Over time, this buildup can lead to blockages, irritation of the intestinal lining, or in severe cases, gut motility issues.

How and Why Does It Occur?

Horses are at risk of ingesting sand when they graze on sandy pastures, eat hay or feed placed directly on the ground, or drink from sandy water sources. When they consume forage or grain contaminated with sand, small particles can accumulate in the intestines. While the horse’s digestive system is designed to move material through efficiently, large amounts of sand can settle in the colon, leading to discomfort, inflammation, or even obstruction.The abrasive nature of sand particles can also irritate the intestinal walls, causing inflammation, diarrhea, or discomfort. Left untreated, sand colic can progress to serious complications, such as impaction, requiring surgical intervention.

So, Why Is Sand Colic Common at This Time of Year?

Sand colic tends to spike during the autumn and winter months, especially in areas with sandy soils. Several factors contribute to this seasonal trend:

1. Sparse Pasture Growth: In autumn and winter, grass growth is very little or dormant, forcing horses to graze closer to the ground, where they inadvertently ingest sand or dirt.

2. Increased Hay Feeding: With limited grass availability, we feed more hay or on the field, hay becomes the primary forage source. When fed on sandy ground, hay can mix with soil, leading to unintentional sand consumption.

3. Dry, Windy Weather: During dry periods, dust and sand can easily contaminate feed or water.

4. Changes in Turnout Patterns: Horses may spend more time in confined areas, such as dry lots or sandy paddocks, increasing their exposure to sandy surfaces.

Preventing Sand Colic

Fortunately, there are several effective strategies to reduce the risk of sand colic in horses:

1. Feed Management:- Provide hay in areas of the field where there is a little more grass coverage rather than in poached areas or provide hay in feeders or on rubber mats to minimise contact with the sandy ground. Avoid feeding hard feed or supplements directly on the ground. Ensure pastures are well-maintained and not overgrazed, particularly in sandy areas. (See pictures)

2. Psyllium Supplements: Psyllium husk is a natural fiber supplement that can help move sand through the digestive tract. Feeding psyllium in cycles (e.g., one week per month) can aid in clearing accumulated sand from the gut.

3. Adequate Forage: Ensure your horse has constant access to high-quality forage, which promotes healthy gut motility and reduces the likelihood of ingesting sand during grazing.

4. Encourage Hydration: Proper hydration supports the movement of material through the digestive tract. Make sure your horse has access to clean, fresh water at all times.

5. Regular Turnout: Allow your horse ample time for turnout in areas with minimal sand exposure. Avoid keeping horses in sandy paddocks for prolonged periods. I know some that just turn out in the sand arena over winter with hay nets as the fields are too clay and deep with mud, but this can pose a significant risk as the hay falls out of the net on to the sand surface of the school which they then ingest. Putting rubber mats under the areas they are eating that can be easily moved when you want to ride on the arena can be of massive benefit.

6. Sand Testing: Perform periodic manure tests to check for sand presence. Mix a manure sample with water in a clear container, let it settle, and check for sand at the bottom. This can indicate if your horse is ingesting significant amounts of sand.

Signs of Sand Colic to Watch For As Early detection is critical in managing sand colic.

Common signs include:

✴️Loss of appetite

✴️Depression or lethargy

✴️Diarrhea or loose stools

✴️Abdominal discomfort, such as pawing, rolling, or lying down excessively

✴️Decreased gut sounds

✴️Weight loss in chronic cases

If you suspect sand colic, contact your veterinarian immediately. Early intervention can prevent severe complications and improve your horse’s chances of recovery.

Does your horse have Urethral Beans: What they are, why they matter to me as a physical therapist, chiro, body worker etc.

Horse owners know that keeping their animals healthy involves regular grooming, hoof care, and dental checks. But there’s a lesser-known yet essential part of equine care: monitoring and removing urethral beans. These seemingly minor buildups can significantly impact your horse’s comfort and even movement if left unaddressed.

What Are Urethral Beans?

Urethral beans are small accumulations of smegma that form in the horse’s urethral fossa, the small pocket just above the urethral opening. Over time, smegma—a mixture of dead skin cells, oils, and other debris—can harden into small, rounded masses or “beans.”

Smegma is a natural secretion produced in the sheath to keep the area lubricated and protect sensitive skin. In geldings and stallions, this material can harden within the urethral fossa, creating what’s known as a ‘bean.’ Left unchecked, these accumulations can grow large enough to interfere with urination & even movement which is what concerns me as a physical therapist.

Why Removing Urethral Beans Is Important

Beans can restrict the urethral opening, causing discomfort or even leading to infections if bacteria builds up around the blockage. In severe cases, large beans may lead to urine spraying or pain when urinating, which can cause the horse to alter its posture or gait.

Discomfort from urethral beans or other infections of the sheath or penis may lead to behavioral changes, such as tail swishing, frequent attempts to urinate, or reluctance to move freely. A urethral bean, or infection if left unattended, can cause significant discomfort. Many horses may show their discomfort through even more subtle behavioral changes, such as irritation when urinating or issues that affect what I’m feeling through the rest of the body such as shifting weight or resisting certain movements. 

How Urethral Beans Affect Movement and Overall Comfort

The discomfort from a urethral bean can lead to changes in a horse’s stance or reluctance to engage in certain activities, affecting training and performance.

A horse in discomfort may develop coping mechanisms to manage the pain, such as altering their gait or moving with a “stiff” stance, which could lead to further musculoskeletal issues if untreated. Because horses are stoic animals, subtle signs like a slight hitch in their stride or unusual stiffness can be easy to overlook. However, these signs may indicate that a bean has reached a size that’s causing significant discomfort.

How to Safely Remove Urethral Beans

If you are unfamiliar with the process of removal or cleaning please contact your vet, as improper removal can cause injury or stress so veterinary guidance is essential, especially for first-timers. The process involves gently examining the urethral fossa for any signs of hardened smegma and carefully removing it if needed. I recommend a regular check and clean schedule, such as once every few months or as advised by a veterinarian, depending on the horse’s needs.

Some signs do suggest it’s time for removal, such as an increased amount of smegma around the sheath, weeing to one side, an obvious lump from the end of the penis.

When I visit for treatment, a lot of the time because the horse is often very relaxed they drop their penis so if I can safely, I will have a check for beans but there are also equine willy wash professionals. However, if your horse is particularly uncomfortable about being handled in this area a vet visit is definitely advised as sedation will probably be necessary. 

Conclusion

Adding urethral bean checks to your routine equine care to ensure your horse’s comfort, health, and performance is essential. Regular checks mean early detection, less discomfort, reduced risk of incorrect movement patterns developing and a happier, healthier horse.

🌟🌟Unpopular opinion🌟🌟  So . . . What’s my beef 🍖 🐄 with pole work clinics?

I love pole work, I’m a massive fan of it, but as I know I have mentioned to many of my clients before, I am just not a fan of this whole pole clinic craze that every man and his 🐕‍🦺 seems to be running at the moment without, it seems, little knowledge of the biomechanics involved.

Ground poles & raised poles are great as part of a training, conditioning or rehabilitation programme to:

• Train proprioception, coordination, skill, balance and dynamic stability 

• Improve/restore joint range of motion

• Develop core strength & activate or strengthen back muscles

• Strengthen propulsive muscles

• Provide variety within training

Stepping over a pole is a complex motor skill requiring neuromotor control and proprioceptive stimuli. Visual perception of the position and size of the obstacle is relayed to the neuromotor control centre to make decisions which command the peripheral nervous system to make an appropriate muscular response.

However, not every pole work exercise is suitable for every horse’s individual needs and if performed incorrectly can set them back in their training or rehab. There aren’t really any generic one size fits all pole work exercises. If you set any array of poles out and put a horse in front of it they will virtually always find a way to get to the other side. Do we conclude it was an appropriate exercise just because the horse managed to make it to the other side without falling in a heap? NO!

When I watch horses navigate pole exercises I set, I am constantly evaluating and re-evaluating on each pass the strategies they use to get to the other side, as for the pole exercise to be of benefit they must be using functionally correct movement patterns otherwise we may as well not bother.

What am I looking for: 

> Maintaining a soft top line

> Suppleness 

> Engaged core

> Lift in the thoracic sling

> Limb flexion in the correct part of the swing phase

> Straightness

Horses that find the exercise too difficult will use other strategies to navigate the pole set:

> Raising their head and neck, putting the spine into extension, losing good dynamic posture

> Unable to maintain balance so looses straightness

> Rushing

> Flexing the hindlimb further in retraction

> Performing a passage like motion

> Circumducting the hind limb

In both ground work and ridden work (when appropriate), I watch my clients horses over various pole exercises to evaluate what strategies the horse uses. I can then change the difficulty level up or down or change the whole exercise if needed.  Doing pole work badly is worse than not doing it at all because you will be further ingraining a poor movement pattern, you can be doing more harm than good. 

I also like to coach ground work so then I can teach owners what to look for in a quality movement & poor movement so they know when a pole exercise, lateral exercise, rehabilitation exercise, etc. is good/bad for their horse or when their horse is becoming fatigued with the exercise. One horses weakness is another horses strength area, the way one horse passed over the poles is different to the next one so in a clinic type situation (where there are usually about 4 horses but I have seen up to 6 in some!) the exercise, distances, arrangements would need to be altered every 2 minutes for each individuals movement pattern. This just isn’t feasible so most coaches will just leave them all to do the same exercise, for some it might be perfect but for others in the group far from it, which can be of real detriment😔 A pole clinic can seem like a cheaper way to get tuition, to get your horse out and about, to experience work in a group situation and to have social time with your friends, but not if you are doing them all the time and taking some of the exercises home to repeat when you have no idea if they are the right exercises for your individual horse. There is no way all 6 horses in one group have the exact same needs when it comes to any exercise but especially pole work, so at least a few horses within the group are not doing the right exercises their horse needs. If you then take some of these inappropriate exercises home with you and repeat them on a regular basis this further enhances their weaknesses, poor posture, poor movement which ultimately leads to injury.

Unfortunately, I’ve seen some really bad examples of inappropriate pole exercises recently, ultimately to the detriment of the horse. One example was being called a passage pole clinic where the coach was setting the poles on purpose to make the horse struggle so they would have to get this passage like movement. This is fine if you have a horse that is at the correct training level to be doing passage, but not one of the participants (horse or rider) was at this level. If this exercise was repeated too often in a horse that has not been progressively conditioned to this level of work (& I mean over years not weeks), it will cause injury very quickly 😭

If you want any more information or to discuss further, feel free to contact me.

How do I build muscle on my horse?

This is a question that I get asked a lot especially regarding a certain area. For example, lack of back muscle, hind end, gluteal region, top line, neck etc. Where ever your horse might be lacking, there is one simple answer, exercise & correct nutrition.

There is no magical topline gaining feed or supplement that is going to make your horse gain muscle in the specific area it needs to, however saying that he horse cannot build correct muscle without good general nutrition.  The horse needs to get more energy from the food than it is using per day putting them into a positive energy balance and specifically it needs good quality protein.  What denotes protein quality is the essential amino acid lysine but you cannot simply increase the amount or protein or lysine in the diet to increase the amount of muscle, it doesn’t work like that.  They cannot absorb or use more than their recommended daily amount, feeding too much can cause other problems putting the kidneys under pressure to filter it out into urine.  You will find creatine in lots of horse muscle building supplements which although they have been shown to work for human muscle building, have absolutely no effect on horses as they cannot absorb it. Overall for muscle & general health it is recommended to replace energy from starches & sugars with energy from oils, a balanced vitamin & mineral supplement especially vitamin E, lysine and sufficient salt & electrolytes if in heavy work.

When it comes to the exercise, a variety of correct and appropriate exercise gradually increasing in intensity, duration & frequency over an appropriate amount of time (that varies depending on the individual horse their signalment; age, fitness level, ailments, etc.) is the one thing that in conjunction with correct nutrition can build muscle. We do not increase intensity, duration & frequency at the same time we only ever do one at a time and take a great amount of care not to over train as eventually this will have a negative effect on both muscle building and overall fitness. Once they are at a good general level of health and fitness we start to use more targeted exercises to help with the areas of concern in particular.

What increases the intensity for them? Some things such as terrain, speed, duration, environment, type of exercise, surface all have an effect on the intensity so we can control & use that to help our training. However, other things naturally increase the intensity for the horse that we don’t have as much control over but we need to take into account when thinking about building muscle such as their overall health, weight and condition score, their conformation, the riders weight, weather etc.

Muscle training & training horses in general is a very fine line between loading the muscles hard enough to not only increase the number of muscle fibres (hyperplasia) but also to increase the size of the muscle fibres too (hypertrophy), while at the same time avoiding damage to bone, joints, tendons and ligaments. This why it is important to have regular assessments with someone like me that is a strength and conditioning coach, rider coach and equine physical therapist to ensure that the training programs’ intensity is correct for this horse at the present time.  If there is failure to gain muscle despite targeted training we must consider that this could be due to musculoskeletal disorders or pain, again why regular reassessments with your equine physical therapist are required to monitor this. Just because your horse is not “lame” this does not mean that there cannot be an underlying musculoskeletal condition such as back, neck or SIJ pathology, pain from issues like saddle fit, bridle fit, bitting problems or pain from other disorders within the body such as gastric ulcers. For more information or to discuss your horses training plan, please feel free to contact me.

Rider biomechanics is such a massive subject area and one that I am very passionate about, but I don’t want to get in too deep in a simple blog but it is important to me not only as a coach, trainer and rider, but also as an equine physical therapist, it is such an essential aspect of riding that for some reason is so often over looked by coaches. Everyone knows that poor riding can have a negative effect on the horse, their health and way of going. No one likes to think of themselves as a “poor rider” but to me this includes poor rider biomechanics too, as this can massively have a negative influence on the horse. Its not just about having a pretty position it is so much more than that.

So many riders have been taught incorrectly or using out of date research over many years and this has become their body’s default riding position. There is now so much more data that shows how we need to sit, our weight aids, posture, harmony, neutrality, and now it is not been corrected by many coaches and because you can now “ride” you go to coaches that are going to get you jumping higher, wider, bolder, braver, doing higher level dressage moves etc., rather than concentrating on these foundations and the basics of your own biomechanics which if they are not correct, your centre of balance is in the wrong place, your weight aids are incorrect, the horse can’t carry you properly in balance, or you cause him to brace through his back, blocking him, which affects his dynamic posture, he doesn’t move right which over time leads to a long term compensatory lameness issues, but not because of his own compensations (he has those to deal with as well any way!), but because of compensating for you. So in a nutshell; YOU CAN MAKE YOUR HORSE LAME! I see it so often, more often than I would like. Even in some riders at quite a high level, they don’t understand why their horse is blocked through the back when they ride, struggles with certain movements and I can feel it when I come to treat them. Then when I strip everything back and watch them ride, look at their biomechanics on the horse it all becomes obvious. Sometimes all it takes is a few tweaks to their dynamics here and there and it can make a massive difference to the horses comfort and way of going.

A lot of the time when I first start coaching people I take lots of photographs and video’s and use an app called the coaches eye so I can slow everything down, draw on it and show riders exactly where the issues lie, and we can compare the beginning of the session to the end, or in a few sessions time to see the differences that such small alterations make to the horses performance. So often when riders look at videos people take of them they are looking at the horse; is his head in the right position, how much is he clearing the fence by, etc. not at themselves, or they can pick out their flaws but are not sure how to correct them, and some are completely oblivious that their posture is causing the horse to shorten his stride, tighten on the left side etc.

Studies have shown correct seat and position are the basis for a good performance. One study in particular aimed to measure deviations from the correct seat, test a seat improvement program (dismounted exercises), and investigate whether horse behaviour was affected by the rider’s seat and found that in particular improvement of backward tilted pelvis, which I see very often, showed a reduction in horse behaviour classed as “evasive,” and the horses’ heart rate decreased (elevated heart rates are associated with stress and pain). Heart rates of riders decreased therefore it was a either a lot less effort for them to ride in a biomechanically more efficient posture or it was less stressful for them too when the horse is less evasive. 78% of riders felt the exercises improved their riding performance.

It also applies if you have any physical medical issues, tightness, old injuries in your body that affect what you can do, your posture, movement etc. This is when you need to go see a good human body worker yourself, get yourself sorted, as again you will be affecting your horse. Most people put their horse first but there is no point in getting the horse treated if their problem is being caused by you. I work in conjunction with some really fantastic human bodyworkers so that together, both specialists in our own field can get you and your horse to be happier, healthier, sounder, in better harmony and balance so that you can achieve your goals.

Rehabilitation plans can often seem difficult and daunting.  You have spent a lot of money on expensive veterinary treatments or operations and now your horses success or failure lies in your hands.  You know it is important that you get it right but often the support isn’t there or you don’t know where it is  going wrong until it is too late.

Rehabilitation plans are normally formulated by your vet & /or your physical therapist to provide prescriptive exercise to help your horse recover from injury or illness so that they can hopefully return to the same level of performance as they previously were, or as close to it as is now physically possible. The most common injuries that I formulate rehab plans for include back pain and spinal dysfunction including kissing spine, spondylosis, arthritis, soft tissue injuries such as tendon, ligament and muscular strains and tears, arthritic conditions, and fractures. Most of these conditions require veterinary intervention followed by a course of physical therapy and a prescriptive exercise plan.  These rehab plans use movement and specific exercises to strengthen and support the horse to initiate gait retraining to recover the injury, prevent further injury to the same area or another area in compensation and to optimise function.  These exercises need to be correct, appropriate, progressive and within the correct time frame.  Sometimes rehab plans fail in that the horse does not return to full expected performance level or soundness, or develops another lameness in another area due to compensation.  In my experience the main reasons for this include:

–          Not understanding what it is that is required at each stage – if you don’t understand the exercise or what it is exactly that you should be doing, no matter how stupid you think the question might be, ask anyway, as even doing something slightly incorrectly when repeated over and over can make a massive difference to the success or failure of a rehab plan.

–          Not executing the exercises correctly – the amount of time I see owners not doing exercises correctly, one that I see so often is in-hand walking, how hard can it be, you would think?! In-hand walking shouldn’t be just dawdling along.  It should be an active walk so the horse is doing more of a medium walk, you should be power walking along side the horse, if you are not out of puff from in-hand walking for 15 mins you are probably not doing actively enough for your horse.  You will get back in shape too!  For other exercises too, ask your horses physical therapist to watch you completing the exercise to ensure you are doing it correctly.

–          Not wanting to do a specific exercise because the horse/owner doesn’t like it, doesn’t enjoy doing it, finds it difficult. Rather than working with the horse to calmly encourage them to complete the exercise they try to get the horse to do it by force causing it to be rushed and fearful, anything the horse does out of fear will never be productive or successful in its aims. Time and patience are paramount when it comes to rehabilitation and exercises.

–          Being in too much of a rush – lots of owners are in a hurry to move on to the next stage, in a rush to get back on board, a rush to get trotting, a rush to go from box rest, to get the horse turned out again, etc.

–          Doing exercises too fast – most exercises are best done at a walk; poles, hills etc. So that there is control over limbs and movement, stability, the horse cannot use the momentum and ground reaction force to get itself over the poles that it does in higher gaits.

–          Using inappropriate training aids.  For the majority of rehab plans training aids are not required.  Sometimes a veterinary guided rehab plan they recommends using pessoa or similar. For the majority of cases this is most defiantly not required and can hinder regaining correct posture and movement.  Also the vets don’t check that it is being used correctly which again for most cases it is not!

–          Not doing enough – some times owners seem to think that lengthening the rehab plan is beneficial for the horse and sometimes it can be, but this should be done in conjunction with your physical therapist and or vet as for certain injuries this is not always appropriate as it is the progressive loading exercise that actually aids healing and recovery so if you are lengthening this you may be hindering them.  But also lengthening the treatment plan you need to ensure that you are doing the same exercise for longer.  I have seen some rehab plans fail where the owner has discussed with the vet about lengthening the rehab plan but they take that as do a few weeks of rehab then nothing for a week or 2, then pick it back up again when they have time for a week, then rest for a few weeks again.  It needs to be consistently carried out.

–          Not keeping up to date with regular physical therapy treatments.  Quite often when a horse becomes lame, and is under veterinary treatment the owner will cancel their regularly planned treatment session, with a reasoning of well if the horse isn’t being ridden I won’t feel the benefit.  However, it is important that we do even more as if the horse is lame it will compensate its movement patterns or if it is on box rest will not be doing much movement at all. So it is important that we try to keep the joints as mobile as possible, we keep the rest of the horses body as free and as supple as possible, reduce as much of the secondary and compensation issues as possible.  This is all done under veterinary guidance, it is important that your physical therapist and vet work together for the long term benefit of the horse.

–          Not being fully open and honest with your vet and / or physical therapist.  When we come for a review and reassessment it is important that you are completely honest with what you have been doing with the horse.  If you haven’t been able to complete certain aspects of the plan, you hate hacking, or you decided to up it a level before it was recommended, you need to be honest as this will affect what we are seeing, feeling and the plan we make moving forwards, which can severely affect the success or failure of the plan. Don’t just be a people pleaser and nod yes I have been doing everything as per the plan when you know full well that is not the case

Fascia is often the forgotten tissue of the musculoskeletal system and until relatively recently was thought to be irrelevant.  However, a greater understanding of horse movement, injury, perception, coordination, transmission of muscle force, biomechanics and the adaptations of the fascial system, have shown the importance of this tissue.  There is not a vast amount of research into the equine fascial system, but human fascia research has become more prevalent over recent years as its importance has become more apparent. More research into equine fascia is coming through, however some of the human data can be extrapolated for use in the equine sphere, as in 2017 Skalec & Egerbacher investigated the structure and innervation of the deep fascia of the equine forelimb.  Using dissection, histology and immunohistochemistry, they found that the general structure of the equine forelimb fascia corresponds to the characteristics of the human limb fasciae. However, Ahmed et al. in 2019, examined the histological differences between horse and dog fascia at specific regions compared with the human model, finding equine fascia exhibits a tight, dense composition, while in the dog’s is looser with non‐dense structure.  Equine fascia appears to be different from canine and human fascia, whilst canine fascia is very comparable to the human model.  This shows the need for more specific equine fascia research.

The Fascial System The fascial system in horses, people and dogs is an intricate complex interconnected network of tissue encompassing all fibrous connectie tissue, enveloping muscles, bones and organs individually and connecting them.  Fascia wraps around nerves, blood vessels and other structures forming an uninterrupted, three-dimensional web. This continuous mesh travels through the entire body as one net with no separation from top to toe, or from skin to core.  Fascia keeps the body organised, creating shape and function, and is therefore involved in overall musculoskeletal health.  It holds the musculoskeletal system together, pulling in on tissues as they press out as a tensegrity system. Due to the proprioceptive capacity of fascia and its influence on sensation signals between body and brain, the fascial system can be classed as the largest sensory tissue, therefore is required for structural integration, stability, balanced movement and postural compensation.  It is the organ of stability and mechano-regulation determining how a body is able to move and is necessary for muscles to function with approximately 30% of force transmission occurring through fascia.  Findley et al., 2015 studied the transmission of muscle force to fascia during exercise and found that substantial forces are experienced laterally through fascial tissues when muscle shortens. Fascias’ composition is varied depending on its location and role within the body.  Most is composed of dense, closely packed collagen fibres in layers of thick fibrous bundles with sparse elastic fibres covered by loosely woven laminae of areolar connective tissue. Nerve fibres and blood vessels are throughout; numerous in the areolar tissue but scarcer in the compact layers.  However, some fascia is extremely intricate like the delicate meningeal fascia of the nervous system. Fascias’ multi-layered composition of various densities, textures, molecular and cellular components is thought to facilitate resistance to gravitational forces, volume changes and transmission of muscle force during movement.  Deep profunda fascia under the superficial layer is dense fibrous sturdy tissue in some areas but is less developed in others.  Some deep fascia supports core structures such as the dura matter, mediastinum, pericardium, diaphragm and pelvic floor. Deep fascia can be divided into 2 types; aponeurotic and epimysial fascia.  The aponeurotic fascia envelops muscles connecting them, forming compartments of limbs and fascia septae between muscle groups, it  is thick and tightly attached to the underlying muscle, while the epimysial fascia is specific for each muscle defining it.  In areas of force transmission and movement change, stability is needed; these areas are covered with aponeurotic fascia, e.g. the lumbar back and ventral line. In areas where more movement is needed, fascia is thinner, providing proprioception for refined movement. Retinacula areas are all over the body, which sense movement and posture precisely. Microscopically  crimping of collagen fibres is visible in horse fascia, and histology reveals species variations between horse and dog fascia are related to the absence/presence of superficial adipose tissue and the amount of elastic fibres. Dysfunction of the Fascial System Good musculoskeletal function depends on pliability of the fascia, not just for movement but for sensory input, as the sensory nerves communicate between muscles and the central nervous system are found in fascia. When fascia is well-functioning, fibres slide and glide over one another allowing the fascia to move in all directions.  When it becomes disorganised, strained or dehydrated, its ability to glide is impaired, it loses its flexibility leading to reduced range of motion in muscles and joints. Areas of tissue become thickened and tug on the fascial network further up the chain and when the body moves with tension fascia thickens and stiffens even further.  The cause can be a natural consequence of trauma or injury, repetitive actions, inflammation, or immobility or when the body is forced to show movements its tissues are not prepared for.  Fascia adapts to restricted patterns and spreads it throughout the horse’s entire system beginning the cycle of restriction producing more restriction.  The result is fascia no longer has as much give contributing to overall musculoskeletal pain.  In turn this leads to local and global problems in the body, signals about joint position and muscle coordination falter causing acute and chronic imbalance, myofascial imbalance, joint, venous and lymphatic dysfunction.  This also accounts for the compensations that are seen in the body which can occur far away from the source; therefore restriction can be in one or several movement directions and will affect more than just that area. Fascia Training for Specific Disciplines Trainers of all equestrian disciplines are interested in finding a movement that is free and as effective as possible without compromising other areas of horse health. To achieve this, fascia needs to function well.  Depending on how the horses’ body is used, demolition and building will happen as fascia adapts to these changes applied to it. Peak limb force is a major determinant of the strain placed on the musculoskeletal tissues of the limbs. The peak load that can be withstood by the limbs limits maximum speed.  Every cell in the body is hooked into, and responds to the tensional environment of the fascia. The extra-cellular matrix of the fascia is capable of remodelling itself in a variety of ways, in response to direct signalling from the cells; injury; long-held mechanical forces; use patterns, gravity; and chemistry within the body. If mechanics are altered the cells can change their function.  The intricacies of fascia remodelling are still being researched but knowledge of tensegrity (tension and integrity) and remodelling is the future basis for therapy and discipline specific training.  Change the demand on the fascial system, by training for specific discpline or sport, and it responds to that new demand for optimal posture and function essential for the demands of the discipline.  It also means small problems can be prevented from escalating into larger issues and to help the long-term consequences of injury. When thinking about discipline specific fascia training, fascial elasticity is also an important element to consider.  Fascial elasticity is stored and returned quickly so is only a factor when the motion is cyclic and quickly repeated, such as galloping, but not when the repetitive cycle is too slow.  Building in this elasticity requires putting demand on the tissues slowly. The fascial system responds better to variation than to a repetitive program. Evidence suggests that the fascial system is better trained by a wide variety of adjustments in angle, tempo, load, etc. Working in one track may be useful for muscles but is not beneficial for fascia. Loading the tissue one way means it will injure more easily when a movement out of its usual line occurs. This is vital to consider when thinking of a flat race horse where training is linear, with little if any cross training, variety is low and movement is highly repetitive.  Exercises that focus repetitively on the same range or plane of motion cause fascia to become sticky and thick, limiting glide which causes some of the dysfunction previously discussed. This is also important to consider at the elite end of dressage where demand to get the precise technical movements faultless, such as piaffe for example, can mean some highly repetitive training.   Not only that, the variation in forces of different movements change physiological demand, for example, in passage, there are higher vertical impulses than in collected trot, causing greater elevation of the centre of mass therefore greater ground force reactions. Forelimb and hind limb vertical force distribution determines the position of the centre of pressure. Horses are thought to adjust force magnitudes in order to control movements around the centre of mass the fascial systems proprioceptive and adaptive precision is thought to play a large role in this.  Elite dressage horses may also not be getting the same multidisciplinary exercise they were at the lower levels. A logical training regime based on applicable, variable strategies providing different movement directions and exercises at each horse’s level will help fascia develop well and remain healthy.  Seven myofascial lines have been found in the horse, whole body movements that engage these chains are the best way to train the fascial system and cross discipline training will help get the variation in movement required.  According to Myers 2009 looking at human fascial training these methods include exercises of adaptive movement; due to the role of fascia in proprioception and kinaesthetics, proximal initiation; starting movements with a dynamic pre-stretch, initiation in the desired direction and letting the more distal parts of the body follow in sequence, like an elastic pendulum, however this is difficult to achieve with horse.  Also surface tissue stimulation to enhance proprioception; rubbing and moving the skin and surface tissues to enhance fascial proprioception can be extremely effective.  This is due to the multitude of sensory nerve endings, which may also help to communicate to the nervous system there is no longer need for tension in the area, also the basis of some fascial release techniques which aim to improve the slide and glide of the tissues, hydrating them through compressing and releasing. This pushing on fascia between bones, muscles, organs, and nerve fibres has been shown to free mobility more than passive stretching alone.  Research shows that due to the influence of myofascial release on the nervous system, it largely helps with the baseline tone of muscles too. A well hydrated fascia network plays an enormous role in overall fitness too, so it is vital that the facial system is fully functional and well trained.   Management and overall state of health also has a big effect on the fascia such as amount of turnout so the horse can get the chance to use its body freely, in many different ways, on different surfaces and terrain. Conclusion The effect of a healthy fascial system on the horses’ body as a whole has been shown to be highly relevant, and an important factor to consider when training horses’, be it for racing, show jumping, eventing, barrel racing or dressage.  For example in flat racing good fascia health is required so the whole of the musculoskeletal system is working at maximum effectiveness to get the speed and stamina required.  In the dressage horse the refinement and precision that comes from the sensory and proprioceptive capacities of the fascial system are of highest importance.  A need to ensure the fascial system is not over looked, as it has been in the past, has been highlighted in this review. It is extremely important when choosing training methods to ensure fascia training is taken into account, consequently all the structures of the musculoskeletal system will be supported and enhanced by a well maintained fascial network in the course of the horse’s education, as well as helping refine the skills involved in each discipline and preventing injury.  Developing better fascial training plans based on the demand of each individual equestrian sport can extend functional movement up the age scale to ensure career longevity future proofing the horse.  More equine specific research relating to fascial response to specific training is required so more specific equine exercises can be developed.

I hope you all had a fantastic Christmas and are looking forwards to the New Year. For a lot of people 2016 has not been a good year in many respects.  A year with your horse has many ups and downs but hopefully you are all looking forward to an amazing 2017 with your horses.

On a personal front, my horse is “off” for the winter.  I say “off” in inverted commas as even though technically she is out of medium-hard work which she is normally in, I’m still doing bits with her, she isn’t completely turned away.  I’m doing ground work with her, lunging in Pilates bands, long reining, straightness training, riding bareback, lots of stretching and walks down the lane just to keep her ticking over.  As I’m not riding quite so much, except for a few clients horses, and what with the extra Christmas goodies I have noticed a few of my clothes starting to get a bit snug!  So thought I needed to do something about it and beat the new year’s resolutions, as they never work, and drag my backside from out in front of the Christmas TV to start to think about getting fit again, losing a few pounds and go for a run.  I was really not in the mood but I made my self.  I was determined, so with the dog, children and husband in tow we set off.  I really wanted to push myself I knew I could do it so even when I felt tired I kept pushing myself to carry on.  But was this the right thing to do?! No, I found, obviously!  By the time I made it back home my already bad hip was killing me, when I had started to fatigue and carried on my feet had gotten clumsy so twisted my ankle twice, I hadn’t left enough time after eating so felt sick, and the following day the DOMS (delayed onset muscle soreness) in my legs were agony and I couldn’t move for 2 days.  Obviously, I know what I should have done, I should have said to myself, I’m just going to pace myself, walk for most of it and run a bit, then build it up day on day with lots of stretching in between, but when you get that determined feeling in your head your body just pushes through it. However, now I’m not feeling quite so head strong about it and it has put me off wanting to go again which defeats the object.

This is the exact same way with our horses. They may have had a bit of downtime over the Christmas/Winter period and you may be thinking about getting them back into work.  Please be very aware that they, like me, need to build that fitness up slowly.  Many people think, ‘My horse has only had a couple of weeks off they will be fine to get straight back in to working at the same intensity that they were before’.  But this is not the case.  Horses need to be brought back up to fitness slowly as there are so many different aspects to fitness; stamina, suppleness, strength, speed, there are so many different parts to the body that need all of these aspects of fitness to be built up slowly so they don’t break down with injury.  Injury WILL happen if you try to do too much too quick without building all aspects of fitness slowly in all aspects of the horses body, especially the tendons, ligaments, muscles as well as the cardiovascular system.

We also need to consider the psychological effect of pushing the horse too soon.  Them, again like me with my running, will not want to push themselves the next time if they think it is going to hurt, as soon as a horse starts to hurt they begin to develop compensatory mechanisms and incurring issues, pain and reduced range of movement and injuries in other areas.  This time of year is a great time for getting your horse a check-up with your physical therapist.  A check up and treatment with me will get them on the right track before the hard work begins again, to pick up and underlying issues and get a baseline of where you are starting the year from, and to be able to monitor progress and problems.

Many people like road work to slowly increase their horse fitness and workload, but as the amazing equine science consultant Dr David Marlin recently published on his facebook page there are many factors to consider with doing this. Some of the main points to consider are below.

• Roadwork results in forces on the hoof around 20x higher than working on good grass or artificial surfaces. A great deal of this is absorbed by the hoof, fetlock and bones below the knee but may still lead to damage to joints. Firm wet sand is better than roads but still around 8x harder than good grass or good arena surface.
• Roadwork DOES NOT “harden” or strengthen tendons
• Roadwork DOES increase bone strength – you only need a few minutes of trot to achieve this
• Roadwork DOES contribute to joint/cartilage deterioration
• Roadwork – No limit to walking! Trotting should be LIMITED to no more than 5 minutes per day
• Working on very SOFT SURFACES increases the risk of soft tissue (muscle, tendon, ligament) injuries and working on UNEVEN surfaces carries an increased risk of injury. Both of these are another issue associated more with winter riding.
• BAREFOOT horses are at a similar risk from roadwork as shod horse with respect to forces transmitted up the leg (the difference between shod and unshod is in how the force travels through the foot). With our current knowledge, there is no reason to conclude that barefoot horses are at a lower risk of concussive damage from roadwork.

Wishing you all every success and happiness with your horses in 2017.  Call, text, messenger or email to book your horse in for their 2017 year start check-up.

Best wishes

Michelle

Veterinary thermography is becoming very popular and I am a big fan of it especially for horses with non-specific difficult to diagnose lameness, multiple limb lameness, to determine if a horse is in pain, or to monitor rehabilitation and treatment.  However, there are some thermographers, physio’s, physical therapists, vets, companies etc. out there using industrial instead of medical/veterinary grade cameras, or even worse a thermal camera that attaches to a smart phone. 

Having completed some thermography training myself I understand this is simply not acceptable for many reasons.  These cameras are not specifically designed for physiological testing, they are not calibrated for measuring metabolic heat (which has a very narrow temperature range), which means they are not accurate or sensitive enough to provide useful information.  The images are not taken by someone specifically trained to get the best images to see problematic areas. The images produced need to be interpreted by a veterinarian that has been specifically trained to report on these images as a ‘hot spot’ is not necessarily related to the area they are seen on the image, due to the heat following the metabolic and neural pathways. A vet or other person not specifically trained to interpret the image may start trying to self-diagnose and treat from the image which could cause serious harm to the horse and neglect of the area with the actual real problem, which obviously poses a serious welfare issue.

For my clients I only ever recommend Syncthermology for all veterinary digital infrared thermographic imaging.  They are the only company using medical grade cameras in the UK, the only company that performs a stress test as standard, their technicians taking the images are highly skilled to get the best images, they have their own veterinary surgeons specifically trained to interpret and fully report on the images.  These results and veterinary reports will include objective opinion, recommendation and information that will assist your own vet in making a diagnosis, in selecting further diagnostic tests if required, helping them to select treatment options and monitor recovery.

Thermography is a great tool in the right hands!!  For more information see http://www.syncequine.com/ and please do not let someone with an industrial camera or smart phone app take thermal images of your horse, it may appear to be a good low cost option but chances are they have no idea what they are doing or what they are looking at!

For anyone in the North West region that wants to know more the Sync North West Team will be attending the Joanne Shaw Equestrian working hunter Clinic on Saturday 13th February.  They will be holding demos throughout the day and the team will be happy to chat to you about the services they provide, and I will be there too.  The address is Joanne Shaw Equestrian, Red House Farm, Barkers Hollow Road, Preston-On-The-Hill, WA4 4LL.