Saturday, October 16, 2010

Deli has staff to dote on her.

I just had Deli massaged – something I consider an essential part of her rehabilitation.

She also loves her “spa days”, so I consider it a mental break for her as well.

Deli’s injury involved a severe tear of her groin muscle, as well as tears to the hamstrings on her right side. When the injury was new I felt like I was in a race against time because her leg was incredibly swollen. My job at that point was to get the swelling down or else risk, at the very least, all the tissues in being stretched out to the point of usefulness. I actually cheered when blood and fluid pooled on her belly in an edema instead of going down into her leg — it couldn’t do any damage other than look strange (like a furry water bed). At one point excess fluid even dripped from her swollen udder.

These kinds of injuries only happen in horses when they do the “splits”. That is a movement horses are not built to do! I’m convinced that she was rolling in the deeper sand near her paddock gate at our old barn and got her leg caught between gate and fence while on her back. I’m sure she freaked out, struggled, and in the process tore her psoas (groin) muscles and hamstrings on the right side. I suspect she even has small tears in her upper-leg tendons.

As I can attest from my own severe muscular and ligament damage after being hit by a car in September 2009, recovery for these kinds of injuries takes a long time. Soft tissue is problematic – for severe tissue damage inflammation needs to be controlled because in the extreme, blood flow is impeded. To heal, blood flow is needed. In some respects Deli is lucky that she injured her upper leg, because there are ample vessels surrounding the area. Of course, a horse’s lower leg does not have muscles at all, and tendon injuries in the lower leg tend to take quite a long time to heal because blood flow in the lower leg is dependent on movement. Fresh blood flow flushes old blood (often collecting in hematomas) and chemical buildup from torn muscle away, and brings in oxygen and nutrients to the area to aid in the repair of damaged tissue. With muscle, fibers need to be laid down a certain way for the muscle to work best. To get the muscle to lay down in this optimal way is difficult when there is a severe injury like Deli and I have suffered – it requires work and rest. The work is to get the muscle being used correctly to get those fibers to lie down smoothly and prevent excessive scar tissue development. The rest is to give time for that muscle to repair and heal.

As an aside: you can probably guess from this analysis that I am not a proponent of stall rest except in a very narrow set of circumstances. For Deli, “rest” means she gets to hang out in pasture with her buddies, get hand grazed or massaged. If she wants to trot around and play in pasture, that’s okay. She’s not the type of horse to push her body when it hurts. Additionally, all physiological evidence points to blood flow is encouraged by the normal function of a horse’s foot – simply put the flexion and act of walking turns each foot into a little pump. When they say “no hoof no horse” I like to think of each foot as a miniature heart that services the horse’s legs.

On top of her training in horse physiology, my masseuse has a useful “toy”: a thermography camera. This device is incredible: it shows the heat in various places on a horse’s body by indicating different temperatures with color. These photographs she took during our most recent massage session showed that there was still inflammation along the psoas and hamstrings that Deli tore. The camera allows us to pinpoint the where the tissue needs help and work, which is superb. In particular, you can feel the difference once you know where to look – the inflamed groin muscle feels hard and unyielding compared to her uninjured left side.

Overall the camera tells us that Deli is doing better: the inflammation is pretty much confined to the injured area rather than spreading out to the surrounding tissues. Any minor injuries have healed. It’s a case of what we see is what we get when using thermography. And with regular re-assessment (planned for every 4 weeks right now) we can see how Deli is healing if faring under her rehabilitation and adjust it where appropriate.

Given all this information, Deli’s current rehabilitation program is to work then rest. We are going to hit the hills for at least one intensive workout a week (assuming the ground doesn’t get too slick!) and work on lunging in a way that gets her to use her hind end instead of being protective of her injuries. Our under-saddle time in the arena will reflect this as well, with a focus balance and use of her hind end in a productive manner. As for our rest days she will get some (less professional) massage from me. I also have plans for further ground-work (she likes having her brain engaged) and do some work on learning how to open and close gates in-hand so that training in that area will come easy when she is under saddle.

It’s going to be a long journey to get her back to 100% again. I’m still feeling weakness and pain from my own injuries, even though they occurred more than a year ago. Deli’s rehabilitation probably won’t take that long. Or at least I’m hopeful that it won’t since she has improved steadily since being injured about four months ago. For one, she is a natural athlete and I am not. For another, I injured tendons, ligaments, bones and muscles throughout my entire body when I was hit by that car, whereas Deli’s injuries are localized. Regardless, “rest, heal, stretch and strengthen” is going to be our mantra for some time.

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