Movement is key to managing arthritis, so current restrictions call for out-of-the-box thinking, explains Dr Liz Barr MRCVS
After a winter of limited turnout as a result of relentless wet weather, which made fields resemble mud baths, many owners now find themselves with limited opportunity to exercise their horses due to the Covid-19 lockdown. This can cause real difficulty in managing any horse, but particularly one with underlying arthritis.
Arthritis is a disease that causes inflammation and stiffness of the joints. Joints are made up of cartilage – the smooth material that forms the primary weight-bearing surface – and underlying bone. The synovial membrane lines the inside of the joint and produces synovial fluid, a thick substance that lubricates the joint during movement.
The most common type of arthritis is osteoarthritis, where progressive degeneration of the cartilage occurs. This is accompanied by inflammation, with proliferation of the synovial membrane and changes in bone both around the joint and beneath the cartilage. The synovial fluid becomes thinner and often increases in volume.
Osteoarthritis is caused by a number of factors, including ageing, mechanical overload and genetics, and may result from either abnormal loading of a normal joint or normal loading of an abnormal joint.
Abnormal stresses on a normal joint can be compounded by factors such as obesity, trauma, a defect in the joint surface or altered loading. Abnormal joint physiology may be exacerbated by the ageing, inflammation and fatigue of the components of the joint. Both result in cartilage breakdown, an ineffective repair response and mechanical failure, causing joint destruction and pain.
Signs of arthritis include pain and lameness associated with the joint and possibly some increased synovial fluid within it, known as effusion. A reduced range of motion may be evident when the joint is manipulated and flexion tests will usually make lameness worse.
Ready, steady, move
It may seem counter-intuitive to exercise a horse with joint pain, yet movement is beneficial in almost all cases.
While immobility can increase stiffness and pain, exercise will keep muscles and surrounding soft tissues strong and this will maintain support for the joints. Reducing exercise may also result in unhelpful weight gain.
Exercise for arthritic joints should be aimed at keeping impact low. Working on a good but not overly firm surface, on a horse walker (making sure to switch direction) or on a water treadmill is ideal, although I usually advise against lungeing because constant turning places increased stress on the joints.
These are unusual times, however. Not everyone has access to a walker or a water treadmill, and it is debatable whether we should be riding our horses while our emergency services are under such strain. So how can we exercise an arthritic horse?
Hacking or light riding within a property and where it is safe to do so may be considered. Long-reining is another good option, or light lungeing with care not to put excess stress on the joints. Exercises that encourage muscle strength and coordination, such as working over poles in-hand or on the lunge, will also help to strengthen supporting muscles – as long as tight circles are avoided.
Applying heat may ease pain associated with arthritic joints. This can be done with a solarium or heat lamp, or simply by making the most of the spring weather and turning a horse out with the sun on his back prior to exercising.
Start each session slowly, as most arthritic horses will “warm out” of lameness as the stiffness is reduced with gentle exercise. Take care not to rush, as pain from arthritis will often vary from day to day – if the horse is having a bad day, he should not be forced to work through it. As important as the warm-up is cooling down. Horses with underlying arthritis should be trotted and then walked on a long rein and allowed to stretch before the end of exercise.
Some horses benefit from the application of ice after work. This will reduce heat, pain or swelling in affected joints that may have been exacerbated by exercise. Ideally, the horse should then be turned out for a period to allow him to move around naturally.
Treatment on hold
For horses maintained on regular intra-articular medication of the affected arthritic joint, treatment will need to be delayed until after lockdown as per current RCVS guidelines.
From a medication point of view, this means that in the majority of cases the options are limited to the standard oral non-steroidal medication, licensed for use in horses. There are certain intramuscular injections, but use of these will need to be reviewed with your own vet who knows your horse as an individual.
Regular physiotherapy treatment will help to keep muscles supple and strong, protecting the joints. Access to physiotherapy treatment has been limited during the lockdown, but owners can use baited (carrot) stretches to maintain a horse’s flexibility. I would suggest that any excessive bending and forced movement of the affected joint without professional guidance should be avoided, however, as this may exacerbate lameness.
Some horses with arthritis may benefit from being fed supplements, including substances such as glucosamine, chondroitin, methylsulfonylmethane (MSM) and the herbal extract boswellia. While there is limited clinical evidence on the efficacy of these supplements, my personal feeling is that they do no harm.
Horses are grazing animals, designed to travel long distances while selectively picking suitable grasses and plants. Regular movement will help any horse – not just the arthritis sufferer.
Be careful to monitor a horse’s weight through any management changes, cutting concentrates in line with reduced workload and considering his overall feed and forage intake if he is out enjoying the spring grass. But, in the medium to long term, try not to worry unduly about the effect these unusual times are having on a horse who suffers with arthritis.
In time, restrictions will lift and normal exercise will resume. Muscle strength will be rebuilt, vets will be able to offer different treatment options and physiotherapists will be able to ameliorate any secondary muscle stiffness and pain.
It was the wet winter that prompted Sharon Richardson to seek alternative ways of exercising Flo, her 17.2hh Dutch warmblood mare.
“Our fields were wet, so Flo had to spend a lot of time indoors,” explains Sharon, whose 10-year-old former eventer has arthritis in both hind fetlock joints. “I started long-reining her using the light from the car park that shines into the sand school.
“Flo is now back out in the field during the day, but we’re not hacking because of the coronavirus lockdown,” she says. “I’ve continued long-reining her over poles, to encourage movement in her fetlocks, and we’re doing lots of suppling exercises in walk and carrot stretches.
“Ordinarily, Flo would have IRAP,” adds Sharon, referring to the practice of harnessing the regenerative and anti-inflammatory properties of a horse’s own blood cells and injecting them into his damaged joints. “She would also have weekly water treadmill and combi-floor sessions at Rhoden Rehabilitation in Kent, and regular sports massage. I’m doing what I can at home, using a hand-held massager and my own cold laser, and I’m a big fan of Back On Track therapeutic leg wraps.
“Flo is turning into a nice dressage horse, so this break is a training opportunity.”
Ref Horse & Hound; 23 April 2020