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There are now an estimated 3 million riders in the UK. The equestrian lifestyle is undoubtedly enjoyable in the most part (apart form the early mornings and mucking out!). However, it is no secret that it can also be a dangerous pastime to have. Unfortunately around 350 UK riders are injured each year, with many more suffering from more than the usual bumps and bruises that we all come to expect.

At Physiolistic, we are keen to support you in your enjoyment of the sport and minimise injury and subsequent time out. Of course, some injuries are unavoidable when we are working with such large and often unpredictable animals, but there are ways in which we can put ourselves in the best position to cope with what our four legged friends throw at us! This blog looks at the 5 of the most common riding injuries – both traumatic (unavoidable), and non-traumatic (preventable) – and describes how physiotherapy can help you.

1. Fractured clavicle (broken collarbone)

The clavicle, or collarbone, attaches to the breastbone at one end, and the shoulder blade at the other, essentially connecting the arm to the body.

This is unfortunately one of the most common riding injuries, and is sometimes even known as a ‘jockey’s fracture’ due to it’s high incidence in equestrian sports. Commonly, the cause of the fracture is falling from a horse after the horse spooks, bucks, or refuses a jump, resulting in the rider landing heavily on the outside of their shoulder, or outstretched arm.

Clearly, this is a traumatic injury and not one that is easily avoided. However, it is mostly treated without surgery but will require you to have your arm in a sling for several weeks to allow it to heal. During and after this process, you will need the regular input of a physiotherapist to regain full movement of your shoulder as well as full strength, so you can get back on the horse!

Some of our work together might involve:

- Radiofrequency treatment to assist in the healing of tissues and the reduction of a tightening around the joints

- Gentle range of movement exercises using various pieces of equipment, both in the clinic and at home, to get your arm moving again and ensure optimum posture.

- The use of Compex, our top of the range neuromuscular stimulators, to ‘wake up’ the muscles after being immobilised in a sling, so they are ready for action. All of our physiotherapists are accredited Compex Advanced Trainers and can guide you to get strong again as quickly as possible.

- The use of our diagnostic ultrasound to keep an eye on how well things are healing.

- The use of our in-house gym to up the challenges as you progress through your rehab so you are not only back in the saddle, but succeed in meeting your training and competition goals

And so, yes, a ‘jockey’s fracture’ can be painful, and stop you in your tracks for a few weeks, but by working together, and with all of the above resources at our fingertips, we can get you up and running (and riding!) again in no time at all.

2. Low back pain

Low back pain is something that many horse riders are familiar with, novice or expert. This may be something that manifests over a long period of time, or might be more acute – “just as I picked up that water bucket”, or “after I rode that fresh youngster”. Low back pain something that most people will suffer with at some point in their lives and physiotherapy is central to rectifying it, and preventing future episodes.

You can expect to have an initial conversation about how the pain started, and when it hurts. Depending on the cause, we might look at your body positioning when you are lifting heavy loads, or mucking out. Or perhaps your pain is more related to your riding, in which case we will consider your riding position and how we might improve that to eliminate your pain. Here at Physiolistic you might expect us to do some of the following:

- Use our diagnostic ultrasound to look at the activation of your ‘deep core’ muscles in your abdomen. These muscles are extremely important in supporting your upper body when lifting, moving, and riding. Often, these are not as strong as we would like them to be and this can have a real impact on your back, as you are asking the small muscles to do the job of these big ones, which can be uncomfortable with sustained / repetitive use.

- Ask you to get someone to video you riding, so that we can look at your movement patterns and body positioning on the horse. This gives us clues and tips as to what is causing your back pain and how we can help you with physiotherapy.

- Use of Compex, our top of the range neuromuscular stimulators, to help strengthen that all-important core, as well as any other muscle groups that might need a bit of a kick start to help reduce the load on your back.

- Use our radiofrequency therapy to loosen up any tight muscles in your back and promote a healing process for those that might need it.

- Use of our in-house gym to get you fit and strong, and into a great exercise routine to prevent future episodes of back pain.

- A series of one-to-one Pilates classes to help you to establish the skills needed to keep you strong – both in your core and whole body. All of our physiotherapists are Pilates-trained.

In all, low back pain can be just that – a real pain – and can stop us from loving what we do. However it is very common and we as physiotherapists are really best- placed to help you overcome it and enjoy your horse without restriction.

(The use of diagnostic ultrasound to scan the deep core and assist activation)

3. Fractured metatarsal

A lot of equestrian can identify that moment of blind panic as the heaviest horse in the yard somehow finds his way on top of your foot! Ouch!! This can result in a bad bruise at best, but you may be unlucky enough to sustain a fracture to one of the long thin bones in your feet, your metatarsals.

There are lots of different types of metatarsal fracture, and some are worse than others, meaning that the initial treatment will also vary. If a fracture is suspected, you will need an x-ray at hospital, and then the doctor will make a decision about whether they want to do an operation or whether it will heal without.

Regardless of whether you need an operation or not, one thing is for sure, and that is that it will be very sore and painful for a while, you will have some difficulty walking (and might be on crutches), and you won’t be able to do all of your usual horse-related activities. Our focus as physiotherapists is therefore to get you back on your feet, walking normally, re-establish range of movement and strength in your feet and legs, get your fitness back up to scratch, and of course, back in the saddle. Here are some of the ways in which we can work with you to achieve that:

- Provide you with crutches if you need them, and teach you how to use them safely and comfortably.

- Provide expert advice about how to reduce swelling and bruising. This may involve the use of our ‘PhysioLab’ packs, which provide you with unparalleled cryotherapy (or ice / cold treatment), to reduce bruising and swelling. We have these available for you to borrow in the early stages of your treatment so that we can make progress more quickly.

- Refer you to one of our Specialist Consultants for a surgical opinion if we feel one is warranted.

- Guide you through a personalised step-by-step treatment programme to re-establish your range of movement in your foot and ankle.

- Support you in reducing your reliance on the crutches as you become ready.

- Use our ‘FootPlate’ technology to analyse your gait - or walking pattern – in detail so that you are not left with an altered position that will cause you other problems at a later date.

Equestrians are familiar with the saying, “no foot, no horse”, and after sustaining a metatarsal fracture it can feel as if the same is true for us! However now you can see how we can fast-track your recovery and soon you’ll have forgotten all about it – just stay away from those big heavy feet!

4. Meniscal injury

The meniscus is a piece of cartilage that provides a cushion between your femur (thighbone) and tibia (shinbone). There are two menisci in each knee joint. They can be damaged or torn during activities that put pressure on or rotate the knee joint.

Damage to the meniscus can be acute / traumatic, when there is an injurious episode. Footballers are most commonly affected by this injury, when their foot is planted on the floor and they rapidly turn their body, in turn ‘twisting’ their femur on their tibia. However, riders can also sustain this type of injury – again, usually from a fall, either landing heavily on your foot and then twisting, or commonly when the rider’s lower leg gets stuck under the horse when both horse and rider go down together.

As cartilage, the meniscus also degenerates over time, particularly with repeated ‘loading’. The knee is one of the most weight-bearing joints in the body, so they are used to carrying a degree of load. However, as riders, we frequently place even more load through the knees, and therefore compromise the meniscus. This happens both in the saddle (think rising trot, galloping, jumping), and out of it (carrying heavy buckets of water / hay bales, everyday yard work), and can make our menisci more vulnerable to damage or tears when we do have an accident.

The management of meniscal tears is now very rarely surgical – generally unless there is other significant damage to the knee, surgery will not be considered and ‘conservative’ management (good physiotherapy) is the best way to recover. The time taken to recover will depend on factors such as the exact location and degree of injury to the meniscus, the state of the meniscus in general, and how much you are able to adhere to a rehab programme (we all know that horse riders are notoriously bad at this as, well, there are just things that needs doing, aren’t there?!)

Here are just a few of the ways in which we can help you recover at Physiolistic:

- Expert advice to alleviate any acute pain in the short-term and start to reduce inflammation.

- Provide expert advice about how to reduce swelling and bruising. This may involve the use of our ‘PhysioLab’ packs, which provide you with unparalleled cryotherapy (or ice / cold treatment), to reduce bruising and swelling. We have these available for you to borrow in the early stages of your treatment so that we can make progress more quickly.

- A rigorous, individual rehab programme to improve the support around the knee via a strengthening process to ‘offload’ the meniscus. This is the most important element to getting you back to your normal activities and is hard work, but we are here to guide you each step of the way. Depending on your individual circumstances, this might involve:

o The use of Compex, our top of the range neuromuscular stimulators, to ‘wake up’ the muscles and kick off the strengthening process after the trauma.

o A set of exercises to ensure you are able to move your knee through its full range of movement.

o The use of our in-house gym to continue to challenge the muscles and build support for the knee to allow a return to full function. Your physiotherapist will ensure that you are able to replicate and practice these exercises independently either at home or in your own gym, and that you are comfortable with them

o An ongoing programme tailored to your own needs and support with your return to riding.

5. Groin strain

Ouch, this can be a cheeky, painful one! It can happen in the blink of an eye – and normally because we are trying to prevent further damage, one way or another. To set the scene, picture the warm up arena, first horse, both of you fresh (and stiff – and likely cold!) off the lorry, he spooks, bucking like a rodeo, and what do you do? You cling on of course…with your legs. Your adductor muscles (down the inside of your thighs), are quickly propelled into action and contract like your life depends on it… and perhaps it does… however, these muscles have not had a chance to warm up, and are not used to such forceful, instant, and prolonged activation, producing a perfect recipe for a groin strain. Again, these can range in severity of course, and this will dictate your recovery period but one thing is certain – you need to get hold of a good physiotherapist, and fast! If you make your way to Physiolistic, here is what to expect:

- A full examination and assessment to assess the degree of the strain

- Instant access to top of the range technology to relieve that otherwise inescapable pain that dictates your every movement. For example:

o Radiofrequency treatment in clinic to promote healing of muscles and other tissues. This will make you feel better but also actively kick-starts the healing process to get you better sooner.

o The use of our ‘PhysioLab’ packs, which provide you with unparalleled cryotherapy (or ice / cold treatment), to reduce bruising and swelling. We have these available for you to borrow in the early stages of your treatment so that we can make progress more quickly.

- The use of Compex, our top of the range neuromuscular stimulators, to begin to activate the injured muscles again after the initial period of reduced use due to the pain, and subsequent loss of strength.

- An individualised rehabilitation exercise programme to improve strength, speed of muscle activation, and endurance. This will target both the affected muscles and other opposing and supporting muscles to ensure that you are ready for your return to riding and better prepare you for other unpredictable moments! This will include:

o Exercises in the clinic and at home

o Exercises in the in-house gym at the clinic, which you can practice in the gym at home if you have access, or we will adapt them for home practice.

o Possibly Pilates (available on a 1-to-1 basis with any of our physios) for overall strengthening and ongoing training to support your time in the saddle.

So, don’t despair if you’ve become injured whilst riding, or you feel that your riding or equestrian activities are compromised because of pain or discomfort. As you now know, Physiolistic are here to help – we have expert physiotherapists and many tools at our fingertips to address the problem and get you back to enjoying your horse before you know it! Sophie Davies Senior Physiotherapist

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