Equine Physiotherapy Case Study: Management of Navicular Syndrome in a 16-Year-Old Gelding

Over the years we have seen a lot of cases of navicular syndrome, with the advancements in technology, the physiological structure of the horse's distal limbs can be assessed in great detail and with this we can often see an increase in the diagnosis of certain issues such as navicular. One case that I want to share with you today is that of a gelding based in Kent....

Case Background

- Horse: 16-year-old Warmblood gelding

- Discipline: Dressage (retired from competition)

- Primary Complaint: Chronic lameness in both front feet, primarily affecting the right forelimb. Initially diagnosed with Navicular Syndrome 2 years prior, with intermittent flare-ups.

- Veterinary Diagnosis: Navicular Syndrome (confirmed through radiographs, MRI, and clinical examination). Degenerative changes to the navicular bone and associated soft tissue structures (deep digital flexor tendon, navicular bursa).

- Owner's Goal: Maintain horse’s comfort for light riding and pasture soundness.

Physiotherapy Objectives

The role of physiotherapy in managing Navicular Syndrome is multi-faceted. The main goals for this horse are:

1. Pain management.

2. Improving biomechanical function.

3. Strengthening supporting musculature.

4. Maintaining joint range of motion and flexibility.

5. Optimising posture and movement patterns to reduce abnormal stress on the surrounding structures.

Initial Assessment

Upon initial evaluation, the following observations were made:

- Gait: The gelding showed a shortened stride in the front limbs, with a noticeable "toe-first" landing pattern, particularly in the right forelimb. Head bobbing was observed during trot, indicative of pain or discomfort. The left forelimb appeared to be compensating for the right.

- Posture: The horse stood with an increased weight distribution toward the hindquarters, likely to alleviate pressure from the front limbs. Muscle asymmetry was noted, with significant atrophy in the pectoral and shoulder regions, indicating long-term compensatory patterns.

- Palpation Findings: Tenderness was observed in the deep digital flexor tendon area. There was some tension in the shoulders and upper back, likely due to compensatory movement patterns.

- Hoof Conformation: Mild under-run heels were present, with a contracted hoof capsule. This is a common feature in horses with navicular issues, as they tend to shift weight away from the heels to avoid pain.

- Previous Treatment: The horse had been managed with corrective farriery, periodic corticosteroid injections, and non-steroidal anti-inflammatory drugs (NSAIDs).

Plan for Physiotherapy Treatment

1. Management of Pain

- Pulsed Electromagnetic Field Therapy (PEMF): Applied to the navicular region, this helps reduce inflammation and improve blood circulation in the affected area. Treatment was given twice a week for 4 weeks, reducing as improvement was seen.

- Therapeutic Ultrasound: Applied to the soft tissues around the navicular bone to further aid in reducing inflammation and promoting tissue repair.

- Manual Therapy: Gentle soft tissue mobilisation techniques were used to release tension in the shoulder and neck muscles caused by compensatory strain. The horse responded positively, showing less tenderness over time.

2. Biomechanical Improvement and Gait Rehabilitation

- Proprioceptive Re-education: The horse’s “toe-first” landing needed to be corrected to prevent further strain on the deep digital flexor tendon. Ground poles were introduced to encourage a more natural heel-first landing. This exercise was initiated at the walk, using a gradual increase in the number of poles as the horse improved.

- Corrective Exercises: Hill work at a walk was introduced after the first 4 weeks to encourage proper engagement of the hindquarters and promote a heel-first landing, which helps reduce strain on the navicular area. Short, controlled walks over varied terrain improved proprioception and limb placement.

- Stretching and Flexibility: Dynamic stretching exercises were prescribed, focusing on the forelimbs to improve the range of motion in the shoulder and carpal joints. These exercises helped to reduce compensatory stiffness in the front limbs.

3. Muscle Strengthening and Postural Correction

- Core Stability Training: Core activation exercises such as belly lifts and tail tucks were employed to enhance the gelding’s postural control, especially while transitioning weight back toward the hindquarters. This took pressure off the front limbs, reducing strain on the navicular region.

- Strengthening Exercises: Long-reining and lunging with emphasis on transitions were used to promote balanced engagement of the hindquarters. Working on a slightly uphill slope encouraged the horse to load the hind limbs properly, which helped alleviate some of the pressure on the navicular area.

4. Posture and Movement Optimisation

- Postural Re-Education: Groundwork with the use of long, slow rein-back exercises was incorporated to correct the horse’s tendency to carry excess weight on the forelimbs. This encouraged a more balanced movement pattern.

- Carrot Stretches: Specific stretching techniques targeting the neck and shoulder regions helped release tightness and improve flexibility. These stretches were performed daily by the owner to maintain flexibility and prevent compensatory tension.

5. Hoof Care and Farriery Support

- While physiotherapy focused on movement and musculoskeletal health, close collaboration with the farrier was crucial to manage the horse's hoof conformation. Physiotherapy sessions were coordinated with farriery visits.

Monitoring Progress

Short-Term Improvements (4-6 weeks)

- The gelding began to show a more heel-first landing after 4 weeks of therapy, which was encouraged by proprioceptive and strengthening exercises.

- Gait symmetry improved, with reduced head bobbing at the trot. The horse became more willing to move forward, showing less hesitation in the affected limb.

- Muscle tension in the shoulders and back decreased, and palpation revealed less tenderness in the navicular region.

Long-Term Management (3-6 months)

- Regular physiotherapy sessions were reduced to bi-weekly after 8 weeks as the horse’s movement improved.

- Groundwork focusing on proprioception, core stability, and correct movement patterns became part of the horse’s routine, allowing the owner to manage the condition between physiotherapy sessions.

- Ongoing collaboration with the farrier ensured that hoof care and therapeutic interventions worked in tandem to support the horse’s biomechanics.

Outcomes

- Pain Reduction: The horse displayed significant improvement in comfort, as indicated by the reduced need for NSAIDs. His overall lameness score decreased from a 3/5 to a 1/5.

- Improved Gait and Movement: The gelding’s stride length in the front limbs increased, and he consistently exhibited a heel-first landing at the walk and trot. Muscle strength, particularly in the hindquarters and core, was significantly improved.

- Owner Satisfaction: The gelding was able to resume light trail riding and continued to enjoy pasture time without signs of discomfort. The owner was equipped with a home-care plan to manage the horse’s condition.

Conclusion

Physiotherapy played a pivotal role in managing the chronic nature of Navicular Syndrome for this 16-year-old gelding. A multifaceted approach, combining pain management techniques with biomechanical retraining, strength development, and postural correction, helped improve the horse’s quality of life. The collaborative efforts between physiotherapist, farrier, and owner ensured that the gelding's condition was well-managed, allowing him to continue light work and enjoy a pain-free retirement.

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