Monday, October 2, 2017

Exercise and Rehab Plan for a PSSM Horse

Is it possible to bring them back once symptoms have started?


Just after a colic episode, during his most severely symptomatic months.
Note the wasted and tense muscles around his flanks, lumbar, and stifles.

Before answering this question, let's look at everything I've done to help bring Jax back to his former glory.  Keep in mind that he went severely symptomatic, and due to misdiagnosis was laid off for 6 months which made things much worse.  If you're seeing subtle signs and have time to work with your horse daily (or at least 4-5 days/week) then you may not have a journey as difficult as we've had.


EXERCISE PLAN:

Note: injury, illness, and time off can set your horse back.  In these cases, lower the mileage and intensity of workouts for a few days to keep from setting off an episode.

The first few months of rehab (before diagnosis and moving Jax to a new barn) I worked on fixing his feet and lunging about 4-5 days/week.  This helped him to build up strength, but wasn't quite enough to get him rideable.  After diagnosis (about 4 months into rehab) I moved him to a place with trails and an indoor arena.  I started riding him for about 10-15 minutes at a walk doing suppling exercises:  walking over poles, bending around cones, backing, etc.  We started venturing out onto the trail for slow, one mile rides just before winter. 
For the really cold months (and while he was on alfalfa) his muscles were very stiff so we rode inside most of the time.  We started adding short trot sessions (maybe 2 minutes total) and worked up to 25-30 minutes total ride time, again using lots of suppling exercises.  Just before spring, I was able to add some canter (1-2 very short bursts per session) and we were up to 2 miles on the trail, walk only.  We kept building through spring and into summer, and by mid-summer we actually had enough canter to do a playday with a few friends (some barrels, pole bending, and a few games).  As the summer progressed, we made it up to 6 miles on the trail with lots of trot and canter.

At the time of writing this, we're at almost 18 months of rehab.  He's not 100% yet, but he's probably about 95%.  He's got his canter back, though it's still rough some days and he's much better cantering straight than he is in circles (the trot started out the same, and I think we'll get a more collected and refined canter in a couple more months so that we can add circles).  On his bad days, we do a maintenance day (see below) with either a lunging session for exercise or a short arena day with suppling exercises.  Sometimes a light day may be about 2.5 miles of walking on the trail.  It's been a long, slow process but he is getting stronger and is almost back to the horse he was at his pique (around the middle of his 7th year, about 3 years ago).


Here are a few ridden exercises that I use to work both his mind and his body.


MAINTENANCE DAYS:

Occasionally, (about twice per month, more if needed) Jax will start to get a little slower, a little more tender in his muscles, and over all just a little "down" compared to his normal self.   There are also times that he's been working hard for a week or so and I feel like he should get an easier day to help keep him going well.  These are times that I'll throw a "maintenance day" into our rehab plan.  Maintenance days usually look something like this:
  • (everyday) Check his back for soreness after assessing how he walks in from the pasture
  • (everyday) Feed 1/2 of his "grain" mix
  • Full trim on all four hooves if needed (usually do touch-ups in between these days)
  • Myofascial grooming work about 1-2 hours over his whole body, focusing on major muscle groups and sore spots (I groom him this way everyday, but usually for only about 10-15 minutes before tacking up)
  • Percussive massage (see below) - about 1-2 hours, focusing on major muscle groups of the neck, back, hindquarters, and sore spots
  • Light lunging with walk/trot/canter, some walking or backing over poles/up hills, and other light groundwork to loosen his muscles
  • (everyday) Feed other 1/2 of his "grain" mix
  • (everyday) Put him back out to pasture
These days are necessary to keep him going.  The next day is usually an easy walk trail ride (maybe 3-4 miles) to loosen him up more without asking for too much work, then we can start back where we left off the next day.

A sleek, loose-muscled Jax after a maintenance day,
during a leisurely hand walk.


MASSAGE AND BODYWORK:
  • Starting out light - Masterson method - This method is wonderful for when Jax can't handle other types of muscle work.  Many owners on the PSSM Forum (Facebook) use it as well.  Look up his book on Amazon and his videos on YouTube for more information.
  • Stress Points - "Beating Muscle Injuries for Horses" by Jack Meagher - this book is amazing and can show you where your horse is really hurting and how to fix it.  The Masterson method was a great start when Jax was really bad, and this was a great complimentary method once we got to a point that he could handle it.  You can find it on Amazon.
  • Percussive Massager and Myofascial Release - Jax gets percussive massage (from a $30 hand-held massager I bought on Amazon) as often as needed, but at least once every 2-3 weeks.  The first couple of months of rehab he was getting daily massage due to severe muscle tightness.  He now gets daily grooming with a jelly groomer to loosen his fascia (see Myofascial Release for PSSM Horses), which has reduced his need for daily massage dramatically. 
  • Stretching - many PSSM horses are helped by stretching.  Jax can handle that some days, but not very often.  I usually just rely on a slow, walking warmup and a Back On Track blanket (in cooler weather) rather than stretching him.  On days that he's really bad and we can only do groundwork, I might stretch him as much as he can tolerate since he won't get a lot of exercise on those days.


HOOF HEALTH:

One of the most important things to remember about PSSM horses - their muscles can't compensate for foot pain.  So, if anything - and I mean ANYTHING - is wrong with their feet, you will find problems in their muscles.  Anything from a bad trim, to Low Grade Laminitis (which seems to be a problem for some PSSM horses, including Jax), can be detrimental to your rehab plan.  Before you can fix the muscles, you have to fix the feet (or at least start the hoof rehab process, and rehab the hooves as you rehab the body like I did with Jax).  Jax had issues with "long toe low heel" and it's taking a while for his feet to get back in shape (especially since he is prone to low grade laminitis every spring), but I can feel that as his feet get better his muscles get better.

If you are rehabbing feet, you may have trouble with abscesses.  Jax never had an abscess until he went symptomatic and his feet fell apart.  The longest episode he's had to date was a two week span with mild shoulder spasms caused by abscess pain.  Here's a pic of the culprit:




As soon as this blew, he started to do really well (even though he'd been off work for two weeks).  Don't underestimate how important healthy hooves are, especially to a PSSM horse.


START A DAILY JOURNAL OF SYMPTOMS, ISSUES, BREAKTHROUGHS, ETC.:

One of the things that really helped me figure out what my horse needs is a daily journal.  Every day I put notes on what tack I used, what feed/supplements I gave, the type of work we did, when his feet were trimmed, pics of feet after trim, who did the trim, notes on sore muscles, days he was massaged, and anything else I could think to put down.  I included pics and videos to monitor changes in specific muscles and posture.


ENVIRONMENT:

Cold, wet weather sets Jax back for days.  If it's going to be cool and wet (70*F and below) or  just cold (40*F and below) he gets blanketed.  Before symptoms, he grew a coat like a bear and stayed warm all year.  Since symptoms, his muscles can't handle the stress of shivering to stay warm - it leads to spasms every time.



SPECIAL EQUIPMENT FOR A HORSE WITH A MUSCLE MYOPATHY:

If you've looked through my tack reviews, you've seen that everything I review is either treeless, bitless, or barefoot.  Believe it or not, I'm not a hippy :) However, my boy has specific needs, and these are the types of tack that he does best with.  When he's back sore but needs exercise, a bareback pad works best.  Even on his good days, the rigidity of a tree is too much but a well-fitting treeless works great.  Since he rope walks when his shoulders are sore, he can't have metal shoes or he'll give himself splints (he got 6 splints in the 6 months he wore shoes!).  His jaw used to get very sore with a bit, even though I have fairly light hands - he does great bitless.

Back on Track blankets and pads are also very helpful.  I use one under his saddle every day that's below 80*F (some people won't use them over 70*F, but Jax has a harder time warming up than cooling down so he has no problem with it in slightly warmer temps).

This doesn't mean that every PSSM horse needs exactly what Jax gets, they're all different so you'll need to find what works for yours.

So, can a horse come back after major symptoms set in?


My answer to this question is a hopeful YES.  It's a lot of stress and hard work from both horse and owner, and not everyone is in a position to do everything that I've listed above (fortunately, not every horse needs this much help).  These horses have a lot of heart, give them a chance and they may surprise you!

Sunday, October 1, 2017

Myofascial Release for PSSM Horses

I wrote this for a forum I'm on early August, 2017:

So, I've been watching YouTube to find massage, stretch, myofascial, and any other techniques to try and loosen up my horse's muscles - he's been doing really well and staying loose, but about two weeks ago he went lame from a constant shoulder spasm in both shoulders. The spasm finally subsided and he's now on Bute-less for a bit, which I think is really helping. His muscles have been much better on a higher fat diet - I got him up to 2 cups of oil for a couple of days, but he's starting to leave food in his bowl so we're back down to 12 oz (1.5 cups), which isn't bad as he was doing well on this amount. A few days ago I found this playlist for the Posture Prep Cross Fiber Groomer and it looked very interesting.

I've been doing it for about 3 days now with a grooming mitt that I already have, and the difference in my boy's muscles and skin pain and tightness is pretty drastic. After 3 days he's no longer sensitive to touch, his back pain is less, and he just looks looser. He's still slightly lame in his shoulder from the spasms last week, but even the stress lines there have improved quite a bit and he's now rideable (for short distances) again. The first day I worked on him for over 2 hours, the 2nd day over an hour, and today about another hour focusing on hindquarters and shoulders. I've been doing it everywhere, not just on the areas shown. I think this works by releasing the fascia and also through mild massage of the muscles.

The first pic is from about a month or so ago, 2nd pic is after the 2nd day of trying this (yesterday), and 3rd pic is from today and really working on his hindquarters. 4th pic is the grooming mitt that I used. He didn't love it the first day as he's been really skin sensitive, but today he did and I got a really good stretch out of him after he was done. If you try this and your horse is sensitive, be careful as they can be reactive. My boy usually just steps away when I hit something that is too sensitive, and that first day I hit many sensitive spots.






Edit to add: My horse's tail always curls to the left when he lifts it and is very stiff and hard to pick up (like he's clamping it but he's not). After the 2nd day he was lifting it straight most of the time and I could lift it easily - that's never happened in the 6 years I've owned him!

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UPDATE END OF AUGUST, 2017:

Today was the first test for how well my boy would do after the fascia work. The 2nd and 3rd pics above were taken about a week into little-to-no work due to muscle spasms in his shoulders. It turns out he had an abscess brewing in both front feet, which finally popped yesterday and the spasms stopped. I gave him yesterday off and worked him with the jelly groomer again, and even with a total of almost 2 weeks with no work, he stayed nice and loose (with only one day of massage, which he really enjoyed again after doing fascia work). I worked him lightly with the groomer today before work, and found a sore spot in his hindquarters (the muscles around his hip joint) - this is where most of his problems are, so I massaged/groomed that area which caused his back muscles to flinch (I think I now know where the sore back is coming from), then put liniment on those areas to heat/loosen them up.

After all that, he looked great and acted happy and comfortable, so I decided to take him for a short trail ride. We were just going to walk for a little way, see how he was feeling, and turn back early. He felt so good from the second I got on him - no 20 minute warmup as usual - and continued to feel good through a 2.5 mile ride. He was still feeling great when we got home and acting normal, but there was a slight shoulder spasm that went away quickly (I'm assuming that muscle was still a little compromised from the last couple weeks).

I have not been able to give my horse more than 1 day off in the 2 years since he became symptomatic - it usually stiffens him up too bad. I really expected him to be a complete wreck today. He did get a little handwalking during this time off, but it wasn't enough for his usual exercise needs. The only thing different other than the fascia work is that I put him on Buteless - which I'm sure helped immensely.

So here's the list of things that this type of fascia work has definitely helped with: loosened his muscles, kept them loose through no/little work, completely got rid of his skin sensitivity, less back pain coming in from the pasture, hip/hindquarters are moving looser, and no exercise intolerance after being off work. I also uncovered a couple of divots in his shoulders and neck once his skin was loosened up, and was able to find spots to work on that I couldn't find before as the tight skin was hiding it.

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UPDATE END OF SEPTEMBER, 2017

My boy spent the next 1.5-2 weeks outdoing his normal self - we went 7 days with up to and over 5 mile trail rides, some very technical and about 1/2 of those days included a lot of trot and canter work. One day I even got him to canter for about 1/2 mile! That hasn't happened in over 2 years. Also, this last year of rehab he's not been able to work hard for more than 3 days without crashing after - there has been no crash this past month.

I also took my first mini vacation right after that, and left him for 5 days in the pasture with no exercise and only hay and grass (no grain). The day I came back I hand walked him and he seemed perfectly fine. I then started building up mileage the next day, starting at about 2.5 miles (we normally start back at 1-1.5 miles) - he did amazing. He still has unlimited canter, and his body stayed nice and loose while I was gone (he normally can't do even 1 full day off work).

I've switched his food around a bit during the spasm episodes mentioned in my original post. He's now on 1 lb Renew Gold, 1 tbsp Mag Ox, 1.5 cups canola oil, 1/3 scoop Health E, and 1 tbsp baking soda - all mixed with water to make a nice mash. On some days I add 1 oz CoMega Supreme just to give him a couple extra vitamins. He's doing so well right now. Here's a pic of his muscles from yesterday. He's starting to gain muscle along his topline and really fill in his neck and shoulders (sorry you can't really see it cause he's eating lol), there's still a dip just before his lumbar that needs to fill in - I've found that working that hip joint (circled) really helps some days to get his back bone so it won't stick up like it is in the photo, but those muscles are so tight that it will be a work in progress for a little while.

The lines radiating from the circles show tight muscles coming from the tight joint, and I think that's what is causing his back soreness



MSM for PSSM and sore-muscled horses

I wrote this for a forum I'm on back in April, 2017:

So, this is an older article about the benefits of MSM for sore-muscled horses. I found it quite interesting, as I've had my horse on MSM for about 2 weeks now and he's doing wonderful - he's going on long trail rides daily and his muscles are softer than they've been in years. Here's one of the most interesting bits I found in the article:

"The results showed that all of the horses receiving MSM had dramatic improvement in three ways. Thermography showed less inflammation and soreness, particularly through the back and hind end. **emphasis mine**  (The change was faster and more dramatic for the horses on the higher dose.) Additionally, their serum chemistry demonstrated significant drops in two crucial parameters: AST (aspartate aminotransferase) and CK (creatine kinase), tests that indicate metabolites from muscle damage. Finally, all treated horses improved their average training time--group two (the lower dose) by two seconds, and group three by 2.62 seconds."

I had my boy on plain MSM when he was around 5 (before major symptoms) and he did well on it, but later on I tried a joint supplement with MSM and other things, including glucosamine, and he didn't do well on it at all so I removed that supplement and didn't add back the MSM - lesson learned lol. I know that some horses can't handle MSM, but the article discusses how the main reason it helps could be that it's high in sulfur - perhaps a supplement with sulfur could potentially help horses with muscle issues that can't handle MSM?

One other thing to think about - some PSSM horses don't show elevated AST and CK, could at least some of these horses be on MSM during the time of testing? Or possibly some other source of sulfur?

MSM Helps Sore Muscles on TheHorse.com

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UPDATE OCTOBER, 2017:

I took Jax off of all of his supplements for a few weeks, then added them back slowly to test/reaffirm the need for each in early September.  He did really well for a couple of weeks, but started having back pain again.  I went back through my notes and decided to add MSM back, and after a few days his back pain is much better.  So, twice after adding MSM I noticed a major difference in muscle pain/stiffness, so he'll be staying on MSM from now on.