SAIC - The Cairo story

by Milyn Brazier

We arrived at the SAIC campsite in Modimolle (Nylstroom) on Sunday afternoon with a storm tailing our heels. Along with the rolling thunder, there was the bubbling excitement of the up and coming endurance race. It was time for the South African International Challenge

As we were setting up our treatment site, a young girl came hobbling past wearing her riding clothes and a pair of her mother's slippers. She asked whether we could strap her foot. She explained that her excited little horse had stomped on her in a struggle while tacking up and now all she could fit her foot into, were her mother's slippers. We managed to strap her with a type of pressure bandage and some kinesio tape to assist in the swelling's drainage. This was our first encounter with the young and determined Ms Jessica Mostert.

Enter Cairo

Two days later the same young lady, her sister, Dominique, and her mother, Vanessa, came to our site asking for help. Right behind them was the 11-year-old Prins Cairo, a handsome bay Arab with the same big, excited but anxious eyes as the rest of the family.

Jessica Mostert: "The day after Milyn and Emrie strapped my foot, I went for an outride. When I came back a few hours later, I told my mom there's something wrong with my horse! I checked him completely and all I could see was that he had a sore back, but I still took him for the pre-check that all the WP horses had to go through.

"The vets told me I had better go to Milyn and get him sorted, otherwise I wouldn't be starting the race! This would also have meant that I would have had to hand my WP colours back! I took him to Milyn and asked her to please fix him. Maybe it was the tears in my eyes, but she immediately started checking him."

On assessment, little Cairo had a very sore back and right hind quarter. His thoracic and lumbar spine was completely out of alignment and he was spasmed severely on both sides of his back, but significantly worse on his right. On trotting out, he showed a distinctive drop on the right hip and didn't track up with his right leg at all.

Cause of the pain

I explained to the family that it would definitely be a challenge to get him sound, but that it was possible given that we were dealing with muscular and skeletal misalignment only and no underlying lameness, as this had already been ruled out by the veterinarian.

It was a priority for me to find out what the mechanism of injury was that led to Cairo's discomfort. We covered all possible factors from travelling, to possible injury while riding, rider's own injury and influence on the horse as well as the rider's seat. We came to the conclusion that the saddle was what was causing his pain.

Generally, when I take all the factors presented and put them together and then analyse these along with the pattern of pain that is presented, I am mostly able to form a hypothesis of where the problems may have arisen from. This is simply a hypothesis, but I find that it is accurate more often than not.

Saddle

On assessment of Cairo's saddle, it was clear that the saddle was leaning back and placing too much pressure on Cairo's lower back. One can do a simple test to check this using a stick of Lip-Ice (as illustrated in the photograph).
We needed a different saddle if we were going to ride this race. No amount of padding or thickening was going to help. I called on my good friend and colleague, Leon Liversage, and without a moment's hesitation he analysed Cairo's back and returned with a saddle which was a perfect fit.

Now that the cause of the problem was sorted it was up to me to get Cairo through the first vet check!

Treatment

I treated Cairo on the Tuesday before the race when he was referred to me and gave him quite an intense session of physiotherapy. This consisted of mobilisation of tissue and bone as well as skeletal manipulation (chiropractic techniques).

The family was instructed to do a range of little exercises to supple up the back and help with the inflammation that I would be causing from my treatment. I called on Dr Marc Walton to inject Cairo with traumeel, a homeopathic type anti-inflammatory, into his back muscle where the spasm was most prominent.

After such an intense session, horses are generally treatment sore and it is essential that one takes this into account on your reassessment. As a rule, I choose not to treat horses this aggressively on the day before a vet check. Because we had no time, however, I had no choice.

Heat and light treatment

On Wednesday morning we trotted Cairo out and he was significantly better, yet he was still dropping his right hip on the trot out. At this stage I knew he would still not pass the vet check which was only hours away. I very lightly treated Cairo again ensuring that any residual spasm was removed. I used a lot of heat modalities on his back. I chose not to use any massage techniques, as this may have caused increased sensitivity, but rather mobilised the muscle.

I asked Dr Hercu van Niekerk for more suggestions and he advised I try hot and cold therapy. Our goal was to get as much blood flowing in this painful area as possible. On trot out after all of this, he was better but it was still my opinion that he would not pass the vet check.

It is my experience that horses with back pain of this nature often warm up out of their back pain and on the subjective evaluation with the family they did explain to me that in the last few days of riding when Cairo did feel uneven, he did get better the further they rode.

I explained to the Mosterts that our only hope now was to get the deep muscle, which therapy was not reaching, as warm as possible. This would require active muscle work and a lot of it. The instruction was to trot Cairo in hand for 45 minutes before we go to the vet check. The whole family took turns in running with their amazing little horse and when he got back to me 45 minutes later and warmed up, he was sound as a bell.

(READERS PLEASE NOTE: This will not necessarily work in any and all cases and should not be tried without the guidance of a vet or physio.)

I advised the Mosterts to keep him moving and warm, and off we went to the vet checks. Cairo trotted out perfectly with not even a complaint of a back pain noticed.

The plan of action from there on was essential and I made sure it was clear: "Leave him and his back alone. We had treated enough, anymore would definitely lead to sensitivity. Let him rest. Do his mobility exercises once more in the evening, but let him be."

Simple logic

Their ride advice was simple and logical: Start slowly and warm him up well. For the first 2 to 5 kilometres start trotting on the right rein so that he is warmed up before asking too much from the right hind quarter. And so the second and primary challenge began.

As they came trotting in after the first leg, I stood with Vanessa waiting. Cairo looked fine. He was so excited we could hardly keep him still. Jessica had looked after him well and his heart rate was low enough to present almost straight away. On assessment, Cairo showed no indication of discomfort on his back or in his hind quarters. While grooming, I ensured that there was no cold water put on any of his 'danger' areas and we kept him warm with a blanket ensuring to cover his lower back and hind quarters.

We went through our first vet check with flying colours.While Cairo was resting, I examined him again and decided it best not to work with him for concern of causing sensitivity. He had no discomfort or pain anywhere.

The second leg pursued as smoothly as the first, they came in looking wonderful. I assessed him and he was absolutely pain free. There was no indication of muscle spam in his hind quarters anywhere. A lot of people had suddenly joined in to help the family groom so I stood back as my job was done and I was happy with him to go to the vet check. Cairo seemed to get agitated with all the people around him and wouldn't stand still for his heart rate to be checked. I walked to the vet check to give them some space.

Disappointment

In the meantime, someone thought they would help and poured ice water on his back and hind quarter. The girls said it was too quick to stop. By the time he had reached the vet check he was cramping in his hind quarter. There was nothing I could have done; it was too late as the cramp only kicked in at the vet check. I suspect the sudden cooling off of a problem area that required blood flow, was what led to the cramping. By the end of the day I had confirmed my theory, as I had seen it in a few other horses too.

We had no words. After all our hard work, someone trying to help, didn't! I checked on Cairo and advised the Mosterts what to do with the back, which was not much more than TLC and the mobility exercises. That afternoon when Cairo moved out again, he was once again sound as a bell. Our hard work and Cairo's dedication wasted because of a simple error!

Vanessa Mostert writes: "Cape Town to Nylstroom is far, but my daughter, Jessi, worked really hard to make the WP team and as a family, we were going to be behind her all the way!

"The support we received from Milyn cannot be taken lightly! The dedication she gave to a little girl who had a dream was a joy to watch! When her hard work paid off and Prins Cairo passed the vetting, she cried as hard as I did!"

Why the treatment?

The first and most logic question people ask in a scenario as described above is this: Why start a race with a horse that isn't 100% right?

We, as health professionals, are trained to do what is best for our patients, but are often also faced with the reality of the sport. If I thought in any way that what we were going to do to Cairo was cruel or unfair, I would have had no part in it and I know neither would his owners. Cairo had a sore back and it needed to be attended to, the only difference was that we had to rush against time and try to speed up recovery as much as possible.

The reality was of a family who had spent money and a lot of time on a young girl's dream to ride in the tri-nations. At no time during the race was Cairo uncomfortable or in pain, until he was over-groomed. It is my opinion that this little horse wanted to race just as much as his owner did. His demeanour showed no signs of extreme pain or discomfort.

He simply reacted on localised pain that, in my opinion, needed to be treated in any case. The family, Cairo's vet, Dr Marc Walton, and myself at all times kept as priority that if he looked like he was getting worse with treatment or showed any signs of increased discomfort, we would withdraw him from the race. Prins Cairo just had other plans.

The dedication and commitment that the Mostert family showed to their horse, to the endurance sport and to one another will stay with me forever as a reminder of how our horses are able to motivate us to achieve greatness.
You came to make your family and your horse proud of you and that you did, Jessica. Well done!!

Outsider

My summary of the SAIC is that it was one of the toughest races yet. There were a lot of horses with metabolic conditions that failed the vetting that I could only assume would be as a result of the humidity of the area. However, these conditions would best be commented on by qualified veterinarian.

The conditions that fell under the scope of physiotherapy was predominately overworked and fatigued hind quarters due to the thick sand the horses had to get through. Some of these horses we were able to help finish the race.
Something that I will be sure to research and report back on to readers in future, is the use of ice water when cooling horses down. I do believe there is a place and necessity for the use of ice water, but as an observation I saw a few horses stiffen up and cramp up behind after the application of ice water on the hindquarters.

For more information or if you have any questions, please e-mail Milyn on mbphysio@vodamail.co.za