Let's talk about equestrian rehabilitation or rehab through rider fitness exercises. Veterinarians have written a lot on how to rehabilitate our equine partners after various injuries whether they are trauma to soft tissue or changes in the skeletal or joint structures. However, many of us have ailments of our own that often hinder our performance in the saddle that require equestrian rehabilitation. In my horse sales adventures, I have frequently received calls from potential buyers who have had hip and knee replacements, rheumatoid arthritis, heart conditions, asthma, scoliosis, etc. Sometimes our maladies are temporary and can be improved and sometimes the condition is more permanent. Most often, as in life, riders are "a work in progress," in that we hope to improve our limitations with rider fitness exercise, treatments, equestrian rehabilitation or surgical intervention.
Since I started riding as a 7-year-old horse-crazy little girl, I had no physical or mental limitations and would ride any horse in any tack under any conditions. That is until I experienced mind-numbing back pain following a day of judging a horseshow for eight hours from a metal chair with my legs crossed for most of the day. I went to see a chiropractor, Dr. Brad Weiss, who adjusted me, which yielded some relief but I still had tremendous, searing pain whenever I sat for more than 30 minutes at a time. After getting an MRI on my lower back, Dr. Weiss clipped the images onto the light box in his office and said, "Oh! That disc looks like a jelly donut that someone stepped on! I can't help you with that. I will refer you to a pain specialist." In retrospect, I believe that the training technique of my first dressage instructor of telling me to keep my shoulders "behind my hips" in arched back alignment to correct my hunter "hovering forward" seat 15 years ago was partly responsible for my herniated discs.
One week after getting my second epidural shot from the pain specialist to relieve the pain from the disc pressing incessantly on my sciatic nerve, my husband and I conceived our first child. I continued to ride and show my Grand Prix mount pregnant and with two herniated discs until I was five months pregnant. This should come as no surprise since horsewomen are really tough cookies and patch themselves up to crawl back into the saddle all the time—especially to show Grand Prix.
Fast forward to the delivery room. After carrying my son for 41 weeks, he was induced and 19 hours of labor with "failure to progress" finally ended in a c-section delivery. I really didn't want to have my abdominal wall cut for several obvious reasons, not the least of which was the longer recovery and challenge to the core muscles required for riding. Two months after Benjamin was born, I was back on the operating table for a discectomy, laminectomy and spinal fusion of the L-4/L-5 and L5/S1. Basically, they scraped out two bad discs, inserted artificial discs, secured a supporting plate to the side of my spine with titanium screws and closed me back up with the intention that the three vertebrae would be fused together permanently. I also awakened from surgery with a condition called "drop foot" in my left foot, in which the nerves associated with foot extension or dorsiflexion are damaged.
During my pregnancy, I invested in personal Pilates sessions to improve my core strength and alignment. The techniques and exercises that I learned will stay in my toolbox for the rest of my riding career. Many other riders have sung the praises of Pilates for maintenance and core strength improvement. I also spent six months in post-operative physical therapy with Dr. Richard Asaro, a physical therapist who helped me to regain strength in my core muscle structures, back and recover foot extension/dorsiflexion. The exercises that he had me do three times a week during our training sessions will also become part of my fitness repertoire from now on and I think they could be helpful to others with similar weaknesses.
Dr. Asaro also encourages "drawing-in" of one's abdominal muscles and proper alignment of hips, spine and shoulders for all exercises. Naturally, during the first month, we saw the best rate of progress since I started from a place of considerable weakness all the way around my torso. The three exercises I share here are the most helpful exercises that contributed significantly to my recovery. These exercises are important to promote lumbar spine and sacroiliac stability, which has been particularly challenging in my case since my lower abdominals were damaged during the c-section.
When it comes to lumbar spine stability, what we are looking for is to strengthen the deep multifidi, which are the deep para-spinal muscles in the lower back arranged at a 45 degree angle and the deep abdominal muscles. Of these, there are four layers: the transverse abdominus, the internal obliques, the external obliques and rectus femoris. As athletes, we are most concerned with the transverse abdominus and the internal obliques contracting with the deep multifidi simultaneously to provide a stiffening effect of the intervertebral segment of the lumbar spine. When it comes to the lumbar spine, we are most interested in the five vertebral levels with a disc in between each. Every vertebral level is comprised of a vertebra, a disc and a second vertebra. The reason that the deep multifidi, transverse abdominus and internal obliques are considered segmental stabilizers is because they have attachments at each and every vertebral level. Conversely, the rectus abdominus is the top layer of abdominals which has attachment from the sternum to the pubis. It doesn't attach directly to each vertebral level.
These are the primary stabilizers of the lumbar spine and the sacrum. There are additional secondary stabilizers of the lumbar spine and the sacrum which are the latissimus dorsi, the gluteals, the hamstrings and even the hip flexors. The latissimus dorsi and gluetals provide stability through the thoracic lumbar fascia. The hip flexors provide anterior support to the lumbar spine and have some element of segmental stabilization. The hamstrings provide stability via its attachments to the pelvis. Dr. Asaro and I have chosen to share these particular exercises to provide stability and training to stimulate the deep segmental stabilizers. Once those are performing well, we can incorporate the more global secondary stabilizers like latisimus dorsi, gluteals and hamstrings.