Osteopathy and horseback riding: the health of the rider

Did you know that 30 to 40% of riding injuries occur when the rider is next to the horse? It was in 2000 that Waller highlighted the risk when caring for horses. 

The causes of stable pathologies are diverse:

• Trampling
• Handling
• Kicking
• Maintenance of the box
• Crushing
• Road transport

They can cause:

• Tendinopathies
• Low back pain (disc disease, etc)
• Trauma (fracture, sprain, head injury, etc.)

The prevention of stable pathologies is infinitely linked to the respect of the safety rules of the stables. 

• Never position yourself or your horse in such a way that you can get stuck in a stall
• Never surprise a horse, always warn him vocally of your arrival
• Never approach a horse from behind, always from the front or from the side (warning him of your arrival)
• Respect the safety distances between horses (on foot or on horseback)

Having a good physical condition is also part of the prevention against stable injuries. This part is often too much neglected by the riders!

According to a 2007 Mayberrey study conducted in three states (Idaho, Washington and Oregon), the risk of injury decreases with practice and training hours. The more you practice horseback riding, the more training you have, the more your risk of injury decreases. 

44% of injuries occur after the rider has been thrown from the seat by the horse.
10% of these injuries are due to being run over by the horse. 

• Be in good physical condition: the more muscular you are, the more your muscles will protect your entire body.
• Wear the right equipment :
  • Have a horse spray every time even for a quick ride. The spray can should of course be adapted to the size of the rider. Just like motorcycle helmets, it is better to change a bomb that has had a shock.
  • Back protector: even if it is mandatory for cross-country riding, it is still not mandatory for other disciplines. Just like back protectors for motorcyclists, back protectors can be necessary.
  • To be shod with boots or boots with chaps, these shoes are not only used to save the bottom of the pants but also reduce the risk of traumatism like sprains.

The patient who has suffered an equestrian trauma can be treated by an osteopath in the absence of medical pathology. 

Your osteopath will start his session with painless manipulation tests that will allow him to identify the origin of the pain as well as to visualize the areas in pain (muscle, bone, tendon, ligament, ...). 

If the practitioner suspects a contraindication such as a fracture, he or she will not treat you and will refer you to your doctor. 

If the patient has no contraindication, the osteopath will draw up a dysfunctional assessment to visualize the cause and the repercussions on all the adjacent structures. The osteopathic treatment will allow the removal of possible blockages due to trauma through a combination of techniques adapted to each person. 

To conclude the session, your osteopath can also advise you on your diet and on physical preparation exercises to optimize recovery. 

According to Cruche in 1984, there is no correlation between the frequency of back pain and the number of years of practice, so it is not the intensive practice of riding that causes back pain. It has also been proven in numerous studies that horseback riders do not have more back pain than other athletes from other sports. 

With the exception of falls, it is not riding itself that causes back problems, but all the activities that go along with it, which are called stable injuries. 

On the other hand, horseback riding strengthens the back through sitting. Because of its unstable nature, the muscles of the back are obliged to contract in order not to fall, so they are naturally strengthened by riding a horse. This is also the case for sitting on a stool, a ball, or any other non-stable surface. The chair is obviously not a factor since after only three minutes of sitting, studies have proven that the muscles of the lower back no longer send nervous information to the brain. 

What strengthens the back are the micro-traumas linked to the practice of a sport. This theory has been demonstrated in running and is applicable to horseback riding. 

In April 2017, a team of Australians concluded that the more running you did, the stronger the discs between your vertebrae became. They conducted their study on three different groups: 

• A group of non-runners
• A group of runners with an average of 20 to 40 km per week 
• A group of runners with more than 50 km per week

With the help of MRI, they compared their spines and more specifically the lumbar vertebrae of the participants. They showed that in the group of runners, the discs between the vertebrae were more hydrated and therefore thicker, their center was also better reinforced, which favors the role of shock absorber of the intervertebral discs. 

To show you the importance of physical preparation, here is a study based on swimming. They say that swimming is good for your back, but studies prove otherwise! 

In 2009, Mr. Hangai and his collaborators established the proportion of disc pathology in the population of non-athletes and athletes with more than 10 years of practice, and here is what they discovered: 

• 25.6% disc damage in runners
• 31.4% of non-sportsmen 
• 36.2% among footballers
• 57.2% among swimmers!

To complete this study, Dr. Kaneoka showed that 68% of elite swimmers had disc pathologies compared to 29% of casual swimmers!

The studies can be explained by the fact that swimming does not involve stresses transmitted by the ground and therefore the role of the discs as shock absorbers is not necessary in this case of practice. We can also add for swimming a component of undulation which makes that we shear the discs and the risk of disc herniation increases. 

Over time, the physical preparation of elite swimmers has evolved and imposes floor work to add axial stress to the back and Folkvardsen's study in 2016 proves this as there is no longer any difference in the rate of disc pathology in elite and amateur swimmers.

We therefore recommend that riders practice muscle strengthening outside the stables to optimize physical preparation. 

It can never be said enough, but the better the physical condition of the rider, the fewer the sprains. For the rider, ankle and wrist sprains are the main cause of falls. 

Proprioception : 

A major component in the prevention of sprains is the perception that our brain has of the positioning of all parts of our body. If your proprioception is sharpened, the body can automatically set up reflexes to avoid injuries in case of a fall for example. On the other hand, if you don't really work on your proprioception, the reflexes are not good and you are more likely to get injured. 

Here are some examples of exercises to maintain ankle proprioception: 

• Brush your teeth on one foot Stand on one foot
• Walking on unstable ground (mattress, sand, ...)
• Stand with eyes closed on one foot 
• Stand on two feet or one foot on proprioception boards (proprioception tray or cushion)

Strengthen the ankle:

The exercises listed below will allow you to work the fibular muscles which are linked to the lateral stability of the ankle. Obviously, the stronger the ankle muscles are, the more stable and strong the joint is, hence the importance of muscle strengthening. 

Here are some examples of exercises to strengthen your ankles: 

• Bouncing strides Running in sand (e.g., in the quarry)
• Tiptoeing (skipping rope is a great exercise)
• Jumping through hoops, or in a rhythmic ladder

Equip yourself properly: When riding, wearing boots provides support for the ankle and greatly reduces the risk of sprains.

To prevent wrist sprains, it is necessary to strengthen the muscles in this area. You can help yourself with a stress ball that you regularly squeeze in your hand. It is the regularity of the exercises that will be beneficial for the muscular reinforcement. 

• Rest
• Raising the foot or hand 
• Ice? Icing used to be recommended, but recent studies have shown that ice has an anti-inflammatory effect. Inflammation is a natural process that the body uses to heal. Therefore, it is now recommended to stop icing in order to let the body react. Ice has an analgesic (pain-relieving) effect but will slow down recovery.
• Do not take anti-inflammatory drugs: during a sprain, the inflammation produced releases elements that help the healing of the ligament. By taking anti-inflammatory drugs, we stop this inflammation and therefore we slow down the recovery...
• Immobilize accordingly: In children, certain precautions apply and immobilization is encouraged. Since bones are not fully ossified, X-rays cannot eliminate the presence of fractures, most hospitals put children in a cast for sprains. But in adults, it is different, studies have proven that wearing a cast is detrimental to recovery. A study carried out on small rabbits showed that it was worse to put a cast on than to do nothing at all, and that the right thing to do is to immobilize with strapping.
• Osteopathy has a role to play in the management of sprains:
  • In the short term, your osteopath will first carry out orthopedic tests in order to eliminate any contraindications (such as a fracture), his role is to remove all the blockages generated by the sprain mechanism. In case of doubt, the osteopath will redirect you to the emergency room or to your doctor for further tests.
  • In the long term, the osteopath will also treat the repercussions of the sprain on adjacent areas and on the rest of the body. Having a sprain (or pain) changes the gait and modifies the supports. By modifying these supports, the rest of the body will compensate and the loss of mobility will settle. The osteopath's goal is to rebalance the whole body, so that it functions optimally.
• PodiatryWith the use of insoles, you can limit the risk of sprains and prevent the foot from tilting. Orthopedic inserts do not exempt from muscular reinforcement or proprioception exercises, they are a complement. Wearing insoles to fight against sprains must remain exceptional. 
• Physiotherapy, complementary to osteopathy thanks to its massages, its cryotherapy has its major role in the management of sprains. 

This type of muscular pathology is frequently found in horsemen:

• Sore muscles: they can last several days and appear in amateur riders or in sportsmen resuming physical activity after a break. To relieve sore muscles, you can apply heat to the affected area. 
• The pathology of the adductors but also the glutes and solar: the adductors are muscles located inside the thighs which allow the rider to maintain himself on the horse thanks to the movement of tightening of the thighs called adduction. When practicing speed, endurance, jumping, etc., the rider is in a so-called suspended position, i.e. the seat (buttocks) is not placed on the saddle, but is balanced on the stirrups with the torso tilted slightly forward, the calves and inner thighs in adduction. The posterior muscles of the spine and the buttocks also provide support.

Warm up: Before the practice of each physical activity, it is advisable to:

• Do a specific warm-up for the muscle groups that will be mobilized during the activity. 
• Cold stretching: For the prevention and treatment of injuries, regular cold stretching is recommended. 

To stretch well: Be careful not to confuse stretching with warming up, which is done before physical activity and mobilizes the joint and wakes up the muscle. 

• Stretching should never be done just before a physical activity, otherwise the risk of muscular and/or tendon injuries will increase by 20%.
• Stretching should be done cold, at least 2h/3h after the physical activity Regularity is the key.
• It is better to do a little regularly than a lot infrequently.

Strengthen your muscles: Thanks to specific exercises for each muscle group or with sheathing, it is essential to work the entire body parts together. 

Have a good lifestyle: Good hydration Good regular sleep Good nutrition Good dental hygiene: a cavity can be the source of bacterial entry causing the body to react and decrease performance

Good and well adjusted equipment: The quality of the equipment but also the adjustments play a major role in the prevention of injuries, the height of the stirrups must for example be at the same level to avoid the installation of imbalance.

A good practice of riding: Symmetrical riding practice (change direction in the arena) Finding the right balance between being sheathed and being loose (this is acquired with experience but also with the mind).

The treatment is of course different depending on the type and origin of the injury: 

• Put cold for tears, breaks, elongations. 
• Putting on heat for contractures and aches

• Do not massage in case of tear
• For muscular lesions, put a compressive strapping

• To have a kinesiotaping If your practitioner is trained in the application of these bands, he or she can apply them to you and will of course adapt their application to the problems encountered.

The tendon is the part between the muscle and the bone. When we practice a physical activity, the tendon fibers and the muscle fibers can be too much or badly solicited, they are thus in suffering. We then witness their remodeling. 

A few years ago, the term tendonitis was used because it was thought that there was inflammation. This is the reason why some doctors still prescribe anti-inflammatory drugs for this type of injury.
However, studies have shown that except for the first few days, there are no inflammatory cells in cases of tendonitis. The name has therefore been changed to tendinopathy or tendon pathology.

After an injury, the tendon reforms and the tendon fibers tend to re-consolidate in the form of a small bundle. It is therefore essential to stress the tendon by stretching and/or contracting it appropriately.

In cases of tendinopathy, rest is not useful. Physical activity must of course be adjusted and reduced but it is necessary to continue to work the tendons.

In horse riding, the use of the forearms with the reins leads to forearm tendinopathies such as De Quervain's tendinopathy orepicondylitis. The hanging position also leads to tendinopathy of the adductors. It is therefore necessary to learn riding techniques quickly so as not to be too tense on the reins or badly positioned in the saddle. 

• Cold stretching
• Good dental hygiene
• Specific strengthening exercises for the tendons. For example, for the forearm and wrists, you can take a ball in one hand, squeeze it and release it gently.

Regardless of the rider's level and age, it is recommended to have an osteopathic consultation once or twice a year. 

Riders who always ride the same horse are advised to consult their osteopath at the same time as the horse is consulted by an equine osteopath. 

Before a post-injury treatment, your osteopath must first check that there is no contraindication to the treatment. If there is a contraindication, he will refer you to a specialist or to your doctor for further examination. 

Your osteopath will perform a series of painless tests to determine the imbalance and the cause of the injury. He will then use a series of techniques to treat the origin of the problem and the repercussions it has caused. The osteopathy session should reduce the pain felt by the patient and maximize the recovery of the athlete. 

If trained, your osteopath can also apply kinesiotaping and/or strapping to provide faster relief and optimize treatment. 

Simply by examining you, your osteopath will be able to determine with precision if you have weaknesses in certain areas of your body, he will be able to advise you on exercises to reduce the risk of injury but also guide you to improve your performance. 

Your osteopath can also enlighten you on subjects such as exercises to work with your horse, stretching, strengthening exercises, hygienic and dietary advice. Do not hesitate to ask him your questions. 

Marie Messager
Osteopath D.O
2 rue Alexis de Tocqueville
78000 Versailles