Exercises to help prevent injuries, extend your career

Dr. H, a recent graduate, was attending the American Association of Equine Practitioners (AAEP) meeting in Orlando, Fla., this past December. While standing in the convention-center lobby waiting for a lecture to begin, he noticed three older veterinarians over in a nearby corner engaged in serious discussion. He recognized all three as leading lameness experts and well-respected practitioners.

"Wow, there must be over 100 years of equine practice experience in that conversation," he thought to himself, wondering what they were discussing. Were they talking about new research? Discussing some revolutionary technique or procedure? Or just swapping "practice gems" developed over all those years?

Dr. H, feeling a little uncomfortable but unable to resist, moved casually closer to the conversation so that he could hear.

Watch your back: Practitioners know they should lift with the legs, not the back, but that's not always possible if one wants to avoid being kicked.

"My back has been killing me, too, more and more lately" said one.

"It's not my back that's hurting, it's my hip; and my orthopod is suggesting that I get a replacement soon," replied the vet to his left.

"Well, I'd rather be looking at a hip replacement than a knee replacement. I've heard that hips go well and you can come back fairly quickly and keep practicing, but knees are trickier and my right one is almost bone-on-bone now. What are you guys taking for pain management anyway?" asked the oldest vet.

"Wow," thought Dr. H, "they're just talking about all their aches and pains, and those guys sure sound pretty well worn out. I'm glad I'm not there yet," he mused as he ambled away and left the older vets to their consultation.

This incident actually happened. It is a realistic commentary on the toll that equine practice can take on the body of the average equine practitioner.

The types of animal-related incidents that cause serious injury and death have been catalogued for large-animal veterinarians but the unreported bumps, bruises and other injuries that occur in the day-to-day life of an equine veterinarian tend to accumulate.

Many veterinarians suffer from leg and back arthritis. Injuries or acquired conditions in the wrists, shoulders and neck are common, too.

A brief look at the types of procedures that equine veterinarians are required to perform daily shows that lifting or bending is required when flexing joints, inspecting or injecting joints and examining legs and feet. Often the bending and/or lifting must be done with attention to avoiding trauma, rather than the correct body positioning.

Two sources of injury

Veterinarians know that it is better to lift with the legs, not the back, but it is not always possible to be in the correct position with legs squarely under the weight to be lifted. "Far better to strain a back lifting than to get kicked in the knee because I wasn't out of the way" is the generally accepted viewpoint.

The other main cause of injury for equine veterinarians is the fact that many routine procedures require work with the hands above the shoulders.

"This is a very inefficient position," says Jake Irwin, doctor of physiotherapy and owner of Pro Performance Therapy in Alpharetta, Ga. "Lifting or doing forceful work with the hands above chest height puts the shoulder at risk for strain damage or worse," says Irwin, who provides performance training and therapy for athletes ranging from weekend warriors to professionals in the Atlanta area.

"A large percentage of single-arm sport athletes (tennis players and baseball pitchers, for example, whose sport requires them to use one arm predominantly in motions that keep the hand above the chest) have a significant amount of degeneration occurring in their shoulders," says Irwin, "even if they are currently asymptomatic."

Equine veterinarians routinely examine mouths and teeth, perform dental procedures and intra-nasally vaccinate horses that are significantly taller than the average human. Not all of these procedures can or should be done with tranquilization every time, so the amount of shoulder stress in equine practice is significant. As more and more women practitioners, who are generally shorter than men, enter the profession, the amount of shoulder stress caused by routine practice could possibly increase.

Action-specific conditioning

It is well established that in order to be strong and flexible within a certain range of motion and for specific activities, an athlete should condition and train specifically for those activities. This "sport-specific" conditioning advice often is given by veterinarians to their clients when called upon to help design programs to rehabilitate injured equine athletes or to help promote equine fitness as a means of reducing injury risk.

Poles and cavaletti to muscle up the back and legs; long, slow distance training for endurance; or transition work for a weak top line — all these are sport-specific exercises designed to help keep horses fit.

Veterinarians, however, traditionally do a poor job of keeping themselves fit for the task of being veterinarians. Sport- or job-specific exercises could help prevent much of the accumulated "wear" seen in older practitioners and is a habit well worth adopting.

3 exercises for 3 sites

As observed in the accompanying sets of photographs, three easy exercises, done just three times a week for about 30 to 45 minutes, targeting the three sites most commonly injured in equine practice, can mean the difference between a shortened career and a long, healthy one.

The stresses

Lifting legs

Here are two views of lifting the hind leg as part of a flexion test which is done during a lameness or pre-purchase examination.

To do it correctly, the practitioner's body isn't in the most comfortable or correct lifting position.

Lifting correctly for the human rotates the horse on its opposite (non-lifted) leg and actually stresses the hip and SI joint and not the hock on the lifted leg, which is what you are trying to do in the first place. As a result, back injuries are very common in equine veterinarians.

Examining legs

Inspecting legs, injecting legs/joints and working on the feet/hooves often require lifting with a straight back and/or legs, which is not the correct posture to avoid back injuries.

Working on feet

Examination of the feet/hooves occurs many times each day and not always with the correct posture for lifting. Years of this activity can weaken and eventually damage the back.

Working above the shoulders

Equine veterinarians often must do things with a horse's head, eyes, nose, mouth and teeth often while the horse is trying to lift its head up and away from the veterinarian. This constant pulling and jerking with hands above the shoulders causes stress to the shoulder joint and related muscles and tendons and can affect the veterinarian's neck as well.

The shoulder joint is a frequently and chronically injured area for veterinarians.

Additionally, work in this position often puts the wrist at hyper-flexed or hyper-extended angles, contributing to wrist strain as well.

Exercises

Wrist-roller exercise

This may be old school, but it's effective for the hard-to-strengthen wrist. A hand weight (3 to 5 lbs) is tied with a cord, which is then tied to a short piece of round wood (piece of broom handle or that recently broken manure fork). The length of cord need be only a few feet. This exercise can be done standing or sitting (even watching television). Simply grab the wood with both hands (palms down) and, using your wrists, roll up the cord on the wood, raising the weight. Lower and repeat. Three sets of 10. This exercise strengthens the wrists and the forearm muscles which you use for floating teeth and for anything that requires grip strength.

While you're sitting

Sitting reduces the dependence on abdominal and core muscles that keep the lower back straight. Long-term sitting (driving) can weaken these areas, leading to possible back strain, sprain or even arthritis and disc disease. In the truck, you can do wrist strength and grip exercises. Simply keep a tennis ball in the truck and squeeze it at each stop light (three sets of 10 with alternate hands).

Scapular position exercises

These exercises help strengthen the shoulder and keep this area flexible. Assume the position shown. This can be done with two chairs. Start with a weight in your extended hand and, keeping the arm extended, lift the arm up and out to end in the position shown. Form is crucial; use only enough weight to be able to correctly maintain form (generally 3 to 5 pounds, more as you strengthen but not more than 10 pounds; three reps of 10 on each shoulder).

Trunk stabilization exercises

For this you need an exercise band a large rubber-bandlike device that is put around your legs at the calves. They are sold at fitness/exercise/sporting-goods stores. Stand as pictured with your legs together. Balance on your left leg as you slowly extend your right leg behind you about twice the length of your foot (2 to 3 feet). The extension should be slow and easy, and your swinging foot should stay close to the ground. Bring your leg back to the starting position and then slowly extend it three-quarters toward the side, again about 2 to 3 feet away and low.

Return to starting position and now extend the right foot to the side the same distance and return.

This exercise is designed to strengthen the core muscles of the hip and upper leg and abdomen that stabilizes the left leg while you move the right. Repeat with the left leg (three sets of 10).

Core exercises

This exercise strengthens the back and side core muscles. Lie on your stomach on the floor of the bed. Place a pillow under your chest/pelvis so that your back maintains a slight arch.

Arms and legs extended, raise your right arm and extend and lift your left leg at the same time. Lift them only a foot off the surface and hold for a count of 8 to10. This will call on the core or stabilizing muscles needed to help your back. Let your arm and leg return to starting position and work the alternate arm and leg (three sets of 10).

Dr. Marcella is an equine practitioner in Canton, Ga.