Emma Barber Healing Hands Veterinary Physiotherapy

25/04/2025

What are your opinions on the use of corticosteroids?

Personally I do think they have a place in certain cases, but agree with the statement that if we are having to use multiple treatments of corticosteroids in a short timeframe to keep a horse sound, then we must address and reduce the workload the horse is placed under.

A 2017 study found that racehorses receiving corticosteroid injections were FOUR TIMES more likely to suffer musculoskeletal injuries. These weren’t minor lamenesses, they led to long layups, early retirements, and in some cases, catastrophic breakdowns. That stopped me in my tracks. When we inject a horse to keep them “sound,” are we treating the injury, or are we simply hiding the pain?

Corticosteroids are powerful anti-inflammatories. They offer quick relief, especially for sore joints, but repeated use has a risky side. Over time, corticosteroids can accelerate cartilage breakdown and damage the very structures we’re trying to protect. That’s not just theory, it’s been proven in multiple studies. One 2022 review published in Equine Veterinary Education warned that long-term use of corticosteroids, even in low doses, can lead to irreversible joint degeneration.

And it’s not just steroids. Treatments like IRAP (interleukin-1 receptor antagonist protein) and PRP (platelet-rich plasma) are widely used, but the science behind them is still emerging. A recent meta-analysis found highly inconsistent outcomes with some horses showing improvement, and others none at all. These therapies show promise, but they are not miracle fixes. Their long-term benefits and risks remain unclear, especially when used repeatedly without a comprehensive rehab plan.

Even alternatives like Adequan and Polyglycan come with caveats. Adequan (polysulfated glycosaminoglycan) can help reduce inflammation and protect cartilage in the short term, but does not show lasting curative effects without rest or additional therapy. Polyglycan, often marketed as a joint lubricant, has been linked to increased bone proliferation and osteophyte formation. That means while it might make your horse feel better in the short term, it could be quietly encouraging abnormal bone growth that worsens arthritis and limits joint mobility over time.

It seems that most injections don’t fix the problem, they just silence the alarm bell. And when we quiet that bell without solving what caused it, we set the horse up for further breakdown. They keep working through masked pain, compensating, and eventually injuring something else. What seems like a solution quickly becomes a cycle of damage.

So, what does responsible use look like? It starts with intent. Injections should never be used as routine “maintenance” or as a preventative measure in otherwise healthy joints. There is no such thing as a preventative joint injection. Every time you inject a joint, you’re altering its natural chemistry and potentially weakening its future integrity. Instead, injections should be used after thorough diagnostics: imaging, flexions, lameness exams, and only as part of a comprehensive plan. That means rest. That means thoughtful rehab. That means time to retrain healthier movement patterns so the horse can come back stronger and more balanced, not just numbed. Injections can open a door to recovery, but they are not the recovery itself.

Responsible use also means reevaluating the workload. If a horse needs regular injections to keep doing the job, then maybe it’s the job that needs adjusting. I’m not saying injections are evil. They’ve done wonderful things for horses I’ve known and I’m not saying we should all stop injections forever. But if Beauty’s hocks need to be injected three times a year just to keep her jumping the 1.20s, maybe the 1.20s are no longer where she belongs. Maybe it's time to listen to what her body is telling us.

I’m not a vet. I don’t have a medical degree. I’m just someone who enjoys research and writing, and I would still argue that we need more research to ultimately determine what is "safe" for our horses. However, I do think it's important to be aware of what the science currently says, and having hard conversations about if the potential risk is worth the reward.

Your vet is your best friend in this process. Don’t change your horse’s care plan because someone on Facebook shared a study about joint injections being questionable…or because someone else said they’re harmless. Talk to your vet. Ask hard questions. Understand exactly what these drugs do, how long they last, and what they mean for your horse’s future soundness. Your vet knows your horse better than I ever could, and they want to help you make the best choices, not just the most convenient ones.

Studies used:

Johnson, B. J., et al. (2017). "Association between corticosteroid administration and musculoskeletal injury in Thoroughbred racehorses." Journal of the American Veterinary Medical Association, 250(3), 296–302.

Textor, J. A., & Tablin, F. (2012). "Platelet-rich plasma in equine musculoskeletal therapy." Canadian Veterinary Journal, 53(8), 841–849.

Frisbie, D. D., & McIlwraith, C. W. (2014). "Evaluation of autologous conditioned serum and platelet-rich plasma for treatment of musculoskeletal injuries in horses." Equine Veterinary Education, 26(12), 572–578.

McIlwraith, C. W., et al. (2012). "Effects of intra-articular administration of sodium hyaluronate and polysulfated glycosaminoglycan on osteoarthritis in horses." EquiManagement Clinical Research Reports.

Burba, D. J., et al. (2011). "Evaluation of pentosan polysulfate sodium in equine osteoarthritis." Equine Veterinary Journal, 43(5), 549–555.

Garbin, L. C., Lopez, C., & Carmona, J. U. (2021). A Critical Overview of the Use of Platelet-Rich Plasma in Equine Medicine Over the Last Decade. Frontiers in Veterinary Science, 8, 641818.

Boorman, S., McMaster, M. A., Groover, E., & Caldwell, F. (2022). Review of glucocorticoid therapy in horses: Intra-articular corticosteroids. Equine Veterinary Education, 35(6), 327–336.

Nedergaard, M. W., et al. (2024). Evidence of the clinical effect of commonly used intra-articular treatments of equine osteoarthritis. Equine Veterinary Education.

21/04/2025

“Good work sticks and so once I’ve completed rehabilitation I turn the horses out for 1-2 months. when they come back to work they will normally feel better and have retained the work, horses with serious physical restrictions will have regressed to almost a starting point again”.

If our rehabilitation doesn’t “stick”, we have to consider why.

The ethics of rehabilitation for horses

Ethics means, just because you can doesn’t mean you should.

Let me explain that further, the horse in the pictures below taught me a very valuable lesson after years of believing I was helping horses. I had never considered that if there was significant bone changes from years of soft tissue problems or genetic issues contorting the horses body that those things are irreversible.

The horse below is martini, he is a Swedish warmblood bred for dressage. He was started at 5, ridden on and off but always having issues with anxious tension. He got some cracking scores early on and won a dressage series but as time went on the work became more tense and he got hotter to ride. He was great to trek out and super safe. Then his owner decided to sell him due to a lack of time. He was hard to sell because of how hot he was to school, so the price was significantly dropped and he was now sitting in a paddock overweight and out of shape. That’s when I bought him for cheap, I thought because he’d been started later(5) that he would have years left although I suspected I’d have metabolic issues to deal with because of how obese he was.

When I got him home the first thing I did was get X-rays of the knee down in the fronts to see how his joints looked and to check for any pedal bone rotation from the white line separation/inflammation of being overweight and lack of hoof care. Mild rotation of the near side front but clean joints and now I could show those x-rays to the farrier for remedial shoeing, for the barefooters….he was foot sore and I needed him to get moving asap, he went barefoot again later on. He developed a serious floating issue where he would fall over on the right side as soon as you moved forward but he was fine on the left side. I only learned about the floating issue on his first ride to the vets, the previous owner had only reported scrambling but this had progressed to actually loosing his balance and falling down when driving 1 metre forward.

Months of diligent slow rehabilitation followed, body work, Inhand work, lunging, diet overhaul, 4 weekly reshoes. His bloodshot eyes and pain face slowly started to fade and I felt confident we were making good progress. In this time he got a full dental that helped free his neck up immensely but a slight restriction bending right still remained. He was ready to start ridden work so I had a WOW saddle fitted to him, he had a large shoulder and short back that needed a set back panel. After three months we started ridden work, we did allot of hacking out which he loved and then we started schooling. We spent allot of time learning new postures to take the neck out longer but while ridden it was very difficult for him. It felt rather than he didn’t understand that he physically couldn’t because he would always oblige with what I requested for a moment and then retract.

6 months passed and that’s when I took the after photo below. Around this time I was listening to podcast of a person who rehabs horses and she planted a seed that started the doubt in what I was doing. She said, “Good work sticks and so once I’ve completed rehabilitation I turn the horses out for 1-2 months. when they come back to work they will normally feel better and have retained the work, horses with serious physical restrictions will have regressed to almost a starting point again”. She said “those horse are normally dealing with serious boney changes or deformities and the moment you turn them out the bones dictate the soft tissues”.

That was a light bulb moment for me because so often I had rehabbed horses at the charity I operated Stable to Stirrup or in my project horses and in their new homes it had fallen apart in a matter of months.

So I turned martini out for 2 months and slowly I watched his body go backwards and his behaviour decline. I had one ride to confirm what I had already suspected, he was back to square one…..in fact he was worse because now he protested to go forward. What I now know is that I had totally destabilised his physical coping ability and in that process made things worse. Horses compensate when things are hard and through the process of learning new proprioception I felt I had caused things to get tighter than before turn out.

Mentally he was always looking for danger around him, always jumpy at the slightest thing that didn’t upset my other horses. Then he would stand for hours in a corner away from other horses with his head down looking depressed. That’s when I decided this is no life for a horse and I made the call to put him down.

I was commited to the whole process and decided to dissect him as the final chapter in learning from him. I could have never imagined what this horse was coping with. My background in taxidermy means I am confident in handling lifeless bodies.

The findings as follows

ECVM (equine complex vertebrae malformation) unilateral C6, transposed to C7
Arthritis in every anticular process neck joint
Kissing spine
Sacroiliac disease
Boney growths through out the sacro lumbar junction.
Bone spurs on the lumbosacral junction that was restricting flexion of the hind.

So this is the next horse that I’ll bring you his story of learning! On his specific behaviours and physical restrictions I felt under saddle, there’s so much to talk about with this horse so your all welcome to ask questions but more will be revealed over the next few months.

He’s at rest now

*he was 13 when put down
*in the second picture he’s been clipped out as it’s the middle of winter and yes it does change the colour and visibility of his brand.

His story is available on patreon.

20/04/2025

This exercise is designed to target the development of the thoracic sling, promote a stretch through the lower back and iliopsoas muscles, and encourage weight shift toward the hindquarters.

To perform it, have the horse place its forefeet on a slight incline or step—such as the height of a standard kerb or a reinforced pallet. Allow the horse to lower its head and stretch forward, as it would when reaching for feed or treats. This position helps activate a stretch through the iliopsoas and lumbar spine. Encourage the horse to shift its weight backward onto the hindquarters, promoting engagement of the pectoral, abdominal, and hindlimb muscles.

19/04/2025

19/04/2025

To improve a horse’s proprioception—their awareness of body position and movement—it’s great practice to expose them to different surfaces and uneven terrain during training and conditioning.

This challenges and retrains the neural pathways that govern muscle and joint function, improving balance, coordination, and responsiveness.

This can be done as simply as walking through long or short grass, and can be felt yourself when walking in long grasses, which increases effort and promotes increased joint mobility altering the step pattern 🐴

Sorry, couldn’t resist using Steps for the background music!

16/04/2025

How well does your saddle fit? A saddle that is even a little too tight (or too wide and dropping down on the wither) can impact how your horse moves.

10/04/2025

When a client asks if you offer veterinary physiotherapy or groundwork training for their T-Rex 🦖🤔

First thought, does he bite?
Second thought, where do I get a bigger box??

10/04/2025

INAPPROPRIATE TOUCHING

I'm reading an amazing book called Amphibious Soul by Craig Foster, the Academy award winning documentary film maker of "My Octopus Teacher".

If you haven't read it, I highly recommend it, it is simply profound.

In the book he says "As a rule, I never touch an animal unless they touch me first".

In my work building relationship with horses, I do this too. Most times a horse will touch you with their nose/muzzle first, and matching that greeting (versus labelling the horse as a biter) is a game changer.

But there's a phenomenon I have noticed going on with people trying to build relationship with their horses that I have labelled "inappropriate touching", and it looks a bit like the photo below.

This picture was taken at a horse expo in Pennsylvania recently, where I worked with a demo horse who has a "biting issue". He would reaching out in a way that his owner was termed as nipping, whereas I interpreted as him saying hello, similar to reaching out to shake hands with someone.

When he reached out I would greet him with a flat hand that he is able to to nuzzle, lick or even scrape his teeth on. After doing this a while his snappy acting motions got less so, and he was no longer needing to say "hey, pay attention" , but was more "hey, how's it going". I was explaining to the audience that I was meeting him in the way that he was meeting me (with his muzzle) and that it's not an invitation to touch other parts (yet).

I then said that it's many people's default to reach up and rub a horse between the eyes, whether that's what they are offering or not, and that if you do, it's inappropriate touching and it gets in the way of connection. It doesn't meet their needs, and is all about yours.

With the horse in the picture, he'd been engaging me with his muzzle, and I said to the audience "watch what happens when I try to rub him between the eyes". As you can see in the photo, he has raised his head up and is clearly indicating "No, not there, on my muzzle".

We had a Connection And Attunement retreat here at the Journey On Ranch a week ago, and I used my wife Robyn to illustrate this point to the participants. I said "imagine I'm at a gathering and meeting Robyn for the first time". We walked up to each other in that way people do when they see someone new and they can tell an introduction is shaping up, Robyn reached out with her hand to say hello and instead of me reaching out to shake her hand, I gently reached up and lightly brushed a wisp of hair from her cheekbone and tucked it behind her ear.

The participants all gasped and the ick factor was high.

Even though it was caring, and gentle, it was inappropriate at that moment.

Now Im not saying you can't rub your horse on the forehead. I'm saying if your horse has a disregulated nervous system around humans because they don't feel seen (and safe), try to meet their needs first, before trying get get yours met.

I recently saw an instagram post from a University in the UK, and the professor was explaining that they were doing studies on horses to determine levels of stress. In the background a horse was standing with his head out over a Dutch door. While he was explaining their investigations on stress, a female student (or maybe another professor, I don't know which) walked up to the horse. The horse reached out with his muzzle to greet her.

She ignored this and reached up to rub the horse between the eyes.

He turned his head 90 degrees to the left to communicate that wasn't what he was offering.

Her hand followed him and kept rubbing.

he then turned his head 180 degrees to the right, saying "No, not like that".

Smiled, gave him another pet between the eyes, and walked of camera.

While the professor was saying that they are doing experiments determining the amounts of stress horses are under, someone in the background was actually creating stress, without either of them even knowing it.

Once you understand how sentient horses are, and how subtle their communication, you can't unsee it.

08/04/2025

Damage to the nuchal ligament is seen in many horses as a result of increased flexion of the neck.

Sadly it is still seen in many training practices.

Multiple studies have shown that increased flexion of the neck during riding or lunging can have many negative effects on the horse’s body and is a welfare issue. Please read this comprehensive article: https://www.nature.com/articles/s41598-024-72766-5

Image:
Riding behind the vertical or lunging while restricted with side or draw reins can also damage the nuchal ligament. The nuchal ligament is the main ligament of the neck, running from the occipital bone to the thoracic spine with attachments to the cervical vertebrae. It plays a crucial role in supporting the neck during locomotion and allowing for energy-efficient movement.

During hyperflexed head and neck positions, there is increased tension on the cord portion of the nuchal ligament and its attachment to the occipital bone. In horses ridden behind the vertical, the nuchal ligament does not function as a unit, with both parts – the cord and lamina- complementing each other. The cord is under increased tension, which over time can lead to degenerative changes in the ligament and bone changes at its attachment site, resulting in new bone formation – exostoses.
Between the first cervical vertebrae and the nuchal ligament are often developed nuchal bursae, cranial that is above the atlas, and caudal nuchal bursa between the cord and axis. When the nuchal ligament is under extensive tension, that can also initiate inflammation of those thin-walled structures. Cranial and caudal nuchal bursitis can be confirmed by ultrasound.

https://vetmed.agriculturejournals.cz/pdfs/vet/2020/08/01.pdfhttps://avmajournals.avma.org/view/journals/javma/237/7/javma.237.7.823.xml

Links to my work:
Patreon page that supports my work
https://www.patreon.com/equineanatomyinlayers

Whole Horse Dissection online (12 months access)
https://ivanaruddock.podia.com/the-equine-anatomy-in-layers

Atlas of the Equine Musculoskeletal system
https://ivanaruddock-lange.com/equine-atlas/

07/04/2025

Long rein work can be incredibly beneficial for horses recovering from various issues, such as sacroiliac strain, ORDSP (kissing spine), or those needing to strengthen their topline without the added weight of a rider.

It’s also excellent exercise for you, though it can be tricky if you have shorter legs!

30/03/2025

Still not grown up at 24!

17/03/2025

Fascinating video showing anatomy of the “hunters bump”.

17/03/2025

The growth plates of horses fuse much later than most people realise. Asking too much too soon of a young horse risks damage to these vulnerable areas.

15/03/2025

Eve’s 2nd Birthday today 🥕 🥰

13/03/2025

I did this post before and want to add in extras

Its only grass glands

Were you brought up to believe that the swelling of the parotid (grass) gland is normal, its why it adopted the name of grass glands because years ago we would only come across this as we turned our horses out full time in the springtime if I had a penny for every time I heard oh its only grass glands I would not be writing this post I would be sat on a beach and be mega rich lol

And again, we often hear the word metabolic and go straight to Cushing's or some other extreme but metabolic simply refers to metabolism and how the body utilizes the content we put into the energy it gives us and how the intake of nutrition may affect us. Basically, is the horse taking in a substance which may help or hinder it

So if we start omitting the word grass and replace it with the correct word parotid and add itis we may get an inkling as to why a gland is swollen, I mean we all know why ours swell it usually means we have eaten something which we may not have an allergy to but we may be a little intolerant to and remember it's not just what is eaten, environment can have a huge effect on how our bodies are coping

Glands swell for a reason and it's usually the bodies response to something which it is trying to combat, it often can coincide with shedding season and we know that is a hormonal response so is there a link there somewhere? Remember just because it's common does not means it's normal

And at least as humans we only have to cope with environment or food, horses sometimes have to cope with the riders' hands placing the horse in such a position that the swelling will occur because of how they have to hold their heads the saliva glands are innervated by the glossopharyngeal nerve (cranial nerve nine) which is a mixed nerve so aids with swallowing and tongue movement (again rider influence can have a major affect so freedom of the mouth is so important we often only focus on a relaxed jaw but we need a jaw to be able to move) so we must strive to give as much chewing time for horses that we can and often when anyone hears the word metabolic the horse is placed in an area where less chewing time can occur and less chewing time can change the saliva composition to could lead to more dental issues

Saliva production is an autonomic response to chewing the longer a horse chews the more saliva will be produced

We often not only see horses with swelling in their jawline but also underneath the jaw and the nasal area and you can see by the picture that there are more than one salivary gland and if one is affected then all are affected, I have also included cutaneous areas as these areas go hand in hand and can become over sensitive (most people will be either familiar with the horse being irritated and twitchy either at the girth area, or the horse shaking its head when you touch the base of the shoulder) so this tells you it’s a more global problem rather than a singular gland

So, if we visually see it, we must also look at how internally is the horse being affected (omitting the rider part for now) if your horse is also super sensitive with the fly twitch muscle (cutaneous) if your horse is bloated, if your horse is lethargic, if your horse is showing out of the norm behavioural signs then often I try to explain it to owners like having a food intolerance we may be able to keep eating it but we are going to not just have swollen glands we are going to feel pretty crap also but if your horse just has a swollen parotid gland with no other issues then you may have to look at your hands, your bit or the riding style and we can't forget environment you could be the best rider, feed the best quality feed and fibre but look at the surrounding fields as the content of them could be the culprit in your horses intolerance's and allergies

So no its not just a grass gland swelling there as always is much more than just one part

Does stress play a factor, if your horse is uncomfortable then is their nervous system under fire we all know how stress can have an adverse affect on the body as it tries to regulate itself and combat the internal struggle

Whatever the factor swollen glands are in the most basic terms uncomfortable, sensitive and will restrict movement and remember just because something is common does not mean it is normal

11/03/2025

The use of varied terrain is a fabulous exercise for horses.

It improves the strength and activity of the small postural muscles used for stabilisation.

Improves awareness of foot placement, improving proprioception

Builds confidence, provides mental stimulation and helps with focus

Increases fitness and endurance

And, of course, it’s fun!

Post a pic of your happy hack! 👇🏼

10/03/2025

Goodbye my old friend 😢. You’ve been my companion for more years than I can remember, you’ve been my car, my office, my general dogs body!

We nearly made it to 200k miles (made it to 198400!), but it’s time for you to move to pastures new, I’m sad to see you go 😢.

02/03/2025

Last bit of evening grazing in the sunshine for the two retirees! Both having come through winter well, particularly Ellin who’s a little round!