Equilibrium Veterinary Physiotherapy

21/04/2026

The most common injury i treat!

I had a really interesting conversation with a client recently that properly made me stop and think.

They’d watched a video from quite a big social media account where suspensory desmitis was being described as a neurological issue 🤯… and a neurectomy was basically presented as the only option.

Now — just to clear that up straight away — it isn’t neurological. It’s a musculoskeletal soft tissue injury, and whilst surgery can be an option in some cases, it is absolutely not the only route, and it doesn’t fix the underlying problem.

It just reminded me how important it is that we show people the whole picture, not just bits of it.

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Honestly, I see suspensory injuries all the time. Some weeks it feels like every other horse I see has some degree of involvement — whether that’s proximal, through the body, or into the branches.

And it’s very rarely down to just one thing.

In most cases, it’s a bit of a perfect storm of factors building up over time. Things like:
• repetitive, unvaried work
• foot balance and farriery
• conformation (you’ll often see things like straighter hocks or a more upright hoof–pastern axis)
• general weakness or lack of stability
• horses that are a bit more hypermobile and rely more on their soft tissues for support
• sudden changes in workload or surface
• and quite often, something else going on higher up — sacroiliac, hocks, stifles — that ends up overloading the suspensory

I also think we need to talk a bit more about young horses here as well. It’s not that young horses shouldn’t be worked — they absolutely should — but when the work is too much, too repetitive, or too high impact (jumping being a big one), you can end up overloading tissues that just haven’t adapted yet.

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If you think about what the suspensory actually does, it’s a huge part of how the limb functions.

It’s there to support the fetlock, control extension, and help store and release energy as the horse moves. When it’s not doing its job properly, something else has to pick up the slack.

In the hind limb especially, that often means more strain going through the hocks, stifles, and even up into the SI and lumbar region. So it’s never really just a suspensory issue.

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In terms of treatment, there are a few different routes vets might take.

Steroids are sometimes used to settle inflammation and pain, and they can help in the short term, but they don’t fix the underlying issue. And from a tissue perspective, they can actually inhibit collagen production and affect how well that structure heals if they’re not used carefully.

Shockwave is another one people often ask about. It’s used to stimulate a healing response and modulate pain. Some horses do really well with it — others, not so much. If I’m being honest, I probably see about a 50/50 split in real life.

PRP is a bit more of a biological approach — using the horse’s own growth factors to try and improve the quality of healing within the ligament.

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Then there’s neurectomy.

And this is the bit where I think there’s quite a lot of misunderstanding.

Yes, it can reduce pain. But it does that by cutting the nerve supply — it doesn’t repair the ligament, and it doesn’t restore normal function.

So you’re still left with a structure that may not be doing its job properly, and a body that’s still compensating… just without the same pain feedback.

From a biomechanical point of view, that’s something I personally find quite difficult, because the underlying issue hasn’t gone anywhere.

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You’ll also often hear the “just turn them away for 12 months” approach.

And yes — the ligament will heal.

But the question is how well it heals.

Without controlled, progressive loading, you can end up with quite disorganised scar tissue that isn’t as strong or functional as it could be. And that’s where re-injury risk can creep in.

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From a physio point of view, this is where we can really make a difference.

For me, that’s usually a combination of:
• the right therapy (I do use Indiba a lot in these cases)
• a properly structured rehab plan
• looking at the whole horse, not just the ligament
• and gradually building strength, stability and correct movement patterns back up

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Suspensory injuries aren’t quick fixes.

They need time, the right input, and a bit of patience — but when they’re managed properly, you can absolutely improve outcomes.

As always, work closely with your vet, but just know there are options, and it’s rarely as black and white as it might sometimes be made out to be.

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If you’re dealing with anything like this or just want a second opinion on how your horse is moving, feel free to drop me a message 🙂

09/03/2026

So true ❤️

25/11/2025

Interesting paper...

Two recent papers in the EVE Journal were punlished on the effects of corticosteroid injection sin joints. They were meta-analysis, meaning they took information from over 600 papers about this topic into account. This means the outcome of a meta-analysis is more reliable as an "overall opinion of scientists" than a single paper. Both papers show clearly that 1 injection in a joint (when needed, because acute joint inflammation is present) might be beneficial, but that more than 1 injection in the same joint will cause cartilage damage and degeneration of the joint. Think about that when you do "regular joint maintainance" or inject multiple joints without a clear indication.

Your vet should know this information!

25/11/2025

Interesting paper ...

Two recent papers in the EVE Journal were punlished on the effects of corticosteroid injection sin joints. They were meta-analysis, meaning they took information from over 600 papers about this topic into account. This means the outcome of a meta-analysis is more reliable as an "overall opinion of scientists" than a single paper. Both papers show clearly that 1 injection in a joint (when needed, because acute joint inflammation is present) might be beneficial, but that more than 1 injection in the same joint will cause cartilage damage and degeneration of the joint. Think about that when you do "regular joint maintainance" or inject multiple joints without a clear indication.

Your vet should know this information!

07/07/2025

Spaces still available 🙌🐴⭐️

Mark Phillips Jumping Clinic

Wednesday 16th July

We are delighted to welcome back world renowned trainer and xc course designer, Captain Mark Phillips, for his annual clinic here at Hill Top Equestrian. Mark is a phenomenal trainer with a keen eye for the fine detail that really improves combinations quickly. Having been US Eventing Team Trainer for 20 years, a 5* winning rider himself and now a hugely successful xc designer (including this year's Blenheim European Championships) it really is an honour to listen to his wealth of experience and expertise.

Small groups of up to 4 people for 90 minutes. Suitable for anyone jumping 80cm- BE Intermediate in our wonderful large indoor arena with a mixture of SJ and arena xc fences, working on accuracy, rider position and technical lines.

Spectators welcome £5 per morning or afternoon sessions or £10 for the day, no need to book can just come along and pay on the day.

Booking form for riders:

https://goo.gl/forms/QwBKjkO6yFg0BiQC3

Morning sessions - 10.15 - 12.45
Afternoon sessions - 1.45 -4.15

Please message us for more info or text/ call 07977 508017

15/06/2025

Highly recommend ! ⭐️⭐️⭐️⭐️⭐️

14/05/2025

People still dont realise what an effect saddle fit has on a horses performance ❤️

There’s been a lot of talk lately about saddle fit in the upper levels, especially the connection between back atrophy and high-end “custom” saddles that aren’t doing what they claim to do. I wanted to offer my perspective as someone who’s seen the inside of the machine. For a time, I worked as a brand rep saddle fitter for one of the major French companies, the kind that markets itself as “different,” “elite,” and “horse-first.”

It was, hands down, the most disorganized, chaotic, and ethically slippery company I’ve ever been a part of. Orders were managed on paper forms and Dropbox folders, shuffled between departments with zero accountability. Saddles regularly arrived built incorrectly. When that happened, which was often, it wasn’t seen as a crisis, it was just another day at the office. Clients would wait up to six months only to receive a saddle that didn’t match the order and didn’t fit the horse.

The training I received as a rep? Laughably minimal. We were taught how to check wither clearance, determine tree shape, and “balance” a saddle using foam inserts in the panels. No real education on biomechanics. No instruction on how saddle pressure affects movement or chronic pain. No understanding of equine spinal anatomy. And certainly no discussion of long-term horse welfare. When I mentioned learning more from independent fitters, I was told not to. Literally warned by my boss that “those people have an agenda against French brands.” She even insinuated that a certain independent fitter was the reason the last rep quit.

Management also regularly groaned about clients who wanted to have an independent fitter out at the same time as a brand fitter, labeling them as "high maintenance." It was as though questioning the company's methods was a personal affront, rather than a legitimate desire from owners for the best care for their horses.

From the beginning, I felt caught in a system that rewarded sales over ethics, obedience over insight, and pressure over compassion. I was encouraged to focus not on the horse’s well-being, but on how quickly I could convert a client’s concern into a credit card swipe. Even our elite sponsored riders, some of the most accomplished athletes in the sport, couldn’t get saddles that fit correctly. Saddles arrived wrong. Panels were lopsided. Horses were sore. We all knew the saddle could be wrong, and it often was, but the unspoken rule was to get something close enough and push it through. If they can’t be bothered to properly fit the horses that carry their name into international arenas, what makes you think they care about Pookie, your 2'6” hunter at the local shows?

We were explicitly instructed that if a client had a saddle more than a few years old, even if it was still working perfectly, we were to find something wrong with it. The goal was to sow just enough doubt to get the client to trade in the saddle and order a new custom. Not because their horse needed it, but because their wallet could support it.

That’s when it started to really wear on me. I couldn’t sleep. I would lie awake at night feeling sick: not just because we were misleading clients, but because we were hurting horses. Every day I watched animals be dismissed as “hard to fit” when the reality was that the saddle being sold to them should never have been placed on their back to begin with. The moment that broke me came at the end of winter circuit. We hadn’t met our quotas yet. The pressure was sky-high. One of the top reps began pushing saddles onto horses that visibly, obviously, did not fit. It didn’t matter that this would harm the horse over time, it mattered that the sale was made.

Perhaps the most disturbing part is the panel design we used by default, a soft, rounded latex insert, was built not to support muscle growth, but to fill the void left behind by muscle loss. Our whole system was based around accommodating atrophy, not fixing it. We had specialized modifications to make the panels more forgiving to wasted backs, as if the problem wasn’t the saddle, it was the horse’s inability to conform to it. Back atrophy wasn’t treated as a red flag. It was normalized. Built into the product line.

After six months, I started to unravel. I didn’t recognize myself anymore. I had entered the role wanting to help horses, and moved across the country to do so. I had left a steady job that I was happy in thinking this would be a way to combine my skills and my passion. I found myself trapped in a toxic cycle of moral compromise. Eventually, I couldn’t fake it anymore, especially since I had begun my equine bodywork certifications. I told my boss I was done. I remember saying, half-joking, half-begging for her to understand, that “I’m not making enough money to cry every night.” “That’s just part of the job,” she responded.

That was a year ago. Since then, two more reps have cycled through my old territory.

So if your high-end “custom” saddle doesn’t fit… if your “fitter” keeps blaming your pads or your horse’s shape… if your horse’s back is getting worse instead of better: you are not crazy, and you’re not alone. You’ve been caught in a system that was never built to prioritize your horse’s health in the first place.

This isn’t just a string of bad luck. It’s systemic. It’s built into the model. These brands don’t invest in education. They invest in optics. They train salespeople, not fitters. And they sell you the idea of customization while relying on generic templates and pressure tactics behind the scenes.

I’m not saying every brand rep is malicious. Some are kind, well-meaning, and genuinely doing their best within a rigged game. But when you pay someone a tiny base salary and dangle their entire livelihood on commissions, it creates a perfect storm of pressure and desperation. Good intentions don’t last long when survival depends on making the sale. That’s why I left. That’s why I speak up. That’s why I’ll keep urging riders to work with independent fitters: people who don’t make a commission off the brand, who aren’t beholden to a sales quota, who care more about your horse’s comfort than the label on the flap.

That’s why I walked away. I couldn’t keep selling saddles that were hurting horses and gaslighting riders into believing it was fine. I couldn’t sleep knowing I was complicit in their pain. So if something in your gut has been telling you this isn’t right, listen. Trust it. Ask questions. Get a second opinion. Seek out an independent saddle fitter whose only loyalty is to your horse’s well-being, not a sales quota. You deserve transparency. You deserve honesty. Your horse deserves comfort, freedom, and a fighting chance to thrive: not just survive under eight thousand dollars of leather and lies. Don’t let the system convince you this is normal. It’s not, and the more of us who speak up, the harder it becomes for them to keep pretending it is.

25/04/2025

There is not enough knowledge imparted to owners of the degeneration caused to joints by repeated medication, but also repeated needles into joints!.

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.