KS rehab with comorbid EPM

Is back soreness after work (or voluntary play/exercise) typical of KS rehab, or is this a sign that my horse isn’t ready to start rehab and/or has another complication?

Now that my gelding is non-symptomatic with EPM and causing trouble from boredom I have begun trying to rehab a second time for his KS (T14-16). My plan was to spend the first 4-6 weeks ground driving and lunging on the flat, adding in equibands around 3 weeks in. Assuming all went well I was going to add in pole and hill work after that, gradually increasing difficulty and begging adding in some under saddle work early May. However, whenever I work him, or he plays hard in his pasture, he comes up back sore around T5-8. Sometimes it’s as small as a little tension and slight shifting away from pressure, but other times it escalates to a full body flinch.

I’m not sure if this is typical, especially as he has only been in light work for the past 18 months, and I should keep him working through it or continue as I have been and not working him (aside from his own antics in pasture) until it isn’t sore. I know it’s better for KS to keep them in work, but I worry about another EPM relapse if I stress him out from being sore. I have not talked with his vets about this yet as they are both on leave at the moment.

I will put a more complete medical history and timeline below.

Horse is a 12 year old OTTB gelding I bought in May of 2020. Looking back he probably started having mild neurological symptoms around January of 2021, but my trainer (whom I have since left) and I attributed to him being unbalanced. He started having significant back soreness and some intermittent front end lameness in July of 2021 and was subsequently diagnosed by x-ray with KS in T14-16. Beginning in August treated with shockwave, robaxin, and 6 weeks of groundwork rehab before slowly introducing work under saddle again.

The ground work rehab went great, but he was definitely uncomfortable staring back under saddle, so we did another 3 weeks ground work and tried again. We were just starting to move towards semi-normal light work at the walk and trot with some attempts at canter when he began having meltdowns again. In June/July he began showing significant neurological symptoms including temporary asymmetrical loss of control of his hind limbs and head shaking and he was diagnosed with EPM.

With my vets encouragement I treated with a round of Ponazuril and then turned him out in a pasture to be a horse and hopefully unwind. He finally appeared to be symptom free in December, and around that time the barn owner started calling me saying he was bored and causing trouble so I started working him about once a week, weather permitting.

I have a KS horse, she went for surgery but tbh I am not sure it did much. I only ride her once a week or so but if she was to start showing back soreness I would just lunge and do ground work until she was good again. I don’t think trying to push through it would lead to anywhere good as I assume any soreness would be coming from the spine and not just from being weak and needing to muscle up.

Did you ever do updated xrays? Its possible the KS is still bothering him.

I haven’t done updated X-rays yet, I was hoping to wait until his regular vets were off leave and until we’re sure that going back to work won’t stress him out into the EPM relapsing.

Like you, I’ve been backing off if he seems sore, but then I started wondering if it could be delayed onset muscle soreness from him using his back muscles again after they atrophied so badly.

I don’t have anyone very lightweight that I trust and would feel comfortable asking to ride him (he is quirky on a good day) at the moment. I do plan to work on my own fitness as well while we’re building his muscle with groundwork, so hopefully I’ll be back down to 140 (I’m 5’5”, 150lbs now) and in better shape when it comes time to get back on him.

My guy has 2 ks spots and along with the exercises it would help a lot if you learned some massage techniques.

After you do your work and because the muscles are loose and warm the massage would really help.

Dont we all love a masage or hot shower after hard work? :slight_smile: My guy takes a snooze and absolutely loves it.

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I didn’t do KS surgery as my guy was 18 at the time it was offered. He gets yearly hock injections, had mesotherapy and cortisone shots in the KS areas.

walking poles and warming up long and low is what brought him back. Getting him over his back and lifting his withers but rounding all over.

He receives Craniosacral every 3 months, which seems to be the right concoction for this guy. I have thrown everything at him, PEMF, Chrio, Red light, many different massage people. Purchased my own massage blanket and thumper. At the end of the day, his Carniosacral and the hock injections have helped the most as well as long and low work.

Poles are your best friend. If you can get them to stretch down and low on the lunge, its good, but I couldn’t with mine.

If they are still showing pain, I would say there is something secondary there, like SI or hocks, to cause the continuous back soreness.

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Do you have any recommendations on where to learn some massage techniques? I’m sure my rehab lease would love it too!

Surgery is not something I would pursue with my boy either. Not only is it out of my budget, I wouldn’t feel comfortable doing back surgery on a horse that is neurological and supposed to have limited stress.

When I was rehabbing him the first time he was really good at stretching on the lunge or at liberty in the round pen, pole work was always difficult though.

After the way he looked on Wednesday though, I have a call in to my vet to reevaluate if rehabbing is even realistic. His back was so sore he couldn’t even handle the weight of my hand in his back, but only on one side. We have lots of snow right now so he could have just tweaked something slipping in the snow, but I worry about the EPM coming back.

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