“Musicians in general are intelligent and the time spent on extensive explanation and advice is well spent.” (A. B. M. (Boni) Rietveld, Dancers’ and musicians’ injuries)

“Injuries are caused by bad luck, fatigue, and stress, but, most of all, by faulty technique.” Boni Rietveld is an orthopaedic surgeon who devoted his professional life entirely to the prevention, diagnostics, and treatment of dancers’ and musicians’ injuries.  Analogies between humans and equines have to be approached with extreme caution as there are considerable differences between human and equine physiology and neurophysiology. However, as well as for dancers and musicians, the main cause of horses’ injuries is faulty techniques.  

Through 30 years of experience, Dr.  Rietveld has observed that faulty techniques were often due to ignorant compensation for physical limitation. Through the same period of time I have observed that faulty techniques in equestrian education were often due to ignorance of the athletic demands imposed on the horses’ physique by the performances and consequently incapacity of the trainers to identify and correct horses’ faulty compensations. Trainers know how the movements are supposed to look like but lack sound understanding of the underlying biomechanics factors. In dance, ignorant compensations for physical limitations form a structural predisposition for dance injuries. As well, improper analysis or ignorance of the horse’s physical limitations allows compensations predisposing the horse for injuries. Rietveld comments, “The dance teacher is the first line of defense in the prevention of dancers’ injuries.” In parallel, the horse’s teacher is the first line of defense against injuries. Unfortunately, when knowledge is lacking, trainers and self-proclaimed masters becomes the main factor of equine injuries. They advertise rehabilitation but they deliver debilitation. For instance, when lateral movement is asked spinning a rope, or touching the legs with a whip, or touching the horse’s body with a bamboo pole, the trainer ignorance exposes the horse to performances for which the horse’s physique is not properly coordinated and consequently, predisposes the horse for injuries. 

One major cause of equine injuries is asking performances before the end of the growing process. In humans, growth end first in the feet and the last body part to grow is the back. Equine growing follow similar patterns. In humans, polyarticular muscles which span more than one growth plate such as the rectus femoris, sartorius, and hamstring, became temporarily “too short” and are especially more vulnerable for growing pains. The situation is different in equine in terms of which muscles are involved, but the same principle applies. Dr. Rietveld observed, “Due to this stiffness and discomfort, the dance student is temporarily unable to fully lift the legs or make high kicks. In the worst case, the student is criticized and judged to be lazy by the teacher, starts forcing, develops complaints and gets injured.” This applies almost word for word to equines. Horses are criticized and judges to be lazy by trainers, they are forced to perform and get injured. All these primitive training psychologies resuming equine behavior into social order and leadership, label the horse’s resistances, as behavior issues. This includes laziness. These so called behavioral issues are in fact cries for help. Feeling discomfort or pain, a horse protects his physique resisting forward movement, or lateral bending or other move. When the trainer’s knowledge is insufficient, the horse has no hope for soundness.

Rietveld wrote, “Dancers are used to discomfort, but, because of their body awareness and due to their high physical demands, a pending injury is noticed in an early stage, often before modern imaging technology shows abnormalities “ The same can be done with horses as long as the rider and the trainer priority is not executing the move but instead, educating and precisely coordinating the horse’s physique for the athletic demand of the move. During this education, hesitation, slower reaction time, mild kinematics abnormalities, are signs which, if observed and intelligently analyzed, can prevent injuries. The horse on the introductory video recovered from navicular syndrome. Prior becoming very lame, the horse had difficulties with the tempi changes. He was not capable to execute more than three or four before missing a few. The horse needed a few stride to recompose his canter before being able to execute another short series of three or four tempi changes. He was of course accused of laziness and forced to perform. As a result, he developed severe lameness of the right front leg and was diagnosed with acute case of navicular syndrome. The limb kinematics abnormality causing excessive abnormal stress between the deep digital flexor tendon and the distal sesamoid bone, resulted from a spastic scoliosis in the cranial thoracic area bending the thoracic vertebrae on the right side. By correcting the back muscles imbalance causing lateroflexion and inverted rotation of the cranial thoracic vertebrae, it was possible to correct the limb kinematics abnormality allowing the remodeling process to restart. Navicular syndrome is primarily a remodeling disease. Abnormal stress shut off the remodeling process and since new cells are no longer created, degeneration occurs. The horse became sound and almost a year later, when asked for tempi changes, the horse has no difficulties executing long series of tempi changes. If, instead of being interpreted as laziness, the horse’s difficulties have been intelligently treated and analyzed, the horse would never have developed navicular syndrome. 

“Knee injuries, especially of the patello-femoral joint, are the second most common (25 % of all injuries) in dancers.” (Boni Rietveld) Stifle injuries are also common in horses.  In dancers, knee injurie often result from insufficient external rotation of the hips. ”The knee externally rotates in flexion, but not in extension. Usually, dancers are unaware of the fact that they use this phenomenon to compensate for insufficient turn-out in the hips: starting from ‘demiplié’, hyperpronation and maximal external rotation the feet are fixed to the floor and the knees are extended. The resulting torque on the knees leads to rotatory malalignment of the patello-femoral joint and tension of the medial structures. This is called ‘screwing your knees.” (Boni Rietveld). The left picture shows  “demiplié” executed with proper outward rotation of the hip. The right picture shows the same move executed by the same dancer but with improper outward rotation of the hips. The dancer compensates insufficient outward rotation of the hips through greater flexion and rotation of the knees. The dancer screws his knees. 

The rider screws the horse’s stifles as well when limbs movements are asked acting on the limbs or manipulating the limbs without adequate mechanism of the thoracolumbar column and pelvis. The horse is not designed for outward rotation of the hips like a human. The similarity is that if limbs movements are asked acting on the legs with a whip without adequate coordination of the thoracolumbar column and pelvis, abnormal stresses will damage stifles or other joints. This is true during forward movement and this is true during lateral movements such as shoulder in. half pass or others. For instance, during the swing phase, the hind limb and therefore the femur, rotates around the hip joint. In synchronization with the pendular movement of the femur around the hip joint, an inward rotation of the femur occurs, medial to lateral during the swing and lateral to medial during the stance. Normal limbs kinematics demands that the engagement of the hind legs combines pendular movement of the limb around the hip and dorso-ventral rotation of the pelvis. In his quantitative study comparing the limbs kinematics and vertebral column mechanism of good movers and the limbs and vertebral column kinematics of bad movers, Mikael Holmström observed that good movers exhibited greater dorso-ventral rotation of the pelvis. If the trainer is unaware of the necessary correlation between pelvis rotation and forward swing of the limb and stimulates greater engagement of the hind legs touching the limbs with a whip or a probe, a twist will occur between the femur and the tibia exposing the stifle to injury. The trainer screws the horse’s knees. 

Jean Luc Cornille 2015

IHTC Course