Who is The Athlete?
Imagine you are a low-level professional athlete who sustains a moderate or severe training injury. Your team at a physical medicine and rehabilitation center or hospital may include most, if not all, of the following: a specialized physician—perhaps even multiple if the injury encompasses more than one function of the body—, physical therapist, occupational therapist, recreational therapist, nurses, technicians, medical assistants, social worker, athletic trainer, and more. Each of these healthcare providers may also be receiving support from assistants, residents, or students of their own, and more severe or chronic conditions may even call for multiple teams within each of these specialties. Your health insurance coverage will hopefully allow them to safely and affordably make a plan of care for your recovery. After inpatient care or initial treatment, you will continue to receive treatment, therapy, and follow-up care with your team until you have reached the desired level of function with your injury or condition, or in a worst-case scenario, potentially continue to receive regular maintenance treatment for the remainder of your career. While we do often hear about famous career-ending injuries, a safe majority (approximately 70-85%) of athletes are able to return to their careers after their recovery. After all, human physical therapists have been utilized since the late 1800s, and the first association for sports medicine was founded over a century ago. If gladiators in 6th-century Greece had team physicians, of course a modern semi-pro baseball player would too.
Now imagine—or possibly recall, as I safely estimate that many equestrians may have unfortunately dealt with a devastating injury to their equine partner during their career—that your horse sustains a moderate to severe training injury. Upon authorizing the release of unholy amounts of money from your emergency funds, potentially filing a claim if you happen to be a professional rider with an equine insurance policy, you await the prognosis from your veterinarian on whether or not your athletic partner has a chance of survival, let alone the chance of competing again. Your horse's healthcare team consists of your veterinarian and their technician, possibly a consulting or partner veterinarian or surgeon if you are privileged to such. After receiving the initial treatment, surgery, or care necessary to address the injury, your horse is prescribed medication and stall rest, and you may be asked to schedule a follow-up appointment for x-rays, ultrasounds, or bloodwork to ensure that the healing is on track. If you are lucky enough to have access to a sports medicine veterinary specialist, perhaps you may also be able to schedule shockwave therapy, or find a local equine massage therapist to help ease your horse's localized pain.
Can you imagine telling our injured human athlete to simply confine themselves to their room for 8-12 weeks, before gradually returning to work on their own? Even after a simple fracture, months of physical therapy would be prescribed, if not wholly required, before returning to any level of performance. A more complex injury would see the utilization of the entire medical team. I myself underwent five months of physical therapy after a car accident that resulted in only moderate whiplash in my neck.
Nearly every professional athlete has a sports medicine doctor, team physician, athletic trainer, or physical therapist—often all of the above. The moment you reach this point in your career, these become requirements, benefits, must-haves, non-negotiables. If a college football player sprains their ankle, they have a team in place to get them back onto the field as soon as possible. If an NBA player tweaks their knee, you can bet they'll have multiple providers working with them on exercises, potentially even for the rest of their professional career. More than just exercises, each athlete may have their sports medicine provider, nutritionist, psychiatrist, athletic trainer, and any consequent assistants working in tandem on preventative measures and safety during their athletic training. If injured, they will see a member of their care team for diagnosis, and then work together for months to rehabilitate and recover from the injury.
Equestrian sport is the only Olympic-level sport that includes a competing non-human athlete. While the rider has to maintain peak levels of fitness to compete at the top level, so does the horse. While equine medicine has veterinarians, and a competitive equestrian may likely seek the care of a specialized veterinarian, what about the aftercare that the human would receive? Where are our equine physical therapists? Where is our athletic team?
Well, one answer is that our veterinarians must play the role of not only primary care and sports medicine doctor, but also dentist, podiatrist, pulmonologist, nutritionist, internal medicine physician, cardiologist, radiologist, and orthopedic surgeons, often as well as our acupuncturist, chiropractor, and physical therapist. Meanwhile, in addition to ensuring that we are performing to the best of our own athletic ability, the riding trainer must also play the role of athletic trainer for our 1200-pound athletes. While many veterinarians now specialize in certain areas of medicine, such as internal or sports medicine, we still rarely see the level of specialization that our top human athletes are granted in their care, prevention, and rehabilitation. And how could we, when we have one program creating veterinary providers who must be prepared to wear the hat of every subspecialty? How can we expect our veterinarians to operate within one specialty, when they barely make the salary to repay their school loans? Save our farrier, saddle fitter, and perhaps massage therapist, the other therapies, modalities, treatments, and one-on-one care offered to our human athletes are administered to our four-legged athletic partners via veterinarian.
This is not to say that our veterinarians do not do this job well; the veterinary specialists who provide sports medicine care are doing so flawlessly. But would we sacrifice the level of care a human athlete would receive from their team of dozens of care providers by relying on one provider to do the work of many? Why do we do so for our equine athletes who are definitively more fragile and more sensitive; an incredible, massive, powerful microchip ready to malfunction at any second from one pebble, one wrong plant, one misstep, one misplaced scratch? If track athletes have an entire physical medicine team, why is this not commonplace for the 1200-pound track athletes who must also carry another human on their back?
The difficulty lies in the accessibility. While the US hosts over 270 physical therapist programs and 417 physical therapy assistant programs, there is only one US university-based credential program for equine physical therapy or rehabilitation, the Equine Rehabilitation Certification Program at the University of Tennessee. There is also one dedicated non-university facility providing a credential program to become a Certified Equine Rehabilitation Therapist, at Florida's Animal Rehabilitation Institute. Both of these programs offer certification only to current licensed Doctors of Veterinary Medicine, Doctors of Physical Therapy, Registered Veterinary Technicians, or Physical Therapy Assistants. While the healthcare field employs over 225,000 physical therapists across the country, we only see handfuls of sports medicine veterinarians scattered throughout the US. If you don't live in an equestrian mecca such as Ocala, Aiken, or Lexington, it's possible you may have never encountered a sports medicine equine vet.
Thankfully, these providers have begun to slowly emerge within the equine world within recent years. Specialized sports medicine veterinarians are beginning to become accessible to all levels of equestrians, and in certain states with heavy equestrian populations, we are even starting to see equine sports medicine facilities or practices run by veterinarians. Additionally, to my great excitement, we have also begun to see the emergence of a few rehabilitation and recovery centers, where our equine athletic partners can receive care from massage therapists, modality technicians, and athletic trainers while under the treatment plan of a supervising veterinarian. Some of these even offer conditioning programs to allow competitive horses to stay in top physical shape while receiving treatment. While not yet commonplace, these few facilities give hope to the prospect of one day having equine physical therapy and rehabilitation care as a standard in athletic equine maintenance.
So, in my continuing effort to be more transparent and open about my life, struggles, disability, efforts, and dreams, I wanted to explain the driving force behind my personal and career endeavors the last few years. I want to do my very best to become certified before designing, opening, and operating a equine rehabilitation and recovery center and program. I think the equine industry can make so much greater of a movement towards equine recovery, and hope that we will one day see equine rehab centers and providers as a regular part of the maintenance our four-legged athletic partners receive.
The following are just some of the common modalities you may expect to see offered at such equine rehab centers:
“Last season certainly took its toll on the team. Coaches, trainers, and even the owner commented on the past year’s success and the hard work that went into it. The off-season months were a time of some well-deserved rest. This year it seemed as if we were destined to repeat our performance. Some early successes had things looking optimistic, but then the setback… A leg injury, a sore back during rehab, and the emotional and psychological toll felt by everyone involved. The doctors, trainers, and coaches worked tirelessly to make sure we made a full recovery and finished the season strong. The many doctor exams, rechecks, and rehabilitation sessions were worth it. We’re going to have a successful and exciting ending to the season after all.
If you’re reading the above paragraph in Canada, chances are you might think it’s describing your favourite NHL player in the middle of the Stanley Cup playoffs. Go back and read it again from that perspective. You can imagine that high-performance athlete having incredible tools at their disposal for their health and well-being as an athlete. But really, all of those same things can be said for the equine athlete in your life. If you read the opening paragraph from the standpoint of your horse, all the same things apply.
... It’s a well-accepted fact that we should all try to be in the best shape we can be for optimum health. An active lifestyle with regular exercise has proven to have many health benefits. Just the fact you are reading this article means you likely throw hay, clean the barn, and ride a horse for exercise and enjoyment. The same benefits are realized for horses when they are kept active and in shape. We probably ask more of them as athletes than any other domesticated animal. Fortunately, they are more than capable of the challenges we throw at them to train and compete. With that demand on them, it is fantastic to have today’s modern capabilities to maintain them and treat them like the finely-tuned athletes they are.”
