When working with a rehab project that is green (and off the track) would you ride the horse with a sore back and work to stretch and strengthen his unsoundness while riding or rehab from ground work and PT until his soreness is resolved. The horse's legs are sound and he has a good mind. Caveletti, walking hills, with short (10 step) backing sets (uphill) have been introduced as part of his rehab in ground work.
The approach you are taking in working the horse carefully from the ground first to rehabilitate the topline I believe is correct. At RRA, we would look at why the horse's back is sore. We use massage and chiropractic extensively in the program and a horse that comes in like this would be given an assessment by both professionals. Massage can help relax tight muscles and loosen areas that are holding tension that shouldn't be. Making sure the spine is aligned and the sacrum is straight and level, the ribs are all "in" and the neck and poll are in proper shape is critical in these cases. The things that you are already doing as part of his PT are all great, with cautions about moderation on the backing. Make sure that the horse's withers don't drop as he is working backwards and that the legs move as equal diagonal pairs as he steps.
Before we ride a horse with back problems that have already manifested soreness, we longe. For some, we use side reins adjusted lightly to help the horse learn to reach over the top and push the poll forward to help elongate the neck and elevate the back. It is critical that you do not force the head in tightly or overflex the neck, but rather that you allow the horse to relax the head and neck forward, out and down. For others, we use a combination of side reins and a "butt rope" in a modified Pessoa Longeing System to help connect the back end over the top to the front end.
Be careful that your adjustments are correct whenever you use any kind of equipment to help your horse change his way of going, and always be safe! Cavaletti work on the longe is wonderful for horses overcoming back pain. Some other techniques you might try are TTeam Touch exercises advocated by Linda Tellington Jones like the sternum lift and the tail tuck, magnetic therapy (we use a "Mag-Boy" by Nikken) and LEPT (infrared equipment by Bio-Scan) treatments, which can also help restore mobility to a damaged topline. These are all hands-on therapies that are relatively inexpensive and that you can do yourself with just your hands and simple equipment.
Once the horse lets us brush and massage the long back muscles, has been given the all clear by veterinarian/chiropractor, can release the back upward in the belly lifts and seems reasonably pain-free, we will begin light riding. For horses with back pain, forward, downward stretching is critical to their rehab. When we start riding, we might choose a nicely balanced western saddle with a therapeutic foam pad as well as a sweat rug and thick cushy pad. We longe with the saddle before riding and when we sit on the horse, even if we are riding western, use a light forward seat to encourage stretching down. The opening rein work shown in the new DVD "any Horse, any Rider" is ideal for this kind of rehab. When the neck reaches forward, the nuchal ligament helps the entire upward ligamentous system stretch and elongate the topline, and strengthen the underline. This allows proper engagement of the haunches. For a better understanding of how the horses musculoskeletal system works, read "Tug of War: Classical vs. Modern Dressage" by Dr. Gerd Heuschmann.
So the important elements are the chiropractic and the riding technique you use to rehabilitate your horse. I acknowledge your courage and thoughtfulness in taking on a TB rehabilitation project like this. With good work and conscientious application of good techniques, your horse should recover and be a good partner for you!
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