The Equicore Interview - Dr. Nicole Rombach
Ethical Horse Products is proud to present to you an interview with one of the founding members of Equicore. The company that produced the Equiband system. We invited Dr. Nicole Rombach, and Sue Palmer to discuss and answer questions about the Equiband. This FAQ system is designed so that you not only can watch the interview in bite sized segments, but also search the transcripts to find exactly what you want!
We hope you enjoy this presentation, and that your questions are answered!
We hope you enjoy this presentation, and that your questions are answered!
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1- An Introduction to Equicore and the concept of Equiband.Sue Palmer MCSP: “Before we begin, could I ask you to introduce yourself?”
Dr Nicole Rombach: “Good morning and thank you. I am one of the founders and owners of Equicore Concepts, whose main product is the Equiband system. Equicore Concepts was founded in 2011.”
Sue Palmer MCSP: “What made you come up with the concept in the first place?"
Dr Nicole Rombach: “During my research for my PhD, the emphasis was strong on core stability, i.e. spinal stability which translates to dynamic stability, which is stability in movement. We saw many horses as part of the physiotherapy program I was working with, and in the veterinary clinic, who were lacking postural control, so in dynamic core stability (note from Sue - dynamic core stability is core stability during movement, as opposed to static core stability, which is core stability when staying still). A series of exercises had been developed previously and used for many years which helped develop static core stability (note from Sue - these exercises are the ones in the book and DVD ‘Activate Your Horse’s Core’ by Dr Hilary Clayton and Dr Narelle Stubbs, available from www.ethicalhorseproducts.co.uk), and we wanted to develop a system that would transfer those ground exercises into dynamic movement, including ridden work.”
Sue Palmer MCSP: “As a Chartered Physiotherapist, this makes a whole world of sense. Pretty much everyone has heard of Pilates, and we all know how important core stability is to us for longevity and comfort, so it makes absolute sense that this is going to be equally important for our horses.”
Dr Nicole Rombach: “It is indeed. It’s key for controlled movement, and there’s a large group of research in the human field showing that if the core is dysfunctional, the ‘slack’ will be taken up by the periphery. So for example, people who develop hip or knee instability can develop that as a secondary result of core instability. It’s the same for the horses, and especially when you consider that many of today’s performance horses are not moving as much as they would in the wild. The horse in the wild would be moving 16 or 17 hours a day, whereas the performance horse today has an equivalent of a more sedentary lifestyle, in the stable and in the field. Therefore the links between sedentary lifestyle and core dysfunction in the human field could potentially be translated to the equine world.”
2 - How the Equiband works.Sue Palmer MCSP: “Can you tell us how the Equiband works?”
Dr Nicole Rombach: “The system itself is comprised of a saddle pad, which comes in different sizes (Pony, Small, Regular, Large), which is designed with layers of material / padding, and is ergonomically shaped (higher in the wither area and at the back of the saddle pad). Each pad has 2 clips, one that points down, and one that points towards the back of the saddle pad, and essentially what it involves is clipping the resistance band into the clips. Once the tension has been adjusted, the band itself will give a constant proprioceptive input, in other words, stimulus, in movement. The band itself is designed of a latex free rubber, and it took about 2yrs to get to the optimal consistency in terms of both tension and thickness. We worked with other types of band, for example the human theraband, but found that even though the tension might be optimal for some horses, the material itself would slide or the band would roll. So in terms of using the horse’s hair as a medium for the band to ‘attach’ to the body, we found that this band was ideal.”
Sue Palmer MCSP: “Was that through observing the horses visually, or through objective measurements?”
Dr Nicole Rombach: “Both! We played with different thicknesses of the band. If it’s too light, the stimulus isn’t effective enough, so the band would slide but you could see that it would provide little proprioceptive input. It it’s too thick then the tension is too great, and the stimulus cannot remain dynamic when you’re going through movement. We used trial and error over about two years.”
Sue Palmer MCSP: “That’s a lot of work that’s gone into it from some very knowledgeable people!"
3 - What is the goal of Equiband?Sue Palmer MCSP: “What is it you hope to achieve with the Equiband?”
Dr Nicole Rombach: “The majority of horses that were seen in the veterinary clinic had a requirement for more optimal core stability, so that was the idea behind the design. It can be used in various stages of riding or training. In earlier days the theraband was cut to a certain length and placed through a hole in the saddle pad, in a more rudimentary version that was not so aesthetically pleasing, and not as user friendly because you could not clip or unclip in the middle of a training session. Now we have a system that we can use at any time during the training, and you can decide when it’s more appropriate for that horse in a particular work session.”
Sue Palmer MCSP: “I think the fact that it’s so user friendly is one of the key aspects of the system. Once you’ve set it up for your horse, it is literally a matter of seconds to put it on or take it off.”
Dr Nicole Rombach: “Absolutely. Clip on and ride away!”
4 - How has the Equiband been received and the research behind it?Sue Palmer MCSP: “Are you pleased with how the Equiband has been received?”
Dr Nicole Rombach: “I have to say it has exceeded expectations! In the USA the orders that come through are now 95% purely vet referral, and that’s huge to see how the veterinary community has really embraced the concept as part of a rehabilitation system for horses that have specific issues. It’s recommended regularly for horses after kissing spine diagnosis, after colic surgery, and as well in cases where gait irregularities have been observed. Because when the core is ‘off’ the movement is distributed through the limbs, and we’ve seen a number of cases where giving that core stability in movement, the gait asymmetry has essentially disappeared. Again, the focus is on movement retraining from the inside out.
The fact that we now have some research that’s been made public on the effects of the Equiband system has certainly added to its credence. There are more research projects currently underway and further in the planning. We know from the study that has already been published that you can see an alteration in the symmetry of movement (excursion) of the back and the pelvis. Back motion and pelvic symmetry are key indicators of performance, so to be able to achieve this through use of the system is certainly very useful.”
Sue Palmer MCSP: “That was the study that was carried out at the Royal Veterinary College in London and published May 2017?”
Dr Nicole Rombach: “Correct, yes.”
Sue Palmer MCSP: “The key finding was ‘improved dynamic core stability’.
Dr Nicole Rombach: “Yes. Of course, other studies are underway. These include studies with riders, because of course it’s key to look not only at the movement of the horse without a rider, but also how it translates into ridden work. There’s a lot of anecdotal evidence and feedback on the efficacy of the system and positive results that riders feel. But in order to remain in the realm of it being approved and recognised under veterinary use further studies are necessary. So it’s exciting to see that students in different fields, both the physiotherapy field here in England, and people in other areas of research, are embracing the system, to look at different parameters or variables within the studies, so that we can expand on it’s use, and really understand better where the use is most appropriate, and how it can be applied in not just clinical or therapeutic settings, but also as part of overall maintenance or conditioning programs.”
Sue Palmer MCSP: “Evidence based practice is the way to go, it’s the gold standard. You’d hope, really, that it’s always going to be ‘further studies recommended’ because it’s always about ongoing learning, progressing, developing, improving.”
Dr Nicole Rombach: “Absolutely.”
Sue Palmer MCSP: “It sounds as though we’ve already come a long way with that, from an initial saddle pad with a hole through it, to now a much more user friendly version.”
Dr Nicole Rombach: “Exactly, yes. This has been a seven year journey so far, and I hope a journey for many more years to come.”
Sue Palmer MCSP: “It’s great that so many vets are recommending it"
5 - Future Products?Sue Palmer MCSP: “Do you have any other products in the pipeline at the moment?”
Dr Nicole Rombach: “From the equine side, no. Although in addition to the band system, we do have an additional part that is not sold with the general system. When clients purchase the Equiband system they will be given a saddle pad, 2 abdominal bands and 2 hindquarter bands. There is a thoracic sling system available, which clips to the small ring that’s attached to the forward arch of the saddle pad. That’s used in more specific cases under veterinary or therapeutic guidance, for horses that have a weakness in the thoracic sling, i.e. lower neck into the cranial [front] portion of the back. This is a key area of stability required for the forelimb, and shoulder into neck, and many horses that have issues in that area have really benefited from use of the thoracic sling. However, it really goes back to the fact that the core, that abdominal tunic, needs to be sufficiently strong, so again, using it with clinical reasoning, and ensuring that the starting point is further back."
6 - A question of tension…Sue Palmer MCSP: “In the study that was done at the Royal Veterinary College, the tension of the bands, I believe, was 30%?”
Dr Nicole Rombach: “Correct”
Sue Palmer MCSP: “What made you choose that level of tension?”
Dr Nicole Rombach: “The maximal tension that we recommend is 50% of full stretch. Anything over that is really too strong, or too high a tension, so it wouldn’t be showing the continued stimulus as a continuous input during movement. Whereas not having sufficient tension does not give you any stimulus or input. This is a question that comes up often, when clients will say that the abdominal band appears to slide back, or the hind quarter band appears to ride up, that generally there’s not a sufficient tension on the bands. So the 30% was set as a guideline as part of the standardisation for the research protocol, knowing that it would give a sufficient stimulus or input, but that it would also be able to remain in place, so not too loose. In terms of standardisation for having a constant contact during the experimental study. "
7 - Should you use different tensions?Sue Palmer MCSP: “Would you recommend a different tension for rehabiliation compared to maintenance?”
Dr Nicole Rombach: “Excellent question, and the answer there is no!”
Sue Palmer MCSP: “That’s a simple answer, I like simple answers!”
Dr Nicole Rombach: “Essentially, so long as you can see that the stimulus is effective, that is what’s important. Tension will vary between horses, for example depending on the coat length and time of year you might need to adjust the tension. So on a finer coat you might see a more obvious stimulus or input, so engagement of that abdominal musculature. In the longer haired horse, or it can be somewhat breed specific, you need more of an input or stimulus. But essentially you will have the same setting for a given horse, whether it’s for maintenance or as part of a rehabilitation program."
8 - Frequency of use?Sue Palmer MCSP: “In terms or rehabilitation and maintenance, do you have advice on variations of frequency of use?”
Sue Palmer MCSP: “And I believe that’s the same in the human field.”
Dr Nicole Rombach: “Absolutely. There’s a strong body of evidence with that. The muscles that are involved with dynamic stability, so superficially the transversus abdominus, which is fascially connected to the rectus abdominus muscle, deeper perivertebral (around the spine) we have the deep multifidus, the stabiliser muscle of the spine that runs across the dorsal aspect (atop the vertebral bodies), then deeper down in the back we have the psoas complex as well. So again, when there is a dysfunction in these muscles, when they do not activate as they should because of lesion or injury to a particular area, pain can be removed but that muscle function is not automatically reactivated. That is why you need a constant light proprioceptive input or stimulus to retrain that particular neural pattern or movement pattern.”
Sue Palmer MCSP: "Is there a stage at which that neural pattern has been retrained and then you could use the Equiband perhaps once a week as a reinforcement?”
Dr Nicole Rombach: “Yes, absolutely. In movement retraining or neural pattern programming, it is individual dependent, but essentially, three to four weeks will see an integration of that motor pattern into normal movement, it becomes an automatic pattern. So as a suggestion, the band system would be used daily for three to four weeks, and from there on, start to play with intervals. So for example two days on, a day off, which then turns onto one day on, two days off. A lot of folks have asked whether this is a training aid that puts a horse in a position, and I have to say that this is completely contrary to the intention. What we want to do here is through stimulus, rebuild that motor pathway, that movement output, that retraining in the brain. So the idea really is that over time, its use becomes less frequent. It’s up to the rider, or ind eed the clinician or therapist in the therapeutic setting, to recognise whether that motor pattern is holding.
And then, as part of a general maintenance program, it really varies. On my horse, for example, who is using it as part of a general conditioning program, I’ll use it twice a week, one day during hacking for example, one day using the abdominal band in low cavalletti training (a low jumping session), one day perhaps for the flatwork. Remembering again that the muscles that are being recruited are large compartmentalised muscles. So in different movements, for example in dressage movement we find they are recruited differently, and also repetitively, to for example when you’re hacking out. So again I feel that the idea of switching it up from an input to the brain is really useful.”
Sue Palmer MCSP: “Sometimes using it in the school, sometimes using it going up and down hills, sometimes using it over some poles…”
Dr Nicole Rombach: “Absolutely.”
Sue Palmer MCSP: “And I’m guessing there’s a difference in hand and ridden as well, so sometimes using it in hand and sometimes using it ridden is beneficial?”
Dr Nicole Rombach: “Yes. From the in hand perspective, I find it’s an incredibly useful tool in the early stages of rehab. So the horse has been laid up with, for example, a suspensory ligament injury, but has been cleared for hand walking. Ideally during that rehabilitation time in the stable a program of ground activation exercises has already been introduced. Once the movement retraining starts in hand, it’s an ideal time to introduce the Equiband system, because you’re getting the core activation but you’re not loading the structures that have been affected by the lesion."
9 - How long should you use the Equiband?Sue Palmer MCSP: “What length of time do you recommend people use the Equiband for, in each session?”
Dr Nicole Rombach: “When you first introduce the band system (and let’s focus on the healthy horse that is going to use it as part of the conditioning program), the horse will generally fatigue fast. The muscle recruitment, especially of the deeper stabilising muscle, will cause the animal to fatigue faster. So initially the suggestion is to halve your training time, so if you usually have a 40 minute workout on the horse, initially halve that. Walk breaks are important to allow the horse to relax, to recover, and then picking up the work again. If the horse is healthy and it’s part of a conditioning program, by the end of week three or four you should be able to integrate your full training time.
Again it’s horse dependent, and if you have a horse who comes in, for example a broodmare whose had time off in the field, hasn’t been worked for 15 or so months, what you would do then is integrate that slower, so perhaps give a longer time of introduction. Whereas fitting it on a horse where you would like to improve the general condition, for example a young show jumper who is in full work, you could increase the time of use somewhat faster. Let the horse be the judge, and generally the rider who will use the system is already cognisant of where that horse is in its current training and will be able to read when fatigue sets in. One thing that’s really important is that you do not enter into a fatigue stage because then the very pathways that you’re looking to activate will likely be circumnavigated and secondary or compensatory patterns will kick in to support those fatiguing muscles. Essentially less is more.”
Sue Palmer MCSP: “I know that’s something that clients have said, is that they can see the horse working as soon as he starts moving with the bands on and they can feel him tiring much more quickly.”
Dr Nicole Rombach: "For sure. In terms of feedback, you might notice that the breathing changes, the breathing pattern. When the rider feels that the horse starts to fatigue, that’s the time to take a break, there’s no point working beyond that neural fatigue."
10 - Showjumpers and the EquibandSue Palmer MCSP: “With show jumpers, for example, would you use the Equiband system as part of their jump training?”
Dr Nicole Rombach: “Good question. Yes, the abdominal band for sure. It depends on the horses’ fitness and what the rider is looking to achieve. But certainly for the lower fences, I feel that it can be used safely over a combination of fences. Certainly on the days that you have cavaletti, so more of your motor training or retraining over lower fences. I personally wouldn’t jump with the hindquarter band on, although I had one client who very proudly sent me a video of the horse jumping a rather large oxer with both bands - kudos, I personally wouldn’t try it! Again, it comes down to the rider knowing the horse, and what’s most appropriate for that horse. So, for example, on days of doing ground pole work, and the motor exercises or movement training over those pole exercises, I would happily use both the abdominal and the hindquarter band.
Sue Palmer MCSP: “In the past, I’ve advised using the bands for the beginning of the session and taking them off part way through the session. Would you suggest actually that you keep the bands on for the whole session and just make it a much shorter session, or use them at the beginning, or is it very individual and either can work?”
Dr Nicole Rombach: “It’s ideal certainly to introduce them at the beginning of the session. When you introduce them later in the session you are already in a motor pattern and you already have an element of fatigue, so from the neural input perspective I wouldn’t call that ideal. So start out with the bands at the beginning of the session, if they need to be removed do so. So for example at the earlier stages of the horse becoming conditioned to longer use of the system, what folks will do is start the session then after 20 minutes or so remove the bands and continue the training. In an ideal world, it would be the full session, but for a shorter period of time, and then graduating into longer sessions. But that may not, you know if you’re in the middle of the competition season, the trainer might not be willing or able to take out two weeks to truly introduce that horse to the bands and have them accustomed to the full session.”
11 - Equiband as a proprioceptive mechanismSue Palmer MCSP: “In terms of how the bands work, I tell clients that it activates reflexes using the hair follicles and the skin receptors. Is that the same as a resistance band, the Theraband type for example that we use in humans?”
Dr Nicole Rombach: “Bit of a difference there Sue."
Sue Palmer MCSP: “You call it a resistance band when you’re talking about it…”
Dr Nicole Rombach: “I don’t actually know, now that we discuss that, I don’t know whether that’s the most appropriate term. We’re using the proprioceptive mechanisms, so essentially the receptors that are found throughout the entire body, but also in hair and skin, as giving a feedback to a certain part of the body through application of the band. And then in movement the body distorts, so through that movement that is, I suppose, where your resistance would come into it, and then that would work as part of the stimulus. But perhaps it’s more passive resistance. In the human field of both therapy and conditioning you can actually move the body part and the the person can consciously apply the stretch to move into resistance. So either through isometric contraction, so the muscle doesn’t change length when it contracts, which is more perhaps what we [equine practitioners] are working with, or into eccentric contractions, essentially the phase where the muscle will lengthen during contraction and then that can be used as a very specific part of training of either a body part or a certain movement, a combination of body parts that move. So yes, we are applying a resistance, but perhaps it’s more of a stimulus, thinking on that”
Sue Palmer MCSP: “It’s really interesting. It’s a question that came up when I was demonstrating it [the Equiband system] to a large veterinary practice, and the guy said ‘So this is a resistance band’ and I said ‘No, it’s not’, and I looked at the instructions and I was like ‘Well, it says it’s a resistance band, but actually…’”
Dr Nicole Rombach: “I think perhaps we can wax poetic on this. Use resistance as a portion in there, but when you’re looking at the activation, I don’t know that it’s consciously done in the same pattern as what it would be in the human field. As in for human practice, you would use, for example, a resistance, be it a weight, a band, whatever you choose, to activate a certain muscle group, but you are still putting the body consciously through a certain movement pattern. Whereas here it’s more of a constant contact that would give that impetus."