I was watching a webinar the other day about rehabilitating stifle injuries and it got me thinking about what people consider “rehabilitation”. A lot of the time I hear “my horse is rehabilitating on box rest from a colic surgery, tendon injury, wound etc”. And yes. major trauma like that most certainly requires box rest but box rest is not rehabilitation. Years ago, the only way that injuries were rehabilitated was box rest or to turn them out, but with the way that technology and the natural therapy industries are changing there are many more options for horses today, much like human physical rehabilitation.
Rehabilitation is additional to box rest and appropriate for a whole heap of other conditions that would not require a period of rest. In fact rest itself is not ideal for most aspects of rehabilitating an injury so it is even more important that these horses on box rest receive adequate rehabilitative support.
There are three stages in injury
- Acute – Pain and inflammation are present. The stage where rest may occur
- Proliferative – Where functional restoration occurs and rehabilitative therapy will occur
- Remodelling – Muscle re education and the most important stage for appropriate rehabilitation.
The time that the horse spends in each phase is unique to the injury and one thing that you need to remember is that injury does not always include visible pain. Injury can cause a loss of proprioception, a loss of strength, maybe a lack of flexibility etc.
Some of the most common injuries that are rehabilitated include: Trauma, Wounds, Muscle Injury and Musculoskeletal Pain, Tendon Injury, Osteoarthritis, Splints, Fractures, Spinal Dysfunction, Back Pain, Sweeney (injury or paralysis to the suprascapular nerve), Fibrotic Myopathy (hamstring injury), Muscle Atrophy, Limb Inflexibility, Neurological Issues, Navicular, and really anything else that might cause a loss of performance.
So what is rehabilitation? Rehabilitation is defined as “the act of restoring something to it’s former condition”.
The most important factor to consider with regards to rehabilitation is that it should not just focus on the injury itself, but on the entire “biomechanical horse” and any compensatory pain and issues. When we look at a horse for rehabilitation we need to ask ourselves “what functional limitations have occurred and how can we best target those for the horse”?. Especially if you are not entirely sure what the actual injury is.
Whatever the nature of the injury, wether it be something noticeable like a wound, something that needs veterinary diagnostics or just a horse experiencing poor performance, there will always be compensatory issues that need to be addressed. Perhaps it was even old compensatory issues that caused the new injury?
Rehabilitation should start the moment the injury occurs. Even if the horse is on box rest, so long as there is no infection, rehabilitative exercises and therapies can help. Most vets will recognise the need for rehabilitative therapy and will guide you as to what would suit your horse, but some are not aware of all that is out there.
Rehabilitation can be a combination of therapeutic exercise, manual therapy and physical therapy. The aim of rehabilitation is to restore optimum physical function to the horse. It is not just about bringing a horse back into work after an injury, it’s about restoring tissue mobility and function, tendon and ligament strength, muscular strength and flexibility, balance and proprioception as well as addressing any issues such as muscular pain and spasm, atrophy, hypertonicity, fascial adhesion etc
Some of the most common rehabilitative therapies include:
- Therapeutic Exercise – Treadmills, Aqua Treadmills and Spas, In Hand Work, Manual stretching, Core Strength Exercises, Proprioception training
- Manual Therapy – Physiotherapy, Chiropractic, Acupuncture, Massage, Tissue Mobilisation, Myofascial Release, Bowen Therapy etc
- Physical Therapy – Laser Therapy, Therapeutic Ultrasound, Hydrotherapy, Cold Compression and Cryotherapy, Thermal Therapy, Red Light, Shock Wave, Microcurrent and Electro Therapy, Vibration Plates, Hyperbaric Oxygen Therapy, Magnetic Therapy and many more
With rehabilitation programs, they need to be specific for each horse and each injury, unfortunately there is no “one plan fits all”, and they also must take into account the resources available to you as the owner, and the budget you might have. A lot of this equipment is not readily available, and in Australia with don’t have Equine Rehabilitation Centres like the do in USA and UK.
In a study done in 2018 by Wilson, McKenzie and Deusterdieck-Zellmer (https://pubmed.ncbi.nlm.nih.gov/29942811/) the most commonly used rehabilitation modalities were:
- Controlled Hand Walking (97.3%)
- Therapeutic shoeing (96.1%)
- Ice (95.2%)
- Compression Bandaging (89.5 %)
- Platelet Rich Plasma (86.5%)
- Therapeutic Exercise (very unspecific….) (84.3%)
- Protein Therapy or IRAP (81.4%)
- Stretching (83.3%)
- Hydrotherapy (82.9%)
- Thermal Therapy (77.6%)
- Massage (69%)
- Acupuncture (68.3%)
These are all mainly acute phase therapies. Well the first 7 are at least.
It is also very important to look at what might have caused the injury (injuries that aren’t trauma related) and rectify those issues as well. Especially if it requires working with saddle fitters, dentists, farriers etc
You must remember that good rehabilitation is a team approach with a vet, farrier, physical therapists etc. “TeamWork makes the DreamWork”.
We offer a huge range of rehabilitative therapies at Equestricare and are also available to talk to you about your specific horses needs. Our aim is to keep horses pain free and performing happily. And whilst not all injuries can be prevented, it is important that you take steps in your horses daily routine in order to enable them to have better proprioception, balance, strength and flexibility in order to handle situations they are faced with without becoming injured.