How therapeutic exercise programs can help keep equine athletes and recreational horses alike feeling their best

Physical therapy. When you hear those words, you might think about regular office visits for supervised stretches, exercises, and icing, all in the name of rehabbing from injury or easing aches and pains. But physical therapy can apply to horses, too. Physical therapists like me work with horses to help them optimize movement, recover from injuries, and reach peak performance. In this article we’ll discuss the basics of equine physical therapy and how it might help your horse.

The Four Pinnacles of Equine PT

Trained and certified physical therapists use a comprehensive assessment model addressing four key areas to help equine athletes stay sound or recover from injury. After veterinary diagnosis and referral of the case, therapists start by determining if horses have full range of motion. Second, they ascertain whether patients can move through that full range. If not, the animals are most likely lame—and the veterinarian needs to stay involved.

The third area therapists evaluate and manage is motor control, which involves assessing and retraining dynamic strength and stability. For example, a horse with poor core strength might struggle to perform a canter transition without throwing his head in the air. Identifying that core strength is limiting his ability to push into the canter is an example of addressing the problem, not a symptom. In this scenario, core strengthening exercises, such as lateral tail pulls or walking over elevated cavalettis, will be more effective than practicing canter transitions repeatedly.

The fourth area to assess and optimize is the horse’s ability to deal with load. This includes carrying a rider and possessing the strength and motor control to perform more advanced movements, such as jumping fences or changing leads.

In my experience, one of the most effective tools to retrain and improve these areas is a therapeutic exercise program. Therapists design these programs to improve the movement deficits they identified on the assessment. They modify and advance them over time to help the horse progress, return to his prior level of performance, or reach peak performance.

Kevin Wahl, DVM, Dipl. ACVS, a partner at Idaho Equine Hospital, in Nampa, says one of the main roles of rehabilitation is to get the horse fit and strengthen injured tissue to the point the horse can withstand the normal stresses applied to those tissues during exercises. “This is where the rehab program shines, in my opinion,” he says. “You can use rehabilitation and physical therapy in a way that stresses the injury, strengthens the injury, and promotes proper function of the injured tissue without overstressing the injury and causing more harm.”

What’s in an Exercise Program?

Therapeutic exercise is designed to resolve a specific problem, such as stifle weakness or lack of core muscle engagement. The goal is to help your horse move optimally and handle the demands of his sport and workload. A comprehensive therapeutic exercise program addresses:

• Range of motion Do the horse’s joints have full range of motion?
• Proprioception Does your horse know where his body is in space? You often must retrain this system after an injury and/or if your horse has been in pain.
• Motor control How does your horse regulate how he starts, moves through, and ends a motion?
• Strength Does your horse have adequate strength for his job?
• Endurance Can your horse produce enough energy to perform?
• Speed Can your horse safely move fast enough for the demands of the sport?

A good exercise program addresses all these areas and focuses on progressive overload—applying stress to the system in small, organized increments to create physiological adaptations such as increasing muscle mass, building more blood vessels, strengthening connective tissue, and increasing nerve conduction speed.

In his busy practice Wahl says properly conditioned patients tend to get injured much less frequently than the under- or overconditioned ones. “I often see people competing on a horse that is not fit or riding the horse past the point of fatigue, and I feel that is where a large percentage of injuries occur,” he says. “There are always going to be the fluke injuries that cannot be avoided; however, once a horse is tired, that horse can no longer protect his body.”

Exercise Research Can Help Horses

Understanding how horses move is important when creating an effective exercise plan. Researchers, veterinarians, and physical therapists often look to biomechanical research and treatment protocols from humans to better understand how to treat horses.

Sheila Schils, MS, PhD, former professor of equine science at the University of Wisconsin River Falls and a researcher at EquiNew Therapy LLC, for example, is studying how the horse’s neck design impacts head carriage. She has studied the biomechanics of human cervical spines and used that information, plus a strong understanding of equine anatomy, to create recommendations for how to best prevent and rehab cervical injuries in horses. A collaborative paper on this topic will be released for publication soon.

One of the benefits of working with a professional when creating an exercise program is they use evidence-based research, rather than simply experience, to create a tailored program for each horse.

Therapeutic Training Aids

A variety of training tools can help improve a horse’s range of motion, body awareness, neurologic integration, and strength. Work with your veterinarian or physical therapist to decide which training aids to include in your program. Remember, these tools are only as good as the exercise program your vet or therapist prescribes for your horse and the skill of the rider or trainer using them. It’s important to know the purpose behind using a training aid and incorporating it into a treatment plan, rather than just arbitrarily adding it into the mix.

Tactile bracelets

These lightweight bracelets can be placed on the horse’s pasterns to stimulate the skin and increase the flight arc of the leg (Clayton et al., 2008). They teach the horse to lift a foot higher off the ground—helpful if he drags a toe or doesn’t lift a previously injured leg as high as the noninjured one. The main issue with these bracelets is horses can get desensitized quickly. Think about how you can wear a watch and forget you have it on. The bracelets can have the same effect but are helpful for short sessions.

Used for: Range of motion

Leg weights

Like tactile bracelets, adding a small amount of weight to a horse’s leg can cause the horse to walk with an exaggerated stepping motion because he must contract more proximal (nearer to the body/point of attachment) muscles to lift the heavier leg. In my practice I have used this approach to build stifle strength after an injury. Excessive weight or overuse, however, can injure soft tissues. 

Used for: Range of motion, proprioception, strength

Foam pads and wedges

Commercial foam pads are useful for improving range of motion and proprioception. The horse stands on the pads, which challenges the postural muscles and proprioceptive system. Some pads also come in wedge form, which can help increase range of motion by lightly stretching connective tissues in the lower limbs.

Used for: Range of motion, proprioception, strength

Resistance band systems

These tools increase core and spinal muscle activation. Researchers (Pfau et al., 2017) have shown band systems help increase thoracolumbar stability and reduce the risk of pain or injury from hollowing the back.

Used for: Strength, proprioception

Ground poles

Poles are one of the most useful tools to help improve lower limb range of motion, strength, and proprioception. You can place them on the ground or elevate them up to 8 inches and have your horse walk or trot over them. You can also place poles in an organized pattern, such as 3 to 4 feet apart, or scattered randomly so the horse must navigate his way through a maze. Small bounce fences are also extremely helpful to improve reaction time and strength.

Used for: Range of motion, proprioception, strength, speed

Aquatic treadmills

These cause a horse to walk with increased joint flexion and lift his legs higher off the ground. They can also help build strength and endurance as the horse pulls against the water. Depending on the water depth, the horse might experience a buoyancy effect that reduces impact on the leg joints, which is beneficial during recovery from injuries such as tendon or ligament strains.

Used for: Range of motion, strength, endurance

No Cookbooks!

Therapeutic exercise programs aren’t like recipes in a cookbook. A therapist must tailor them to each horse after evaluating movement, strength, and neurologic control. Working with trained professionals and veterinarians to develop a program is the best way to address your horse’s problem areas safely and effectively. The American Physical Therapy Association has created a special interest group, Animal Physical Therapy, to provide information, governance, and resources for this growing field.