Lauren V. Schnabel, DVM, PhD, Dipl. ACVS, ACVSMR, an associate professor of equine orthopedic surgery in North Carolina State’s College of Veterinary Medicine, in Raleigh, and Brian K. Noehren, PT, PhD, FACSM, director of the Human Performance and Biomotion Laboratories at the University of Kentucky, in Lexington, reviewed useful prehabilitation steps during the 2021 American Association of Equine Practitioners (AAEP) Convention, held Dec. 4-8 in Nashville, Tennessee.

Prepare the environment

Find the optimal environment for a horse’s recovery before surgery. Schnabel said this might include a quiet barn with other horses on similar schedules, calm and confident handlers, ideal stall options (with good ventilation and a window or inside/outside access, if possible) and sizes (12-by-12 or larger), and, for horses intolerant of stall rest, long-term sedatives such as reserpine or trazodone.

Acclimate the horse to stall rest

Help the horse adjust to the recovery lifestyle and therapies early. Get the horse used to bandages, especially full-limb bandages, and devices for recovery such as ice or compression systems, she said. Practice exercises and hand- or tack-walking with the person who will be doing them postoperatively.

Plan for diet and stimulation

Ensure the horse is on a proper plane of nutrition (body condition score of 5 or 6) for healing, while also accounting for reduced exercise and calorie expenditure during recovery—particularly if the horse has metabolic disease, said Schnabel. For stimulation, provide the horse with the same amount of attention (e.g., grooming, affection) now that you will after surgery. To combat boredom, offer slow feeders, stall toys, and open the stall window.

Focus on range of motion

Ideally, you want your patient to have full range of motion before surgery, said Noehren. You can achieve this, said Schnabel, through manual techniques and passive stretching exercises such as holding limbs gently in flexion and extension. You can also add range of motion exercises such as ground poles and aqua treadmill conditioning when appropriate, depending on the injury.

Reduce swelling

Control swelling and effusion as much as possible using modalities such as bandaging, icing (e.g., ice boots, cold salt water spa), compression, kinesiotape, laser, therapeutic ultrasound, and pulsed electromagnetic therapy. Use dynamic compression devices to improve lymphatic drainage and circulation.

Practice gait training

You’ll want the horse moving symmetrically in recovery to avoid compensatory injuries and uneven weight-bearing. Before surgery, work with a farrier to ensure the horse has proper foot balance and shoeing to reduce the strain on the injured area, said Schnabel.

Practice strength training

In humans, said Noehren, physicians want an injured limb to have 80% of the muscle strength as the opposing healthy limb before surgery—something he acknowledged is very challenging. For horses, Schnabel recommended performing mobilization and core exercises and controlled exercises with tools such as elastic band systems (e.g., Equiband) and functional electrical stimulation.

Improve neuromuscular control

Methods Schnabel said can aid in proprioception and neuromuscular control include walking over ground poles and different surface types, standing on balance pads, and wearing ankle weights or other devices that provide tactile stimulation.

All these techniques and considerations can benefit horses not only pre-surgery but also in recovery. Work with your veterinarian to create a prehabilitation plan that fits your horse’s needs and timeline.