Immobilization or stall rest is sometimes necessary for an injury to heal, especially in cases of severe tissue damage (such as tendon or ligament injuries and fractures), but other times keeping horses moving is a better approach. The key is choosing the right exercise for the type and location of the injury. We cannot just tell horses, for example, to engage their core. Instead, we design exercises that achieve the desired result.

The goals of therapeutic exercise are to increase tissue strength, improve range of motion and quality of tissue healing, and prevent scar tissue formation.

Although controlled exercise is an important part of equine rehabilitation, there are few well-designed, randomized studies investigating therapeutic effects on musculoskeletal injuries. As with many other equine rehabilitation approaches, treatments are often based on what is known from human physical therapy.

Steady Beginnings: Walking

Controlled exercise often begins with walking activity, which can include hand-walking or walking on an automated horse walker or exerciser. A 2018 international study regarding the use of rehabilitation modalities in horses reported that 97.3% of respondents utilized controlled hand-walking and 56.7% used automated horse walkers (Wilson et al., 2018). The goal of walking is to improve mobility, reduce swelling, facilitate tissue repair, and promote cardiovascular fitness and bone strength. In some cases this can be achieved on a land or underwater treadmill, which might be preferred if turning or circling is not advised based on the injury.

As horses progress through the healing process, new, targeted exercises may be introduced.

On the Way Up: Inclines

Inclines can be incorporated into rehabilitation programs to facilitate activation of abdominal muscles and strengthen other muscles, particularly in the hind end. Exercises might include walking up and down hills or utilizing inclines on a land treadmill.

Up and Over: Poles and Pedestals

Walking or trotting over ground poles and raised cavaletti activates the full range of motion of the front and hind limbs. These exercises are useful for rehabilitation of neurologic cases by training proprioceptive skills and visuomotor coordination. It is also beneficial for improving or restoring joint range of motion through increased flexion (Brown et al., 2015). Trot poles strengthen propulsive muscles, including hip flexors, without overloading musculoskeletal tissues or increasing the extension of fetlock joints. Importantly, beneficial effects persist throughout the course of the exercise, unlike the use of proprioceptive stimulation devices in which the effects decrease over time.

Obstacle work might also include pedestals. Horses can be asked to walk up onto and over a pedestal or to stand on the pedestal, simulating collection. Similar to poles and cavaletti, this strengthens abdominal muscles and proprioceptive skills.

On the Line: Ropes, Lines, and Bands

Systems of bands or ropes positioned across a horse’s back and/or around their hindquarters have become popular in equine rehabilitation. Some are used while longing and others are used while riding. These include the Pessoa training aid and Equiband. When using these tools, it is important to avoid inducing hyperflexion of the neck (i.e., the head needs to stay in front of the vertical).

The Pessoa training aid is an array of ropes, pulleys, and straps intended to assist with building muscle and increasing the horse’s use of its back muscles during longing. While working in this rig, horses are collected, with a raised poll and decreased stride length. The system allows for different positions that put horses in various frames, from “long and low” to an upright frame. It might improve posture, stimulate core muscle activation, and improve gait quality without increased load on lower limbs.

The Equiband system is comprised of abdominal and hindquarter resistance bands attached to a saddle pad. It is used to promote hind-limb engagement and might aid dynamic stabilization of back muscles (Simmons et al., 2015), as well as strengthen core muscles.

Tissue healing is a complex and variable process, but it does follow predictable phases. An appropriate exercise program complements and enhances the healing process of the injured tissue.

Many horses suffer complex injuries, so it is important to have a full, accurate diagnosis prior to starting a controlled exercise program. Rehabilitating one injury while neglecting another can lead to incomplete healing or reinjury. It is important to work with a veterinarian and equine sports medicine and rehabilitation specialist throughout your horse’s rehabilitation.

This article was originally written by Amy Young and published in the Horse Report from the Center for Equine Health at the UC Davis School of Veterinary Medicine in Summer 2022.

Resources:

Wilson, J. M., McKenzie, E., et al. International Survey Regarding the Use of Rehabilitation Modalities in Horses. 2018. Frontiers in veterinary science, 5, 120

Brown, S., Stubbs, N. C., Kaiser, et al. Swing phase kinematics of horses trotting over poles. Jan 2015. Equine veterinary journal, 47(1), 107–112.

Simons, V., Weller, R., Stubbs, N., et al. Objective Assessment of Back Kinematics and Movement Asymmetry in Horses: Effect of Elastic Resistance Band Training. Sept. 2015. Equine Veterinary Journal, 47: 11-11.

Haussler, K.K., King, et al. The development of safe and effective rehabilitation protocols for horses. Jan. 2021. Equine Veterinary Education, 33: 143-151.

Stubbs, N.C., Kaiser, L. J., et al. Dynamic mobilisation exercises increase cross sectional area of musculus multifidus. March 2011. Equine Veterinary Journal, 43: 522-529.