underwater treadmill
When rehabilitating horses that have been out of work due to injury, the aim is to restore and maximize strength and improve aerobic capacity. Ideally, the long-term goal of a rehabilitation program is for the horse to return to sport and avoid re-injury.

During the British Equine Veterinary Association Congress, held Sept. 7-10 in Liverpool, U.K., Steve Adair, MS, DVM, Dipl. ACVS, ACVSMR, CERP, professor in the University of Tennessee College of Veterinary Medicine’s Department of Large Animal Clinical Science, in Knoxville, discussed his techniques for building rehabbing horses’ strength and proprioception (awareness of where their limbs are in space).

Due to the variability in injuries and prognoses, each horse requires an individualized rehabilitation program. “The limitation is going to be based on the weakest tissue,” said Adair.

Therefore, the rate of rehab will differ between cases. Work with a veterinarian to build a plan, and schedule reevaluations to determine if the current plan is still the most effective, if it needs to be altered, and whether other steps are necessary for the best outcome.

Improving Proprioception

Adair said caretakers have many methods for improving a horse’s proprioception, including elastic bands and cavalettis. Elastic bands can help the horse reattain balance, bring his hindquarters underneath him, round his topline, improve coordination, and minimize disconnect between the hindquarters and front end.

Cavalettis, when used in a plan made with your veterinarian, have many rehabilitation benefits. Stepping over raised cavalettis creates a more active hind leg, which increases flexion and protraction. They help build the horse’s strength and balance and can be implemented in hand without the extra additive of a rider. This helps the horse prepare for eventual ridden work and provides a way to train all three gaits without a rider’s weight. Cavalettis also help raise the horse’s back, create a “telescoping” neck, and encourage the horse to use his abdominal muscles. Adjusting the height and spacing of the cavalettis as the horse builds strength adds more variability to the exercise.

“The higher they are, the more complex it gets,” said Adair. Adjusting spacing “really affects their balance, their coordination, and their proprioception.”

Adair told The Horse he suggests caretakers start over low cavalettis and “always begin in hand on the straight, avoiding tight circles. As tissue healing progresses, then we will change spacing and height (still at hand).”

He added, “In some cases (i.e., a torn distal interphalangeal collateral ligament, which connects the pastern and coffin bone) we may try to avoid longeing altogether and transition from in-hand to being ridden over poles (but only on the straight). Later in the return-to-work period we may introduce curves and longeing.”

Strengthening and Conditioning

Adair described four methods of increasing strength and conditioning in rehabilitation plans: ponying, hill work, aquatic exercises, and sport-specific training.

Ponying Ponying a rehabbing horse from another horse is a useful middle step that allows the horse to begin working over longer distances with less control than hand-walking. However, it’s important to be aware of how the horse is moving next to the ridden horse. Often, the head is unintentionally pulled toward the lead horse, creating an altered gait and affecting balance and biomechanics. Focus on keeping the horse as straight as possible when using ponying in a rehabilitation program.

Hill work Hill work can be done in hand or under saddle. The increased incline and decline strengthen muscles and offer a slow-speed way to increase cardiovascular strength while maintaining minimal impact.

Aquatic exercise Both swimming and underwater treadmills improve rehabbing horses’ cardiovascular and musculature fitness without the impact that comes with traditional exercise. However, this means weight-bearing muscles are not in work. Additionally, swimming exercise typically encourages horses into an inverted frame, which can be counterproductive to end results. If a horse is not a good swimmer or flails during exercise, additional injuries can occur, so use caution when incorporating swimming exercise into a program and introduce it gradually, Adair told The Horse. An underwater treadmill can help increase fitness and balance without the potential negatives encountered with swimming. It is more controlled, provides resistance to movement, and provides buoyancy to reduce ground force reactions encountered on dry land.

Introducing horses to an underwater treadmill is best done in phases, said Adair. “We first lead the horse to the edge and let them play in the water,” he explained. “Then we let them walk through the water several times. We then put them back in the stall and let them chill. We then bring them back and walk them into the water and make them stop and stand on the treadmill.”

Adair said he repeats this process several times, with breaks in between. Once the horse is comfortable, he said he will “bring them back, walk them into the water, make them stand on the treadmill, and then turn it on.” Usually, he added, training a horse to be comfortable using the treadmill only takes a day.

Sport-specific training Introduce sport-specific work, especially under-saddle ridden work, slowly, said Adair. In a generic program, Weeks 1 and 2 should include limited walking three days a week. Increasing ridden exercise to five days a week typically occurs during Week 3, adding small amounts of trot at Week 4. Based off the same generic program, you can begin small amounts of canter work during Week 8.

Returning to Competition or Full Work

It’s imperative to work with a veterinarian and reevaluate the horse frequently to determine if the current rehabilitation plan is still ideal. “If you’re not doing objective evaluations during either your rehab or your training and conditioning period, then you’re not going to know when you need to adjust what you’re doing,” said Adair. “(Check-ins) to evaluate these horses on a frequent time frame allow you to address (potential problems) before they become significant injuries.”

Adair told The Horse the frequency of rechecks depends on “what you are rehabbing and if you are doing it in a facility or at home. In-clinic patients are probably evaluated (i.e., palpated, flexed, etc.) daily and have a full exam (i.e., lameness assessment) weekly. Imaging is usually done monthly.”

If the horse remains at a home facility, Adair said he usually has the owner provide weekly updates, including photos and videos, and then does a hands-on evaluation every four to six weeks.

Take-Home Message

Catching re-injury early can minimize damage. You might need to alter the initial rehabilitation plan depending on the horse’s individual rate of healing. Before the horse returns to competition, the injury should be sufficiently healed to reduce the chance of backtracking in his recovery.