Bandage changes. Incision care. Stall rest. Medications. Vet rechecks. Hand-walking. Tack-walking. Sedation to “take the edge off.” If you’ve ever guided a horse through the recovery and rehabilitation process post-surgery, you know it’s hard work. The journey of rehabbing an equine athlete back to his former abilities after surgery can be incredibly rewarding but also frustrating—and even dangerous—at times. Luckily, new research and technology are emerging, guiding equestrians toward a better, safer, and more effective way to approach rehabilitation from surgery that starts long before heading to the OR: It’s called prehabilitation.

Rehabilitation vs. Prehabilitation

What’s the difference between rehabilitating and prehabilitating your horse, besides the “p”? The prefix re means “again,” of course, while the prefix pre means “before.” Habilitation, in the context of physiology, refers to the process of becoming fit for a particular purpose. Therefore, prehabilitation is done pre-surgery to help maintain the patient’s fitness post-surgery. The goal of prehabilitation is not to replace either rehabilitation or the surgery itself. Rather, the American College of Surgeons describes prehabilitation as “a process of improving the functional capability of a patient prior to a surgical procedure so the patient can withstand any postoperative inactivity and associated decline.” In humans this essentially consists of optimizing physical fitness, strength, and mobility to balance out the losses caused by immobilization and inactivity postoperatively.

With horses, we face the additional challenge of behavioral complications that stem from not acclimating to varying triggering stimuli before surgery. By nature, these animals are not designed to handle the lifestyle associated with surgical recovery—one of confinement and restricted movement.

“In my experience, many horses have trouble after surgery adjusting to life without work and without any exercise, even when temporary,” says Lauren Schnabel, DVM, PhD, Dipl. ACVS, ACVSMR, associate professor of equine orthopedic surgery in the Department of Clinical Sciences at North Carolina State University (NCSU) College of Veterinary Medicine, in Raleigh, and the co-founder and chief medical officer of Vetletics Inc. “This (period of stall rest) sets them up for anxiety, stall vices, and often unpredictable behavior that is dangerous to both themselves and their caretakers.

“Additionally, many horses do not readily accept certain types of bandages, rehabilitation equipment, and rehabilitation exercises, especially if the first time they encounter them is postoperatively, when they are uncomfortable and in pain,” she continues. “They may kick out with the bandaged leg or stomp with it or chew at the bandage, none of which are desirable postoperatively and could prevent healing or lead to further injury. Worse, these horses may kick out at equipment or the person performing the therapy or exercises if they are unfamiliar with them and also nervous or painful.”

In other words, the recovery period after surgery is not the ideal time for novelty in your horse’s routine.

“In fact, you even slow down the rehab progress by waiting until after surgery to habituate the horse to their rehab routine,” says Katie Hawkins, BA, MA, an FEI-permitted and certified equine massage therapist (CEMT) and certified equine rehabilitation therapist (CERT) who runs Unbridled Equine LLC, an equine massage and rehabilitation business in St. Charles, Illinois. “Even just a few weeks of prehabilitation before surgery pays dividends. If the horse’s owner has the foresight to see the benefits of prehab, it will exponentially help them, their horse, and their veterinarian after surgery.”

She takes her own patient Jack as an example. An 11-year-old dressage horse originally suffering from a suspensory ligament injury, Jack was eventually also diagnosed with overriding dorsal spinous processes, aka kissing spines. Jack came to Hawkins’ facility overweight, unfit, inverted in his posture, and lacking engagement from his back and hind end because he had been laid up from his suspensory injury. Jack’s two months of prehabilitation before his kissing spines surgery was a game changer, Hawkins says