Neurologic diseases such as equine protozoal myeloencephalitis (EPM) and wobbler syndrome (cervical vertebral compressive myelopathy, CVCM)can present with clinical signs ranging from mild and nearly invisible to dangerous for both the horse and his handlers. Horses with more severe or progressive neurologic conditions might need to be euthanized, while other horses could benefit from a rehabilitation program. “Safely rehabilitating a wobbly neurologic horse back to ridden work is possible,” said Tena Ursini, DVM, PhD, Dipl. ACVSMR, clinical instructor of equine sports medicine and rehabilitation at the University of Tennessee’s College of Veterinary Medicine, in Knoxville, during her presentation at the 2024 Veterinary Meeting and Expo, held Jan. 13-17 in Orlando, Florida.

Treating the Root Cause of Neurologic Disease in Horses

“With neurologic rehab, the No. 1 goal is stabilizing the instabilities, and the No. 1 rule is keeping the horse and his handlers safe,” she said. Before initiating any rehabilitation program, Ursini emphasizes the importance of a full veterinary workup followed by treating the primary cause of the neurologic deficits with the indicated medical or surgical treatment. She also supplements the diet with the neuroprotectant vitamin E if bloodwork shows a deficiency and sometimes medicates the horse with daily firocoxib if the neurologic deficit has made his body sore.

Stabilizing Neurologic Horses

Stabilizing the instabilities, aka “unwobbling the wobbler,” often looks like improving proprioception (awareness of where one’s body parts are in space), increasing muscle mass, and decreasing ataxia (incoordination). “Whatever a horse struggles with, that’s what he’s going to work on,” Ursini said. She recommends both static and dynamic exercises as part of the neurologic rehab, noting that these should be tailored to the individual patient:

• Stall gymnastics and physiotherapeutic stretches involve baiting your horse with a carrot to flex his spine and touch his elbow, flank, and hind fetlock with his nose on both sides, as well as performing sternal lifts and butt tucks. Ursini also calls these “horse yoga.” These exercises help strengthen his core, back, and hind end muscles, which will improve stabilization.
• Dynamic mobilization exercises using ground poles build strength. Research shows that leading a horse over ground poles activates his core, increasing both longissimus dorsi and multifidus (back muscles) activity two- to threefold¹. Walking a horse over poles set at increasing distances from one another can also increase stride length, improving the horse’s range of motion. “Additionally, random arrays of stacked poles challenge the horse’s knowledge of where his legs are in space, making him work on his proprioception,” Ursini explained.
• Water treadmill sessions increase muscle strength, improve range of motion of the spine, and build topline musculature.
• Equicore makes a training aid that can be used to promote straightness in unbalanced horses. “The apparatus is useful for rebuilding gait cadence and symmetry and discourages ‘dangling’ of the hind legs,” said Ursini. She cautioned that the device can decrease muscle activity if the horse learns to lean against it for support, so handlers should closely monitor their horses and avoid making them overtired, which could increase the likelihood of leaning on the device.

Adjunct Therapies

At the University of Tennessee’s Equine Sports Medicine and Rehabilitation Center, Ursini’s team also employs a multitude of therapeutic modalities:

• Therapeutic laser can reduce pain and inflammation and promote nerve repair.
• Electrical stimulation (i.e., TENS unit) can be used to maintain muscles, to some extent, if the horse is completely stall-bound and unable to exercise.
• Chiropractic care must always be performed by a licensed veterinarian who will recognize neurologic cases in which chiropractic care is contraindicated (i.e., a cervical fracture).
• Acupuncture can be used for soft tissue pain and soreness secondary to the unbalanced biomechanics of neurologic horses.
• Hyperbaric oxygen therapy can promote nerve regeneration and regrowth.

Take-Home Message

“Even the best rehabilitation plan at a professional facility might not give your neurologic horse 100% of his function back, but most can have some usable purpose after recovering from their neurological deficits,” Ursini said. She encouraged horse owners to be flexible with the timeline of their rehabilitation plans and to keep a close eye on their horses’ progress with pictures and regular veterinary re-evaluations.

¹ Ursini TL, Shaw K, Levine D, Adair HS, Richards J, “Electromyography of the Multifidus Muscle in Horses Trotting Over Firm and Soft Surfaces” Journal of Equine Rehabilitation 2023. (1).

Ursini TL, Shaw K, Levine D, Richards J, Adair HS, “Electromyography of the Multifidus Muscle in Horses Trotting During Therapeutic Exercises” Frontiers in Veterinary Science 2022. (9).

Shaw K, Ursini TL, Levine D, Richards, J, Adair HS, “The Effect of Ground Poles and Elastic Resistance Bands on Longissimus Dorsi and Rectus Abdominus Muscle Activity During Equine Walk and Trot.” Journal of Equine Veterinary Science 107 (2021): 103772–103772.