Soft tissue injuries involving tendons and ligaments are common in sport horses and generally require six to 12 months to heal completely. A rehabilitation plan helps the horse heal and build strength over time and reduces the risk of reinjury, said Katie Ellis, DVM, MS, Dipl. ACVSMR, a clinical assistant professor and section head of field services at the University of Georgia’s College of Veterinary Medicine, in Athens. Ellis outlined how she rehabilitates sport horse soft tissue injuries at the 2024 American Association of Equine Practitioners Convention, held Dec. 7-11, in Orlando, Florida.  

The Ideal Rehabilitation Plan for Equine Soft Tissue Injuries

Ellis outlined her preferred rehabilitation plan for sport horses with soft tissue injuries as follows:

Months 1 and 2

• Stall rest with hand-walking.
• Physiotherapy (i.e., carrot stretches).
• Icing the affected limb once or twice daily.
• Administering topical and/or systemic anti-inflammatory drugs.
• Applying standing wraps to the affected limb and its opposing limb when the horse is stall-kept.
• High-power laser therapy applied by a veterinarian or supervised technician.

Months 3 and 4

• Stall rest with walking under saddle (”tack walking”).
• Walking over ground poles in hand.
• Continue all therapies and medications from the first two months.

Months 5 and 6

• Stall rest with walking under saddle and small amounts of trotting (depending on the type and severity of the injury)
• Walking over ground poles in hand.
• Icing the affected limb after riding.
• Continued physiotherapy.
• Standing wraps in the stall.

Months 7 and 8

• Stall rest with walking under saddle and trotting gradually included and interspersed throughout the ride (no trotting through turns).
• Walking over cavalletti (raised poles) under saddle.
• Physiotherapy.
• Icing the limb after work.
• Standing wraps in the stall.

Months 9 and 10

• Small paddock turnout added gradually (sedation provided by the veterinarian might be necessary).
• Canter work gradually included in under-saddle rehabilitation.
• Trotting and cantering through turns under saddle.
• Gradually adding cavalletti into under-saddle work.
• Physiotherapy.

Months 11 and 12

• Small-paddock turnout.
• Adding 20-meter circles and lateral movements (i.e., leg yielding) to ridden work.
• Physiotherapy.

Month 12 and Onward

• Normal turnout.
• Advanced/discipline specific maneuvers.

Rehabilitation for the Uncooperative Equine Patient

“Most patients will not follow the ideal example,” said Ellis. While some might not physically hold up to this plan, others might not be mentally capable of following it.

For horses not compliant with stall rest, Ellis typically recommends chemical intervention with a long-term sedation option such as trazadone or reserpine. Some horses do well in a stall with a small attached runout where they can walk outside without picking up any speed. Others might need to be turned out in a very small paddock next to other horses to remain calm during the rehabilitation process.

If a horse becomes dangerous to hand walk, Ellis sometimes recommends administering sedation before walking or, if the horse is cleared for it, starting to walk under saddle sooner than expected.

“If the horse is not compliant, I recommend adding more interesting exercises to keep them focused,” she said. “This might include ground poles, patterns, or even a walk around the property if the footing is safe.” In some situations she advises the owner pony the horse off a quiet horse in the early stages of rehab.

If the horse is too difficult to ride, Ellis might recommend increasing his turnout time sooner than planned and/or delaying ridden work. If safe for the individual horse and rider, she might choose to include light sedation for the early stages of ridden work.

Managing Client Expectations

“I find it can help the client to give them a time frame for total healing,” said Ellis. “My rule of thumb is six to 12 months for tendons and eight to 12 months for ligaments.” Having a timeline helps the owner stay on track with the rehabilitation plan and remain compliant throughout the process.

“Assure them the goal is to have the horse back in full work at the end of 12 months,” she said. For the clients that like to be very involved in their horse’s daily care, Ellis teaches them physiotherapy exercises to perform with them. She also has them use an electromagnetic blanket if they have access to it or balance pads as the horse progresses in his rehabilitation. “I find that giving them lots of other activities to do with the horse can help keep them busy and invested in the rehab.”

Repeat Imaging for Equine Soft Tissue Injuries

Ellis said she repeats imaging before increasing the horse’s workload and at every recheck, which she plans for every 30-45 days. “The imaging results rarely guide my rehab recommendations if the horse is improving clinically,” she said. “This just allows me to establish a new baseline.”

To check the horse’s clinical improvement Ellis watches the horse jog on a straight line but does not longe them in a circle. However, if the horse worsens during the rehabilitation process, she might perform a more extensive lameness examination or imaging to find the cause.