rehab techniques for horses
Veterinarians have a variety of therapies and equipment they can use to help rehabilitate horses coming back from injury. During the 2018 American Association of Equine Practitioners Convention, held Dec. 1-5 in San Francisco, California, a group of them gathered for a Table Topic discussion on this subject. Melissa King, DVM, PhD, Dipl. ACVSMR, and Carrie Schlachter, VMD, Dipl. ACVSMR, moderated the talk and answered questions about rehabilitating stifles, backs, suspensories, and more.

Stifle Injury

Resistance Band Training One veterinarian in attendance had been treating a horse recovering from a surgically repaired meniscal tear. The menisci are the cartilaginous discs between the femur and the tibia that facilitate frictionless stifle joint movement.

King, an assistant professor of Equine Sports Medicine and Rehabilitation at Colorado State University’s College of Veterinary Medicine & Biomedical Sciences, in Ft. Collins, said she likes to rehabilitate hind-limb structures using a Theraband system, in which she wraps resistance bands around the horse’s hindquarters, connecting them on each side to the saddle pad.

“I’m trying to encourage proper alignment during a controlled exercise program,” said King. “I’ll frequently use this system because horses won’t travel correctly or under themselves.”

She might use a belly strap, as well, to encourage horses to lift through their abdominals.

King said her team only uses a resistance band system on a horse two or three times a week, noting that horses will fatigue quickly at first.

Underwater Treadmill Schlachter, the medical director at Circle Oak Equine Sports Medicine and Rehabilitation, in Petaluma, California, said she uses underwater treadmills on these cases, starting a week or two after surgery with a six-minute session, and increasing that by 30-second intervals.

“Most horses are trained on a circle, but the stifles are designed to go straight,” she said. “An underwater treadmill rehabilitates them in a straight line.”

Water depth varies depending on what the veterinarian is trying to achieve.

“(Shallow water) has less resistance, but the horse tries to stride up out of the water, which increases range of motion,” King said. “As the water gets over the tarsus (hock), there’s more resistance, a longer stride.”

Other Approaches If practitioners don’t have access to an underwater treadmill, she said they should initiate range of motion (e.g., hand-walking over ground poles) in these horses quickly. “Also work on pelvic and stifle stability using caudal (toward the rear) and lateral (side-to-side) tail pulls,” said King.

Schlachter added that she might also perform three shock wave therapy treatments on meniscal tears. Rehabilitation time can vary from four months with a small tear, to eight to 10 months with larger ones, she said.

Hind Suspensory Strains

Another attendee asked about rehabbing a horse with an injured hind suspensory ligament, which runs from the base of the hock down around the sesamoid bones in the fetlock.

“You rarely get just hind limb suspensory injuries,” noted King. “There are often other associated comorbidities,” which are conditions occurring simultaneously.

Schlachter agreed, adding that she often sees a connection between discomfort in hind suspensories and the sacroiliac (SI, where the sacrum meets the ilium of the pelvis) and lumbar (beneath the loin) region. “Pain in one is causing pain in the other,” she said.

For clients’ horses like the attendee’s, which aren’t markedly lame but have performance limitations, King recommended keeping them in work, but backing them down to just walking and trotting.

“Footing is important,” she said. “Stay out of deep footing.”

She said she might also perform shock wave therapy or laser therapy, which segued into a discussion on the latter.

Laser Therapy

King said laser therapy has analgesic (pain-relieving) and anti-inflammatory effects on a cellular level. Lasers are organized into four classes (1-4) by how much damage they can do to a human retina. She explained that classes 3 and 4 are therapeutic, with 3 considered low-level and 4 high-level, based on their power output in watts and the wavelength of lightdelivered. High-intensity class 4 lasers are significantly more expensive.

King noted there’s been very little research comparing these two laser types on horses, but that some veterinarians have seen good results.

Schlachter said laser is a popular therapy at her practice, particularly for treating horses with acute back pain and wounds. She cautioned, however, that class 4 laser is prohibited on horses competing in Fédération Equestre Internationale (FEI) events.

At King’s clinic, laser is most commonly used on surgical incisions, as an analgesic and to decrease swelling, and on tendon and ligament injuries during the remodeling phase.

Back Pain

Many audience members said they commonly encounter horses with back pain.

If the pain is in the horse’s thoracic (mid-back) area, said Schlachter, she tries bodywork such as acupuncture and chiropractic. Then, if she’s ruled out saddle fit as a contributor, she said her go-to treatment is shock wave therapy.

For lumbar and sacroiliac pain, Schlachter said she tries laser therapy, and then proceeds to SI injections if diagnostic imaging hasn’t revealed anything significant.

“Back pain is a common comorbidity,” said King.

When working on one of these cases, she first tries to pinpoint the root cause, then begins doing a lot of body work plus shock wave therapy. This could include chiropractic adjustments, acupuncture, kinesiotape, core work, baited stretches, and massage. Depending on the location of the back pathology (for example, cranial to mid-thoracic dorsal spinous process impingement, or kissing spines), placing these horses on the underwater treadmill can exacerbate issues due to the increased range of motion, King said.

Schlachter recommended carrot stretching as an easy, affordable monitoring tool.

She noted that she finds functional electronic stimulation (a type of electrotherapy that stimulates the motor nerves responsible for muscle function) particularly effective for lumbar and sacral pain because, in her experience, many of these chronically painful horses have very tight muscles.

The discussion then turned toward incorporating exercise into a back pain rehabilitation program. Schlachter advised keeping a rider off horses with moderate to severe back pain for 21 to 45 days.

“Turn them out where they’ll have their head down as much as possible,” she said.

Then, depending on where the pain is, she’ll incorporate other exercise programs, such as long-lining over ground poles. “Anything to get them to look down and arch up,” she said.

Schlachter said she’ll also perform core exercises with a bellyband if the surcingle used to anchor the pad with the band attachment doesn’t cause pain.

Once the horse can be ridden, she recommended practicing transition work and pole work and riding in a square pattern, not a circle.

King’s recommendations under saddle included working long and low, encouraging the horse to relax and stretch over his topline and swing his back, for the first 10 minutes and limiting trot work initially. “Walk and canter, then practice transitions, and trot at the end,” she said. “Practice serpentines, figure-eights over poles, and backing through patterns, asking for full range of motion over the back.”

Take-Home Message

“Equine rehabilitation requires a global approach,” said King. “Rehabilitate the entire horse, not just the injured region. Horses often develop maladaptive compensatory mechanisms due to the primary source of pain that if left unaddressed will continue to cause additional lameness issues and poor performance.”

And just as each animal is unique, so is each rehabilitation case, said Schlachter. “What worked for your neighbor may not work for you or your horse,” she said. “Remember to stay focused on the end goal and keep the rehabilitation team informed of the progress along the way.”