Sometimes rest is the best recipe for recovery
Deborah Hamel is in the business of rest. On a spacious farm in Normandy, France, she provides injured horses a place to recover. She tends to their needs with conservative therapies such as hydrotherapy and cryotherapy (icing), and her Phoenix Farm just won the Normandy Horse Council’s 2019 Equi-Projects Business Creation Prize for her efforts.
“The idea is to care for and recondition these (convalescing) horses … mainly sent to us by equine veterinary clinics that support the concept,” Hamel says. “But, of course, we also welcome those that just need a restful break in the great, green open.”
This kind of rest and recovery facility isn’t just attracting the attention of regional award councils. It’s representative of equine veterinarians acknowledging the importance of rest in the healing process. As veterinary medicine progresses, it brings more advanced clinical and surgical therapies for our horses. But often, our sources say, we just need to give Mother Nature the time and conditions to work her magic.
The Science of Healing
This story isn’t about simply healing injuries; it’s about healing them well.
“It’s like getting a gash in your hand,” says Elizabeth J. Davidson, DVM, Dipl. ACVS, ACVSMR (Equine), associate professor of sports medicine at the University of Pennsylvania School of Veterinary Medicine’s New Bolton Center, in Kennett Square. “You could just let it heal with time, but the scar is going to be big and ugly. If you went to a doctor and got it sutured up, though, it would leave a thinner, more cosmetic, and probably more functional scar.” Scar tissue, she reminds us, is tougher and less elastic than healthy tissue, so minimizing it can help restore proper function to the injured area.
“Tendons, ligaments, muscles, and even bones are much the same,” Davidson adds. “The injuries are actual tears or breaks, and you want to get those tissues to heal as neatly as possible, to ensure that they not only look good but function well.”
Invasive techniques such as surgery and biologics injections (e.g., stem cell, platelet-rich plasma [PRP] treatments) can promote adequate healing. But so can well-planned periods of rest following science-based recommendations—because certain body tissues heal very well on their own, says Santiago Gutierrez-Nibeyro, DVM, MS, Dipl. ACVS, ACVSMR, an equine surgeon at the University of Illinois Veterinary Teaching Hospital, in Urbana.
“The body has an arsenal of stem cells and other cells ready to just jump in and replace torn tendons, stretched ligaments, broken bones, and more,” he says. “Time off is us letting the body do its job.”
A Prescribed Treatment Based on a Clear Diagnosis
Indeed, rest is just as much a therapy as surgery, injections, and medications, says Charles C.M. Arensberg, VMD, of Equine Veterinary Care and Fair Hill Training Center, in Elkton, Maryland. In many cases it’s a prescribed treatment.
But it has to be done the right way, be it in a stall or in a paddock, with or without controlled exercise. Just as you wouldn’t operate on the wrong leg or administer the wrong drug, you can’t give your horse the wrong kind of rest for his health issue, says Arensberg. And deciding what rehabilitative rest will look like for your horse without seeking veterinary advice is asking for trouble.
This type of rest rarely means simply turning your horse out to pasture for a few months. “When people are saying, ‘My horse is lame, so I’m just going to give him four months off,’ I worry tremendously,” Arensberg says.
While pasture rest might be appropriate in some cases, true rehabilitation usually requires confinement to a stall or very small enclosure, our sources say.
The only way to rest an injured horse properly is to know exactly what you’re dealing with, they add. “The key is first and foremost, before instituting any kind of recovery plan, having a really good comprehensive diagnosis of what the issue is,” Davidson says. “The type of rest, the length of time to rest, and how quickly we start doing controlled exercise during the recovery period all depend on the tissue type damaged.”
Modern diagnostic technology makes it easier to pinpoint exactly what’s causing certain signs of disease or injury, says Gutierrez-Nibeyro. For instance, “MRIs can give us definitive diagnoses today, whereas in the past we’d take radiographs and have to guess about what we couldn’t see,” he says.
Even if owners can’t afford or access MRI, an on-site veterinary evaluation with a physical exam and radiographs is still far preferable to the “wait and see” method, our sources agree.
“Rest is an absolutely integral component of recovery, but rest without a diagnosis is a prescription for problems down the road,” says Arensberg.
Aggressive vs. Conservative Treatment
Whether dealing with musculoskeletal injuries, respiratory issues, or gastrointestinal problems, owners often find themselves faced with a choice: aggressive or conservative treatment. Aggressive treatment involves direct intervention, with therapies such as surgery, joint injections, biologics, and extracorporeal shock wave therapy. Conservative treatment, on the other hand, mainly involves prescribed rest accompanied by controlled exercise and, sometimes, complementary rehabilitation therapies such as cooling, heating, water therapy, laser, chiropractic, acupuncture, and more.
Aggressive treatments can run into the tens of thousands of dollars, says Gutierrez-Nibeyro, and in some cases rest and recovery can be just as effective. “It really depends on the diagnosis and on the individual horse,” he says.
In fact, in a recent review on foot injuries, he and his team revealed that aggressive treatments often have no benefits over well-designed rest and rehab programs. “With bone bruises or stress fractures, for example, these horses can make a full recovery with just time and letting Mother Nature do her thing,” he says.
Surgery—to repair a long bone fracture with plates and screws, to free up a roarer’s larynx, or to untangle a strangled intestine, for instance—has a clear place for treating certain kinds of pathologies (diseases or damage), says Gutierrez- Nibeyro. And stem cell treatments, PRP, and shock wave therapy show promise in healing certain horses and issues, he and Davidson say. But, they point out, for a vast number of health problems, these new treatment modalities are still showing borderline benefits over conservative treatment alone.
“Mother Nature has certainly been healing things for a long time, and we have yet to find (solutions) that can speed that up,” Davidson says. “All these tools we have available today might help Mother Nature do her job better—for example, by encouraging better scarring—but they won’t make her any faster.”
Returning a horse’s injured tissues to in working order requires patience and precision. To get a tendon to heal, for example, you need to not only minimize scar tissue but also encourage that tissue to be pliable.
“We have specific, regimented, albeit sometimes intensely boring structured (soft tissue) rehabilitation programs with regular follow-ups, usually every 45 to 60 days, to make sure both the horse and the owner are coming along at the appropriate rate,” Arensberg says. “They don’t cost much money, but they do cost a lot of time.”
Most limb injuries involving soft tissues require two weeks of strict stall rest at first, so the horse doesn’t exercise that tissue more than the absolute minimum, Davidson explains. After that, depending on the diagnosis, horses can move on to limited, timed hand-walking with weekly progression.
A horse with tendinitis resulting from a large tear, for instance, might require five minutes of hand-walking a day for a week, adding five minutes a day every week for several weeks, our sources say.
Over two months that lesion will fill with new tissue that’s “slightly disorganized,” says Arensberg. That’s a critical moment to seize, because it’s your chance to “train” the scar tissue to become more elastic and work more like a tendon. If an ultrasound confirms that level of development, then in many cases you can—and should—jog the horse unmounted (e.g., on a treadmill, exerciser, etc.) progressively over the next six to eight weeks to help turn that tissue into a sort of rubber band, he says. “Hopefully those fibers will start to lengthen and organize, basically aligning with the rest of the collagen fibers in the tendon,” he says.
With these tendon injuries, plan for six months of rest and rehabilitation, with strict adherence to the controlled exercise protocol, Arensberg says. Too little exercise, and “basically that rubber band will turn into a rock.” Too much, and “you risk rupturing that tendon altogether.”
Resist the urge to jump ahead in the rehab program. “Horses usually want to do more than the injury says they can do,” Davidson says. “The lameness and soreness always get better sooner than the injury heals, so it’s important to follow the veterinarian’s set program regardless of how great your horse feels (or how bored you are).”
Treating the Body and the Mind
Stall rest isn’t fun for anyone— especially the horse. It can even be detrimental to his welfare, causing high levels of stress. What’s more, locking him up might make him more active and lead to further injury, says Gutierrez-Nibeyro. If he does well in a stall-sized pen, you can at least keep him outside, he says.
Some horses do better inside a stall, though, where they can’t see what they’re missing, Davidson adds. “It really depends on the horse,” she says. Essentially, the right place for restricted movement is where the horse moves the least. Keeping various stall toys and a haynet full of less nutritive hay can keep him busy without piling on the weight.
Arensberg says stall rest can include— depending on the diagnosis—a stall with a tiny attached run or turnout. And judicious use of veterinarian-guided tranquilizers can help make the days during the rehab process seem shorter. “We’ve got to treat the mind as well as the body,” he says.
More equine rehab and rest therapy centers—such as Hamel’s Phoenix Farm—are cropping up in the United States and Europe, but “the science is still lacking” as to the efficacy of the complementary therapies they use, says Gutierrez-Nibeyro.
Certainly, cryotherapy can be beneficial immediately after injury, but other trendy treatments such as seaweed therapy might just be luxuries, says Davidson. “We all like our spa days,” she says. “And that kind of spills over into the equine world. Science will have to tell us what the exact benefits of these alternative rehab treatments are.”
An undisputed benefit of a therapy center, however, is passing on the task of following the proper rehab protocol to an experienced professional. “The reality is a lot of owners just don’t have the time or the patience to carry out the rehabilitation program,” Gutierrez-Nibeyro says. “A lot of these centers do a pretty good job as long as they’re closely working in conjunction with a veterinarian.”
When your horse is injured, he needs a veterinary evaluation. Whether you pursue aggressive treatment or a more conservative route can depend on finances, logistics, and what’s available to you. Regardless of the choice you and your veterinarian make, remember that even rest has prescribed doses. By taking rest seriously, our sources say owners can see sustainable healing that can, in many cases, rival results they would have seen with more invasive therapies.