Immobilization or stall rest is sometimes necessary for an injury to heal, especially in cases of severe tissue damage (such as tendon or ligament damage and fractures), but other times keeping horses moving is actually a better approach. The key is choosing the right exercise for the type and location of the injury. We cannot just tell horses, for example, to engage their core. We have to design exercises that achieve the desired result.
The goals of therapeutic exercise are to increase tissue strength, improve range of motion and quality of tissue healing, and prevent scar tissue formation.
Although controlled exercise is an important part of equine rehabilitation, there are few well-designed, randomized studies investigating therapeutic effects on musculoskeletal injuries. As with many other equine rehabilitation approaches, treatments are often based on what is known from human physical therapy.
The key is choosing the right exercise for the type and location of the injury.
Steady beginnings – walking
Controlled exercise often begins with walking activity, which can include hand walking or walking on an automated horse walker or exerciser. A 2018 international study regarding the use of rehabilitation modalities in horses reported that 97.3% of respondents utilized controlled hand walking and 56.7% used automated horse walkers (Wilson et al 2018). The goal of walking is to improve mobility, reduce swelling, facilitate tissue repair, and promote cardiovascular fitness and bone strength. In some cases, this can be achieved on a land or underwater treadmill, which may be preferred if turning or circling is not advised based on the injury.
As horses progress through the healing process, new, targeted exercises may be introduced.
A Note on Stretching
Stretching exercises may be indicated to decrease pain, improve range of motion (Haussler et al. 2020), strengthen muscles (Stubbs et al. 2011), and prevent injuries. Research suggests that passive stretches held for 30 seconds provide optimal results. Dynamic mobilization exercises (i.e. “carrot stretches”) are useful for horses with back pain or on stall rest to help maintain core strength. Research has shown improved joint movement, improved muscle symmetry, increased core strength, and improved lateral bending.
On the way up – inclines
Inclines may be incorporated into rehabilitation programs to facilitate activation of abdominal muscles and strengthen other muscles, particularly in the hind end. Exercises may include walking up and down hills or utilizing inclines on a land treadmill.
Up and over – poles and pedestals
Walking or trotting over ground poles and raised cavaletti activates the full range of motion of the front and hind limbs. These exercises are useful for rehabilitation of neurological cases by training proprioceptive skills and visuomotor coordination. It is also beneficial for improving or restoring joint range of motion through increased flexion (Brown et al., 2015). Trot poles strengthen propulsive muscles including hip flexors, without overloading musculoskeletal tissues or increasing the extension of fetlock joints. Importantly, beneficial effects persist throughout the course of the exercise, unlike the use of proprioceptive stimulation devices in which the effects decrease over time.
Obstacle work may also include pedestals. Horses can be asked to walk up onto and over a pedestal, or to stand on the pedestal, simulating collection. Similar to poles and cavaletti, this strengthens abdominal muscles and proprioceptive skills.
On the line – ropes, lines, and bands
Systems of bands or ropes that are positioned across a horse’s back and/or around their hindquarters have become popular in equine rehabilitation. Some are used while longing and others are used while riding. These include the Pessoa training aid and Equiband®. When using these tools, it is important to avoid inducing hyperflexion of the neck (i.e. the head needs to stay in front of the vertical).
The Pessoa training aid is an array of ropes, pulleys, and straps intended to assist with building muscle and increasing the horse’s use of its back muscles during longing. While working in this rig, horses are collected, with a raised poll and decreased stride length. The system allows for different positions that put horses in various frames, from “long and low” to an upright frame. It may improve posture, stimulate core muscle activation, and improve gait quality without increased load on lower limbs.
The Equiband® system is comprised of abdominal and hindquarter resistance bands attached to a saddle pad. It is used to promote hindlimb engagement and may aid dynamic stabilization of back muscles (Simmons et al. 2015), as well as strengthen core muscles.
Tissue healing is a complex and variable process, but it does follow predictable phases. An appropriate exercise program complements and enhances the healing process of the injured tissue.
Many horses suffer complex injuries, so it is important to have a full, accurate diagnosis prior to starting a controlled exercise program. Rehabilitating one injury while neglecting another can lead to incomplete healing or reinjury. It is important to work with a veterinarian and equine sports medicine and rehabilitation specialist throughout your horse’s rehabilitation.