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When a horse has suffered an orthopaedic injury involving bone, muscle or soft tissue, the aim of rehabilitation is to restore full function as quickly as possible. Effective rehabilitation will facilitate a healing response without overloading the injured structure.

The risk of recurrent injury is minimised if the repair is of the highest possible quality. This does, however, depend on an accurate initial diagnosis. If a horse with a suspected tendon injury is turned out for a month or so before being scanned, the long-term result will never be as good as that of a horse appropriately confined from the start. An acute injury needs sufficient rest in the early stages.

Yet horses evolved to be moving constantly, so too much box rest can be detrimental. Your vet will advise you to begin controlled exercise with your horse as soon as is practical, taking the severity of the initial injury into consideration.

First steps

The idea is to start loading the affected structures in a controlled manner. In an injured tendon, for example, scar tissue starts forming in a random fashion. The aim is to encourage the healing fibres to orientate in the plane of loading, as they would be naturally, leading to a stronger repair in the long term.

Controlled exercise usually starts with hand-walking exercise. Use a bridle or Chifney with a lunge line if you need extra control, or ask your vet for advice on sedation. Ridden walking exercise can start fairly early, as the weight of the rider does not normally add much extra load. Generally, whichever form of walking exercise leaves the horse calmest is best.

Ideally, walking exercise takes place on a flat, even surface. I am not a fan of horse-walkers in the early stages of injury, although they can be useful later as the amount of walking increases. While the turning motion can 
be harmful in certain cases, such as collateral ligament injury, a horse-walker may be advantageous in developing local musculature after a back injury.

The aim is that the horse is not standing still for long periods of time. A longer ridden session followed by a shorter in-hand walk at the other end of the day may be a practical solution.

Changing gear

Reassessment can then take place to determine the next increase in exercise levels.

By this stage, your horse may be completing 30 to 40 minutes of controlled walking exercise per day. Progression to trotting should be gradual. I would normally recommend adding in a few short stretches of trot work during the first trot week, increasing this to around five minutes of trotting per day, broken up into intervals.

Surface choice will depend on the nature of the injury, but a combination of hard and soft ground will challenge the limbs in different ways. If a horse has a concussive type of lameness, too much trotting on roads can be detrimental. Minimising the use of traction devices such as road nails will help reduce concussion through the feet.

Trotting uphill may be appropriate to build muscle in the hindquarters and increase fitness, but this must be judged according to the original injury as it will put more load on the hindlimbs.

The next stage would usually be to commence canter work or progressive turnout, depending upon the horse’s temperament, the type of injury and the time of year with regards to the state of the ground. Cantering exercise should also be progressive, taking place in a straight line on a gallop or piece of set-aside. If in a school, canter on wide circles and avoid tight turns in the early stages.

Building muscle

At this point, the horse will start to build muscle — a very important part of rehabilitating hindlimb and back injuries. The quality of the work can increase with the quantity, in terms of schooling the horse and asking for more collection. This, again, should be gradual and at the discretion of rider, trainer and vet.

Flexibility exercises such as shoulder-in can be beneficial, but care is needed with more advanced movements. In half-pass, for example, the crossing over of the limbs can put strain on structures such as the suspensory ligament branches. It is very difficult to be 100% prescriptive, so common sense should prevail.

A few minutes on the lunge can take the edge off a horse before controlled ridden exercise. Too much lungeing may not be appropriate in the early stages of rehabilitation, however, and it is not recommended for conditions involving the sacroiliac joint or suspensory ligaments.

In certain other cases, lungeing is helpful — especially in the later stages of rehabilitation to build up spinal flexibility, muscling and fitness. It is particularly beneficial with back injuries and may be introduced relatively early, even after surgery. Lungeing in a Chambon or a Pessoa, if the horse will tolerate it, will encourage him to work in a better outline.

Field days

Turnout can be an important part of rehabilitation, giving more time for healing tissues to mature and remodel. It is also a period of risk, but this can vary depending upon the nature of the injury.

While tendon damage may be exacerbated at this stage, high suspensory injuries tend to tolerate turnout well. Horses who are turned out will have better bone health and fitness compared to those on box rest.

Again, take the horse’s temperament into account when determining how best to manage this transition. Ideally, start him off in a small, well-fenced area so that he can mooch around in a calm fashion — there may be some periods of more exuberant activity, but turnout will not be productive if he starts doing a “wall of death” around a small pen.

The horse can then be reassessed with a view to coming back into full work. Reaching 
this point may take as little as three months for bone damage but up to a year for a tendon or ligament injury.

Throughout, exercise should 
increase steadily with veterinary monitoring. The rehabilitation process is a balance: take it too fast and you risk reinjury; but go too slow, you’ll waste time out of competition and may not promote sufficient healing to produce the best athletic outcome.

Ref Horse & Hound; 26 April 2018