A guide to box rest — how to navigate this testing time

  • When a horse has to stay in the stable for a prolonged period of time, all kinds of problems can ensue. Gil Riley MRCVS advises on how to manage box rest

    MANY conditions or injuries sustained by horses, as with humans, can require a period of rest for weeks or even months. However, unlike with humans, we are unable to advise our horses to take things easy and that’s why stable (box) rest is such an important part of many a horse’s recuperation.

    The duration and nature of the box rest will be individually tailored for each horse and will be dependent on the condition or injury sustained as well as their speed of response to the rehabilitation programme.

    One of the most common reasons for box resting a horse or pony is laminitis. It’s vital that laminitis patients are totally confined to the stable on a deep bed of shavings so that the inflamed laminae are not put under any unnecessary strain while they are repairing.

    A failure to do this can result in the pedal bone, ordinarily supported by the laminae, rotating or even sinking (foundering) and thus greatly increasing the seriousness of the original condition. A horse with laminitis must remain completely boxed for at least three weeks after first contracting the condition, after which gradually increasing turnout can be introduced if the horse’s condition has resolved.

    Most horses post-surgery also require box rest as a fundamental part of the recuperation programme. All horses that have had colic surgery will be put on box rest to prevent the stitches in the body wall being excessively taxed. This minimises the likelihood of herniation of the intestine through the wound in the muscle layers along the midline of the belly.

    Strict box rest in both laminitis and colic cases also requires rigorous control of the diet. In laminitics, a low-calorie diet or weight loss programme is a must. In colic cases, a major surgery can be followed by a period of at least 24 hours of starvation. This is then followed by a bran mash and then a high-fibre diet fed little and often. Restricted diets can be hard with horses with reduced gut motility or gastric ulcers, so best ask your vet.

    Unlike laminitis cases, colic surgeries can often benefit from a short walk out several times during the day to allow a pick of grass and to ease any fluid that may be collecting along the site of the incision – the midline along the belly – which is prone to fluid gathering under the effect of gravity.

    Hand grazing

    Depending on the reason for box rest, your vet may allow some periods of hand-grazing

    A HORSE’S recovery from injuries of the superficial digital flexor tendon – check ligament or suspensory ligament (all structures running down the back of the cannon) – necessitates a prolonged period of box rest. Animals which are recovering from any form of fracture repair, especially those of the limb, will also need this.

    An important part of the repair of these structures is, after a short initial period of complete box confinement to allow the injury or repair to settle, that they should be exposed to a measured workload in the form of walking out on a hard, flat surface.

    This usually means around 10 minutes twice daily, increasing to 30 minutes twice daily over a period of six to eight weeks. Box rest, in association with walking out, gives structures the space to repair through the laying down of collagen fibres (or in the case of fractures, bone).

    The walking out also provides gentle work to encourage the tissues of repair to be laid down in alignment with the direction of load, so they are best able to withstand the stresses and strains of work when exercise is resumed.

    If your vet has advised a walking programme, you must continue with shoeing as the hard surface can quickly cause the horn to crack and foot soreness to develop.

    LESS common but still often

    requiring a period of box rest are eye injuries. Keeping the horse out of sunlight is vital as this can exacerbate discomfort, cause unhelpful squinting, tear streaming and potentially further injury through the horse rubbing the eye in an attempt to alleviate the accompanying irritation. The last thing an injured eye
    needs is further trauma.

    IT is vital that box rest is what it suggests; rest in a stable. An agitated horse running around its stable is not a resting horse and this must be prevented, else the whole treatment plan is in jeopardy.

    Some common problems with box rest can include…


    horse with stable bandages on paying with a snack ball

    SOME horses will tolerate box rest well. These are generally older horses of a more settled temperament; younger horses of the more hot-blooded breeds tend to be the worst patients.

    The stress of box confinement can lead to the horse’s behaviour becoming very unpredictable. Such horses can develop stereotypies to relieve their stress (crib-biting, swaying, box-walking) and these may not disappear once the horse no longer requires confinement.

    For such horses, it is vital to experiment with stress-relieving measures. Is the horse better if it is confined to a stable where it can see other horses in the field? Is it better when a companion is kept in the stable next door to keep it company? Keeping other horses in as company, possibly on a rota, can really help.

    Some distraction measures can be very useful, such as boredom balls, dangling licks or toys, and mirrors can relieve the monotony for some horses.

    Spending as much time as possible grooming the patient will go down very well, as long as it is safe, you are not on your own and appropriate safety precautions – such as tying the horse up and wearing a hat – are taken.

    Food intake can be a good distraction, so small, regular hay nets and frequent low-calorie feeds throughout the day are advised. Double netting the hay is a good idea, as the horse will have to work that bit harder for its food to keep its stomach satisfied.

    In those horses that are bedded on straw, a continual trickle feed of hay can also ensure the horse does not gorge on its straw bed and risk developing an impaction colic. All of this requires a dedicated owner or a supportive livery yard.

    There are various calmers on the market and some owners find these helpful. Most are based on either magnesium or L-tryptophan; this amino acid is the precursor of serotonin (the calming, feel-good hormone in the horse’s brain). While the effects of calmers can be inconsistent, if they seem to work, by all means feed them.

    In the more fractious animals, it may be necessary to discuss the use of oral sedatives with your vet.

    These are also from one of two groups, acepromazine (ACP) and detomidine. The effects of the ACP sedatives tend to be mild but can be very effective in all but the most agitated animals. The detomidine-based sedatives are generally very effective and safe, even if used on a daily basis longer term, but they are more expensive.

    Oral sedation can be especially helpful when the horses are on a walking-out programme as many patients will be fine in the box but are prone to explode once walked outside. It should also be noted that the cost of daily sedative over a period of months in some horses can really mount up.

    Respiratory issues

    PROLONGED confinement in the stable can result in issues with dust, especially in those animals that have a history of respiratory sensitivity or allergies. Signs can include nasal discharge, persistent coughing and airway inflammation.

    Use dust-free bedding and make sure the stable is mucked out several times a day so there is minimal ammonia in the environment. Also, choose a dust-free forage such as a good-quality haylage or soaked hay.

    Provide as much ventilation as possible. Moving to an outdoor stable or one at the end of the barn can help with the ventilation. If the ventilation in the stable is sufficient, spiders should not be able to weave their webs so if cobwebs are on view, maybe it’s not the best stable for a prolonged period of rest.


    ASIDE from impaction colics as a result of eating the bedding, prolonged box rest is associated with a greater incidence of colic. This may be due to the change of management with the horse being confined to the stable rather than out in the field.

    However, should pain-management with non-steroidal anti-inflammatory drugs be concurrent, then these can interfere in gut movement and impaction colics or displacement colics (where the colon or caecum of the large intestine moves out of position within the abdomen) can result.

    Such colics are best prevented by limiting the pain relief to the minimum necessary, ensuring a consistent, regular supply of roughage and of clean, fresh water, and those regular short spells out in-hand.

    No two recovery plans are the same, and while box resting a horse can involve intensive effort on behalf of the owner, its frequent role in achieving the very best recovery for the horse means it is a vital component in many successful rehabilitations.

    Plan of attack

    Sand turn out paddocks in the snow

    The programme for box rest patients is never a one size fits all. Consider some of these options…

    • Outside pen. If the horse will not settle on box rest it may be possible to revert to a stable-sized area outside (pictured). A sturdily fenced off patch in the corner of a field, within a very short walking distance of the stable to which it will go in at night, can work well.
    • Rehabilitation centres. A more recent development in the UK is the growth of rehabilitation centres which are willing to work alongside your vet in achieving the very best recovery for your horse. Such units are staffed with competent handlers and facilities that allow the recuperating patient to be managed in a safer, professional environment.
    • Horse-walkers allow for the walking-out exercise to be performed without a handler exposed on the end of the lead rope and within range of those extendable forelegs. The diameter of the walker should be at least twenty metres as smaller circles can create continual torque on the limbs and joints, sometimes leading to soft tissue injuries.
    • A swimming pool will allow a full-body exercise without the weight bearing down on injured limbs, while water treadmill exercise encourages particular engagement of the back and sacroiliac area.
    • Sending your horse to one of these centres will often be covered on your insurance policy but, even if your horse is not insured, the cost of providing the necessary care at the home stable (bedding, fuel back and forth to the yard etc) may not work out much less expensive than it being performed by the professionals.

    This feature is also available to read in this Thursday’s H&H magazine (22 April, 2021)

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