IN-DEPTH: LAMENESS REHABILITATION


with a bridle on or a chain over the nose or in the mouth can definitely be helpful. Sedation is some- times required. It takes a person with a lot of pa- tience and good horse handling for this to be successful. The footing is also important. It re- quires good, consistent footing. Footing that is too deep can add stress to the injury. Sometimes it is safer and more prudent to walk the horse under tack depending on the case and individual horse. In a clinic situation or rehabilitation facility it is difficult to exercise more than one horse at a time, given that if one horse acts up, in most situations it will set off the other horses. Initially start at 10 minutes a day and increase walking to 20–30 minutes, one to two times a day depending on the individual case and injury severity. It is important to add in daily ice treatment following exercise to help decrease inflammation.


3. Starting to Walk Under Tack


Depending on the case but usually the sooner you can get started the better, and it is sometimes safer than walking in hand. Draw lines and sedation are sometimes required. There should be no lateral work, especially with suspensory ligament injury at first. When ready to add stress to the injury you can start to do some collected work and extended stride walking. It can also be done by walking over poles on the ground. You can then add raising the poles off the ground as well when ready. The next step would be walking up and down gradual hills if available to increase stress and stretching on the tendon/ligament. Other modalities, such as treadmills, work well in


certain situations. There is the cost factor (rent) to consider, but it does help save time, the horse walks at a consistent speed, the footing surface is consis- tent and the incline can be added when ready. You must be careful if the horse is not trained to use the treadmill before the injury, given that they have a chance of injuring themselves and/or re- injury when getting acclimatized to the treadmill (take time to train them to it). There is some con- cern of the constant concussion when walking on the treadmill. Walkers are another option. They are time sav-


ing, decrease labor, and you can do more than one horse at a time. Concerns are the need for good footing in the walker, and it needs to be maintained. Walkers are not recommended for collateral coffin joint injuries due to the constant turning force on the front feet. There is also risk of re-injury due to the fact they can jump around, not as constricted as treadmill. The author usually does not recom- mend the walker until further on in the rehabilita- tion process, obviously the larger circumference of the walker the better (less stress). The underwater treadmill can also be used to help increase cardio and muscle fitness, as well as add gradual stress to injury; the problem is they are expensive and horses must be trained to use them.


They are time consuming to use and require main- tenance, and there is risk of injury if the horse has not used it prior to initial injury. A vibration plate is a good additional tool to the rehabilitation protocol. It allows increased muscle, tendon, and ligament fitness without adding addi- tional stress to the injury, and also increases circu- lation to the lower extremities. The odd horse does not tolerate the time on it very well.


4. Support Bandage


Quite often the question arises: Should you use support boots or bandages during the rehabilitation process? Polo wraps do add some protection, but not a lot of support. Run-down bandages do add some support as do the Professional Choice boots. If these are used, the author likes to wean the horses off them during the rehabilitation process and just use protective sport boots.


5. Tentative Rehabilitation Schedule


When the horse is ready to start back into work, this could be anywhere on average from 3–6 months after the injury all depending on the severity of the injury.


First Month Back to Work


Walking under tack, 20–30 minutes per week and increasing by 5 minutes per week, up to 40–45 minutes at the end of the month. After 2 weeks start to walk over poles, and at 3 weeks start to do some gradual hill work. This could be split into two sessions in 1 day. Routine ice treatment following each exercise is always recommended. A phone timer works well to keep track of time.


Second Month Back to Work


Continue with walking regimen and start to trot 5–10 minutes, split each direction, and increasing by 5 minutes per week. Do not go deep into corners and no tight circles or lateral work initially. Near the end of the month you can start to trot trails and small gradual hills. The walking should be split before and after trotting, and the walking time will start to decrease as the trotting time increases.


Third Month Back to Work


Continue walk and trot, start some trot circles at 20 meters and raised trot poles and start canter work. Canter work can be done by time or number of rounds of the exercise arena, whichever is easier to keep track of. Start gradual and increase accord- ingly. No tight circles at the canter initially. Af- ter cantering for 1 month the horse can usually go back to full work and start to jump or begin more advanced dressage work.


6. Follow-up


It is very important to reassess the injury with a lameness examination and ultrasounds at regular intervals, every 4–6 weeks, and to make sure the


AAEP PROCEEDINGS  Vol. 62  2016 257


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