Rebuilding Athletes To Peak Performance

Rehabilitating a horse after an injury features controlled exercise that promotes range of motion.

Equine rehabilitation has been gaining increased interest since 2002, when the first facility dedicated to rehabilitation of equine athletes opened in Kentucky. Therapies such as stem cell therapy, Interleukin-1 receptor antagonist protein (IRAP) and platelet rich plasma (PRP) are often prescribed by veterinarians and used in rehabilitation centers along with underwater treadmill, laser therapy, cold saltwater spas and hyperbaric chambers.

Rehabilitating a horse after an injury features controlled exercise that promotes range of motion (ROM) and the growth of healthy tissue rather than scar tissue, allowing for a faster return to normal activity levels.

“Veterinarians make a diagnosis, prescribe medication and choose a rehabilitation program, but typically rely on an equine rehabilitation facility outside of their hospital to carry out the therapy,” says Patrick Grohl, owner of Premiere Equine Center LLC, in Oakdale, Calif. “Sometimes finding a qualified rehabilitator can be difficult, depending on the region.”

Levels of rehabilitation differ,  with facilities offering or specializing in specific services. Experts suggest equine practitioners make a connection with a facility they believe can carry out rehabilitation and medication instructions even if performance horses and racers aren’t a large part of the clientele.

“While performance horses are perhaps more predisposed to injury due to their elevated work levels and expectations, any horse, including pleasure riding horses doing lower level exercise, can incur sports injuries or lameness,” says Angie Hager, owner of Los Laureles Equine in Hollister, Calif.

“Rehabilitative techniques are applicable to all of these. Clients are seeing the value in a good rehab program and a huge value in putting their horse in capable hands during this critical time.”

Hager says therapies such as intralesional injection might necessitate an advanced care level with follow-up therapies such as electrical stimulation therapy, hand-walking, Euro-walker ROM exercise and an underwater treadmill if necessary. 

 “The horse usually comes back more fit than when it entered rehab and the goal is to return to training and performance with the injury 100 percent healed,” Hager says. “While there is much variation in post-injury rest/healing protocols, it is important to take into consideration that horses ‘detrain,’ or lose their conditioned level of fitness required for performance, in 60 to 75 days of stall rest.”

Reason for Rehab

Equine rehabilitators say that about half of their clients’ horses have had surgery before  rehabilitation. However, an injury isn’t the only reason a horse may require rehabilitation.

“[Horses with] colic, arthroscopic and tenoscopic procedures, ligamentous/tendon and meniscal surgeries and related sports medicine procedures also benefit from rehabilitation,” Hager says.

“Keeping the horse at its fitness level helps its musculature and supports the injured area. And there’s a psychological benefit of giving the horse a ‘job’ and not just putting the horse in a stall or paddock and letting nature take its course.

“Proper rehab helps to return the horse to its job faster because the chance for re-injury is markedly less. In addition, a horse that undergoes a proper rehab program is much more likely to be successful in accomplishing a return to its previous level of work. This is observably parallel to a human’s need for physical therapy (PT) after injury, where studies have shown that PT after an injury significantly increases the chance for 100 percent recovery.”

Cold Leg Spa

A cold saltwater spa for horses was developed in 1998 by Evan Hunt, MVSc, PhD, a retired professor at University of Sydney-Orange, Australia. Dr. Hunt had an interest in race horses and their injuries and worked to develop a way to better treat or prevent injuries. Now equine spas are sold in the U.S. and other countries.

“The cold water leg spa is newer to the industry and meant to be used after a hard workout,” Grohl says. “This helps reduce inflammation and prevents future injuries. We use this at our facility and at races. The spa isn’t made to be mobile, but we found a way to transport it because there’s such a great need for it.”

Although a great preventive tool, the cold saltwater spa can be used for many purposes.

“The cold saltwater spa is terrific for any injury that has pain, heat, swelling/inflammation, or poor circulation due to damage or injury,” says Brenda McDuffee, general manager at The Sanctuary Equine Sports Therapy and Rehabilitation Center in Ocala, Fla.

“We treat many laminitic horses, soft tissue injuries and joint problems. The 35-degree water has 250 pounds of Epsom salt and regular salt in it. The salt water will cool the legs down even more than is possible with fresh water, so when the horse comes out of the spa his legs will stay cold up to three or four hours and the cold penetrates completely through the legs, much more so than cold hosing, cold wraps or standing in ice water can do.”

Grohl says horses might stay at a rehabilitation facility for 60-120 days or longer depending on their  needs.

“Environment plays a huge role in a successful rehab program,” Hager says. “If a horse is surrounded by horses jumping or running around, they tend to get excitable and are less likely to mentally adapt to a successful rehab experience. In a dedicated rehabilitation facility, the focus can be directed toward providing a relaxing and less stressful environment wherein the horse can undergo therapeutic and exercise programs directed at their specific injury/injuries without anxiety or excitement.”

McDuffee says hyperbaric oxygen therapy and water treadmills are essential equipment for equine rehabilitation, but  smaller pieces of equipment such as therapeutic lasers, electro-magnetic pulse machines, ultrasounds and respirator machines are also an integral part of services.

Other Tools

“The hyperbaric chamber is a cutting–edge modality for numerous wound healings and post-surgical situations,” Hager says. “Many vets have seen benefits of this therapy post-stem-cell injections. It has been proven that the use of hyperbarics, which pushes oxygen into the injured areas, can promote dramatic decreases of healing time.”

The therapeutic vibration floor is another device used in equine rehabilitation. The vibration improves muscle training and toning, improves blood circulation, burns fat, reduces muscle stiffness and treats colic.

“The vibration floor increases blood flow the lower limbs, promoting increased bone density,” Hager says. “This modality has also had positive results with laminitic horses, since it helps to promote hoof growth.” Modalities must be used in an appropriate and timely fashion to benefit the horse at specific phases of the rehabilitation process.

“Along with the advances in therapeutic technologies such as stem-cell, PRP and IRAP, rehabilitation remains paramount to bringing horses back 100 percent,” Hager says. “The days of six months in the pasture are long gone.”


The International Association of Veterinary Rehabilitation and Physical Therapy is an emerging group dedicated to the advancement and education of rehab for all animals.

The American Association of Rehabilitation Veterinarians (AARV) also contributes to the education of practitioners. Knowing these therapies exist and their benefits constitute the first step in creating the best standard of care for all animals’ rehabilitation needs.

“The California Equine Veterinary Rehabilitation Association is a new organization focusing on the development of new rehabilitative protocols applicable to the sports medicine injuries encountered in the sport horse population,” Hager says. “The association is also active in promoting education of the professional and lay community, which is incorporating rehabilitation and physical therapy principles [for] locomotor conditions that are encountered in our equestrian community.” 


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