Rehabilitation Plans How Can They Go Wrong

Rehabilitation plans can often seem difficult and daunting.  You have spent a lot of money on expensive veterinary treatments or operations and now your horses success or failure lies in your hands.  You know it is important that you get it right but often the support isn’t there or you don’t know where it is  going wrong until it is too late.

Rehabilitation plans are normally formulated by your vet & /or your physical therapist to provide prescriptive exercise to help your horse recover from injury or illness so that they can hopefully return to the same level of performance as they previously were, or as close to it as is now physically possible. The most common injuries that I formulate rehab plans for include back pain and spinal dysfunction including kissing spine, spondylosis, arthritis, soft tissue injuries such as tendon, ligament and muscular strains and tears, arthritic conditions, and fractures. Most of these conditions require veterinary intervention followed by a course of physical therapy and a prescriptive exercise plan.  These rehab plans use movement and specific exercises to strengthen and support the horse to initiate gait retraining to recover the injury, prevent further injury to the same area or another area in compensation and to optimise function.  These exercises need to be correct, appropriate, progressive and within the correct time frame.  Sometimes rehab plans fail in that the horse does not return to full expected performance level or soundness, or develops another lameness in another area due to compensation.  In my experience the main reasons for this include:

–          Not understanding what it is that is required at each stage – if you don’t understand the exercise or what it is exactly that you should be doing, no matter how stupid you think the question might be, ask anyway, as even doing something slightly incorrectly when repeated over and over can make a massive difference to the success or failure of a rehab plan.

–          Not executing the exercises correctly – the amount of time I see owners not doing exercises correctly, one that I see so often is in-hand walking, how hard can it be, you would think?! In-hand walking shouldn’t be just dawdling along.  It should be an active walk so the horse is doing more of a medium walk, you should be power walking along side the horse, if you are not out of puff from in-hand walking for 15 mins you are probably not doing actively enough for your horse.  You will get back in shape too!  For other exercises too, ask your horses physical therapist to watch you completing the exercise to ensure you are doing it correctly.

–          Not wanting to do a specific exercise because the horse/owner doesn’t like it, doesn’t enjoy doing it, finds it difficult. Rather than working with the horse to calmly encourage them to complete the exercise they try to get the horse to do it by force causing it to be rushed and fearful, anything the horse does out of fear will never be productive or successful in its aims. Time and patience are paramount when it comes to rehabilitation and exercises.

–          Being in too much of a rush – lots of owners are in a hurry to move on to the next stage, in a rush to get back on board, a rush to get trotting, a rush to go from box rest, to get the horse turned out again, etc.

–          Doing exercises too fast – most exercises are best done at a walk; poles, hills etc. So that there is control over limbs and movement, stability, the horse cannot use the momentum and ground reaction force to get itself over the poles that it does in higher gaits.

–          Using inappropriate training aids.  For the majority of rehab plans training aids are not required.  Sometimes a veterinary guided rehab plan they recommends using pessoa or similar. For the majority of cases this is most defiantly not required and can hinder regaining correct posture and movement.  Also the vets don’t check that it is being used correctly which again for most cases it is not!

–          Not doing enough – some times owners seem to think that lengthening the rehab plan is beneficial for the horse and sometimes it can be, but this should be done in conjunction with your physical therapist and or vet as for certain injuries this is not always appropriate as it is the progressive loading exercise that actually aids healing and recovery so if you are lengthening this you may be hindering them.  But also lengthening the treatment plan you need to ensure that you are doing the same exercise for longer.  I have seen some rehab plans fail where the owner has discussed with the vet about lengthening the rehab plan but they take that as do a few weeks of rehab then nothing for a week or 2, then pick it back up again when they have time for a week, then rest for a few weeks again.  It needs to be consistently carried out.

–          Not keeping up to date with regular physical therapy treatments.  Quite often when a horse becomes lame, and is under veterinary treatment the owner will cancel their regularly planned treatment session, with a reasoning of well if the horse isn’t being ridden I won’t feel the benefit.  However, it is important that we do even more as if the horse is lame it will compensate its movement patterns or if it is on box rest will not be doing much movement at all. So it is important that we try to keep the joints as mobile as possible, we keep the rest of the horses body as free and as supple as possible, reduce as much of the secondary and compensation issues as possible.  This is all done under veterinary guidance, it is important that your physical therapist and vet work together for the long term benefit of the horse.

–          Not being fully open and honest with your vet and / or physical therapist.  When we come for a review and reassessment it is important that you are completely honest with what you have been doing with the horse.  If you haven’t been able to complete certain aspects of the plan, you hate hacking, or you decided to up it a level before it was recommended, you need to be honest as this will affect what we are seeing, feeling and the plan we make moving forwards, which can severely affect the success or failure of the plan. Don’t just be a people pleaser and nod yes I have been doing everything as per the plan when you know full well that is not the case

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