Physical Therapy and Rehabilitation in the Equine Athlete

By Joanne Fehr, DVM

Human athletes have benefited from physical therapy and rehabilitation programs for decades. Programs led by trained therapists using many different types of therapeutic equipment are available to help patients regain strength, balance and coordination while decreasing the risk for reinjury. But equine athletes have only begun to have the advantages of this process in the last decade. The American College of Veterinary Sports Medicine specialty was recognized in 2010 and in 2018 was fully supported by the American board of Specialties and the AVMA.

Today, trainers have access to certified equine physical therapists as well as board certified equine sports medicine and rehabilitation specialists. Veterinary sports medicine and rehabilitation is a multidisciplinary specialty that encompasses in-depth physical and clinical examination, diagnosis, treatment, and prevention of sport and work-related injuries and physical disorders. Rehabilitation of injured animals requires a holistic approach built on controlled therapeutic exercise, functional training, manual therapy techniques, and physical modalities.

Sports Medicine

The performance expectations of equine athletic disciplines only continue to rise, and with them, so do the risks of injury. One study evaluating wastage in event horses found 35% of the horses followed were not re-registered the next year because of veterinary problems – other studies have found anywhere from 21%-45% of eventers experience locomotive injury that keeps them out of performance the following season.

Sport category and performance level also affect both the potential risk of injury and the specific injuries that are diagnosed. According to a 2006 study, the risk of forelimb superficial digital flexor tendon injury is higher in eventing and elite show jumping, while hindlimb suspensory ligament injury is more common in elite and non-elite dressage.  

Older sport horses typically suffer from repetitive-type injuries: exacerbation of osteoarthritis due to sprains or strains involving the soft tissues around compromised joints. These athletes can get an acute overload causing soft tissue injuries associated with the joint capsule or the collateral ligaments.  

Needless to say, when an injury occurs, immediate and effective treatment is of the utmost importance to get the horse back into the show ring or back on the track as quickly as possible. But it is equally important to recognize that time is a crucial component of recovery, and different tissues heal at different rates. An effective rehabilitation program cannot ignore the time it takes for tissue to heal.

Physical Therapy

Shockwave therapy; ultrasound and laser therapy; and PEMF (pulsed electromagnetic field therapy) are all supplemental therapies that can help manage pain, inflammation, and healing. If the primary injury has been of a longer duration, compensatory injuries or lameness may have developed. Chiropractic assessment and adjustments can be very helpful in remediating these secondary injuries and helping to rebalance the body biomechanically allowing better healing as well as improving strength and flexibility.

But whatever supplemental therapies are used, physical therapy is an indispensable aspect of injury recovery for equine athletes. When a horse has suffered an injury, an abrupt return to regular training increases the risk of reinjury. A formal physical therapy program is most commonly required for injuries of soft tissues such as ligament, tendon or muscle.

Muscle injuries heal fastest due to higher turnover of the cells and good blood supply to the tissue, and may only require a few weeks for rest and rehab. Tendon and ligament injuries will require a longer period of rest with stall confinement and local therapies before the gradual addition of controlled exercise. Rehabilitation for surgical patients depends on the specific surgery involved, with stall confinement ranging from 4 –12 weeks to allow for healing time.

Non-weighted Rehabilitation

Stretching, massage, muscle stimulation, and strengthening exercises are all components of rehabilitation. When controlled exercise begins, the program may be as simple as 5 minutes of hand walking twice daily, increasing by 5 minutes a week, or it may incorporate a water treadmill to reduce the load on soft tissue and joints while improving strength due to the water’s resistance.

When a horse has been on extended stall rest, loss of strength in the back muscles becomes an issue. Rehabilitation should focus on restoring strength to those muscles and will include specific core strengthening exercises as well as ground work over poles and cavalettis to gradually engage and strengthen the core back muscles.

Weighted Work

Once the patient has completed the non-weighted component of their rehabilitation program, they will proceed to weighted work under saddle. This changes the biomechanics of movement and places stress on their vertebral column. To start a patient back under saddle after a long rest period it is important to perform warm up exercises on the ground – such as walking and trotting over poles causing the patient to engage their back muscles. Specific rehabilitation exercises can be added to the basic plan to retrain the athlete to use the back muscles correctly and symmetrically.

Trainers who follow their veterinarian’s recommended rehabilitation program will be rewarded with better performance and decreased incidence of reinjury in their horses.