Page 139 - Speedhorse April 2019

hand walking. If we can get them to the stall after surgery/treatment, they may go the first week or two just standing in the stall as the injury begins to heal. Standing, for the horse,
is a form of therapy because now he is on that leg. If it was injured to the point of non-weight- bearing, we have put it back to where it can bear weight, retraining the injured tissue to hold the load, since it was previously unable to do so.”
The horse goes from surgery to immedi- ately standing, which is often a hard hurdle for a human. “We occasionally use a sling for horses that absolutely can’t stand on a leg. We can recover quite a few with major fractures in slings. We have a sling in the recovery stall that we put them in when they are waking up. When they try to stand, we can pick them up with an electric hoist.”
Rehab therapy starts with standing. Horses always try and must be able to stand fairly soon. “Usually after they stand on the leg for a few days and become comfortable, we can begin hand-walking, even if it’s just going from one end of a big stall to the other. Then they gradu- ally go farther, outside the stall, down the barn aisle. Eventually we can take them outside, walk in grass, or in an arena for 10 to 15 minutes. We may be doing other therapies at the same time, like laser therapy or various types of medical therapy. We might be doing cold therapy after each exercise period to make sure we don’t get a lot of inflammation,” says Easter.
“We generally progress from standing to hand-walking to under saddle at a walk. If
it’s going to be a long-drawn-out recovery, we may go from hand-walking to the underwater treadmill. For bad injuries the treadmill, due to buoyancy, is less stressful to injuries and gives us a moving exercise stage before going go back under saddle,” he explains.
“Sometimes we go from a hand walk to tack, carrying a saddle and rider. It’s usually a month of walking under saddle and then grad- ually build from there. It depends on severity of the injury and how stable it is, regarding how fast we progress. It takes a minimum of about 90 days for new tendinous tissue to regain 87% of its original strength once you have initiated fiber growth across that tear. At the end of 90 days, if it’s a fairly mild tear and now has 87% of its tensile strength, it can stand up to fairly aggressive rehab. We often monitor healing through those rehab programs during the first 90 days. At 30 days, maybe the tear is looking pretty good with hand-walking and then we can go to 30 days of walking under saddle, and then 30 days of walking and trotting under saddle, and then 30 more days of walk-trot and a gradually increasing lope period.”
It’s typical to start increasing time in 5-minute intervals per week. “We start doing 5 minutes the first week and increase 5 minutes every week. It
may be a gradually increased exercise program under saddle, but for severe injuries that take a long time to heal, we usually go with underwater treadmill work so we can keep all the joints using their range of motion with the horse striding out nicely in the water and without putting much stress on anything,” he explains.
The length of time depends on the sever-
ity and type of injury and how long we know
it takes (from previous data) for these injuries
to reach certain stages of tensile strength. “The mainstay of all rehab is gradually increasing range of motion, agility and weight-bearing load over a gradual time period while also challeng- ing the tissue until you are back at the previous level the limb was before the injury,” says Easter.
“In the interim, we may employ a wide vari- ety of techniques to help strengthen that tissue as part of the rehab process. With a suspensory branch injury, there is data that shows laser therapy helps the collagen remodeling with some horses. We may use laser therapy to help facilitate healing, provide pain relief and help the internal tissue remodel into more normal fibers. We may use shock wave therapy or dif- ferent kinds of autologous serums like IRAP
or platelet-rich plasma to put into the tissue to stimulate healing or growing new tissue. We often use bone-marrow-derived cultured stem cells to modulate tissue healing in a positive manner. Usually if we use stem cells it’s in the initial phase, implanting those into the torn tis- sue. Then we wait for them to start doing their thing, aiding tissue regeneration, and the rehab comes later,” he says.
Stretching and isometric exercises and core body muscle strengthening techniques also help, especially if the horse can’t do a lot of work yet. “Specific unique techniques to get the horse to arch its back or work different core groups of muscles are applied to keep the sta- tionary horse’s body functioning so he doesn’t lose all the core mass and strength and the spine doesn’t deteriorate and lose bone density. The theraband technique is an example. We put a stretchy band behind the hamstring mus- cles, attaching the band to a surcingle. It’s not very different from the resistance of water, but we can add the band to provide a little more resistance and target some of the core groups of muscles in the rear legs,” he explains.
“These are the main things we do at eCore. Rehab for various injuries may range from two to four weeks, for simple ones, to six months. Some horses require a year. Usually with any type of injury, by a year later what you see is what you get. The horse isn’t going to improve much more after that. Three to six months is usually where most injuries reach their end stages for rehab and healing. Depending on severity and what we know from past data on when that tissue is usually strong, we try to
Rehabilitation is essential to deal with severe injury to ligaments and tendons and will usually begin with some light walking and gradually increase from there.
gauge our rehab to step up the therapy along that time frame. If it’s an injury that typically takes six months for those horses to be back in training, we tailor our rehab so we can gradu- ally increase the stress on that tissue with dif- ferent exercise techniques until we get to that time mark where we know they should be ready to train again,” he says.
“During this time, we are watching and monitoring with x-rays, ultrasound or some- times MRI to see how it heals, and we try to make sure we are not overstressing or under- stressing. We want to push that tissue the right way at the right stage as it heals. Our goal is also to shorten the time, since time is money,” says Easter.
“For many performance horses, includ-
ing racehorses, the 3-year-old year is crucial
to show the worth of a stallion or mare and is always the most stressful year for the musculo- skeletal system of the horse. We have goals that we aim for when getting these horses back to soundness. These horses need to win as much as they can,” he says.
It’s in everyone’s best interest to safely get injured horses back to performing so they
can be at their maximum as soon as possible
to prove themselves as athletes. “We have to always walk the fine line of pushing them, while still being safe for the horse. Rehab has improved and we now have a lot fewer horses miss their major events, and most of the 4 and 5-year-old horses are able to keep going. The 3-year-old year is the hardest, but we now have the ability with our improved rehab to be able to shorten their recovery time so they can make those crucial events,” says Easter.
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EQUINE HEALTH