Rest and Rehabilitation

Chapter 91Rest and Rehabilitation



Barrie D. Grant


The number of publications about the effects of exercise on bone, cartilage, and tendons has increased substantially. The results of these investigations have allowed not only the research community but also practicing veterinarians to gain more insight into the effects of mild, moderate, and strenuous exercise on the skeletal system, especially regarding the pathogenesis of fractures and osteoarthritis. Unfortunately, results of controlled studies of the effects of deconditioning on bone, cartilage, and tendons have not been disseminated widely. Presently each clinician recommends a rest and rehabilitation program based often on intuition, anecdotal experience, and tradition. These recommendations have withstood the test of time, however, and can serve as a guide.


The number of alternative therapies and therapists has also increased. Although some benefits to this approach are possible, many of the modalities have not been tested in a standard scientific method, and popularity often is based on the principle that alternative approaches are less expensive and have faster results.



Principles of Rest and Rehabilitation Programs


The following are some basic principles that should be considered when formulating a specific plan for a specific injury.


1 Is the diagnosis complete? An incomplete diagnosis and thus treatment lead to poor results. Arthroscopic removal of a carpal fracture in the apparently lame limb will have poor results if there is an osteochondral fracture in the contralateral fetlock joint. Hindlimb suspensory desmitis is unlikely to resolve satisfactorily if mild ataxia is concurrent. An expedient, complete, and accurate diagnosis affords the best chance for long-term success.

2 Horses can tolerate extensive periods of stall confinement without becoming deranged psychopaths. They do need to be in clean airy stalls, so they can see other horses, and energy intake should be reduced. Clinicians should avoid walking horses every 4 or 5 days to see how they are doing, because horses tend to find any excuse suddenly to jump or rear and may sustain reinjury.

3 The heart and muscles do not undergo any clinically significant deconditioning for at least 4 weeks after a standard anaerobic training program. Therefore many horses with minor injuries, or even a suspicion of a minor ligament or tendon problem, possibly can heal with 4 weeks of rest, with little loss in performance. The cardiac parameters actually improve 5 days after the last extensive training effort. Little will be lost and much could be gained if experienced jumping and dressage horses with lameness problems could be walked under tack for a week before major events.

4 An earlier return to training, in the form of walking under saddle, swimming, or controlled exercise on a treadmill, can reduce the chance of further injury than if a previously stall-confined horse is turned out in a paddock and allowed to run, buck, slide, and turn quickly. If paddock turnout is used, then administering sedation and gradually increasing the size of the paddock are recommended. Leaving a horse in a paddock continuously also is best once the horse has been introduced to the freedom. If a horse is stabled each evening, then it tends to buck and play again each morning when released.


Rest


The basic principle of rest is to reduce the force and strain on injured tissue and allow the normal reparative processes to proceed without further insult. Muscle tissue can heal in a much shorter period than tendons or ligaments, but the repair of cartilage is accomplished by the metaplasia of replacement tissue, which takes 4 to 6 months. The quality and quantity of rest depends on the severity of the condition, the disposition of the horse, the owner, and the trainer, and their expectations.



Complete Immobilization


Although complete immobilization can be accomplished with internal fixation, external coaptation with a cast also can reduce the motion of fracture fragments and excessive strain placed on damaged ligaments or tendons. The long-term use of cast immobilization can result in osteoarthrosis (fracture disease) and osteopenia. Normal joints can tolerate at least 4 weeks of cast immobilization without significant irreversible change to the articular cartilage.1 Well-designed splints and braces offer an alternative for conditions that do not require complete rest or can be used for intermediary support in the transition from a cast to having no external support.



Stall Rest


Stall rest is the most common form of rest recommended and is highly effective as long as weekly episodes of outside activity do not interrupt it. The effects of controlled exercise on articular cartilage remain controversial. French and colleagues2 concluded that early postoperative exercise is not detrimental to repair of experimentally created osteochondral defects of the carpus. Other investigators suggested deleterious effects of early exercise on the healing of carpal osteochondral defects.3 However, exercise may be beneficial in maintaining normal concentrations of glycosaminoglycan in insulted articular cartilage.4 The administration of polysulfated glycosaminoglycans may have a protective effect against the deleterious results of early postoperative exercise on experimentally induced osteochondral defects.3 Only a cost-benefit investigation with a sufficient number of horses will show if the expense of the medication is justified, with an earlier return to competition compared with horses restricted to stall rest.


Owners are always concerned about the effect that enforced stall rest can have on the mental status of horses, but provided that energy intake is restricted and horses have visual contact with other horses, most adapt satisfactorily. During inactivity many horses lose muscle mass and tone, which are rapidly restored, and horses that become overweight are less likely to return to athletic competition than leaner cohorts. It is important to stress good husbandry practices, because soiled wet bedding or infrequent hoof care can lead to chronic hoof problems. I have seen many horses with joint disease develop subsolar hematomas on the opposite limb, predisposing to or because of the joint disease. These hematomas can become subsolar abscesses if the husbandry is inadequate.


Experience has shown that 60 days is the minimum amount of time necessary for the repair of soft tissues after orthopedic surgery,2

Related posts:

  1. Lameness in Horses: Basic Facts Before Starting
  2. Thermography: Use in Equine Lameness
  3. Counterirritation
  4. The Carpal Canal and Carpal Synovial Sheath

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Jun 4, 2016 | Posted by in EQUINE MEDICINE | Comments Off on Rest and Rehabilitation

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