Rest and Rehabilitation

Chapter 91Rest and Rehabilitation



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.







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.




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

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

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