I’m facing 4 months of stall rest for a broken coffin bone and have many of your same concerns. We’re only 2 weeks into it so far, and will be going for a CT scan and consultation with the surgeon at New Bolton on Tuesday. I’m pretty sure I’ll be taking her out for some hand grazing once the grass starts growing because I wouldn’t think a few small steps outside would be any different than moving around in a stall.
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That’s actually a good point I didn’t consider! I still wonder why this rehab is so much “less” exercise vs the soft tissue one, but perhaps it’s because it’s in the knees?
FWIW, calm hand grazing with NO intentional walking is allowed for mine right now. Not that there’s any grazing to be had.
Joint replacement is SUCH a different beast than an arthroscopy in humans. People with knee replacements are up and walking pretty much right away. My doctor was back at work, walking with a cane, the Monday after a hip replacement on Thursday.
When I had a knee scope, I was on crutches non weight bearing–something horses cannot do–for FOUR WEEKS. It took months and months and months to rehab. I think it was six weeks on crutches with the hip scope, also with a shit ton of rehab.
Joint replacement is not analogous to what your horse had done, and you can’t draw that parallel.
Talk to your team about his mental state & if any compromises can be made. But you’ve spent a lot of money and time and energy getting to this point–don’t throw that away because you think he should be okay to do more. Trust your experts.
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I sympathize, and can’t offer any good suggestions one way or the other. We are on week 12 of my mare’s rehab and it has been very challenging having her on stall rest (and she was allowed 30 minute hand walks right from the start as she did not require surgery - I break out in a cold sweat just thinking about rehab plans like yours).
Another mare at my barn is also rehabbing on a much longer timeframe and has been on trazodone for about six months, with not even a small runout allowed for five+ of these months. It has kept her sane. I don’t know if medication would be an option for you. I would have definitely needed to use this if she was confined to a stall only (mine is allowed stall-sized runout).
I have largely followed vet’s orders but my personal belief is horses should be out and moving whenever possible, so there has been some moral angst and I’ve been a bit liberal with reintroducing turnout as she has been sensible so far and we are in the stage where she needs movement (but not antics, so still a balancing act).
For what it’s worth, I personally ascribe to the belief that the vet prescribed orders are generally the “best practice” for recovery from a clinical standpoint and probably the best road to injury healing, in a vacuum. However, from an animal husbandry perspective of the person who needs to exist with this animal, and the animal who needs to exist with themselves, deviances sometimes must be made. If the horse is going to absolutely lose their mind and medication is not an effective solution, I’d adjust as necessary while adhering as best I could and accept the potential consequences, but of course YMMV (and I do not have high dollar animals at high levels).
If he’s allowed to hand graze, but no grass this time of year, you could try a snuffle mat with alfalfa pellets (the ones for large dogs work, if he’s the type to try to find them rather than just picking it up and turning it over). I have a carrot ball that can entertain for ten minutes. My mare is very tactile and also likes dumping out her own shavings and playing with the paper bag (staples removed first).
This sounds brutal and I hope you both can find some equilibrium!
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Oh yeah - he’s on traz. And still UnHappy 
. I’m thinking oral Ace will be next for his time out of the stall.
This is exactly my feeling! Now, I’m just musing - I won’t change anything without talking to a DVM. But my “to the book” rehabs have not been as successful as the more… realistic/balanced rehabs I’ve done due to circumstances. I’ll never again fully stall rest a suspensory, for example. But I do realize this is a different issue - I have access to more textbook facilities which helps, but this horse is his own worst enemy when it comes to self-preservation. I’m expecting the Brain to become our problem more than anything.
I think doctors, vets included give us recommendations based upon ideal risk/benefit ideologies but it is up to us to communicate real world feedback as we progress through the process. For example I had one mare who was supposed to be handwalked through the beginning of her rehab but even with drugs on board she was a danger to me and herself so we opted to just keep her in the stall.
My foal had umbilical surgery and was supposed to be stall rested for x amount of time then turned out for 10 minutes then increasing by 10 minutes every day. That resulted in her running like a lunatic for the first 10 minutes every day. We then opted to just put her out and leave her out and she didn’t run at all. Totally different situations that ended up needing different solutions than originally planned based on real world findings with this particular horse.
Whether you decide to modify the plan on your own or in partnership with your vet is up to you but the point is sticking to a plan as written in the beginning as opposed to tailoring that plan with feedback you are getting from your horse is not wise
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Full stall rest for tendons/ligaments is a pretty dated recommendation, so I wouldn’t follow that either! I do think cartilage damage might be a completely different ballgame than the usual injuries we are used to rehabbing, so it’s well worth consulting with your vet and understanding the reasons behind the plan they’ve prescribed. You could also try a virtual consult with someone more experienced. For tendons/ligaments, Dr Carol Gillis is awesome and makes the consulting process very easy—I’m not sure if she has any particular expertise with cartilage or how different that is, so take it FWIW. Best of luck with him!
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It’s her recommendation that we followed for the suspensory - and it is full stall rest! It was supposed to be until the horse was cantering under saddle (nearly a year of stall rest), but he didn’t make it past the walking stage (3 months) before we HAD to turn him out. He would’ve killed us and himself if we’d continued. His leg looks great - a vet can tell something happened, but it’s pretty clean now.
If I ever have to do that again, it’ll be solo turnout for initial healing and then back out on good footing as long as they can keep a lid on it. I’d rather turn out and use trazodone or something to keep them calm vs stall rest for a year.
But yes, arthroscopy and cartilage damage is different than a tendon.
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Oh gotcha, I thought by “full stall rest” you meant no handwalking. I think the turnout thing really depends on your horse and your paddocks.
There is no such thing as riding a stall rested horse at any gait except maybe a tack walk bit even that I don’t consider full stall rest personally. That’s just no turnout
Fair enough. No turnout, then! I have never restricted a horse to no turnout for extended periods for any purpose other than medical care - so I used the term incorrectly. It’s always “he’s on stall rest” colloquially - even if the horse is handwalking or whatever. I’ll have to stop saying it that way, to be more clear!
Regardless, I’ve not had good results long term with no turnout - restricted turnout has been hit or miss. I’ve been lucky that most of my horse layups have not been serious (just the two TBs being repeat offenders 
), and they’ve generally been allowed to go out. The times I’ve done extended rehab, I’ve just not had the stellar results I’d hoped for. The horses have ALL recovered better once they stopped going insane inside. (Turns out that practicing circus acts and reining patterns in the stall is Not Great for healing!) Maybe if I had calm lazy horses that didn’t metabolize drugs like champs
I would hope my vet or the school could provide some in-depth reasoning for doing it this way, and where the line is between “he’s going to have to put up with it” and “okay we have to try SOMETHING that isn’t technically in the textbook”. That would ease my mind a bit. I’ll have to try again to talk to them about it.
My broken scapula horse didn’t get normal turnout for approx. 18 months. He’s not only alive but doing low level dressage and jumping again because he was a really good patient and I took it very slow. That injury required very minimal movement to prevent the build up of bone callus that could cause long term problems.
Remember that their knee is like our wrist. Lots of little bones, and it doesn’t get much muscle support. Yet they do a lot more motion and weight bearing on them than we do on our wrists. Knee arthritis is not good for any horse and can cause significant lameness and gait issues. It’s a thing that can progress to the point that it’s a solid reason for euthanasia. You don’t want that, and ideally you want the horse to have some sort of performance career in the meantime. You really do want this to heal well without stress and irritation if you want a good prognosis. It’s much more of a big deal than removing a minor ankle chip, for example.
Patient compliance is a thing for both horses and humans that affects outcomes.
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Keep in mind that the body does not replace cartilage and in a joint the body’s response to trauma(surgery included) is to heal itself with calcification of the cartilage. Inflammation can last up to 6 months and blood flow that’s necessary to healing is minimal within the joint. I share your theory on rehab to keep them moving but in this instance I’d follow the protocol until later in the process and after updated X-rays.
My horse and several TBs I’ve rehabbed through a nonprofit greatly benefitted from clicker training for mental exercise. I usually outfit them in their bridle, take them out of their stalls, and work on different skills to trick them into thinking they’re doing “work”. My typical go tos are manners with taking a treat (for newbies directly off the track), touching a target (stationary, moving), self-haltering, lifting each leg, smiling, standing at a target, placing feet on a target, and come. It’s a great tool to teach your horse to problem solve and work on frustration tolerance which can be very mentally engaging, especially for the TBs that believe the whole meaning of life is to be DOING.
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Alfalfa pellets make good treat options (provided your horse is okay with alfalfa. Timothy cubes if not. Look for mini cubes.
