Rehab/Layup -- what do you do?

[fizzyfuzzybuzzy]

If you have/had a performance horse with an injury or illness that required significant layup and rehab, do you do this yourself? Do you get a rehab plan from your veterinarian that you perform yourself? How do you decide what or if you use complimentary therapies (including massage, chiro, PRP, IRAP, Shockwave, hyperbaric, hydro/treadmill, and the list goes on)? Do you send them to a rehab professional to either design a program or follow a program your vet sets forth? What credentials and facilities do you look for if you do send them to a pro?

Just as a side note: I do not have a horse that is injured or ill, this is purely out of curiosity.

[ndirish07]

I think you’ll find the answer will largely be “it depends.” It depends on your facilities you have available where you keep your horse, the type of rehab they need, whether there is available support/staff to support stall rest and handwalking and all that comes with it (extra stall cleanings, extra shavings, administering sedation as needed, handwalking), and/or the owner’s time, skill, and availability to oversee it.

I’ve done both-- I sent one to a facility on two occasions, and the most recent I did at home. I get a rehab plan from my vet that includes periodic U/S. I do what my vet recommends regarding the modalities of the rehab. For the most recent one, I had the ability to oversee his rehab which was largely straight forward. When my horse had colic surgery and needed to be fed every 3-4 hours, he went to a rehab facility. They were equipped to deal with him and had all sorts of options for turnout size to accommodate him.

[No1]

Do it myself. I’m kind of a control freak and I’m very experienced in many aspects of rehab, so I’d have a hard time letting it go.

Depending on the situation, the vet involved, and the horse; I would either do what the vet said or add or subtract from what the vet says.

[joiedevie99]

I’ve done both. As a boarder, I’m not able to go to the barn more than once a day, unless it’s for a short duration (i.e. the first two weeks after I brought a horse home from surgery). So step one is an honest evaluation of what the barn staff is going to be able to manage. Fortunately, in full service/training programs, this is often quite a lot - hand walking, icing, cold hosing, wrapping, meds, laser, etc. Those therapies, combined with things the vet would come for - shockwave and injectables of all kinds - get through many, many injuries in house.

I consider sending them out when the climate/facilities are working against me (hand walking a horse in winter without an indoor or an unattached indoor), we need to build substantial muscle without full impact (treadmill/swimming), or the horse needs things the barn is unlikely to do well (eye meds every 2 hours around the clock, re-feeding after colic surgery every 3 hours, horse is wild and needs drugs for daily interactions). Sometimes it’s a monetary decision too - once the vet is coming 2-3 days a week for different therapies or diagnostic monitoring, it can work out cheaper to send the horse somewhere like SUNY Morrisville Rehab that has everything in house and will give you a package price.

[lintesia]

My first horse was laid up for what turned out to be 5 months with a high hind suspensory. I knew my h/j barn could not provide the layup support and therapies he needed so he went from the vet clinic directly to a layup facility. The layup facility was run by a vet, so some of the therapies prescribed by the clinic (therapeutic ultrasound, for example) were covered by insurance. Even though the distance meant that I could no longer see him on a daily basis, the knowledge that he was being cared for at a high level made me never regret the decision.

For this horse, when it was time to start rehabbing, I initially thought I could do it. He started with something like three 2-minute trot sets, etc., and he had to be sedated for every ride (thank goodness for Sedevet). But because I was a novice, I could not get past how different his trot was from the horse pre-layup to the horse I was now trotting around. He felt awful and every misstep turned me into a Debbie downer about his chances for recovery. So, I turned him over to the dressage trainer I was with (I also knew that my h/j barn was not the place to rehab my horse) and simply paid for him to have rehab rides five times a week. Once he started cantering, I resumed the rides. We followed the vet’s directives by the book and he ended up becoming my AA hunter and the insurance company even removed the exclusion on the injured leg.

I used the down time with this horse to further my education in stable management and riding, and with horses I’ve had since, I’ve done all of the rehab myself. Still by the book according to the vet’s directives, of course!

[NancyM]

Like No 1 above, I’ve done it myself. No one else would have been so foolish as to attempt to do it. And you couldn’t have paid enough money to someone else to do the job, it took a year. As my favourate vet said at the time (after also investing time and effort into the situation and charging me for drugs only because he was kind) “Sometimes they surprise you, and live”. And you learn the meaning of the words “cascade effect”. My horse had a brain injury with concussion, ataxia, and broken shoulder (we presume). Then founder with a 14 degree rotation, coffin joint infection. She was a survivor, toughest horse ever. And never gave up the fight to live, even when things looked grim. Had a career as a broodmare afterwards, until the arthritis got too bad.

[JB]

It really does depend. I’ve done this twice myself, once while boarding, once at home The rehab didn’t require special skills or equipment

Every rehab goes better with body work of some kind, at some point. Injuries create compensations. So for that, it’s about which to use, at what point. Non-injured body parts can have massage work done right away. Some chiro work too but I’d put the money into massage first. Injured areas need to be past the acute phase for most therapies

Bone injuries could probably heal faster if swimming or a water treadmill was used in the beginning of active rehab Soft tissue injuries, which my guy’s both were, benefit from firmer footing in the beginning.

A lot depends on the turnout situation, and the temperament of the horse.

Most rehab isn’t complicated. It’s a progression of slower work to longer work to adding gaits to adding different footing to adding time.

It’s usually about whether the owner has the time - maybe they need to be hand walked 2-3 times a day and the owner works f/t 45 minutes from the barn, or whether the owner can physically handle the horse - maybe the horse needs better living through chemistry to get through the initial work after the layup

You just have to look at the situation in front of you. You might even decide it’s best to send the horse somewhere else for the actual layup - maybe he’s going nuts in your quiet 3-horse back yard barn, but would be very happy in a very busy larger barn while stuck in a stall.

[fizzyfuzzybuzzy]

Thanks guys!! So, follow up questions – how detailed a plan does your vet usually give you? I’m thinking about humans. When we have an injury, once the actually injury is healed, there is a period of active rehab that includes certain exercises to strengthen the damages area, but also the areas surrounding to prevent reinjury. Does the vet specify what kind of footing? Does your vet have relationships with body workers they recommend if they don’t offer the service(s) themselves?

Keep the replies coming, I find this kind of stuff so interesting!

[JB]

It really should included some reasonable instruction guide if the owner isn’t at all familiar with rehab.

Rehab is a “more” version of fitting up a young, unstarted horse.

Suspensory injuries require a different approach than, say, extensor tendon injuries - one is a weight-bearing structure, the other isn’t

Muscles need a different approach from ligaments.

Minor vs major injury to the same part are generally the same outline, but with a very different timespan

Some vets don’t have a alternative people in their circle, some do. My vet doesn’t use a chiropractor at all, but loves that I have one whose work helps my horses.

[ndirish07]

How detailed was the plan? The most recent suspensory I did I received essentially an 8 page program that spanned from handwalking all the way to jumping. It was super detailed and I loved it. The tendon injury on another horse, I had loose instructions to start at X time, and build every 3-4 days. Same approach as the detailed program I got, just more going off feel than anything. Colic surgery? There wasn’t a plan per se. He had a strict re-feeding schedule, then adding turnout, then talk walks, and building core strength back. That was more complicated on the front end, but I found it to be so so much easier than a soft issue when it came to adding in work.

[joiedevie99]

@fizzyfuzzybuzzy

So, follow up questions – how detailed a plan does your vet usually give you?

Very! But not necessarily all at once. For soft tissue injuries (most of my rehab experience), we ultrasound every four weeks, so we’re never planning rehab more than 4 weeks in advance. We’re generally increasing time or intensity by a small bit each week - maybe we up the hand-walking time by 5 minutes per week, then we add 1 minute of trot per week, etc.

[Amy3996]

I rehabbed one by myself for a DDFT injury and can confidently say that I will never do it again. If I ever end up in that situation again, I’m going to seek out a pro rehab facility.

The initial phase of the rehab wasn’t difficult. Strict stall rest, icing 20-30 minutes 2-3x a day. As it progressed though, it got more and more time consuming and I wasn’t at a facility that could help me with any of it.

It built up to 30 minute hand walks twice a day, followed each time by 20-30 minutes of icing, plus isometric exercises and stretches. Board only covers stall cleaning once a day, so I was cleaning his stall 2-3x because he was on 24/7 stall rest for four months. Grooming, wrapping, etc. all added to that. It amounted to 4-6 hours of work every day.

I was fortunate that I was a college student on summer break while all of this was going on, so I had the time. But it was an exhausting process that ended when we lost him to EPM likely brought on by the stress of the injury and stall rest. I poured everything I had into his rehab for those four months and burned out in a big way. And then we lost him anyway, to something none of us saw coming. It was brutal. I love my horses dearly but I can’t and won’t put myself through that again.

[Xanthoria]

I’ve done it both ways - rehabbed a stall bound 2 yr old for 6 months, again at 5 I think for 9 months and AGAIN at 7. Did all the sedation and handwalking and insanity. Barn was very close by though. Also had a horse at a rehab facility after surgery who received very poor care (cruciate injury misdiagnosed as a hoof abscess and horse PTS as a result… that injury may have happened at the rehab place too, or at the very least went from a very minor issue to a life ending one there)

In each case vet provided weekly handwalking regimen building up to tack walking and gradual return to under saddle work if appropriate. I used an app called Interval Timer to time daily workout (minutes of walk trot and canter) and a spreadsheet to track the program.

For me it really depends on the horse (how they are to handle when stressed), how much time you have, and your ability to sedate, wrap, and so on. Rehab facilities around here aren’t very cheap either, so there’s that…

[MsM]

Whether you can rehab yourself depends on a LOT of factors - injury, horse temperament, time available, facility, etc. And, of course there are finances.

The most difficult rehab I did was a DDFT injury down in the hoof. The biggest issue was trying to keep the horse quiet. Stall rest was not an option since all the horses have all day turnout and he is not quiet in his stall in the best of times! Fortunately the BO constructed a tiny electric fenced paddock for his turnout. It soon became apparent that he needed some chemical help to stay earthbound and he blew through the first two drugs. We finally found one that worked. The handwalking was then not as hazardous. The vet provided a written outline of how to progress and things went mostly according to plan. Hated handwalking in the cold, but I was really glad that it was warm when it was time for under saddle work!
This was a pretty simple rehab with no hosing, poulticing, wrapping etc. so DIY seemed most appropriate.