11/03/2026
Equine Rehabilitation
At Peasebrook, we have over 30 years experience in rehabilitating all types of sports horses suffering from all kinds of injuries or problems. Whatever the case, the fundamentals of the rehab program are the same; to return the horse to the very best physical and psychological state possible and to do everything we can to try and prevent re-injury. To achieve this goal consistently requires a lot of experience, patience, careful observation and excellent horsemanship. Let me map out the process for you:
Firstly and most importantly, we have to fully assess the horse and be 100% confident of the diagnosis in relation to an injury or lameness or behavioural issue. Unless we achieve this, the whole program thereafter is clearly flawed and we would be waisting time, resources and our client’s money. Totally unacceptable!
We may be presented with a horse with an obvious injury, such as a superficial flexor tendon tear which can be thoroughly evaluated with ultrasound imaging, but we should also endeavour to understand why the injury occurred with relevance to helping to prevent re-injury; was it due to ground conditions, either firm turf or compacted arena surface for example, or was the horse fatiguing due to another problem? Was the horse optimally shod, or was the toe over long or the heel collapsed? Is there a back problem or hind limb lameness resulting in overload of the forelimbs? Lots to consider and all important!
So if we have considered all the above and have an answer as to why the injury has occurred, we have to carefully explore our treatment options. In the case of a flexor tendon strain, the aim is to encourage a complete, strong but elastic repair that will have the lowest prospect of re-injury. So we are talking about promoting regeneration of damaged tendon fibres rather than allowing formation of less elastic scar tissue. In my experience the most scientific and the most successful way of achieving this is to inject stem cells into the injury. Stem cells used to have to be harvested from the patient, purified and multiplied which typically took two to four weeks, delaying the onset of healing at a crucial time. Now we can simply buy ready made stem cells off the shelf and speed up the whole process. When stem cells were first marketed to the racing industry in the early 2000’s they were accompanied by what was in my opinion, an unvalidated rehab program which returned the horse to canter work far too quickly which resulted in re-injury. Trainers unsurprisingly lost faith in stem cell treatment only because the rehab program was wrong. Given the correct management and sufficient time for maturation of the repairing tendon fibres, stem cell therapy is the best option. I am using this example to reiterate how important the whole rehabilitation program is from start to finish and that is why case management experience is essential.
If the budget does not allow for stem cell therapy, there are less invasive options to stimulate regenerative tendon fibre repair; class lV laser therapy has been shown to be effective as has Indiba therapy. The latter uses 448kHz radiofrequency waves to cause bio-stimulation.
After the initial treatment for the injury, whether it is regenerative therapy for a soft tissue problem, orthopaedic surgery to place screws to stabilise a fracture or arthroscopic surgery to remove chip fractures ,the next important decision is the subsequent exercise program. Obviously many injuries require complete box rest, a pelvic fracture, for instance, and most soft tissue strains need to rest during the initial phase of healing. Sometimes the horse’s temperament may influence the initiation of walking exercise if he or she is clearly stressed by being totally confined. Starting hand walking requires the horse to be under total control; a bridle must be fitted and a competent handler wearing a safety helmet and gloves must be adhered to. A safe environment is also necessary; we usually utilise our fenced arena or round pen. The horse cannot be allowed to get free under any circumstances. Once in a while we might use a mild tranquilizer to ensure that the process is safe. From hand walking, we usually progress to treadmill exercise; our treadmill is enclosed and offers the option of a variable incline to create a very tailored work-out. We can also trot horses on this machine when the time comes. Horse walkers are a feature of many yards and may be a safe option for many horses to exercise but there is a lack of control if the horse does decide to mess around. I am not a big fan of water treadmills as they restrict the horse’s stride length and build upper body strength which is not always helpful. Swimming is a much more useful exercise as it allows for a good cardiovascular work-out without loading the limbs . It also encourages a good range of limb movement and develops back strength. Not all horses take well to swimming and a good clean local pool may not be available.
There are no hard and fast rules for how long a horse should walk for before trot work can be added, it really depends on the type and severity of the injury. The safest way to progress is to only increase exercise slowly and to monitor carefully for signs of inflammation, detectable by careful palpation, thermographic imaging and ultrasound scanning. At Peasebrook, we are fortunate to have an ECB cold spa so we can immediately treat any unwanted inflammation induced by exercise. Regular lameness assessment is an integral part of our rehabilitation program and foot placement/ loading is closely monitored in case we need to make some shoeing adjustments. Video analysis using programs such as Werkman Black gait analysis can provide really useful information.
As well as working closely with our farrier, it is crucial to have a first-class Physiotherapist involved with every case to try and keep the horse pain free and as mobile as possible.
Once the horse is sound and the injury is healing as planned, we usually introduce ground schooling work in the arena. This is very skilful work requiring experienced staff who can get the horse to stay calm and give us very controlled exercise. We usually fit the horse with an Equi-Ami or Pessoa or keep them in a balanced outline. Ultimately we progress to ridden exercise which again demands experinced skilful staff and correctly fitted tack, especially the saddle.
We haven’t yet mentioned nutrition for our rehab patients but it is obviously another important piece of the jigsaw. We are usually trying to build physique and muscle strength so it is vital to incorporate all the essential amino acids, vitamins and minerals in the diet to ensure that this happens. If the horse is not developing as quickly as we would expect then we have to find out why; parasitism, gastric ulcers, dental problems or some other disease process may require attention.
So the take home message for equine rehabilitation is that you can’t just turn the horse out in the field and expect nature to fix everything. On the contrary this is a precision process where every step needs to be carefully considered and the progress of the horse monitored closely so that changes can be instigated swiftly if deemed necessary. If you are interested in sending us a rehab case, please contact Tim Galer to discuss your requirements.
