The pros and cons of box rest

I've been wanting to talk about box-rest for a while - there was snow much other stuff going on last week that I put it on hold, but anyway, here it is now(!).

The fact is that many of the horses who come here have been put on box rest in an attempt to improve their lameness.  Of course for some horses, box rest is successful but the ones who come here are the ones for whom it hasn't worked.

I can see why vets may feel clinically obliged to put these horses on box rest, because they tend to become lamer the more they move.  Frankie, Bailey W, Solomon and Isha were all classic examples of horses who became much worse even if they were only turned out in small fields so working them was out of the question.

Logically, you would think that box rest would be a solution but there are some fairly obvious pros and cons with box rest.

The only pro is that it stops horses from moving and therefore doing more damage.

The cons are more numerous, as you know:

1. the lack of movement causes muscle, tendon and ligament weakness and doesn't allow any chance for unhealthy caudal hoof structures to become stronger.  There are other physiological downsides to prolonged time in a stable, including the risk of colic and respiratory problems;
2. it often only works while the horse is on box rest - frequently (though not always) lameness recurs with more movement;
3. its hard work, and emotionally draining, for owners and of course they can't ride or work their horses;
4. last but certainly not least, box rest can be extremely stressful for horses, many of whom fret with the lack of movement and contact with other horses.

Personally, I've never found box rest terribly useful.  Many of the horses who come here have a lameness which is made worse by movement but the answer isn't to stop horses moving - much better to enable them to move correctly - once that happens then suddenly more movement isn't a problem any more, but in fact it becomes beneficial. 

To take some examples - Bailey W, Frankie, Solomon and Isha all arrived landing toe-first.  The more they move like that, the more they are stressing the tendons and ligaments within the hoof, and the more likely they are to injure himself.

In those circumstances, even a short canter across a field can result in another soft tissue injury and more lameness.  However, once you can strengthen the hoof and turn a toe first landing into a heel first landing - then movement is no longer a danger, its actually a part of the healing process. 

And in case you think this is heresy, there are SOME vets who agree - including Prof Jean-Marie Denoix, a renowned expert on the equine distal limb, whom I quoted here earlier in the year, following a conference I attended:

"[Prof Denoix] was talking about the rehabilitation of tendon lesions, and the fact that you need to rest the injury without resting the horse. Of course that is precisely what we try to do here - movement within comfort zones is an essential part of our rehabilitation programme.

A traditionalist [who had been insisting that horses in the UK routinely required box rest for tendon injuries, and who was obviously perturbed that it wasn't used in France!] asked him when he recommended box rest. He thought about it for a moment, and said he would of course immobilise a horse which had a fractured limb(!) but other than that, he preferred to keep horses moving. As he said: "French horses don't like being kept in boxes." ;-)"