Wednesday, 22 June 2011

Rehab, movement, box rest and biomechanics

I'm going to bang away again on subjects I keep coming back to and which are inextricably interlinked - movement, box rest and biomechanics.  
In the last year I've blogged here about why movement is vital - it is for any horse, but if you are expecting a horse to build a stronger, healthier hoof, its essential.  One thing you CAN guarantee (which doesn't often happen with horses, admittedly!) is that no horse can build a truly healthy hoof without LOTS of miles, lots of stimulus and lots of varied terrain.  
I've also blogged before about why box rest often doesn't work very well for horses with caudal heel pain or soft tissue injuries within the hoof.  Without movement, horses become frustrated and stressed and their bodies become weak and compromised.  Hooves are no different, and although box rest can seem a tempting way to alleviate soft tissue damage within the hoof, it often causes a host of other problems.   

Its also fairly common - and distressing for both horse and owner - for a horse to come off a long period of box-rest following this type of injury and re-injure itself once it comes back into work - or even following turnout. 
In fact, for horses with DDFT or collateral ligament injuries within the hoof, the key to improved soundness seems to be not stopping movement altogether - but simply stopping the damaging movement.  

I've quoted Prof. Jean-Marie Denoix before, and no doubt I will do so again, but what is required, as he says, is to "Rest the injury, not the horse".  With most rehab horses, this means establishing a correct, heel first landing and providing surfaces which encourage the hoof to load evenly
As a matter of interest, all the rehab horses pictured above were on box rest before they came to Rockley.  For each of them, their level of movement was carefully increased over a few days after they arrived.  

The increase in movement was controlled, and - perhaps more importantly - the surfaces they were allowed to move on were controlled, but increased space and increased movement did NOT impair their soundness.  

In fact, I can't recall a single rehab horse who became lamer because of more space or more movement as long as it was correct movement.  

Admittedly, thats quite a big proviso :-)


Val said...

I am going to add Rockley Farm's paddock system to my list of dream farm amenities.

Clare said...

It is difficult to not end up "box resting" your horse if you have one that is hyper-sensitive to grass and you don't have access to a track system (as most livery yards don't).

I have had to take my boy off the grass and although at the moment the only option for him is to be "boxed", he is by no means "rested". In fact, thanks to Nic's advise about exercising on surfaces that allows him to land properly he is able to do more exercise not less and seems to be improving by the day :-)

Looks like I got it VERY wrong this year with the grass!

jenj said...

Nic, I am curious if you would mind providing more detail about what you did for just one of these horses. How much work on what surfaces, day by day, how much turnout, hand walking, riding, etc. I'm guessing you don't just throw a lame horse out on your track with a bunch of unknown buddies... so what DO you do?

Kate Williams said...

I can't tell you how many times i have urged poeple to not put their horse on box rest unless absolutely necessary. The trouble is we all trust what we are told by professionals and most people in this situation are so despersate to get their horse right they are scared to go against the grain. Take me for example. i have spent years advising people alternatives to box rest (paddock rest, and gentle exercise), and yet when my own horse Saffy went lame 3 yrs ago I totalloy ignored my own advise becasue I was told by my vet if I didn't box rest she would never come sound. Against my better judgement as a therapist, knowledge, and instinct, i box retsed her for 6 months and ended up with a horse lamer than when I started. biggest regret- not listening to my own advise which usually serves me and others well. Lets hope we can convince more people to steer away from such long stints of box rest, and that with time "box rest" is not the dreaded word so often first uttered by vets.

Andrea said...

To play devil's advocate, what about other types of soft tissue injuries? My mare became quite sound and strong while on box rest with controlled exercise, but reinjured herself twice in this way (SDFT/annular ligament damage in both hinds proximal to the fetlock). Once out on 24/7 turnout, both hinds have seen a fair bit of tendon degeneration and major adhesion formation within the tendon sheath (both hinds), and she is still pretty darn lame more than half a year into it. She came sound on box rest less than 2 months into it each time... but again, she reinjured.
On turnout, she seems to have completely stalled out in the healing process. Ideas? She is 10 and has never worn hind shoes, and has been bare up front for 5 years.

Nic Barker said...

Andrea,I read your blogpost last week and was gutted for you...I've been careful to put my own post in the context of soft tissue damage within the hoof because that's what I see. I know that too much (and the wrong) movement can be a problem for injuries further up the limb.

I've been thinking about this since your comment came through, and I will send you a longer post later on...

Nic Barker said...

Jen, the problem is that it varies from horse to horse depending on their hoof health (or lack of it!), social skills, current level of lameness etc.

They all start in the gravel yard with 1 or 2 of my horses then "graduate" to the track and turnout as well if all goes well. It usually takes anything from 3-4 days to a week or more to get to that stage.