Historically, when a horse sustained major musculoskeletal injury or underwent a major surgery, he had to be immobilized before he could begin to use the limb. Results were less than optimal as immobility often leads to loss of flexibility or range of motion (ROM), as well as loss in proprioception (awareness of posture, movement, balance, and location), muscle symmetry, and trunk stability. Sheila Schils, MS, PhD, described the benefits of early mobilization of equine musculoskeletal tissues within the initial days after injury at the 2010 American Association of Equine Practitioners Convention, held Dec. 4-8 in Baltimore, Md.

Schils, who designs therapeutic equipment and treatment protocols in River Falls, Wisc., explained that early mobilization during acute healing phases increases blood and lymph flow and increases tissue tension to stimulate tissue repair and improve tissue alignment. Early mobilization produced a 60% improvement in tendon Type 1 collagen deposition (evidence of healing) along with a 20% improvement in both the ROM and the ability of the tendon to handle ground reaction forces. Mobilization limits fibrosis (scarring) of connective tissues, preserves joint ROM, and improves neuromuscular coordination.

In contrast, Schils reported restricting mobilization of an injury often yields bulky scar tissue and adhesions, along with reduced tissue strength and persistent pain. She added, however, that immobilization is not all bad–for severe tears and fractures a short stabilization period is advised before mobilization.

Schils mentioned that research has shown that longer, slower rehabilitation doesn't necessarily improve the outcome, while early mobilization doesn't increase reinjury rate. Grading of each injury (Grade 1, 2, 3) according to severity helps the veterinarian determine how to proceed in the initial days: Schils recommends beginning ice, compression, elevation, weight-bearing exercises, controlled stretching, and functional electrical stimulation immediately to improve flexibility, with gradual increases in intensity and repetition. Then she recommends adding strengthening exercises, although flexibility remains the major focus throughout rehabilitation