House Arrest: Your Horse on Stall Rest
By Jennifer O. Bryant • Dec 01, 2011 • Article #28500
Photo: Anne M. Eberhardt/The Horse
Every day after work dressage rider Carol Riegel drives to her boarding stable in West Chester, Pa., and assembles a tiny round pen within one of the spacious paddocks. She outfits the pen with a water bucket and a hay net, and then it's ready for her horse, Rhode Show, to spend the night.
"Ben," an 8-year-old Hanoverian gelding, is on stall rest--a "controlled exercise program," as veterinarians call it--recuperating from a torn right front palmar abaxial ligament. The stall-sized round pen enables Ben to see and hear his barn buddies when they are turned out at night, "and to think he's being turned out, too," Riegel says. (She moves the pen daily so it's over fresh grass.)
The rest of the time Ben is either confined to his stall or being hand walked, another facet of his veterinarian-prescribed rehabilitation program. Riegel's veterinarian, Celia Goodall, MRCVS, Dipl. ACVS, co-owns Sports Medicine Associates of Chester County, in Kennett Square.
"She wants me to do 40 minutes (of hand walking) twice a day, but I can't manage that," says Riegel wearily.
It's an unfortunate fact that stall rest--while surely not most horses' idea of a great time--isn't much fun for owners, either. In this article we'll explain why stall rest is necessary sometimes and how to make the best of it for optimum healing, safety, and sanity.
Bed Rest for Horses
"Stall rest is mostly a compliance issue," says Mark T. Donaldson, VMD, Dipl. ACVIM, of Unionville Equine Associates in Oxford, Pa. "If a human gets injured and is in a cast or a splint, we can tell them not to play tennis for a while. We can't tell a horse to please not run around in the pasture, so the purpose of stall rest is to keep them from moving sooner and more than they should."
Many conditions lead a veterinarian to order stall rest: Bone fractures require rest to heal properly, as do certain soft tissue injuries such as suspensory ligament (that runs down the back of the cannon bone) strains, which Donaldson says are the most common reason he prescribes stall rest. Some surgical procedures, such as colic or joint surgery, require a period of stall rest to facilitate healing and minimize stress on incisions and sutures. Healing of a severe wound, such as a lacerated tendon, might also benefit from controlled activity. For instance, veterinarians placed the badly burned survivors of the May 31 fire at international eventing competitor Boyd Martin's West Grove, Pa., stable on stall rest during the acute phase of their treatment until sufficient healing had taken place. A horse enduring ongoing treatment involving intravenous (IV) catheterization might also be confined to a stall to help protect the IV site and keep the needle in place.
As mentioned, stall rest helps prevent a rehabbing horse from doing too much, too soon. "An analogy would be a twisted ankle," says Donaldson. "After a while, it feels better, and so you're tempted to resume normal activities. But it's not finished healing, so it may feel sore again afterward--an indication that you've actually sustained a minor reinjury."
Such a reinjury not only prolongs the healing process but also can make the affected area more susceptible to reinjury in the future, even after the horse is pronounced fit to return to work.
"Tendons and ligaments heal better and faster with restricted (controlled) exercise," says Goodall. Skip the stall rest and the injury "might heal less well, with a poorer fiber pattern," which is a permanent weakness.
Depending on the nature of the horse's injury, the veterinarian might prescribe complete stall rest for days, weeks, or even months, with periodic follow-up assessments. At some point in the process the horse owner might get the green light to introduce very modest activity, such as hand grazing or hand walking, usually for a certain amount of time per day. The activity periods and frequency increase gradually, perhaps expanding to include walking under saddle and turnout in a very small paddock or a stall with a small attached pen or run.
Building exercise incrementally on a strict schedule is key to rehabbing many injuries. Walking a horse under saddle might progress to include trotting the horse for a minute, increasing to five minutes, etc., before eventually introducing the canter. If the horse is recovering from a tendon or ligament injury, the veterinarian might caution against doing anything that could stress the injury. This usually means no turns, circles, and lateral movements. Donaldson likes to see a horse walking, trotting, and cantering consistently sound under saddle before he considers allowing turnout in the horse's usual pasture. Horses at liberty, he points out, are inclined to perform more strenuous (and potentially harmful) gyrations than when under tack.
The Uncooperative Patient
Some horses cope with an extended period of inactivity remarkably well, says Goodall. In general, laid-back types are quieter on stall rest than energetic or nervous horses, and older horses might handle confinement better than youngsters. Although Ben's lazy streak can be a source of frustration under saddle, it was a blessing during his anticipated seven-month layup, says Riegel. Even five months into the process she could still hand walk her horse safely and lead him to and from his round pen in a simple halter and lead rope.
Others--well, they're a challenge. Confinement gives some horses cabin fever: They rear, spin, and kick in their stalls or become unruly when handlers try to lead them or walk them under saddle. The antics can be detrimental to the injury at best and downright dangerous to handlers and riders at worst.
That's where the "judicious use of sedatives," as Goodall puts it, comes in. Some horses simply can't be taken out for a controlled exercise session without a dose of the mild tranquilizer acepromazine--or even a long-term tranquilizer such as reserpine. The latter is more powerful than "Ace" and usually is administered in the horse's feed, Donaldson says. (By the way, he hasn't found that so-called calming products have much effect on fractious stall-bound horses; but if an owner swears a nutritional supplement is helping, he doesn't object to its use.)
To counteract the horse's inevitable boredom, both Goodall and Donaldson have a "whatever works" philosophy: If your horse will play with a stall toy, by all means get him one. If he enjoys your company, spend as much time grooming, hand grazing, and hanging out with him as you can (safely and with your veterinarian's approval, of course). Donaldson, for instance, likes to hang a hay net in the stall with small openings which force the horse to eat slowly and, therefore, keep him busy longer. Eating small amounts nearly constantly also helps prevent gastric ulcers from forming, which Donaldson says are a hazard of stall rest stress. Having hay present at all times might also prevent the horse from eating his bedding--a recipe for impaction colic, he says, especially if the horse is accustomed to liberal turnout. Hay is also high-bulk and relatively low-calorie, which is a boon for those horses that have been taken off concentrates or have reduced rations to suit their abridged energy needs.
The isolation of stall rest is exacerbated if the horse can't see or be with other horses. "I'm starting to think that the environmental factor is more important than we originally thought," Donaldson says, referring to how a stable's atmosphere and the presence or absence of other horses impact a horse's tolerance of confinement.
In that regard, although he's a big believer in keeping horses as close to nature as possible (meaning lots of turnout), Donaldson has made an interesting observation: Horses housed in show barns, typically with limited turnout such that some horses are always inside, actually tend to fare better on stall rest than horses confined alone when everyone else is out on pasture.
However, "I've had some horses I've just given up on," Goodall says of the stall-rest conundrum. "Either they start having repetitive colic, or they are unmanageable" despite all efforts. In such cases, the owner has to make a decision, she says, such as turning the horse out and hoping for the best.
For the owner whose horse requires extensive therapy; whose schedule won't allow for multiple-times-a-day medicating, bandaging, or hand walking; or whose horse keeping situation isn't conducive to stall rest, there's another option: an equine rehabilitation facility.
Staffed by experienced professionals, rehab facilities offer full care and perform whatever treatment regimen the horse's veterinarian prescribes. Some offer treadmills, hot walkers, and even swimming pools. These businesses are not riding and training facilities, so they're typically quiet and restful environments without the kinds of stimulating activities and noises that can set a horse off. All the other residents are rehabbing too, of course, so generally there's always company.
Your veterinarian should be able to recommend a reputable rehab facility, Goodall says. Most charge the equivalent of board at a high-end training facility, typically $30 to $40 a day in her area, she says. It's not cheap, but some owners find the cost worth it for the peace of mind and the relief of not having to shoulder the rehab burdens themselves. The real financial strain, she says, can occur if the owner's regular boarding stable requires the continued payment of some or all of the board fee to hold the horse's home stall.
For some owners, a more affordable rehab option might be a full-care boarding facility. Goodall's clients who field-board often "move them to somewhere with a stall" for layup time, she says. Services at some full-care facilities include medicating, bandaging, and hand-walking. If yours doesn't, then you might be able to pay extra for these services. Depending on how much care your horse needs, the full-care route might be somewhat less expensive than a rehab facility, but discuss the options with your veterinarian before making a decision.
A Necessary Evil
That's how Donaldson thinks of stall rest. "It's not a natural thing for a horse to do," he says. "The isolation is very difficult for them. Horses are herd animals, and they're unhappy when they're kept apart from their friends."
Nobody relishes the thought of putting a horse on stall rest, and no horse owner who's done it is eager to repeat the experience. Should the day come that your veterinarian utters those two unwelcome words, discuss the care and time requirements, the anticipated rehab period, and your options thoroughly so you can make the best decision for you and your horse. And if your rehabbing horse starts behaving like a lunatic, let your veterinarian know so he or she can take steps to keep everyone safe.