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Physical Therapy (Post Injury Reconditioning)

November 2017 - AAEP is on Stall Rest

AAEP is taking the month of November off from "Ask the Vet", but will be back in December to answer your equine health questions concerning winter weather care for your horse with expert, Dr. Christine Tuma.



Click here to read this month's questions and answers.
  1. My 22-year-old Arabian/Welsh pony has been on the borderline of founder for the last couple years. We have monitored her diet, but it seems she has or is going to founder shortly. I just moved her to a different location where she can be monitored more closely. I feel heat in her hooves and her toes are starting to push up, which I am hoping is because of previous poor trimming. I am going to have a veterinarian and farrier out soon, but was wondering if there are better ways to prevent or slow this down from happening.

    (View Answer)

    I would not wait to call your veterinarian to see your pony as it sounds as she is already foundering. Often, older ponies founder due to other reasons than poor shoeing and the farrier will need to work closely with the veterinarian. Not even the best farrier can prevent lamintis in a pony that has an untreated metabolic disorder. Laminitis in older ponies can be prevented if they are diagnosed early with the condition that could lead them to laminitis and treated in time. Your veterinarian may want to test your pony's blood for pituitary dysfunction and insulin resistance, and check the levels of some hormones that can predispose the horse to laminitis.

    Rehabilitation from laminitis takes months or forever, depending on the affected tissues and extent, and how soon treatment begins. A skilled, experienced farrier will be paramount with the guidance of frequent radiographs and veterinarian exams as well as blood tests. Early acupuncture is very important to help control pain and inflammation, as well as once the condition is chronic. The other modalities will vary depending on the reason why your pony foundered. Silvia Do Valle, DVM, Orlando, Fla.

  2. My aunt has a 2-year-old filly that has had a leg problem for most of her young life in which she is constantly lame on her left front leg. The veterinarian said she has a damaged elbow with rough edges, in which case she will never be able to be ridden again. I know I am taking a shot in the dark but I know there has to be a way for her to heal and be an amazing horse. She is too nice and otherwise too sound of a horse to just be standing in the pasture.

    (View Answer)

    I am sorry to hear about your aunt's filly. It is difficult to give a lot of advice only online without a personalized physical exam. I would suggest that she get a second opinion, preferably from a specialist in lameness and rehabilitation, and an AAEP-member veterinarian. She/he will need your filly's previous records and and radiographs or ultrasound copies, so you may want to ask for those ahead. I would think that even if she already had those taken, it may be necessary to repeat them or perform them at a different area in the body as quite often horses have multiple lamenesses.

    You can also ask your veterinarian, who just examined her, if any pain meds or anti inflammatories are indicated, or a special way to shoe her, to at least give her some comfort in the meantime. I would not recommend breaking and riding her as she is too young regardless of her physical condition.

    If the previous are not possible, you can try an acupuncture certified veterinarian, as acupuncture will help relieve pain and maintain muscle mass. Silvia Do Valle, DVM, Orlando, Fla.

  3. My horse has just been diagnosed with a medial collateral ligament tear in the knee. What is the best treatment and rehabilitation for this injury?

    (View Answer)

    Tears of the medial collateral ligament of the carpus usually occur due to trauma to the region and the joint often has severe arthritis. It can also happen secondary to arthritic changes or fractures. The condition can be quite severe and the animal may be only pasture sound in spite of treatment depending on how severe the problem. The treatment will depend if there is also damage to other structures, such as the joint capsule, bones, muscles/tendons, carpal canal, and joints. If acute and no open wounds, the knee can be iced for the first 48 hours. Cold hosing the ligament may relieve some of the pain but unlikely will cure anything. The horse may need surgery depending on the damage to the other tissues, also PRP can be used if not a complete tear. I have successfully treated other types of desmitis with prolotherapy in the past, and currently the use of stem cells for injuries where tissue replacement is desired had been also advocated.

    Rehabilitation of a corrected knee injury depends on the treatment and areas involved and may include laser therapy, passive range of motion exercises, swimming/under water treadmill, therapeutic ultrasound, PEMFs, liniments, immobilization or bandaging, and acupuncture.

    I hope your horse heals soon. Good luck! Silvia Do Valle, DVM, Orlando, Fla.

  4. My horse was diagnosed with EPM. What can I do to help her recover? She is currently on ReBalance and Vitamin E. What more can I be doing?

    (View Answer)

    EPM is a very difficult condition to properly diagnose, and also difficult to treat. Usually the horse needs to take specific antibiotics against the parasite for several weeks, aside from the medications that you are already giving. There is no one cure for it, each case has to be individually addressed as the symptoms and gravity will depend on where the parasite is located in the spine. I'd call your veterinarian and ask her/him for a recheck appointment to follow up with the case in a couple of weeks after treatment has started.

    If it seems that you may need some extra help, then ask your veterinarian for a referral to an AAEP member veterinarian or to a Board Certified Internal Medicine veterinarian. EPM is a very complicated condition. Silvia Do Valle, DVM, Orlando, Fla.

  5. My horse had check surgery two weeks ago. I though it would be a fast simple recovery but its been 2 weeks and he is still at the hospital for rehabilitation. What should the aftercare protocol be for this surgical procedure?  We are located in Palm Beach, Florida. Are there any other aftercare facilities within this area that would be less costly than that of the hospital he is currently residing?

    (View Answer)

    Distal check ligament desmotomy is the name of the surgery performed when the distal accessory branch of the deep flexor tendon is severed. Used often as an attempt to relieve flexural deformities of the distal interphalangeal joint, such as club foot, as well as some types of navicular syndrome. Proximal check ligament desmotomy in another completely different surgery, performed on the accessory branch of the superficial flexor tendon and used as a treatment for tendonitis in racehorses. The surgery areas can heal quickly, around 2 weeks, but the changes in the limb biomechanics can be dramatic and need to be worked on individually for the procedure to achieve its intent. The best person to answer your questions would be the surgeon veterinarian who performed it, as she/he examined the animal and has been accompanying it's progress. Silvia Do Valle, DVM, Orlando, Fla.

  6. I have a horse that is 9 months out from surgery to repair a broken shoulder. What is the best way to help his damaged nerves to recover?

    (View Answer)

    Theoretically, damaged nerves do not recover. In practice though, we often see the damaged nerve function return over time to some extent. It would depend on how much damage and where. If there are smaller collateral nerves that could compensate the deficiency, and the other dated tissues scarring and healing. Sometimes the nerve damage is not extensive but the muscles and ligaments around it are scarred and the limb may not function properly regardless, making it look like nerve damage.

    The idea is to strengthen the supporting tissues to compensate for the nerve deficiency, and maintain the limb functionality. If any nerve tissue heals, it would take over three (3) months. In the meantime, the muscles and supporting tissues will atrophy if not properly exercised.

    Passive range of motion exercises early on are crucial to muscle fitness. Once able to bear some weight, under water treadmill provides buoyancy and resistance to improve muscle, tendon and ligament strength without much impact. TENS has limited range but can also be used, as well as PEMF devices.

    Acupuncture is excellent for long-term balancing both the damaged area as well as the contralateral limb compensation. It is thought to be able to help the body regenerate nervous tissues and decrease scarring. It should be started very early on, once swelling goes down even if there's still fractured bone as it will help it heal faster.

    Bear in mind that most of these modalities have not been extensively researched for use in horses or for the specific needs of your horse and you should first consult your veterinarian about what is the best procedure in your case and have him/her accompanying the progress often. Silvia Do Valle, DVM, Orlando, Fla.

  7. My 18-year-old Appendix mare is prone to hind hoof flaring both barefoot and in shoes. She also tends to be low heeled naturally. The medial hoof wall is more upright with the lateral hoof wall tending to flare out (even over the shoe in a 5-week shoeing cycle). What causes hoof flares? What can I do to prevent this? I believe that it is contributing to stifle weakness that she has developed.

    (View Answer)

    You're right, it may be causing lameness up the leg. I would recommend a full exam with your veterinarian when she is unshod to make sure there are no tumors or white line disease as well as sensitivities. Then you may want to ask your vet to radiograph her feet both laterally and front to back views at least as she may have some pathology inside the hoof in the bones or cartilages. If nothing is wrong, your farrier can use the radiographs as a guide to properly shoe her every 4 weeks with a wider branched shoe on the side of the flare and longer wider heel support as well, if indicated by your veterinarian's exam. Silvia Do Valle, DVM, Orlando, Fla.

  8. My horse developed a dent in her right hindquarter a few months ago. She did not cut the area, no bleeding, nor did she appear to be sensitive to the area. I started noticing that she would bring that leg down faster than the other when she walked. It was almost as if she couldn't extend it as far as her left hind leg. What is going on? I had not been riding her when this showed up. She still has the dent, which is about 8 to 10 inches long and seems to run horizontally on her rear right side about 1/4 inch deep.

    (View Answer)

    It is difficult to know without an examination. She could have ruptured a tendon, ligament or have other muscular damage.  I would recommend a veterinarian exam and likely ultrasound the area to rule out a tumor or abscess. Silvia Do Valle, DVM, Orlando, Fla.

  9. My horse was a hunter/jumper, but he has torn his straight sesmoidian ligament and is also dealing with severe arthritis in his pastern joint. This is all going on in his right front. We injected his joint with cortical steroids and he is now sound at a walk. However, he is still a little off at the trot. Does this mean we are progressing him too fast? Should we continue walking for a few more weeks only? His ligament looks much better. I have been making him wear his back on track boots for 45 mins before I ride for heat therapy and after a workout I use surpass. He also gets previcox. Should I be icing his joint after work too?

    (View Answer)

    How long ago was the injury? I would be afraid to trot him yet. Best to have your veterinarian examine him and have nerve blocks performed to try to isolate the reason for lameness at this point, and find out if it is the arthritis (he would warm up and improve), the sesamoid desmitis (may get worse especially in softer surfaces) or both. If it is arthritis, ice may not be a good idea. I don't think the back in track makes much difference but will not hurt to wear. I would not exercise him without advanced support such as Professional Horsemen sports medicine boots. Hosing in warm water and post exercise standing bandages over the Surpass tight all the way down to the coronet for 12 hours (maximum), may comfort him too. Laser therapy, class 4 or 3b, will take a lot of the pain away and help him heal faster.  Once you find where the pain is, you can also try the Assisi Loop before the bandage. If not sure, you can use it on both areas. Silvia Do Valle, DVM, Orlando, Fla.

  10. My mare suffered a minor strain of her medial collateral ligament, and was on stall rest for five months. My vet says we need to challenge the ligament without reinjury. What kind exercise would you recommend?

    (View Answer)

    I would need to know which joint is involved and to what extent is the injury. Other than stall rest, what other treatments were used? Passive range of options can be used for the first few days assuming the injury has healed on ultrasound. Silvia Do Valle, DVM, Orlando, Fla.

  11. I am racing a 6-year-old Standardbred that has more willingness than any other horse I have raced. However, after he races he absolutely cannot put any weight on his left hind leg. I have had every joint blocked from the coffin joint up to the stifle joint. I also have a pool, which I swim him a couple days a week. He is also turned out in good weather. He will continue to get better day by day after he races and after two weeks, he is sound enough to go again. After he races, he will only walk on his toe for about a day and gradually get better. There is no heat or swelling anywhere though he does have a hunters hump, which could indicate the sacrol or hip joint area.

    (View Answer)

    I'd try nerve blocks next, after the race when he is very lame, preferably. A rectal exam to evaluate the iliopsoas after the race is a good idea also. Assuming that aside from joint blocks, the horse was also negative to regional nerve blocks. To properly diagnose this horse, it would be ideal to have a scintigraphy done shortly after the race. Yes, it is possible for there to be a problem in the hip, a very difficult area to xray, but possible to ultrasound both the sacroiliac and the hip joints. If you are going to scan with an ultrasound I would check the proximal suspensory too even if the tarso-metatarsal joint block was negative.

    Without finding the source of lameness, you can still try a chinese veterinary exam as it may give you some more information,  and treat with either acupuncture and/or chiropractic as in this case won't hurt.

    Also, make sure your veterinarian has checked his testicle and that they remain in the scrotum during the race. It can be very painful for an extended period of time when the testicle is tractioned into the inguinal canal during strenuous exercise due to improper descent or too small of size. Silvia Do Valle, DVM, Orlando, Fla.