The role of rehabilitation facilities is growing rapidly as owners set new standards for healing injured sport horses.

Becky Holder was at her wit’s end. She looked over the stall door at her beloved gray frantically circling his stall and knew something had to change.

Holder’s Olympic and World Equestrian Games veteran, Courageous Comet, had been injured at the 2010 Alltech FEI World Equestrian Games, and his recovery wasn’t going smoothly. At the WEG, Comet threw a shoe on cross-country and strained the check ligament in the opposite front leg, which kept him from completing the event.

“The best vets in the world were there, and they all felt like it was a fairly insignificant, though momentarily painful, injury that should heal very quickly,” Holder said. “When they sent him home, everyone was all smiles, believing that with the correct anti-inflammatories and rest, we were looking at a couple of months recovery time.”

But once Holder got Comet home to her Chattahoochee Hills, Ga., farm, she ran into frustration. Comet, fit enough to run a four-star cross-country course, wasn’t happy on stall rest and took up stall walking.

“It was very difficult to keep him happy,” said Holder, who tried to get Comet out hand walking as much as possible.

Even more worrisome was the lack of progress in Comet’s leg healing, despite Holder’s best efforts with icing and therapy. “It just wasn’t looking the way I thought it should look,” she said.

And an ultrasound taken three weeks after the injury told a disheartening tale. “He had started to lay on so much scar tissue in the area that it was really alarming. They didn’t know why, but his leg was healing by binding scar tissue not within the structures, but outside of the structures.”

Intensive Attention

Holder knew she had to change Comet’s situation to get his healing back on track. She decided to send him to KESMARC Florida, an equine rehabilitation facility in Ocala. The staff there was up-to-date on a wide range of therapies and willing to work with Comet’s current veterinarians, Dr. Christiana Ober and Dr. Tom Daniel.

KESMARC Florida offers cutting-edge therapeutic equipment such as an AquaTred submerged treadmill, a swimming pool, a hyperbaric chamber, an Equigym exerciser and an indoor track. And the facility’s environment helped calm Comet.

“The routine was all about him,” Holder said. “They had him out of his stall seven or eight times a day, so he didn’t get bored. They hand-walked him five or six times a day in their big facility, where he didn’t have the stimuli of other horses being turned out next to him or riding by. They lasered his leg, and he went on the AquaTred, and they gave him all kinds of attention.”

Holder was especially thrilled with the constant updates that KESMARC Florida provided her. They frequently emailed her progress reports and video clips of Comet jogging. Comet’s recovery accelerated as the KESMARC Florida staff followed the program Ober and Daniel had set up.

“It felt like I was getting the total picture and there was a good continuity to everything,” said Holder, who took Comet home in March after 10 weeks at the facility. “When I got him back, he’d kept good weight, and he’d had all his Gastrogard and meds. They’d taken really good care of him.”

Since Comet’s leg had recovered to the point that he no longer needed complete stall rest, and Holder was able to walk him under saddle and turn him out, Comet re-integrated to his home life well and continued to thrive.

“It just gutted me to leave him, but I’d do it again in a heartbeat if I had another horse with a serious injury or that needed to be on stall rest for an extended amount of time,” Holder said. “That level of individualized attention and time is just something that it’s hard for a busy professional rider to provide for an injured horse.”

Keeping Them Happy And Healthy

Injured horses, especially those with competitive careers, require substantial care. Hand walking, cold hosing or icing, wrapping and medicating an injured horse can consume hours each day. And, like Comet, many horses used to turnout and regular riding don’t adjust easily to 24-hour stall rest. It can be difficult to keep them happy and relaxed, and colic can be a real threat.

“It’s hard for a horse that’s used to having an intense job to have that job taken away because he’s injured,” said Kirsten Johnson of KESMARC, the Kentucky Equine Sports Medicine and Rehabilitation Center in Versailles, Ky. (KESMARC in Kentucky shares a name with the Florida location but is now a separate entity.)

“Those horses that are very kind and good-natured in their usual routine can become very hard to handle. The worst place for a horse to be when it’s injured is in the training setting not being able to train. They don’t comprehend why they’re stuck in a stall or hand-walked. But when you put them in the correct rehabilitation situation, it’s much easier for them. They’re in a controlled setting, and they’re kept very busy. And they’re happy.”

Equine rehabilitation facilities offer specialized care designed to cater to an injured horse’s needs. They also provide access to highly specialized equipment such as swimming pools, underwater treadmills, cold-salt spas, walkers and even hyperbaric chambers, which usually aren’t readily available to most horse owners. Equine rehabilitation centers also administer therapies with machines such as the Game Ready hot/cold compression system and laser therapy.

“Equine rehabilitation centers fulfill a very important need. It’s an option I find valuable for injured horses I’ve had,” said grand prix show jumper Mandy Porter of Olivenhain, Calif., who has sent horses to Premier Equine Center in Oakdale, Calif.

“If I know I’m going to be traveling a lot and wouldn’t have the time or the equipment to help a certain problem a horse might have, I would definitely send a horse there,” Porter continued. “It’s comforting to know that they’re not just winging it; basically, they can provide any service a horse needs.”

A Proactive Approach

 “I think that one of the things that’s changed is just the whole thought of what rehabilitation is,” said Dr. David MacDonald of Pioneer Equine Hospital in Oakdale, Calif. “Rehabilitation used to be a box stall or small paddock and a bit of conscientious neglect, in some respects. Now it’s morphed, and I think part of that has been brought about by our knowledge and by people having an increased interest.”

Water therapy is one the most valuable modalities available in rehabilitation centers. “What’s traditionally problematic is the fact that you can’t have a horse not bear weight in an injured leg, whether it be a bone, tendon or ligament injury,” said MacDonald. “They’re not humans, who can sit on the sofa or use crutches.”

In the past, an injured horse would progress from stall rest to hand walking to restricted turnout. But in each of these steps, the horse experiences full weight load bearing on the injured leg.

“When you’re swimming horses, you’re not loading the leg with weight, and you’re not putting as much torque on soft tissue structures, so it can be a great way to start controlled exercise,” said MacDonald. “An AquaTred, which is a treadmill underwater, allows for weight bearing but with reduced force, because of the buoyancy of the water. And then the Eurocizer really allows them to begin normal weight-bearing exercise with a high level of control, as opposed to a turnout situation.”

“There’s nothing about stall rest, hand-walking and turnout that makes sense for some of these high-end athletes,” added Johnson. “Some of them are miserable the entire time and can do more damage in turnout than they would have in a controlled exercise program until they went go back to training.”

Putting The Puzzle Together

Johnson first started a rehabilitation facility in Texas before moving to Kentucky and opening KESMARC 10 years ago. She was involved in the Thoroughbred and Quarter Horse racing industries and in western performance horses before she became interested in taking a more holistic approach to healing equine injuries.

“I just felt like there were horses that were lost,” she said. “I saw trends in the pathology of injury. I saw trends on the human side. A human athlete wouldn’t even consider having an injury and not having rehabilitation. Surgeons will tell you that the surgery is only as good as the work that you put into the rehabilitation following the surgery.

Johnson advocates a holistic approach to a horse’s recovery, and she draws on the rich resources of world-class veterinarians in the Lexington, Ky., area to guide her. Like most facilities, KESMARC will either coordinate with a horse’s referring veterinarian or consult with area veterinarians to create and adjust a horse’s rehabilitation program.

“Every horse is so different, I can’t have a standard protocol. We change as the horse changes. We re-evaluate these horses with the attending veterinarians constantly throughout the healing process to make sure we’re going in the right direction,” said Johnson.

“Every horse is a puzzle, and some of the horses are more complicated than others, but it’s our job to put the puzzle together so that the horses can go back to the best of their ability. The only way I’m successful is if a horse goes back to the level they were at or better,” said Johnson. “It’s an exciting time, and I think there are a lot of great advances being made in keeping horses sounder.”

Those advances also inspired Pat Grohl and Amie Allen, who opened Premier Equine Center in 2008.

“We saw all the new equipment like the AquaTred and the Eurocisers, and there weren’t many facilities in our area to fill that need, so we decided to give it a go,” Grohl said. “When I was younger, you wrapped injured horses and kept them in a stall for a week, then turned them out and didn’t look at them for six months. It’s very different now!”

Both facilities offer not only rehabilitation for injured horses, but also conditioning for horses in a training routine. And both facilities cater to a wide variety of disciplines, both English and western, such a racehorses, show, event and dressage horses, reiners and rodeo horses.

Grohl and Allen built their business through word of mouth, and they still make an effort to attend competitions on the weekends not just to spread the word, but also to follow up on former residents in their program.

“It’s neat when you go to a show and see one that you’ve had in the facility for a few months, and they’re doing well and winning,” Grohl said. “It’s a good feeling.”