White Paper, February 2022
Dr. Larry Bramlage DVM, MS, DACVS
Rood and Riddle Equine Hospital Lexington, Kentucky
Dr. Ali Broyles, DVM, DACVS-LA
Equine Sports Medicine & Surgery Weatherford, TX
“Active rehabilitation is very useful for getting horses with some conditions back to training efficiently and in better condition to resume training without excessive delays.” - Dr. Larry Bramlage
Dr. Bramlage Q&A:
Do you recommend active rehabilitation for your patients?
Bramlage: Yes. I believe it is very useful for getting horses with some conditions back to training efficiently and in better condition to resume training without excessive delays.
Isn’t more time better than less?
Bramlage: No, in a heavily training horse they accumulate wear and tear that needs time and sometimes surgical or medical treatment to recover. But, excessive time is not beneficial to horses who have very active skeletons due to their training level. Their bones are very active in responding to training in order to build and maintain the skeleton in racing or performance fitness. But if you stop the training the bones are just as active at “de-training” the skeleton as they are at training it.
So, how much time is ideal?
Bramlage: That depends on the injury. Some injuries require stall rest. Some do best with controlled exercise. Some do best in the field and some do better with a combination of the options.
How do you know?
Bramlage: Your veterinarian should be the best source of advice here. There is no substitute for pasture exercise for healing wear and tear in a skeleton. Horses evolved as grazing animals so their bone circulation is most efficient with the horse grazing. They will eat a few bites, then walk three or four steps, then eat a few more bites, then walk again. This is the exercise that is best for routine skeletal remodeling, and for healing. Some of our injuries are promoted by the amount of time a heavily training horse must spend in the stall.
“When you“de-train” the horse and then re-train, the soft tissues will train faster than the bone.” - Dr. Larry Bramlage
Dr. Broyles Q&A:
Describe the key benefits of underwater treadmill exercise in horses. How can incorporating a 30-day transition period of Aqua-treadmill exercise be beneficial in horses coming out of a lay off from an injury?
Broyles: Underwater treadmill exercise provides cardiovascular condition and improves muscle strength without excessive stress on the joints, tendons, or ligaments. Both the in-ground and above ground aqua-treadmills at HTC have the capability to adjust the water level which allows for targeted therapy of specific joints or injuries. The higher the water level the more buoyancy the water provides and the less weight bearing stress is placed on the horse.
The aqua-treadmill provides an environment for controlled exercise for rehabilitation in which the height of the water and therefore weight bearing can be tailored for specific horses and their particular injury.
In addition, moving through the water requires increased effort by the horse which results in increased muscle strength and cardiovascular endurance.
Specifically, horses recovering from arthroscopy (joint surgery) or in horses with osteoarthritis the aqua-treadmill has been used to increase the joint range of motion which reduces joint capsule fibrosis
(stiffening). In addition to improved range of motion, the hydrostatic pressure from the water and the low temperature of the water improves inflammation in the synovial membrane. For recovery of tendon and ligament injuries in the later stages of healing, the buoyancy of the water provides controlled weight bearing of these structures which is necessary to stimulate the remodeling process.
Overall, a 30 day transition period from paddock turnout to training, allows the horse to become strong cardiovascularly and muscularly which decreases their chances of fatigue and re-injury when they return to training on the racetrack.
What conditions benefit from the cold saltwater spa and how can this therapy modality be used not only for treatment but also prevention of injuries in the racehorse?
Broyles: The saltwater spa has been reported to benefit a variety of conditions including tendonitis, desmitis, wounds, arthritis, synovitis, bruising, and bucked shins. The temperature in the salt water spa can be chilled more than plain water (between 35-37F) and at this temperature the water is more efficient at reducing inflammation and heat and even provides a pain relieving effect. In addition, water at this low temperature has an increased ability to carry oxygen which strengthens the horse’s natural healing mechanisms. Salt water also has an increased density which increases pressure on the limb which aids in reduction of swelling and edema formation. Cryotherapy has long been used in injury prevention by reducing blood flow to the extremities which in turn reduces tissue metabolism and subsequent inflammatory mediator release and hypoxic injury. bolism and subsequent inflammatory mediator release and hypoxic injury. bolism and subsequent inflammatory mediator release and hypoxic injury. Using the salt water spa after intense exercise such as a breeze might help prevent common injuries that develop post workout such as bucked shins and synods.
What are the benefits of vibration plate therapy and what cases might benefit from this type of treatment?
Broyles: Human studies have found vibration therapy to improve bone density, increase muscle mass, improve circulation, and reduce pain. Fewer studies are available in horses but some of the known benefits include increased back muscle development, increased hoof growth rates, and ligament healing. Personally, I find the vibration plate to be most helpful in horses that have bone or tendon/ligament injuries that require a period of stall confinement. The vibration plate provides stimulation of the bone or tendon/ligament to heal without the risk of re-injury from exercise.
What about hyperbaric-oxygen therapy (AKA HBOT)? How does it work and what cases are best suited for this type of therapy?
Broyles: With HBOT the horse breathes 100% oxygen under pressure which significantly increases oxygen delivery to the tissues. There are many benefits of HBOT as an adjunctive therapy and it is most commonly used to treat infections, wounds, maladjusted foals, tendon injuries and EIPH (AKA “bleeders”). In my experience HBOT has been extremely beneficial in treatment of large wounds and for treatment of EIPH. I have treated several horses suffering from EIPH when traditional medical therapies have not succeeded and seen very positive results. There are only a few facilities that have HBOT for horses and while HTC does not have a HBOT chamber, we are able to refer out horses that might benefit from this form of therapy to Equine Sports Medicine & Surgery in Weatherford, TX.
Offering a complete suite of services for the care, fitness & therapy of your Thoroughbreds.
COLD SALT WATER SPA
Cold Salt Hydrotherapy is used to treat and lower the risk of a multitude of injuries. The soothing salt solutions act as a hypertonic poultice, reducing heat while having a natural healing effect.
In ground and above ground, the aqua treadmills at HTC are designed to relieve stress and promote healing and fitness. They have been proven to be powerful tools for rehabilitation, training and conditioning of horses.
VIBRATION PLATE FLOOR STALLS
Vibration plate therapy can lead to improved performance and even prevent injuries and accelerate healing. Vibration therapy has also been used to treat tendon and ligament injuries, decreased bone density, bucked shins, and arthritis in horses.
REGENERATIVE LASER THERAPY
Once considered career ending injuries are being met with renewed confidence and optimism around the globe. SOUND® brings the ground-breaking RLT Vet Regenerative Laser Therapy to equine medicine.
THERAPULSE BLANKET THERAPY
By stimulating and regenerating cell tissue, it is a highly popular form of therapy for muscles, ligaments, bone repair, wound healing and blood revitalization.
Great for respiratory issues • Treat coughs & excessive mucous
Delivery system for respiratory medications
VETERINARY CARE & SERVICES
Highlander Training & Therapy Centers rest on 189 acres near Sulphur Springs, Texas, 80 miles east of Dallas. Highlander was founded on the core principle of forging champions.We are located within easy shipping distance of nine major racetracks, and we regularly ship horses to and from tracks in Kentucky, New York and across the country. At Highlander Training Center, we strive to produce winning horses
through meticulous horsemanship, carefully balanced nutrition, complete veterinary care, and attention to detail. Our riders, grooms and therapy center personnel are also experienced profession