FITNESS & THERAPY CENTER
WHAT DO DR BRAMLAGE
& DR BROYLES SAY ABOUT EQUINE FITNESS & THERAPY PROGRAMS
Benefits of
Therapy & Fitness Programs
for Thoroughbred Racehorses
WHITE PAPER
February, 2022
“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
Why is “de-training” the skeleton bad?
Bramlage: A horse that has had lots of high level training will have trained his muscles, heart and lungs as well as his bone to fitness. When you“de-train” the horse and then re-train, the soft tissues will train faster than the bone. This can result in recurrence or in “re-training injuries” like tibial or humeral stress fractures. Bone is always the slowest tissue in response to training because horses have such wonderful heart and lungs, and very good muscles for their particular use.
So where does the active rehabilitation fit in?
Bramlage: As a guideline most significant bone injuries will require 60 to 90 days to heal. Healing will necessarily cause some “de-training” in comparison to the normal training schedule. But in instances where you can insert active or controlled exercise you will minimize the “de-training,” reduce the chance of recurrence and prevent re-training injuries. Plus, it reduces the total exercise load to return to fitness if you can keep the horse “toned up” and not let them lose all of the results of previous training.
How do you do this?
Bramlage: It depends on the injury, but especially in instances where there is no structural damage and you are mostly wanting the horse to remodel wear and tear you can make good use of tools like the water treadmill to allow some weightbearing and preserve some fitness while the healing is taking place, especially during the second or third month when it is not detrimental to the healing of the primary problem.
What about things like the salt water spa or the vibrating plate?
Bramlage: The first step in many injuries is to reduce the inflammation. Salt water can be cooled more than plain water. This is very useful in some injuries, especially of soft tissues.
And the vibrating plate?
Bramlage: This is less well documented, and is no substitute for pasture exercise, but in some instances it can potentially help bone remodeling while you can’t allow free choice exercise. There is not much data to know, but you don’t have to force a horse to stand on the vibrating plate. Given the choice they will preferentially stand on a vibrating plate when you expose it to them in a situation where they have a choice. This must feel good to them. That gives you some indication it a positive influence.
“The goal of a therapy and rehabilitation program is to prevent injury, speed up recovery from an injury so there is less time out of training, and prevent re-injury.” - Dr. Ali Broyles
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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. 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 synovitis.
Tell us some of the issues that are positively benefited from using the therapeutic laser that HTC has? In layman’s terms how does the laser work?
Broyles: Low-level laser therapy (LLLT) has been applied in veterinary medicine for a long period of time, however more recently high power laser therapy (HPLT) has become available. HPLT applies a much higher power output compared to LLLT which allows deeper tissue penetration and makes the therapeutic process more efficient.
At the cellular level, laser therapy works by accelerating cellular regeneration and thus healing. HTC has a class IV therapeutic laser which applies this high power laser therapy. Recent work has shown that treatment with this type of laser showed significant overall improvement in lameness and ultrasonographic appearance of tendon or ligament injuries treated with HPLT versus similar injuries that were not treated with the laser.
My clinical impression after utilizing this treatment for proximal suspensory ligament desmitis and superficial digital flexor tendonitis is that it is very useful in speeding up the healing process for these injuries and potentially decreasing the re-injury rate.
Overall what are the benefits of the rehabilitation modalities at HTC and how can they be incorporated into a successful training program?
Broyles: More than 50% of TB racehorses experience a period of lameness during their career which not only affects the welfare of the horses but also has a significant economic impact. The economic impact is realized by days out of training, decreased performance, reduced income from winnings, loss of training fees, and cost of replacing the horse.
The goal of a therapy and rehabilitation program is to prevent injury, speed up recovery from an injury so there is less time out of training, and prevent re-injury. A specifically tailored program for each horse using a variety of modalities such as those available at Highlander aims to get your racehorse back to work at its highest level of performance with the least amount of time lost from training and lowest chance of re-injury.
Using modalities such as the aqua-treadmill, salt water spa, laser therapy, and vibration plate is fairly novel, but could be a game changer in the future.
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.
