12/12/2024
An excellent post, from one of our certified practitioners, reviewing the research around box rest ๐
Definitely worth a read! ๐
The content in our advanced CPD courses is underpinned by research and our students get access to relevant literature to add to their libraries ๐
Lovely to see such a well written review of what we currently know about box rest and controlled exercise!
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๐ฅ๐ฒ๐๐ ๐ณ๐ผ๐ฟ ๐ง๐ฒ๐ป๐ฑ๐ผ๐ป ๐ฎ๐ป๐ฑ ๐๐ถ๐ด๐ฎ๐บ๐ฒ๐ป๐ ๐๐ป๐ท๐๐ฟ๐ถ๐ฒ๐ ๐ถ๐ป ๐๐ผ๐ฟ๐๐ฒ๐?
Box rest, or complete stall rest, has traditionally been recommended for horses with tendon and ligament injuries. However, recent peer-reviewed studies demonstrate to us, that prolonged box rest is not the optimal approach to rehabilitation and can sometimes even hinder tissue healing.
While rest is of course important in the acute phase of injury, in order to reduce inflammation and to prevent further damage, recent research highlights the importance of controlled exercise, to stimulate tissue repair and to restore normal function (Smith, 2019; Dyson et al., 2024).
Early research studies carried out in equine rehabilitation often advocated for complete box rest, with the assumption that immobilising the horse would prevent further strain on the injured tissue. However, the newer research suggests that such an approach can have negative consequences, including muscle atrophy, joint stiffness, and a lack of tissue regeneration (Clayton, 2023; Dyson et al., 2024).
The prolonged immobilisation with box rest, can lead to the weakening of tendons and ligaments, due to the lack of mechanical loading, which is essential for collagen synthesis and the proper alignment of tendon fibers, during healing (Clayton & Murray, 2022).
Tendon and ligament tissues are responsive to mechanical loads and moderate controlled exercise can actually successfully facilitate the healing process, by promoting the production of collagen and other structural proteins, that are essential for tissue repair (Smith, 2019). On the other hand, box rest deprives these tissues of the necessary stimuli for regeneration and can result in delayed recovery (Dyson et al., 2024).
The most recent guidelines suggest that after the acute phase, controlled exercise is necessary to promote tendon healing and to reduce the risk of re-injury. A study by Clayton and Murray (2022), emphasised the importance of developing tailored, individualised rehabilitation plans, that incorporate incremental loading, with the goal of gradually increasing the intensity and the duration of exercise. Ultrasound imaging then, is often used by vets, to assess the progress of tendon healing and to modify the rehabilitation program accordingly where necessary, ensuring that the tissue is not over-stressed, or prematurely loaded (Gillis, 2024).
Controlled rehabilitation plans may include tailored static and dynamic exercise techniques, e.g. stable exercises, walking, pole work and eventually trotting and hill work, which can help to restore functional strength to the injured tendon or ligament, without overloading the tissue (Clayton, 2023).
*** ๐๐ก๐๐ฌ๐ ๐๐ฉ๐ฉ๐ซ๐จ๐๐๐ก๐๐ฌ ๐๐ซ๐ ๐ฉ๐ซ๐๐๐๐ซ๐ซ๐๐ ๐จ๐ฏ๐๐ซ ๐๐จ๐ฆ๐ฉ๐ฅ๐๐ญ๐ ๐๐จ๐ฑ ๐ซ๐๐ฌ๐ญ, ๐๐ฌ ๐ญ๐ก๐๐ฒ ๐๐ฅ๐ฅ๐จ๐ฐ ๐๐จ๐ซ ๐ ๐๐๐ฅ๐๐ง๐๐ ๐จ๐ ๐ซ๐๐ฌ๐ญ ๐๐ง๐ ๐ฅ๐จ๐๐๐ข๐ง๐ , ๐๐๐๐ข๐ฅ๐ข๐ญ๐๐ญ๐ข๐ง๐ ๐ก๐๐๐ฅ๐ข๐ง๐ , ๐ฐ๐ก๐ข๐ฅ๐ ๐ฆ๐ข๐ง๐ข๐ฆ๐ข๐ฌ๐ข๐ง๐ ๐ญ๐ก๐ ๐ซ๐ข๐ฌ๐ค ๐จ๐ ๐๐ฎ๐ซ๐ญ๐ก๐๐ซ ๐๐๐ฆ๐๐ ๐ ***
Studies by Dyson et al. (2024) and Smith (2019), found that horses who underwent complete box rest for extended periods, often faced longer recovery times and were at a higher risk of re-injury, once they returned to work. This is particularly true in cases of tendon injuries, where the integrity of the tissue may weaken with prolonged disuse (Smith, 2019).
While rest is crucial in the early stages of injury, recent veterinary consensus strongly suggests that a well-structured rehabilitation plan, that involves progressive loading, is the most effective for tendon and ligament recovery. This approach not only aids in the physical repair of the tissues, but also help to restore the functional capacity of the injured area (Gillis, 2024; Dyson et al., 2024).
So while box rest may still play a role in the initial stages of rehabilitation, following tendon and ligament injuries in horses, recent research supports the idea that controlled rehabilitation, including progressive exercise and monitoring, is much more beneficial for long-term recovery. This approach allows the injured tissue to heal, while restoring strength and flexibility without the negative consequences of prolonged immobilisation (Clayton, 2023; Dyson et al., 2024).
*** ๐๐จ๐ฏ๐ข๐ง๐ ๐๐จ๐ซ๐ฐ๐๐ซ๐, ๐ญ๐ก๐ ๐๐ฆ๐ฉ๐ก๐๐ฌ๐ข๐ฌ ๐ฌ๐ก๐จ๐ฎ๐ฅ๐ ๐๐ ๐จ๐ง ๐ข๐ง๐๐ข๐ฏ๐ข๐๐ฎ๐๐ฅ๐ข๐ฌ๐๐ ๐ซ๐๐ก๐๐๐ข๐ฅ๐ข๐ญ๐๐ญ๐ข๐จ๐ง ๐ฉ๐ฅ๐๐ง๐ฌ ๐ญ๐ก๐๐ญ ๐ข๐ง๐๐จ๐ซ๐ฉ๐จ๐ซ๐๐ญ๐ ๐๐จ๐ญ๐ก ๐ซ๐๐ฌ๐ญ ๐๐ง๐ ๐๐ฉ๐ฉ๐ซ๐จ๐ฉ๐ซ๐ข๐๐ญ๐ ๐ฅ๐จ๐๐๐ข๐ง๐ ๐ญ๐จ ๐จ๐ฉ๐ญ๐ข๐ฆ๐ข๐ณ๐ ๐ก๐๐๐ฅ๐ข๐ง๐ ๐๐ง๐ ๐ซ๐๐๐ฎ๐๐ ๐ญ๐ก๐ ๐ซ๐ข๐ฌ๐ค ๐จ๐ ๐ซ๐๐ข๐ง๐ฃ๐ฎ๐ซ๐ฒ ***
If you need help with rehabilitating a tendon or ligament injury in your horse, we can help! โค๏ธ๐โค๏ธ Let's follow the guidelines of the experts in this field, after all, they provide us with the most up to date protocols!! โค๏ธ๐ We are also more than happy to work in conjunction with your vet! ๐
https://theosteopathicvetnurse.ie/
๐๐๐๐๐ซ๐๐ง๐๐๐ฌ
Clayton, H. M. (2023). Equine Rehabilitation and Tendon Injury: Current Practices and Emerging Therapies. Veterinary Clinics of North America: Equine Practice, 39(1), 157-172.
Clayton, H. M., & Murray, R. (2022). The Role of Controlled Exercise in Tendon Rehabilitation: New Insights. Equine Veterinary Journal, 54(5), 612-624.
Dyson, S. J., et al. (2024). Rehabilitation of Tendon and Ligament Injuries in Horses: A Review of Recent Advances. Journal of Equine Veterinary Science, 107(4), 118-126.
Gillis, C. (2024). Controlled Exercise and Rehabilitation of Equine Tendon Injuries: A Review of Evidence. Veterinary Surgery, 53(2), 227-235.
Smith, R. (2019). Management of Tendon Injuries in Horses: Is Box Rest Still Relevant?. Horse & Hound. Retrieved from https://www.horseandhound.co.uk.
