By Heather Smith Thomas
Occasionally a horse must be confined during recuperation from injury, illness, surgery or some other situation that necessitates reduced activity. Stall confinement with strict limitation of activity can be a challenging situation for many horses, however.
There are reasons for rest, says Melinda Freckleton, DVM (Haymarket Veterinary Service, Haymarket, Virginia). She says injuries requiring stall rest may be as serious as a fracture or post-surgical recuperation (colic surgery or orthopedic surgery) in which you don’t want the horse to be active and disrupt the stitches or healing tissues. In other instances the horse may still be allowed to move around, but must be confined for some other reason. “I had a case last year in which a horse had stitches in the eyelid. When this horse was left loose he was constantly rubbing the stitches out. I recommended cross-tying the horse in the stall,” she says.
Other reasons for stall rest include soft-tissue injuries such as tendon, ligament or joint injuries, or repair of a laceration. “If a large sutured wound is not kept immobile, it may open up. If that happens very many times, we can’t suture it again. If it’s a big injury that takes a long time to heal, with potential for lots of scar tissue and other negative consequences, the horse needs to be confined.”
There are many reasons for stall rest, and the strictness of rest will depend on the reason. “There must be clear communication between the veterinarian and people taking care of the horse, because it may be different for each horse. The horse with the eyelid sutured wouldn’t need to be inactive, for instance. The owner in that situation could do unlimited hand walking if the patient tolerated it, or even ride that horse if he would accept being ridden with a bandage over that eye,” she says.
In some cases confinement is just a supervisory issue. At the other extreme would be something like a non-displaced fracture, which will heal if the horse can be kept inactive. “That horse must not be allowed to leave the stall at all, and you can’t even allow him to be silly in the stall,” says Freckleton.
HOW TO
FACILITATE STALL REST
The first priority is a safe stall where the horse can’t injure himself. Make sure there are no openings that a frantic horse might try to go through to get out. Openings should not be too big (that the horse might actually get through) or too small (where the horse might get his head caught).
“You need to watch and monitor the horse closely and also know the horse, and what he might do. I had one patient come over the top of a Dutch door when his friend was leaving the barn. He somersaulted and luckily didn’t create new injuries,” says Freckleton.
What worked well for your horse in the past during his normal daily routine may not work during continual, uninterrupted stall rest. Use common sense and assume that some things may go wrong, no matter what you do or how well you plan. It may be trial and error for each horse.
Not every horse owner has a good place to safely and effectively confine a horse. “Have a plan for where you could put the horse if something happens that requires stall rest. Not every boarding facility or stable has a sturdy, safe, well-ventilated and appropriate place for a horse to be confined long-term. If something happens that requires stall rest, you might consider putting the horse in a different facility or rehab center just for this purpose,” she says.
One advantage when moving the horse to a different place is that it’s easier to change the horse’s routine without stressing him. When a horse is at home, he’s accustomed to a certain routine–eating at a certain time, going out for turnout and maybe playing with buddies–and he expects this. “If he’s locked in a stall in the new place, he generally doesn’t become as upset with a different routine. He has a different set of expectations about what happens in the new place–similar to a small child’s expectations about going to camp versus going to school,” says Freckleton. The psychological aspect of having the horse in a rehab facility for lay-up instead of at home is worth considering.
“At a rehab facility there are people who are used to doing this sort of thing and they have lots of good tricks for keeping a horse quiet, happy and entertained. The horse will probably have a friend across the aisle in the same situation. That can really help,” she says.
Even if you are doing it at home, there are some things you can try. “I have a horse of my own that stall-rested for a very long time as a young horse, and he took to it quite well. Once in awhile if we have a horse here that’s having trouble settling in, we put my old horse (who could care less about whether he ever goes out again) in a stall next to the resting horse. He’s a good influence and this can be very calming. It doesn’t work every time, but it’s something you can try—putting a calm, leadership-type personality horse next to the horse that must stay in. It’s not always the best thing for my old horse because he could do with some time outside, but sometimes it’s a worthwhile tradeoff,” she explains.
Another trick that helps some horses is to keep them entertained. “Stall toys are helpful for the horses that will actually play with them. I haven’t had great luck with adult horses and stall toys, but there are exceptions, and those individuals really appreciate having toys,” says Freckleton. These distractions give them something to do, and prevent boredom and frustration.
“Horses that can be a little active and go on hand walks, perhaps with a calm buddy horse, can benefit from getting out of the stall every day for controlled exercise. Some that can’t have this much exercise might be allowed to graze quietly at the end of a lead rope,” she says.
“The attitude of the person holding the lead rope is very important. I had one stall-resting patient whose owner couldn’t handle her horse. He had her number and did what he pleased. Other people could take him out and hand-graze him or walk him without any trouble, but he gave her a bad time. Sometimes, if the owner is having problems with the horse, it’s worth asking a trusted friend or professional to try. Someone else that the horse has a different relationship with may be able to get the horse out and do it calmly.”
If the horse has a quiet disposition, you may be able to take him out of the stall and hold onto him while you are doing something else. “When my old horse needed stall rest years ago, he was such a good boy that the other instructor at the barn would take him out when she was teaching, and stand with him in the middle of the ring. He loved that because it got him out of his stall and let him look around and be very social without any exercise that would harm the ligament problem he was being rested for,” says Freckleton. Sometimes you just need to be creative, to figure out something that will work for that particular horse.
“Another owner whose horse was stall resting used the time to work with that horse doing many ground exercises. She felt she was going ahead in that horse’s training, and the resting time wasn’t wasted. She asked me if that type of activity was safe for that horse during his recuperation, in terms of the level of activity he was supposed to have, and it was, so this was something productive she could be doing with the horse—and it kept his mind occupied. He was a horse that did not appreciate having to just stand around,” explains Freckleton.
In another instance, one of her patients was just starting to get back to work after a bout of laminitis. “Using a deep ring with soft footing, the owner got him used to driving equipment. This horse had never been driven, so she used the time during his hand-walking period to put the equipment on him and walk him around with it on. She felt like she was moving ahead with his training in spite of the lay-off, and the horse was able to get back into work faster.”
Hand walking is boring for many people. “Horse owners need to realize that we prescribe the hand walking as important physical therapy in the course of many situations we’re rehabilitating. It’s really important to do the hand walking consistently and the do it the way it was prescribed,” says Freckleton.
“If it isn’t going well because it’s tedious and you aren’t making yourself do it, be honest with yourself and your veterinarian about this, so you can make another plan. Perhaps you’d rather pay someone else to do the job. Or, if the horse is being a complete idiot and even a professional says this horse won’t walk quietly, talk to the vet about this. Maybe the horse needs a little acepromazine for the walking sessions, or maybe you could alter the environment in some way to help the horse be quieter. Hopping around and spinning or running away while you’re trying to walk the horse can be more harmful than helpful, so you need to do something different,” she says.
“Two big challenges are tough love on the owner’s part, and communication between owner and veterinarian so everyone is on the same page regarding what level of activity the horse can tolerate, under what circumstances, and when does that change? The hardest part for a lot of people is the tough love – locking the horse in the stall. If this is not realistic at your boarding facility, you may have to temporarily put the horse somewhere else. The boarding facility may tell you they’re not set up for that and can’t provide that service. In that case, look at some short-term alternatives, like a rehab facility. If you need a referral, your vet or equine hospital can help you,” says Freckleton.
It’s wise to consider this option if you don’t have time to deal with the horse yourself. “It can be a big commitment. Sometimes the horse must be hand walked 20 minutes twice a day. If you have a full-time job, a family, and other things to juggle, this can be difficult. In a lay-up facility, professionals have their day structured to do this, and it may be better for the horse. Someone who doesn’t ‘love’ the horse and has different expectations can lock him up and be the warden. These people have the time and the calm attitude to take a horse that’s cooped up and actually do 20 minutes of walking twice a day without feeling they have to look at their watch the whole time,” she says. Professionals at a rehab center might also be faster at picking up on something that might not be going quite right, and make a decision that the horse needs to be examined again by the veterinarian, or needs to drop back a step in the rehab.
Taking care of a stall-resting horse can be readily accomplished by many horse owners themselves, however. “Keep checking with the veterinarian about the next step and what it should be. The vet may tell you the horse can be turned out after a certain length of time, into a 30-by-30 space, and this may take some arranging for you to create. Always ask your vet what the next step is likely to be, even if he/she can’t guarantee when or what it might be without seeing the horse again. You can work on making the recommendation possible, or be able to tell the vet you can’t do such-and-such, and ask what other options might be possible. If there might be an alternative to the normal plan, then you’d have an opportunity to do that,” explains Freckleton.
During stall rest, make sure the horse doesn’t gain too much weight. Feeding high calorie food can create a problem; the horse will want to be more active to burn off those calories. “Some people think food is a way to show their love; they feel sorry for the confined horse and feed him too much. Take away the simple carbohydrates in the diet (sweet feed, molasses, corn, etc.) yet still provide a balanced diet. To keep the horse from being bored, switch to lower energy hay so he can eat more of it. You can also put the hay in a hay net with small holes or some other feeding device that provides it slowly, or where the horse can only pull out a small amount at a time. Then he has something to munch on all the time, without eating too much,” she says.
WHEN AND HOW TO GET
THE HORSE BACK TO WORK
“Get directions from the veterinarian about what level of activity can be tolerated, and when it is safe to start increasing the horse’s activity again. With many tendon and ligament injuries we’ll start exercise very slowly, as physical therapy/rehabilitation. We might start by very strict stall rest and then short sessions of hand walking, and then walking under saddle. The exercise can be increased in a progressive and two-fold manner. You must load the injury carefully and encourage the body to strengthen that area, without overloading it, going gradually back to work,” she says.
The horse should be monitored closely, with decisions about those steps guided by diagnostics done at intervals. “We might x-ray a fracture periodically, to make sure it is still healing and there are no detrimental changes occurring due to the increase in exercise. We might re-ultrasound a tendon or ligament injury to make sure we are making gains and not having a set-back,” she explains.
“This is particularly true if there’s been an ‘oops’ event along the way. Perhaps the horse was hand walking quietly and is good about it, but today a car backfired and the horse got away and galloped. In that instance you’d want the veterinarian to check the injury again. If things don’t go according to plan, you should consult with the veterinarian.” You need to make sure the plan can continue or find out if the horse should be less active for awhile to give tissues a chance to recover from this setback.
“In a perfect world, the horse would go in a straight-forward progression from injury/stall rest to perfection again, but it doesn’t always work that way. You need to be emotionally prepared to go one step forward, two steps backward, and then go forward again. This is frustrating, but not uncommon. The horse might make it almost all the way back to normal and then have a bad moment when he does something silly and ends up back at the beginning again,” says Freckleton.
“This can happen even when professionals are caring for the horse; it’s just part of the reality in this game. You must also realize that some horses may not get back to perfect afterward. Sport horses or pleasure horses/show horses working into their older years may have a situation where you’re prescribing stall rest for one problem, but the horse might have arthritis or other problems that are aggravated by inactivity. You must be really creative, and also prepared for the fact that rehab may be even longer than what might be typical,” she says.
“If the problem you are stall resting for trumps the arthritis and other problems, you’ll have to do the stall rest. But remember that when you bring that horse out of stall rest, the rehabilitation won’t be just for that injury, but will now also be for the other complications you’ve made. That horse’s rehab will take a lot longer, with less linear progression to recovery, and he may not ever be quite the same as before, by the time you are done. This doesn’t mean it’s not worthwhile to invest that level of effort in the horse but you need to be aware of this, and asking yourself and your veterinarian what you can do for the arthritis,” says Freckleton.
She had one patient with arthritis, whose owner took him to a swim center periodically during rehab, so his limbs and muscles could move and regain some conditioning without concussion on arthritic joints. “Depending on the resources and facilities in your area (swim centers, underwater treadmills, etc.), if this is within your budget and time schedule, it’s good to look around and see what your options are, and what’s realistic for your horse’s injury.”
DRUGS AND HERBS FOR CALMING THE STALL-BOUND HORSE
Drugs may be necessary to keep certain horses calm. “Some people may be hesitant to use drugs, but there are a variety of medications available, with varying risks and benefits. If your horse’s risk is that he may break his healing leg if he’s not quiet in his stall, you may want to take a chance on sedation. A drug that’s used a lot for this purpose is acepromazine. It has short-term effects and works well if the horse is just upset during the time his buddies go out of the barn and he calms down again after they’ve left. You could use it at strategic times during the most stressful periods of his day, under veterinary supervision to get the dosage right and to make sure the horse isn’t on any other medication that might create a problem with it,” she says.
“Reserpine is another medication commonly used for this purpose. It has some risks for side effects, including diarrhea, but is usually fairly safe. It does not sedate the horse as much, but the effects last a little longer. If a horse is constantly upset, reserpine can be an effective calming agent,” says Freckleton.
“The most controversial (and least safe) drug some people use for stall rest is fluphenazine. It is given by injection, and if overdosed can have very severe side effects (seizures). I think it is currently off the market and only available through compounding pharmacies, but can be a very effective drug if used carefully and judiciously. It must be used under a veterinarian’s supervision. But if you have a situation where you can’t get a handle on the horse’s behavior, and his bad behavior will cause him irreparable harm, this drug may be helpful. Some vets find it very useful in certain horses where the risks are outweighed by the benefits,” she says.
People sometimes ask about using various calming herbal supplements for stall rest. “Some of these probably work. I am not an herbalist so I am hesitant to prescribe these. Anything like this has potential for side effects, and also potential for interacting with other drugs. If you’re using herbal therapies you need to tell your veterinarian, especially if using prescription drugs at the same time. You need to be as careful with herbs as with pharmaceuticals,” she says.
“I know of one pony whose buddy was stall resting in the same barn. The naughty pony broke into the tack room/feed room and sampled everything that wasn’t pony-proof. There was a bucket of herbal sedative the owner was using for the stall-resting horse, and the pony ate most of that bucket. He stood with his head down, with some cardiac arrhythmia (irregular heartbeat) and a sway in his body for a number of hours afterward, so some of these herbs apparently work! You want to be careful using them,” says Freckleton.
“I hesitate to use them, however, mainly because you don’t know the strength from one batch to the next or one brand to another; there is no consistency in herbal preparations as compared to an FDA tested and approved prescription drug. Don’t just assume that because it’s a natural plant or supplement that more is better, or that it won’t interact with other medications.”
Some people have the misconception that natural products are safer, but this is not true. “If products have effects, they also have the potential for side effects.”
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