Comeback: The art and science of equine rehabilitation
Successfully returning to an elite level in sports after a major injury is considered so difficult that awards are given to those who accomplish this feat. The "comeback athlete of the year" typically has suffered an injury or been affected by a disease process and traversed a long and difficult road to recovery before regaining previous levels of skill and ability.
The developing field of rehabilitative medicine, for both people and horses, focuses on managing that path to recovery and helping athletes heal so their eventual return to activity is optimized. The equine athlete seems to be especially adept at healing and returning to function after serious injury or traumatic events.
Indeed, better postoperative monitoring, improved communication between surgeon and client and better surgical handling of incisions can all lead to quicker healing and more complete comebacks among horses.A recent study revealed that most horses (86.1%) were able to return to sporting activities after a major surgical procedure and, even more interestingly, 83.5% returned to their former level of competition or higher.1
Timing is important
One aspect of equine rehabilitation that has potentially been underdeveloped is the timing of return to athletic activity. Bringing a horse back after surgery has always been a balancing act between necessary healing and repair and the need to get the athlete back in the game. A concern for the horse's welfare has been counterbalanced by the economic realities of the athlete's job as a racehorse, jumper, dressage competitor or other sporting participant.
Veterinary surgeons have traditionally adopted a conservative postoperative rehabilitation program. These recommendations, however, may not necessarily reflect the most up-to-date scientific information, and more aggressive yet medically safe rehabilitation programs may be able to get horses to come back to athletic activity even more quickly.
Colic is still the most common reason for major surgical intervention in horses, and the traditional rehabilitation recommendations for a horse after colic surgery have changed only minimally during the past few decades. The standard program calls for owners and trainers to keep their recovering horses on stall rest for the first 30 days, followed by 30 days of hand walking, leading to a final 30 days of turnout in a small paddock.
"The need to standardize postoperative care has developed for good reason," says John Peroni, DVM, Dipl. ACVS, an equine surgeon in the Department of Large Animal Medicine at the University of Georgia. "Surgeons and clinicians have averaged out their postoperative recommendations in order to minimize the complication rate while maximizing efficiency and functional restoration for the equine athlete."
The American College of Veterinary Surgeons website (http://acvs.org/) acknowledges that each surgical patient is unique, but it also repeats the traditional 30-30-30 mantra, noting that "horses with uncomplicated recoveries from surgery typically return to work after two to three months of stall, small paddock and controlled pasture rest."2
Many surgeons adhere to this basic three-month program because it's conservative, safe and easy. "In doing so," Peroni says, "we tend to lose sight of individual variations (in incisional healing) that may enable us to better tailor postoperative care and return to work for our horses."