Doing Rehab Right
The 5-Part Guide to digging deeper in order to heal the whole horse
(and coming out the other side with your sanity intact)
Part 2: The Shrek Model for a Whole Horse Overhaul
Horses are like onions, and rehab is all about layers, baby!
So, you have a diagnosis, and you and your horse have been sentenced to a lengthy rehab program… (If not, you better go read Part 1: The Camel, The Performance Horse & The Last Straw before going any further!)
What next? It’s time to start peeling back the layers of dysfunction and compensation we need to discover and eliminate if we really want to heal the whole horse.
The plan for healing and rehabilitation: are we treating the branch or the root?
First of all, let’s go back over the most relevant bit of Part 1:
Is the diagnosis the primary problem, or is it just a symptom? If not, then where the heck is the nucleus?
Like the camel’s broken back, our horse’s diagnosis may simply be the depressing reflection of the moment their body was no longer able to mask, protect or compensate for an underlying problem.
Moreover, chronic biomechanical dysfunction and incorrect movement also have a way of spreading tendrils throughout the body; reducing room for error and silently inching closer to the point at which it only takes that last straw to blow a tendon below a muscle that cannot lengthen enough, or a twist too far to tear a meniscus that could have been protected by the muscles that would normally stabilise the stifle joint…
What, then, do we have to treat? The fresh injury? Or the root cause?
Yep, you guessed it — both, and all the tendrils in between.
If you’ve already started digging deeper in search of the root and looking further to identify its possible branches and tendrils, you might have realised that it isn’t just the main injury you need to consider: you need a whole horse overhaul.
And to do that, you need a team.
Assemble your A-Team…
It takes a village to rehab a horse and a whole-horse approach to rehab means addressing all factors holistically. However, this DOES NOT mean ditching conventional wisdom.
Your veterinarian should ALWAYS be commander-in-chief. They get to oversee your horse’s program as a whole, and they reserve the right to veto any part of the plan that may be contraindicated in your horse’s case, seek a second opinion from a trusted colleague or suggest a different approach. Pick a good one, and treat them well.
The make-up of the remaining team members might vary a little, but perhaps the two most critical members after your vet are your bodywork and hoofcare practitioners. Whether you elect to use a lay massage therapist, veterinary chiropractor or physiotherapist, barefoot trimmer, farrier or practitioners anywhere along the spectrum, make sure your team is able to communicate so all members can stay up to date — co-consults can be difficult to organise, but are always worthwhile (this is why I will always shuffle my calendar if possible to attend clients’ veterinary appointments).
When training comes into the picture, your coach or trainer needs to join this team, to ensure any work is adapted to the horse’s needs and monitored carefully. You may also need to cover nutritional and dental bases, or seek a second, third or fourth opinion — even if just for a fresh perspective. Speak to your team members. We usually have a great network of colleagues to call upon when we need a fresh set of eyes on a problem, or assistance from someone trained in a technique we think your horse might need at that point in time.
Things to consider…
Rehab is rarely smooth sailing. Remember Part 1? Adapt, adapt, adapt. Solve the problem in front of you. Then the next. You WILL have to tweak the plan as you go along. Working with the horse you have on the day, in the moment, is a basic tenet of good training, and rehab is no different.
It is up to you and your team to know what is normal for your horse, and where you need to use caution or try a different approach that is more likely to suit them as an individual. This applies to the mental and emotional challenges rehab presents too, but more on that in a second…
There are a few important questions to consider before embarking on your rehab journey (and it’s wise to revisit these often):
What potential complications do we need to avoid or prevent?
For example, in fixing one thing, are we going to damage or compromise something else?
Do we have a Plan B/C/D…Z to enact if certain issues arise?
How will you know when to pull the plug on part of the plan and try something else?
Are there other ways we can aid healing?
Are there therapeutic tools that can complement the rest of the plan? Does your veterinarian need to perform the treatment, or can a lay practitioner? Is your horse likely to benefit from a particular medication? Are there nutritional or herbal supplements that may be appropriate in your horse’s case? Is there evidence to support their use? In all cases, remember to Ask. Your. Vet!
How will we know we are on the right track?
What are our milestones and checkpoints? What will they tell us? What do we still need to use our eyes, hands and brains to assess or monitor along the way?
Where are the holes in the plan?
What are we not treating? Where can we provide additional support to reduce any negative impacts on the horse’s physical and emotional wellbeing, and nurture it instead? Where can we do more?
Let’s talk about feelings…
No, seriously. This is both an incredibly important and incredibly neglected part of the rehab picture. Peeling the rehab onion frequently opens up a can of physical worms your horse’s body has kept carefully protected, but this process can also stir up emotional scars, especially when the horse has experienced significant or long-term stress and anxiety associated with pain and discomfort.
Be aware of this, and hold space for your horse in these moments. They are often the catalyst for much deeper healing and release.
All good plans need goals… What are yours?
You’ve probably heard of SMART goals: Specific, Measurable, Achievable, Realistic and Timely. Rehab has a lot to do with all of these things, and the specific and measurable aspects are where diagnostic imaging is especially important.
But what I want you to think long and hard about is whether the goals of your horse’s rehab plan are realistic and achievable. This is where the blood, sweat, tears and heartbreak come in, especially if the diagnosis or prognosis is particularly damning.
When it came to Ollivander’s rehab plan, I knew and accepted going in that to get Ollie to 100% soundness was not realistic or achievable. This was a horse with 55 starts in harness and a sh*tload of wear and tear under his belt, plus the neurological deficits that likely contributed to the damage his body has accumulated over the years.
So what was my goal?
To restore him to the highest benchmark of physical and MENTAL soundness we could reach, within the limits of the irreversible. And to reverse the damage we could.
To remove as much protection and compensation as we could, but not removing protection his body needed.
I wanted to see him full of life and playful. I wanted to see him strut like I had before. I didn’t care if he was never sound enough to perform a low level dressage test. If, IF he ended up back under saddle, I would be happy if he could enjoy swinging along in trot on a trail ride. I would be happy if restorative in-hand training, working in the ‘envelope of release’, kept him ticking over and engaged in his world, while he taught me whatever he had in store.
He will never be ‘sound’. But that’s fine with me, because he has already exceeded the goals I set with his wellbeing in mind, and he continues to reveal more and more of himself each day.
This is the bit where I tell you that Ollie was originally intended to teach me as a subject on my dissection table. And I was OK with that. I was prepared to make the call if I thought it was in his best interests; I had done it three times before, for three relatively young horses betrayed by their bodies.
But Ollie made it clear that he wasn’t ready to go yet. And if he was willing to try, I would too. I made a promise to both of us that, if he told me it was time, or started to give up, I would let him go. But I also refused to betray his trust and give up while he still had a fighting chance, and one he was willing to fight for.
“No, no, no…don’t touch the varnish!”
In less complex cases, you often CAN peel all the layers back and start with a relatively clean slate with time and effort,but not when the horse will fall apart at the seams if you take away coping mechanisms they genuinely need and leave them defenceless.
It’s a bit like restoring a violin.
We waited for many, many years before finally entrusting anyone with the significant repairs my great-grandfather’s beloved instrument needed for it to be playable once more.
‘Alfie’ (nicknamed for the man my great-grandmother fell in love with when she heard him play) had been badly damaged and effectively needed to be rebuilt, but with as a light a hand as possible. We wanted to repair, restore and touch up, but respecting what needed to be left alone.
We chose to repair the worst of the structural damage, while preserving and bringing out everything that made Alfie so special. Alfie would never have the clarity or sharpness an undamaged violin might in the higher register, but without the faults, wear and tear accumulated over several lifetimes, the depth and character of Alfie’s sound — the rich, earthy voice more akin to a larger viola — would be lost, and a beautiful instrument ruined.
That was nearly three years ago, and I have kept that promise to Ollie every step of the way. I know things could change in a heartbeat, but for now he’s still here, and more emotionally open than ever.
Not every horse has that kind of mental resilience. I am in awe of every one of them I have met, and blessed that he is among them.
Would this goal have been realistic if I didn’t have a huge toolbox of skills and a wide network of experts to call on for assistance? Nope. If I didn’t have the financial resources to fund everything aside from the practical skills I could provide? Nope.
Watch your horse, feel their body and pay attention to their state of mind. Let your eyes, hands and intuition grant you the wisdom to accept the things you cannot change, the courage to change the things you can, and the wisdom to know the difference.
A whole horse overhaul isn’t for the fainthearted or the lazy.
Make sure your plan considers all dimensions of the big picture — give as much consideration to the rest of your horse’s body and their emotional wellbeing as you do to the plan for physiological healing or management of the diagnosed problem.
Make sure your goals are specific, measurable and timely.
But above all, make sure they are achievable.
Work f*cking hard, and do it with tender, loving care.
The greater the impact of the injury and the rehab plan, the more your horse will need you to be aware of their emotional state. So lean in, and build a deeper bond while you’re at it.
Be absolutely diligent and do everything you can, but not more than you should, and you might find that in time, the more permanent layers also begin to soften a little and dissolve.
Continue to facilitate healing and restoration, and trust the process.
Your horse will guide you if you take the time to listen to them.
Coming up in Part 3…
It’s time to get stuck into a few Tips, tricks & hacks for tweaking the plan & meeting your horse where they are each day… We’ll chew over some of the issues you might face, and discuss a few tools and techniques you can use to get your horse through to the return-to-work phase. Stay tuned!