Ask the Vet: Physical Therapy

Answered by,  Silvia Do Valle, DVM, Orlando, Fla.
Courtesy of AAEP 

Question: My horse has just been diagnosed with a medial collateral ligament tear in the knee. What is the best treatment and rehabilitation for this injury?

Answer: Tears of the medial collateral ligament of the carpus usually occur due to trauma to the region and the joint often has severe arthritis. It can also happen secondary to arthritic changes or fractures. The condition can be quite severe and the animal may be only pasture sound in spite of treatment depending on how severe the problem. The treatment will depend if there is also damage to other structures, such as the joint capsule, bones, muscles/tendons, carpal canal, and joints. If acute and no open wounds, the knee can be iced for the first 48 hours. Cold hosing the ligament may relieve some of the pain but unlikely will cure anything. The horse may need surgery depending on the damage to the other tissues, also PRP can be used if not a complete tear. I have successfully treated other types of desmitis with prolotherapy in the past, and currently the use of stem cells for injuries where tissue replacement is desired had been also advocated.

Rehabilitation of a corrected knee injury depends on the treatment and areas involved and may include laser therapy, passive range of motion exercises, swimming/under water treadmill, therapeutic ultrasound, PEMFs, liniments, immobilization or bandaging, and acupuncture.

Question: My horse was diagnosed with EPM. What can I do to help her recover? She is currently on ReBalance and Vitamin E. What more can I be doing?

Answer: EPM is a very difficult condition to properly diagnose, and also difficult to treat. Usually the horse needs to take specific antibiotics against the parasite for several weeks, aside from the medications that you are already giving. There is no one cure for it, each case has to be individually addressed as the symptoms and gravity will depend on where the parasite is located in the spine. I’d call your veterinarian and ask her/him for a recheck appointment to follow up with the case in a couple of weeks after treatment has started.

If it seems that you may need some extra help, then ask your veterinarian for a referral to an AAEP member veterinarian or to a Board Certified Internal Medicine veterinarian. EPM is a very complicated condition.

Question: I have a horse that is 9 months out from surgery to repair a broken shoulder. What is the best way to help his damaged nerves to recover?

Answer: Theoretically, damaged nerves do not recover. In practice though, we often see the damaged nerve function return over time to some extent. It would depend on how much damage and where. If there are smaller collateral nerves that could compensate the deficiency, and the other dated tissues scarring and healing. Sometimes the nerve damage is not extensive but the muscles and ligaments around it are scarred and the limb may not function properly regardless, making it look like nerve damage.

The idea is to strengthen the supporting tissues to compensate for the nerve deficiency, and maintain the limb functionality. If any nerve tissue heals, it would take over three (3) months. In the meantime, the muscles and supporting tissues will atrophy if not properly exercised.

Passive range of motion exercises early on are crucial to muscle fitness. Once able to bear some weight, under water treadmill provides buoyancy and resistance to improve muscle, tendon and ligament strength without much impact. TENS has limited range but can also be used, as well as PEMF devices.

Acupuncture is excellent for long-term balancing both the damaged area as well as the contralateral limb compensation. It is thought to be able to help the body regenerate nervous tissues and decrease scarring. It should be started very early on, once swelling goes down even if there’s still fractured bone as it will help it heal faster.

Bear in mind that most of these modalities have not been extensively researched for use in horses or for the specific needs of your horse and you should first consult your veterinarian about what is the best procedure in your case and have him/her accompanying the progress often.