Surviving Stall Rest

A shift in diet, environment and enrichment can help your OTTB face confinement while he heals.

If possible, don’t leave your horse in the barn by himself while all the other horses are turned out. Courtesy istock.com

It’s been said that every horse has something to teach and every human has something to learn, and I couldn’t agree more. My 21-year-old OTTB, Eldorado’s Tune, has been educating me since I met him about a range of topics — horsemanship, riding skills, patience, humility, confidence … and how to handle stall rest.

Dorado raced 55 times until he was 6, has recovered from several racing-related injuries and has the brain of a 4-year-old. He’s also accident-prone. I absolutely love the fact that he’s still feeling spry, but I really wish he understood his limits because when he hurts himself, he winds up on stall rest.

Over the years I’ve learned stall rest doesn’t have to be complicated. But it can be daunting if you’ve never dealt with it. To help, I’ve asked three experts for their tips on how to survive stall rest.

Step One: Don’t Panic

We’ve all heard the horror stories about stalled horses that tear the barn down, kick and scream and suffer self-inflicted injuries. But those horses aren’t necessarily your horse in a stall-rest scenario. So take a deep breath, and don’t panic.

Some horses tolerate stall rest well. Dorado, for instance, doesn’t seem to mind it. “I get to stay out of the rain, nap in my comfortable bedding, eat all the hay I want, get extra attention from mom, hand-graze instead of going out in my drylot and people stop by and feed me carrots because they feel bad for me … what’s not to like?” his innocent face seems to say.

Others will tolerate it for a while, then get impatient. And some very clearly want nothing to do with it. If you’re not sure which category your horse falls into, you’ll soon find out.

Also, know you have options. If you’re not comfortable managing your horse on stall rest or don’t have the time or your barn doesn’t have the amenities for it, consider sending him to a facility that specializes in rehabilitation. If you board your horse, discuss the situation with your barn manager or owner. For a fee, he or she (or even an experienced fellow boarder) might be willing to help with your patient as needed.

One of the most important considerations when managing a horse on stall rest, however, is to stay in touch with your veterinarian and consult him or her before implementing any changes to the routine, says Thoroughbred owner and breeder and equine behaviorist Robin Foster, PhD, CAAB, CHBC. Your veterinarian knows the situation best and will be able to advise you on what will — and won’t — promote the most favorable outcome.

Stall-Rest Setup

If you’re managing your horse’s stall rest yourself, first you’ll need a safe and functional enclosure.

The ideal facility includes “good ventilation and plenty of bedding in a stall that drains well, which will help prevent the impact of urine on hoof quality and air quality,” says Mark T. Donaldson, VMD, Dipl. ACVIM, who focuses on equine sports medicine at Unionville Equine Associates, in Oxford, Pennsylvania. “It needs a safe interior in case the horse becomes fractious.”

If possible, keep barn doors and stall windows open to allow fresh air to circulate, and consider using a fan designed for agricultural or outdoor use to help keep the air moving. This can also provide a cool breeze and relief from insects if you’re resting a horse during the summer.

Also, ensure the stall is well-bedded. In most cases, it doesn’t matter what type of bedding you choose, just that you give your horse plenty of cushion, says Donaldson. Ask your veterinarian for guidance based on what you bed your horse’s stall with and what kind of injury he’s dealing with.

“Unless there is a reason not to bed deeply, the deep bedding may promote the horse’s desire to lie down and possibly rest the injured tendon, ligament or bone,” he says.

“Most important, however, is that the horse should have other horses stabled with him throughout the day,” Donaldson adds. “Horses are herd animals and obviously don’t do well in isolation. Stables in which all horses are turned out at once with the injured horse remaining alone are least desirable. Have stall doors that allow the horse to look out the stall to provide more visual contact with other horses.”

One benefit to rehabilitation facilities, he notes, is that your horse won’t be the only one confined to a stall. “The horses on stall rest in these facilities keep each other company,” he says.

You also might need to “set up” your horse for stall rest, depending on his injury. For example, your veterinarian might recommend applying stable bandages or standing wraps to combat issues such as lower limb swelling. But Donaldson says he prescribes these wraps with caution.

“I don’t unless there is a specific reason to do so,” he says. “If the horse decides to bite at them, they move excessively or if they are applied incorrectly they can twist and irritate the skin (or other internal structures), creating a new problem.”

Your horse might also benefit from a shoeing change, but this depends on the individual and his injury.

“This is an important discussion to have with your vet,” Donaldson says. “Some injuries (such as digital flexor tendon stress, laminitis pain or navicular) will clearly benefit from corrective shoeing even if the horse is only allowed controlled walking. Other injuries may benefit from a barefoot approach, especially if the hoof quality is good. Lower-limb conformation will also dictate the need for shoeing.”

Check with your veterinarian and your farrier at the start of your horse’s stall rest to determine the best option.

Nutrition Needs

There’s a good chance your OTTB’s diet will change when he’s on stall rest. Maybe he’s transitioning from grazing 24/7 to subsisting on hay only, or from needing enough energy to fuel high-intensity exercise to substantially less activity. Those and other factors come into play when feeding your patient.

Water is the most important nutrient in any horse’s diet, but it’s especially important for a horse on stall rest. Researchers have shown that both dehydration and restricted movement increase a horse’s risk of impaction colic.

“The average daily intake for an idle horse is about 41-67 milliliters per kilogram of body weight,” says Kristen Janicki, MS, PAS, an equine nutritionist and OTTB owner based in Nicholasville, Kentucky. So, you’ll want to see an average 1,100-pound Thoroughbred consume at least 5 to 9 gallons per day.

If you’re concerned your horse isn’t consuming enough water, experiment by adding electrolytes or flavoring to boost his intake.

“Researchers have found that horses prefer sweet tastes, so sweetening the water may help encourage drinking,” Janicki says. “But use caution for horses that need a lower-sugar diet.” Unsweetened Kool-Aid, a handful of the horse’s grain or a low-sugar sweet-flavored electrolyte might fit the bill.

You might also offer more than one water source, especially for horses with limited mobility. A few years ago Dorado suffered a bout of laminitis, making it very painful for him to even move around his stall. Our veterinarian recommended placing multiple water buckets around his stall so they’d always be within reach. He remained well-hydrated throughout his layup.

Always ensure your OTTB has plenty of forage when on stall rest, as this important source of fiber is essential for proper digestive function. “Forage should provide 50 to 100 percent of the horse’s energy intake,” Janicki says.

“Slow-feed hay and pellet delivery systems give a confined horse something functional to do; after all, free-ranging horses spend most of their waking time grazing,” says Foster. These keep food in the stomach, which might help reduce the risk of ulcers, colic, hindgut acidosis and oral stereotypies such as cribbing.

Follow manufacturer guidelines for introducing a slow-feed system to avoid compounding or creating new behavior issues, says Foster.

Then there’s grain. Some people say nix grain to help keep them quiet, others to continue with it to help the body heal. Throw in the fact that some OTTBs can be on the lean side and others can become flighty on reduced or no work, and you’ve got a potentially confusing situation.

First, says Janicki, make sure the horse’s diet contains enough protein, vitamins and minerals.

“Simply reducing the amount of grain fed might not be ideal, as feeding some products below the manufacturer’s recommended rate won’t supply enough nutrients,” she says. “Consider adding a ration balancer, which will reduce calories without compromising nutrient requirements and fill in the gaps that might not be met by forage alone. 

“Choosing the right calorie source is key to increasing weight without creating behavior vices,” Janicki adds. “There is evidence that fat and fiber are more suitable calorie sources than nonstructural carbs, lowering spontaneous activity, cortisol and subsequent stress levels. Look for feeds with highly digestible fiber sources (e.g., beet pulp, soy hulls), added fat and low sugar and starch content.”

If you’re unsure if your horse’s nutrition needs are being met while he convalesces, consult your veterinarian or equine nutritionist for advice.

Boredom Busters

“I have noticed that horses that are well-behaved while rehabilitating heal faster,” Donaldson says.

Indeed, behavior is a common concern among horse owners managing horses on layup. Beyond the stress of social isolation is that of limited activities and restricted movement. Some horses become restless, agitated or aggressive, says Foster, and can develop a range of unwanted behaviors.

“In minor cases the behavior may be attention-seeking, frustration or boredom from the abrupt change in routine and activity,” she says, adding that these could also be similar to signs of separation distress: reduced feeding, pacing, pawing and digging and increased vocalizations.

She adds that repetitive behaviors such as cribbing, weaving, pacing, flank-biting and tongue-play can appear or worsen, especially in horses with a history of these activities.

Also consider that Thoroughbreds are workaholics. They’re bred to run, and they thrive on work.

“The Thoroughbred’s inherent competitive nature can be a detriment to the healing process during stall rest,” Donaldson says.

Foster shares a similar sentiment. “Because many retired racehorses are familiar — and even comfortable — with the routine of being stalled for long periods, being confined may not be the primary stressor when the horse is on stall rest,” she says. “A big difference is that at the track the horses also get plenty of physical exercise and attention. The isolation, confinement and lack of physical activity associated with stall rest is a sharp contrast to the busy and stimulating life of a young racing Thoroughbred.”

Environmental enrichment is one way to help stall-resting horses meet their sensory, cognitive and social needs. This can include background music, scratch brushes and mixed browse, she says.

“Engaging his mind can curb boredom and burn calories,” says Foster. “Interactive cognitive challenges include positive reinforcement training, puzzle games (spinning toys for a treat) and treasure hunts (searching for treats).”

She notes that these enrichments are most effective when they’re not left in the stall permanently. Rather, offer them for a limited time, and rotate between activities to keep your horse interested.

For social isolation, a simple solution, such as a mirror hung in a safe location or, again, a window to see and hear other horses, might help, Foster says. But she reminds us that every horse is different and a more effective remedy could be to provide a companion, such as a familiar calm horse, pony, donkey or goat in an adjacent stall. 

“Extra attention from and interaction with people can also help,” she adds. “Time spent grooming, scratching, massaging and simply engaging with the horse can substitute time previously spent in training.”

Another stall-rest staple is hand-grazing and -walking, which can help satisfy many of the needs a laid-up horse is deprived of, including a change of environment, something enjoyable to do, an opportunity to socialize with a person and, importantly, physical movement, says Foster.

But Donaldson says to approach these adventures with caution.

“It’s a balance between the horse’s temperament and the nature of the injury,” he says. “If the injury is minor and the horse’s temperament is good, then walking is excellent physical therapy and can promote healing. If the injury is severe and the horse is fractious and unpredictable, then the risk associated with uncontrolled movement during hand-waking may outweigh the benefit.”

Discuss your horse’s temperament with your vet when making a hand-grazing or walking plan, he says.

Donaldson says teaching your horse carrot stretches and stationary mobility exercises can also be very helpful.

“The restriction associated with stall rest could have a negative impact on range of motion in joints” and other structures, he says, though some of these exercises might be too much for your horse, depending on his injury. Speak with your veterinarian about exercises to avoid.

One more tip: Use caution when eventually returning your horse to his normal routine. “Some practically ‘explode’ with energy, which may put them at risk for re-injury,” Foster says. “One Thoroughbred gelding I worked with was confined to a small paddock for about two weeks following an eye injury. When he was again turned out to his normal larger grassy pasture, he raced around a few loops, leapt into the air, kicked up his heels and flipped himself over with a hard landing. Fortunately, only his pride was injured.”

If possible, transition your horse into gradually larger enclosures slowly, adding a horse or two until he’s quiet enough to return to his normal turnout.

When Things Get Rough

Try as we might to keep horses on stall rest happy and healthy, things don’t always pan out. Some horses just don’t do well in stalls for long periods.

Some stall-bound horses can be difficult to handle, and physical or chemical restraint could be necessary for horse and human safety, says Foster.

“I encourage setting up a situation and routine that minimizes distress and maximizes relaxation,” she says. “For example, if a horse is pacing and calling in the stall, it might be because he can see and hear other horses turned out nearby. This horse might do better if the sights and sounds are blocked or if he’s moved to a different stall.

“As another example, some stalled horses become aggressive toward people or other horses that pass by,” she says. “If room allows, setting up an inner barrier within the stall can provide enough privacy and separation to reduce aggression and increase safety.”

If none of these strategies work and sedation is required, only use it under veterinary supervision.

“Your vet will be able to provide the risk and benefits of the drugs with which they are most familiar,” Donaldson says. “Some are potent sedatives while others act by reducing anxiety.”

And if sedatives aren’t helpful, he says it often comes down to “negotiation and compromise” between owner, manager, vet, farrier and trainer.

“Some horses do more harm than good when confined,” he says. “An informed decision must be made by the owner after considering the risks and benefits of turnout and confinement. If turnout is elected, rehabilitation may be longer because of intermittent re-injury during turnout.”

The Bottom Line

No, stall rest isn’t easy — for the patient or the caretaker. But advanced preparation, an understanding of what to expect and a team approach can go a long way toward a positive outcome.

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