Box Rest

Box rest: Helping your horse to cope

Why box rest?

It is common in human medicine, especially in the case of limb injuries, to confine the patient to bed for a period of time in order that the damaged tissues can be immobilised while healing takes place.

Unfortunately this is not possible with horses so the next best thing is box rest.

Uncontrolled movement significantly impairs the healing of tissues. Wound edges move, leading to opening of the wound and the formation of exuberant granulation tissue which can delay healing for months.

Tendon and ligament healing is disrupted leading to large unstable scarring of the affected structure which then has an increased likelihood of breaking down when the horse returns to work.

Bandaging, especially of the foot, becomes loosened and dirty leading to contamination of the bandaged structure.

Types of box rest

· Simple confinement to a loose box – the commonest form

· Confinement to a loose box and physiotherapy, e.g. limb stretching exercises performed by the owner/physio/vet

· Confinement to a loose box and tethering in the box – this prevents the horse from lying down and is only rarely used, for example in cases of pelvic fractures and in some severe knee wounds

· Confinement to a small yard or very small paddock – this allows limited movement by walking only and is useful in the rehabilitation stage

· Box rest followed by walking in hand – this allows controlled 

mobilisation of healing tissues. The tissues are loaded in a controlled fashion allowing gradual strengthening. In tendon injuries, controlled loading ensures that the tendon fibres heal along the lines of stress, thereby reducing the risk of a second breakdown.

“My horse will go mad if it’s confined…”

Experience shows that even the most highly-strung horse will readily adapt to box rest provided some simple rules are followed. Owner's fears in this regard are often unfounded.

Most horses after a few days or a week if correctly managed will 'switch off' and resign themselves to their fate.

A few management changes may be necessary to help the horse to adjust to it new regime. Depending on your circumstances and the facilities available you may or may not be able to satisfy these recommendations.

· Provide equine company. Even simply putting a retired family pony in an adjacent loose box, especially in situations where the confined horse can see its companion all of the time, will contribute enormously to the wellbeing of the confined horse. Alternatively other horses you own can occupy the adjacent box on a shift system. This is extremely effective. Sometimes a pony or other quiet horse can be borrowed from friends as company. In the later stages of the confinement period the pony and confined horse can be kept together in a large yard.

· Provide a stable mirror. Research has shown that separation anxiety can in many horses be significantly reduced by fitting a stable mirror. The horse perceives its reflection as another horse. The mirror should be sited away from where the horse is normally fed

· Reduce hard feed to a minimal amount. The best feed for box-rested horses is chaff to which a handful of nuts or coarse mix is added. Be generous in feeding chaff as the act of feeding seems to provide some psychological comfort for the horse and occupies it for part of the day. A full bucket of chaff two or three times a day is ideal. Horses recovering from severe wounds or laminitis may need a more specific diet, something that we can advise on

· Ensure continuous access to hay/haylage. Eating rate can be reduced by placing one net inside another or using small mesh nets. 

Replacement of a third of the hay ration with oat or barley straw will help to reduce the risk of the horse becoming overweight while on box rest

· Another useful way of occupying stabled horses is to use a lick or a treat ball. This is a large ball in which some hard feed such as high fibre cubes is placed. By rolling the ball the horse causes small amounts of food to fall out of the holes at the side. Horses will spend hours playing with the device

· Minimise disturbance. Horses are more likely to become anxious if adjacent horses are being taken away, turned out or ridden, especially if at irregular intervals. If possible stable the horse well away from places of equine activity. While in theory yard activities will distract and divert the confined horse the disturbance caused may outweigh the advantages

· Be careful when mucking out. All veterinarians can recall occasions when box-rested horses have barged past or even jumped over wheelbarrows or suddenly exploded when tethered outside the stable and run free until caught, undoing the benefits of weeks of confinement. It is strongly recommended that when mucking out the horse is first shut in an adjacent loose box. Alternatively a chain or similar device can be fixed across the doorway

· Remove the shoes. Pick out the feet once daily, including the central frog groove, to prevent thrush developing. Have the feet trimmed every six or eight weeks unless the veterinary surgeon advises otherwise

· Sedative drugs given by mouth are occasionally used in the early stages to help the horse to adapt

How Long in the Box?

The duration of the period of confinement varies enormously depending on the reason why the horse is being box rested.

It may be as short as a week in the case of simple injuries or foot abscesses, or as long as six months in the case of pelvic fractures and other major injuries.

Your veterinary surgeon will advise you of the appropriate length in your case.

Hand Walking

The controlled mobilisation offered by hand walking is frequently used during the rehabilitation phase.

Horses which have been confined for even a short period may be very excitable when walked in hand so some simple rules must be followed:

· Always use a bridle rather than a head collar, or preferably a Chiffney bit

· Use a lunge line rather than a lead rope. Horses will often rear and buck if startled and it is essential that the handler can stand well clear of the horse while remaining in control

· Be prepared for sudden movement

· Consider sedation for the first few excursions. We can supply an oral sedative

· Choose a quiet route and time. Avoid obvious inflammatory situations, such as barking dogs. In the first instance just walking the horse round a yard or arena may be preferable to using a road

· Some horses are safer if ridden rather than walked. This may not be appropriate for certain injuries so please follow our instructions

· Grazing in hand, bridle and lunge line as before, may provide some diversion and relief for the horse once it can be taken out of the box

Turning Out

The temptation to take the horse out for a few mouthfuls of grass, or to turn it out must be resisted, as all the benefits of the box rest period can be undone in a few minutes. Even the most stoical horse can explode after a period of confinement.

When the horse is ready to be turned out we strongly recommend that the horse be sedated for the initial turnout.

Prepare carefully for the event. There should be no horses in the field or in the adjacent fields to excite your horse. The horse should be hungry so that it will put its head down and graze straight away, and can be starved overnight to ensure this. The application of boots to all four legs is prudent. Oral sedation is often too unpredictable for this purpose. An intravenous sedative injection is much preferred, as it is very reliable.