Prehabilitation gains ground in equine surgery planning
Bottom line
Prehabilitation, or “prehab,” is gaining traction in equine surgery as clinicians and rehabilitation specialists push recovery planning earlier, before a horse ever enters the operating room. In a recent The Horse report, equine rehabilitation therapist Katie Hawkins and North Carolina State University surgeon Lauren Schnabel described prehab as a way to improve fitness, range of motion, behavior, and tolerance for stall rest and postoperative routines ahead of orthopedic surgery. The approach can include acclimating horses to bandages, hand-walking, compression or icing devices, diet changes, and controlled exercise such as ground poles, hot walkers, and water treadmills. (thehorse.com)
Why it matters: For veterinary professionals, the idea isn’t just better conditioning, it’s better surgical recovery planning. Available evidence in equine rehabilitation is still limited, with a 2021 scoping review finding that most published studies are narrative reviews or observational reports rather than randomized trials. Still, the broader rehabilitation literature and emerging equine data suggest there may be practical upside in preparing horses physically and behaviorally before surgery, especially when prolonged stall rest, swelling, and loss of fitness are expected. One retrospective study in Thoroughbred racehorses found underwater treadmill-assisted rehabilitation after arthroscopy was associated with higher return-to-racing rates than conventional rehabilitation alone, though that study addressed postoperative rehab rather than prehab directly. (pubmed.ncbi.nlm.nih.gov)
What to watch: Expect more attention on which prehab elements, such as controlled exercise, environmental preparation, and compression-based edema management, can be standardized and studied prospectively in surgical horses. (frontiersin.org)
Key facts
- Topic
- Prehabilitation, or "prehab," for horses before surgery
- Purpose
- To improve fitness, range of motion, behavior, and tolerance for stall rest and postoperative routines
- Common elements
- Hand-walking, bandage acclimation, compression or icing devices, diet changes, and controlled exercise
- Controlled exercise examples
- Ground poles, hot walkers, and water treadmills
- Key experts
- Katie Hawkins and Lauren Schnabel, DVM, PhD, Dipl. ACVS, ACVSMR
- Evidence base
- Limited; a 2021 scoping review found most studies were narrative reviews or observational reports, not randomized trials
- Scoping review sample
- 49 relevant manuscripts over two decades
- Retrospective study finding
- Underwater treadmill-assisted rehabilitation after arthroscopy was associated with higher return-to-racing rates than conventional rehabilitation
Prehabilitation for horses is moving from a niche rehabilitation concept toward a more organized part of perioperative planning. The latest coverage from The Horse frames prehab as starting recovery before surgery, with a focus on building physical readiness, reducing stress, and preparing horses for the restrictions and therapies they’ll face afterward. The idea has been championed by equine rehabilitation practitioner Katie Hawkins and by Lauren Schnabel, DVM, PhD, Dipl. ACVS, ACVSMR, at North Carolina State University, who has discussed preoperative strategies for orthopedic patients through AAEP channels. (thehorse.com)
The concept isn’t entirely new. The Horse covered prehabilitation for equine surgical patients in March 2022 following presentations at the 2021 AAEP Convention, where Schnabel and University of Kentucky human performance researcher Brian Noehren reviewed how human sports medicine principles could translate to horses. Their recommendations included preparing the recovery environment in advance, acclimating horses to stall rest and postoperative handling, optimizing nutrition and body condition, and improving range of motion before surgery. (thehorse.com)
The newer article adds a more practical, field-level picture of how prehab is being used. Hawkins described using combinations of hand-walking, hot walkers, dry treadmills, and water treadmills to improve fitness and topline strength before surgery, while also getting horses comfortable with the routines they’ll need postoperatively. The article cites the case of an 11-year-old dressage horse with suspensory injury history and kissing spines that reportedly underwent two months of prehab before surgery and returned to showing afterward. That’s anecdotal, but it illustrates the core pitch behind prehab: don’t wait until after surgery to introduce the horse to the rehab plan. (thehorse.com)
There’s also some adjacent research supporting parts of the strategy. A 2021 scoping review of equine rehabilitation literature found just 49 relevant manuscripts over two decades, with most consisting of narrative reviews or descriptive studies and only 10% randomized controlled trials. Hydrotherapy and exercise were among the most frequently reported modalities, but the authors highlighted the field’s limited evidence base. Separately, a retrospective study of Thoroughbred racehorses recovering from arthroscopic surgery found that horses receiving underwater treadmill-assisted rehabilitation were more likely to return to racing than those managed with conventional rehabilitation, although time to return to racing was not significantly different. (pubmed.ncbi.nlm.nih.gov)
Expert commentary around prehab has centered on preparation as much as treatment. Schnabel has emphasized controlling swelling and effusion, improving lymphatic drainage and circulation, and ensuring proper hoof balance and shoeing before orthopedic procedures. North Carolina State researchers have also reported that an equine-specific pneumatic compression device accelerated lymphatic flow in healthy forelimbs, offering a possible tool for edema management around surgery, though that work was a pilot-style study in healthy horses rather than surgical patients. (thehorse.com)
Why it matters: For equine veterinarians, prehab may be most useful as a systems approach rather than a single modality. Horses heading into surgery often face immediate stall confinement, swelling, reduced joint motion, muscle loss, and behavioral stress. Preparing the horse, the handlers, the stall environment, the nutrition plan, and the postoperative exercise routine ahead of time could make discharge instructions more realistic and improve compliance for the veterinary team and the pet parent. At the same time, the profession should be careful not to overstate the evidence. A 2025 survey of ACVS and ACVSMR diplomates underscores how variable rehabilitation recommendations still are, and the authors noted that access, cost, clinician training, and limited supporting literature all shape what gets used in practice. (thehorse.com)
What to watch: The next step is better evidence: prospective studies that test whether prehab changes postoperative pain, complication rates, return to function, or return to performance, and which horses benefit most. Until then, prehab is likely to keep growing as a pragmatic, individualized extension of surgical planning, especially at referral centers and rehabilitation-focused practices that already have the staff, facilities, and client buy-in to implement it. (frontiersin.org)