International Survey Regarding the Use of Rehabilitation Modalities in Horses

International survey of equine orthopaedic specialists reveals diverse treatment strategies for horses with overriding spinous processes

BACKGROUND

Overriding spinous processes, also known as 'kissing spines', are one of the most common causes of back pain in horses. The aim of this study was to investigate which options for diagnosis and treatment are preferred by equine orthopaedic specialists and assess which techniques are used for local injection.

METHODS

An online survey was distributed among members of the European/American College of Veterinary Surgeons, the European/American College of Veterinary Sports Medicine and Rehabilitation, the International Society of Equine Locomotor Pathology and nationally recognised advanced equine orthopaedic practitioners.

RESULTS

The survey was completed by 353 respondents. The injection techniques most commonly used involve placing two needles abaxial to the interspinous space (42%) under ultrasonographic guidance (32%) or one needle in the midline (35%) between two spinous processes. The most popular combination for overriding dorsal spinous process therapy was local injection (26.7%) combined with controlled exercise (25.5%). Manual therapy was considered by 42% of European and 25% of American specialists (p = 0.01). Surgical intervention as a first-line treatment was recommended mainly by specialists working in the United States, the UK or Ireland (p = 0.001). Overall, most equine orthopaedic veterinarians (71%; n = 201) preferred conservative management and recommended surgery only for horses that did not respond to conservative therapy.

LIMITATIONS

Respondents' personal bias may have skewed the findings.

CONCLUSIONS

Despite a growing body of evidence, the therapeutic approach to 'kissing spines' in horses is influenced by professional specialisation and regional preferences. Variations in injection techniques and differing criteria for surgical intervention warrant further investigation.

Interactions Between Biologic Therapies and Other Treatment Modalities

Biologic therapies are becoming increasingly utilized by veterinarians. The literature regarding the interaction of biologic therapies with other therapeutics is still in its infancy. Initial studies have examined the effects of exercise, stress, various pharmaceutical interventions, extracorporeal shockwave, therapeutic laser, and hyperbaric oxygen on biologic therapies. Continued research is imperative as owners and veterinarians increasingly choose a multimodal approach to injury and illness. Further, understanding the effects of concurrently administered treatments and pharmaceuticals as well as the health status of the horse is imperative to providing the optimal therapeutic outcome.

Survey of equine veterinarians regarding primary equine back pain in the United States

Back pain is a common complaint, clinical finding and performance limiting factor in sport horses. This study sought to gather current veterinary trends in the diagnosis, treatment and management of primary equine back pain in the United States. A 22 question survey was distributed electronically to equine practitioners through AAEP and ACVSMR listservs and through closed social media groups. The survey was open from April 20, 2022 to July 5, 2022. Responses were analyzed using Microsoft excel pivot tables. Ninety-seven survey responses were obtained and analyzed. Respondents reported the clinical signs most frequently relayed to them by the owner/rider/trainer of horses diagnosed with primary back pain were behavioral issues and poor performance. Most common diagnostic tests reported were radiography of the spinous processes, thoraco-lumbar vertebral bodies, and transcutaneous ultrasound of the thoraco-lumbar region. Most common pathologies reported were impinging dorsal spinous processes, degenerative sacro-iliac joint disease, and osteoarthritis in lumbar or thoracic articular process joints. In regards to impinging spinous process ("kissing spine") treatments, 72.2% of respondents recommended surgery only after non-surgical treatments failed, and 14.6% of respondents never recommended surgery. The majority (82%) of respondents reported some level of improvement in clinical signs of primary back pain with rehabilitation alone. To date, there has been no consensus or discussion about common abnormalities, diagnostic tests, treatments or management options for primary equine back pain in the United States. Results of this survey are a starting point showing current trends in diagnosis, treatment and management of primary equine back pain among equine practitioners in the United States showing 82% of practitioners using rehabilitation as a component of treatment.

Skills for future equine sports rehabilitation careers

The field of equine sports medicine and rehabilitation provides a career opportunity for students interested in remaining in the horse industry but not focused on a career as a veterinarian. However, throughout the United States, there are limited educational opportunities for undergraduate students to prepare for this career. The objective of this work was to determine what skills and theoretical knowledge professionals in the equine rehabilitation industry deemed most useful for employment in the equine rehabilitation industry, and, using that information, develop a curriculum to meet these industry needs. To meet this objective, a Qualtrics survey was distributed through email and social media to veterinarians, veterinary professionals, rehabilitation service providers, and horse owners. In addition to demographics, the survey asked respondents to list practical skills and theoretical knowledge that are essential for professionals in the equine rehabilitation industry. The majority of the 117 respondents (84%) were located in the United States, with the remainder from Canada (5%), the United Kingdom (5%), and several other countries. Eighteen percent of respondents were veterinarians, 26% owned or managed rehabilitation facilities, 8.5% were veterinary technicians, and the remainder were horse owners, rehabilitation service providers, and others. Horse handling skills (19%) and communication skills (18%) were the most commonly listed practical skills deemed essential for rehabilitation professionals. Of the theoretical skills, evaluation of lameness (29.5%), anatomy (31%), and fundamentals of equine reconditioning programs (32%) were deemed equally important for rehabilitation professionals. These data were used to design a minor in Equine Sports Rehabilitation that incorporated fundamental knowledge in lameness evaluation and rehabilitation methods as well as significant hands-on opportunities with rehabilitating horses and communicating about rehabilitation methods and progress with clients.

Efficacy of a commercial dry sleeve cryotherapy system for cooling the equine metacarpus

OBJECTIVE

To determine the ability of a commercial cryotherapy system (Game Ready Equine) to cool the metacarpal subcutaneous tissue and the superficial digital flexor tendon (SDFT) in horses.

STUDY DESIGN

Experimental study.

ANIMALS OR SAMPLE POPULATION

Six healthy adult horses.

METHODS

Thermocouples were implanted into the metacarpal subcutaneous tissues and the SDFT of six horses. Two treatments (cryotherapy or cryotherapy with 5-50 mmHg intermittent compression) were randomly assigned to forelimbs and performed for 20 minutes. Temperatures were compared to the target range of 10-19°C and between groups.

RESULTS

Only one limb in the cryotherapy/compression group reached the target range after cryotherapy. Temperatures did not differ between treatment groups at time 0. Lowest temperatures achieved in the subcutaneous tissue (p = .0043) and SDFT (p = .005) were 4.9 and 7.6°C lower when intermittent compression was applied. Similarly, applying compression induced a maximum change in temperature of approximately 7.0°C in the subcutaneous tissue (p = .014) and 10.2°C in the SDFT (p = .0001).

CONCLUSION

The cryotherapy system did not cool equine subcutaneous tissue or SDFT to the target temperature range, except in one limb. Combining cryotherapy with intermittent compression did result in lower temperatures and a greater change in temperature of the subcutaneous tissue and SDFT.

CLINICAL SIGNIFICANCE

When using this cryotherapy system, the addition of intermittent compression should be considered to achieve lower temperatures and potentially greater reduction in inflammation. Further studies are warranted to determine the effect of longer treatment times, higher compression settings, and the optimal temperature for benefits in normal and diseased equine tissues.

A Systematic Review of Complementary and Alternative Veterinary Medicine in Sport and Companion Animals: Soft Tissue Mobilization

Simple Summary

Soft tissue mobilization involves different massage and stretching techniques that are commonly used in animals. Despite the frequent use, there is limited knowledge of how the methods affect the animal. Therefore, this study reviews the scientific literature on massage and stretching in cats, dogs, and horses. Three core bibliographic sources were used. Relevant articles were assessed for scientific quality, and information was extracted on study characteristics, species, type of treatment, indication, and treatment effects. Of 1189 unique publications screened, 11 met the inclusion criteria and were included in the review, nine on massage and two on stretching. The risk of bias was assessed as high in eight of the studies and moderate in three of the studies. There were large differences in reported treatment effects; two studies assessed as having a moderate risk of bias indicated a decreased heart rate after massage. According to the results, the scientific documentation of massage and stretching is not of sufficient quality to draw clear conclusions about their clinical effect in horses, dogs, and cats.

Abstract

Soft tissue mobilization is frequently used in the treatment of sport and companion animals. There is, however, uncertainty regarding the efficacy and effectiveness of these methods. Therefore, the aim of this systematic literature review was to assess the evidence for clinical effects of massage and stretching in cats, dogs, and horses. A bibliographic search, restricted to studies in cats, dogs, and horses, was performed on Web of Science Core Collection, CABI, and PubMed. Relevant articles were assessed for scientific quality, and information was extracted on study characteristics, species, type of treatment, indication, and treatment effects. Of 1189 unique publications screened, 11 were eligible for inclusion. The risk of bias was assessed as high in eight of the studies and moderate in three of the studies, two of the latter indicating a decreased heart rate after massage. There was considerable heterogeneity in reported treatment effects. Therefore, the scientific evidence is not strong enough to define the clinical efficacy and effectiveness of massage and stretching in sport and companion animals.

Current use of biologic therapies for musculoskeletal disease: A survey of board-certified equine specialists

Objective

To evaluate the use of mesenchymal stem cells (MSCs), autologous conditioned serum (ACS), platelet‐rich plasma (PRP), and autologous protein solution (APS) for the treatment of equine musculoskeletal disease by diplomates of the American College of Veterinary Surgery (ACVS), and American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR).

Study design

Cross‐sectional study.

Sample population

Diplomates (n = 423).

Methods

An email link was sent to ACVS and ACVMR diplomates. A survey contained 59 questions regarding demographics, as well as indications, frequency, adverse effects, and limitations of use. Responses were analyzed using Fisher's exact test.

Results

One hundred and fifty four surveys were analyzed. Years in practice and type of practice were not associated with biologic therapy use. PRP was the most used therapy (120/137; 87.5%). PRP and MSCs were most often administered intralesionally while ACS and APS were most often administered intra‐articularly. ACS (50/104; 48.1%) treatment was repeated commonly within 2 weeks of initial injection. MSCs (39/90; 43.3%) and PRP (38/100; 38%) were commonly repeated 1‐2 months after initial injection and APS was typically repeated >4 months after initial injection (21/53; 39.6%). Local inflammation and expense were the most common adverse effect and limitation of use.

Conclusion

Diplomates most commonly utilized PRP and MSC intralesionally for soft‐tissue injuries, and ACS and ACP intra‐articularly for joint injury. Protocols for repeated administration varied widely. Local inflammation was a clinical concern with the use of biologics.

Clinical significance

Biologic therapies are used commonly by ACVS and ACVSMR diplomates for soft tissue and joint disease.

A Questionnaire Study on the Use of Complementary and Alternative Veterinary Medicine for Dogs in Sweden

Complementary and alternative veterinary medicine (CAVM) includes treatment methods that are not part of established veterinary medicine and where there is not as yet sufficient scientific documentation of the proposed effects. The CAVM use in Swedish dogs is largely unknown, and the aim of this study was to explore this use. Electronic questionnaires were distributed to dog owners, small animal veterinary practitioners, and CAVM therapists. A total of 253 dog owners responded. Except for massage, stretching, and laser therapy, more than 75% of the respondents stated that they did not use CAVM for their dogs. Of the 216 responding veterinarians, 39% did not use CAVM. CAVM use was more common among respondents with <10 years of work experience as compared to those with >10 years of work experience (p < 0.05). Almost half of the 124 responding CAVM therapists treated dogs; the most frequently used methods included massage, stretching, and acupressure. A majority of all respondents found the current Swedish regulation of CAVM insufficient. Although CAVM use in Swedish dogs appears to be uncommon, there is a need for scientific assessment of CAVM in dogs as regards safety and effectiveness for different indications.

A Systematic Review of Complementary and Alternative Veterinary Medicine: "Miscellaneous Therapies"

Simple Summary

Complementary and alternative veterinary medicine (CAVM) is commonly used in animals. However, there is limited knowledge of how the methods affect the animal. Therefore, this study reviews the scientific literature of 24 different CAVM therapies used in cats, dogs, and horses. Three core bibliographic sources were used. Relevant articles were assessed for scientific quality, and information was extracted on study characteristics, species, type of treatment, indication, and treatment effects. Of 982 unique publications screened, 42 were eligible for inclusion, representing nine different CAVM therapies, which were aromatherapy, gold therapy, homeopathy, leeches (hirudotherapy), mesotherapy, mud, neural therapy, sound (music) therapy, and vibration therapy. For the other 15 predefined therapies, no study was identified. The risk of bias was assessed as high in 17 studies, moderate to high in 10, moderate in 10, low to moderate in four, and low in one study. In those studies where the risk of bias was low to moderate, there was considerable heterogeneity in reported treatment effects. Therefore, the 24 CAVM therapies do not have scientific documentation of sufficient quality to draw clear conclusions regarding their clinical effect.

Abstract

There is an increasing interest in complementary and alternative veterinary medicine (CAVM). There is, however, an uncertainty of the efficacy of these methods. Therefore, the aim of this systematic literature review is to assess the evidence for clinical efficacy of 24 CAVM therapies used in cats, dogs, and horses. A bibliographic search, restricted to studies in cats, dogs, and horses, was performed on Web of Science Core Collection, CABI, and PubMed. Relevant articles were assessed for scientific quality, and information was extracted on study characteristics, species, type of treatment, indication, and treatment effects. Of 982 unique publications screened, 42 were eligible for inclusion, representing nine different CAVM therapies, which were aromatherapy, gold therapy, homeopathy, leeches (hirudotherapy), mesotherapy, mud, neural therapy, sound (music) therapy, and vibration therapy. For 15 predefined therapies, no study was identified. The risk of bias was assessed as high in 17 studies, moderate to high in 10, moderate in 10, low to moderate in four, and low in one study. In those studies where the risk of bias was low to moderate, there was considerable heterogeneity in reported treatment effects. Therefore, the scientific evidence is not strong enough to define the clinical efficacy of the 24 CAVM therapies.

An Evaluation of Current Preventative Measures Used in Equine Practice to Maintain Distal Forelimb Functionality: A Mini Review

Horses are used in a variety of equestrian disciplines predisposing them to musculoskeletal injury or disease including osteoarthritis and tendinopathy. As a result, a number of preventative measures are used within equine medicine and husbandry, ranging from therapeutic shoeing to the use of nutraceuticals. Despite their popularity and routine use evidence base and clinical outcomes are variable, bringing into question the efficacy of these prophylactic measures. In recent years a small number of studies have been performed examining the effect of specific strategies in order to quantify the preventative and protective claims such modalities have on joint and forelimb health. Few have robustly demonstrated a capacity to protect the limb by reducing inflammation, or promoting regenerative pathways. This review focusses on performance horses specifically, and the resounding theme that emerges in current research is the need for longitudinal studies to inform scientific conclusions surrounding single and multi-modal use. Furthermore, there is a requirement to prioritise evidence-based medicine to inform optimal clinical practice.

A Questionnaire Study on the Use of Complementary and Alternative Veterinary Medicine for Horses in Sweden

Complementary or alternative veterinary medicine (CAVM) includes treatment methods with limited scientific evidence. Swedish veterinarians are legally obliged to base treatments and recommendations on science or well-documented experience, but most CAVM methods are not well documented in animals. The aim of this study was to explore the use of CAVM in Swedish horses. Electronic questionnaires were distributed to horse owners, equine veterinary practitioners and CAVM therapists. Of the 204 responding horse owners, 83% contacted a veterinarian first in case of lameness, while 15% contacted a CAVM therapist. For back pain, 52% stated a CAVM therapist as their first contact and 45% a veterinarian. Only 10-15% of the respondents did not use any CAVM method for prevention or after injury. Of the 100 veterinarians who responded, more than half did not use CAVM themselves but 55% did refer to people who offer this service. Of the 124 responding CAVM therapists, 72% recommended their clients to seek veterinary advice when needed, 50% received referrals from a veterinarian, and 25% did not collaborate with a veterinarian. The two most common methods used by the respondents in all three categories were stretching and massage. Most veterinarians and therapists were not content with the current lack of CAVM regulation.

A Systematic Review of Musculoskeletal Mobilization and Manipulation Techniques Used in Veterinary Medicine

Simple Summary

Neck and back pain are common ailments in animals. While there are medical and surgical treatment options available for select patients, conservative care is the most common form of management of pain, stiffness and muscle spasms. Physical therapists, osteopaths and chiropractors use mobilization and manipulation techniques to evaluate and treat muscle and joint problems in both humans and animals, but there seems to be little scientific evidence available to support their use in veterinary medicine. This study reviews the scientific literature with the goal of identifying the clinical indications, dosages, outcome parameters, and efficacy of mobilization and manipulation techniques in dogs and horses. Fourteen articles were included in this review of which 13 were equine and one was a canine study. There was a large variability in the quality of evidence that supports the use of joint mobilization or manipulation in treating pain, stiffness and muscle hypertonicity in horses. Therefore, it was difficult to draw firm conclusions despite all studies reporting positive effects. Future studies need to establish standardized methods to evaluate the optimal dosages of mobilization and manipulation for use in animals.

Abstract

Mobilization and manipulation techniques are often used in small animal and equine practice; however, questions remain concerning indications, dosing and efficacy. A bibliographic search was performed to identify peer-reviewed publications from 1980 to 2020 that evaluated the clinical effects of musculoskeletal mobilization and manipulation techniques in dogs, cats and horses. The search strategy identified 883 papers for review. Inclusion and exclusion criteria were applied. The clinical indications, dosages, outcome parameters, and reported efficacy within each publication were recorded and categorized for comparison with scientific quality assessed according to a standardized grading system. Fourteen articles were included in this systematic review of which 13 were equine and one was a canine study. Seven of these were cohort studies and seven were randomized controlled clinical trials. The canine study involved carpal immobilization-remobilization and all equine studies focused on the effects of passive mobilization (n = 5) or manipulation (n = 8) of the axial skeleton. Study quality was low (n = 4), moderate (n = 7), and high (n = 3) and included a wide array of outcome parameters with varying levels of efficacy and duration of therapeutic effects, which prevented further meta-analysis. Therefore, it was difficult to draw firm conclusions despite all studies reporting positive effects. Optimal technique indications and dosages need to be determined to improve the standardization of these treatment options.

Survey of Integrative Veterinary Medicine Training in AVMA-Accredited Veterinary Colleges

A survey approved by the Association of American Veterinary Medical Colleges was sent to the academic deans of all 49 accredited veterinary colleges to obtain information on educational programs offered in integrative veterinary medicine (IVM). Results were compared to a previous survey with a similar design performed 7 years earlier. Survey responses were received from 43 of 49 institutions (87.8%). Thirteen respondents (30.2%) reported offering a formal course in IVM, 33 (76.7%) offered some level of instruction in the curriculum, and 32 (74.4%) provided clinical services in IVM. The most common IVM topics covered in the curriculum were rehabilitation and acupuncture. Dedicated courses in IVM had decreased since the previous survey, although faculty trained in at least one aspect of IVM increased. Clinical services incorporating IVM were present in the majority of veterinary teaching hospitals. Further investigation is required to determine the effectiveness of current IVM training in preparing veterinary graduates to discuss or utilize IVM in practice.

Equine Rehabilitation: A Scoping Review of the Literature

Simple Summary

When a horse is diagnosed with a locomotor disorder, the veterinarian treats the specific injury to restore the horse to soundness. Even after the injury has healed, however, the horse may not be fully functional due to persistent limitations in movement or strength in specific areas of the body. As in people, rehabilitation seeks to optimize function and reduce any existing disability using a variety of methods including manual therapy, the use of physical and mechanical agents, and specialized exercise regimes. This study has reviewed the scientific literature with the goal of identifying which types of physical therapy have been described in horses over the past 20 years. The most frequently reported techniques were exercise, electrotherapy, and hydrotherapy but there are relatively few publications describing details of their use and outcomes in clinical cases. This study reviews the methodology and outcomes of rehabilitation in clinical cases. The results highlight the paucity of clinically-based reports on the practical applications of equine rehabilitation and physical therapy.

Abstract

Injuries to the locomotor system are a common problem in athletic horses. Veterinarians address these injuries using appropriate medical, surgical, and pharmacological treatments. During or after recovery from the initial injury, horses may be treated for functional locomotor deficits using specific rehabilitation techniques aimed at restoring full athletic performance. This study reviews the literature to identify which rehabilitative techniques have been used most frequently in horses over the past 20 years, the protocols that were used, and the outcomes of the treatments in naturally occurring injuries and diseases. Publications were identified using keyword selection (Equine Athlete OR Equine OR Horse) AND (Rehabilitation OR Physiotherapy OR Physical Therapy). After removing duplicates and screening papers for suitability, 49 manuscripts were included in the study. The majority of publications that met the inclusion criteria were narrative reviews (49%) in which the authors cited the relatively small number of published evidence-based studies supplemented by personal experience. Observational/descriptive studies were also popular (35%). Randomized control trials accounted for only 10%. The most frequently reported rehabilitation techniques were exercise, electrotherapy, and hydrotherapy. The findings highlight the need for further information regarding type of intervention, parameterization, and outcomes of equine rehabilitation in clinical practice.

A Survey of Clinical Usage of Non-steroidal Intra-Articular Therapeutics by Equine Practitioners

There are several non-steroidal intra-articular therapeutics (NSIATs) available for use by equine practitioners for the treatment of performance-limiting joint-related pathology. Information is limited on perceived clinical efficacy, recommended treatment protocols, and associated complications. Our objective with this cross-sectional survey was to investigate the current clinical usage of NSIATs by equine practitioners. An electronic cross-sectional convenience survey inquiring about the use of steroidal and NSIATS (platelet-rich plasma, autologous conditioned serum, autologous protein solution, cellular therapies, and polyacrylamide hydrogel) was distributed internationally to equine practitioners. A total of 353 surveys were completed. NSIATs were used by 87.5% of the participants. Corticosteroids and hyaluronic acid remain the intra-articular therapeutic of choice among practitioners, followed by autologous conditioned serum, platelet-rich plasma and autologous conditioned protein. Polyacrylamide hydrogel was the least used. Practitioners were more likely to use NSIATs if their caseload was > 50% equine (P < 0.001), they treated more than 10 horses intra-articularly per month (P < 0.001), and horses treated were considered English sport horses (P = 0.02). Years in practice and practice location did not influence the use of NSIATs. One of the most common reasons why NSIATs were chosen was to treat acute articular pathologies. As survey limitations, answers to questions regarding clinical response and complication rates were based on subjective estimation and practitioners recall, not clinical records. In conclusion, corticosteroids remain the most widely used intra-articular therapeutic. Among the NSIATs, blood-based products are more commonly used by practitioners, followed by cellular and synthetic products. Equine practitioners frequently use NSIATs, choosing to treat acute joint pathology more than previously reported.

Recommendations for rehabilitation after surgical treatment of cranial cruciate ligament disease in dogs: A 2017 survey of veterinary practitioners

OBJECTIVE

To report current recommendations made by veterinarians for rehabilitation after surgical treatment of cranial cruciate ligament (CrCL) disease.

STUDY DESIGN

Anonymized electronic survey.

SAMPLE POPULATION

Veterinarians performing CrCL stabilization.

METHODS

An electronic survey was created to collect information on general attitudes toward postoperative rehabilitation and recommendations regarding therapeutic modalities and bandaging. Quantitative data are reported by descriptive statistical analysis, percentage of responses, or mean (±SD). The recommendations for postoperative bandaging beyond 24 hours and for postoperative rehabilitation after extracapsular stabilization compared with after tibial osteotomy were tested by using Cochran-Mantel-Haenszel tests, with P < .05 considered statistically significant.

RESULTS

The data analysis included 376 responses (13% response rate). Most (71%) respondents consistently recommended postoperative rehabilitation. Rehabilitation was more than twofold more likely to be recommended after extracapsular stabilization than after osteotomies (P = .0142). Most respondents did not recommend bandaging beyond 24 hours postoperatively (P = .00012).

CONCLUSION

Most respondents recommended either formal or informal postoperative rehabilitation therapy.

CLINICAL SIGNIFICANCE

If the survey respondents are representative of veterinarians performing CrCL surgery, the current attitude is supportive of postsurgical rehabilitation. Most respondents would welcome evidence-based guidelines for rehabilitation protocols.

The Effect of Core Abdominal Muscle Rehabilitation Exercises on Return to Training and Performance in Horses After Colic Surgery

We conducted a retrospective cohort study to test the hypothesis that performing 4 weeks of core abdominal rehabilitation exercises (CARE) postoperatively would be safe and associated with faster return to training and improved performance after colic surgery. Performance horses that recovered from colic surgery performed by the same surgeon and survived ≥ 1 year from 2008 to 2017 were included. Data were obtained from a review of medical records. Information about the horses' rehabilitation and performance was obtained from owners/trainers. Data from horses that completed a 4-week CARE program after surgery were compared with control horses that did not do the exercises after colic surgery. Data were analyzed using univariate and multiple regression, P < .05. Eleven CARE horses and 51 controls between the ages of 3 and 18 years were included in the data analysis. All CARE horses completed the rehabilitation program with no reported complications, returned to work faster after surgery, P = .002, and to training faster, P = .0002. After colic surgery, 81% of CARE horses improved their performance level compared with 7.8% of controls, P < .001. Core abdominal rehabilitation exercises were safely performed by horses after colic surgery with no reported complications and may have facilitated faster convalescence and improved performance.