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The 3 Assumptions of Rehab Nutrition

Rehabilitation. A dreaded state of being I've been lucky enough to mostly avoid until now. Last week I handed a man I met just 30 minutes prior a large check and my best horse. I don't know if I'll see her in two months or three, but hoping that some stall rest and scheduled regulated aqua therapy and laser treatments will make her right again. This article is about her nutritional changes necessary for rehabilitation.


The weekend before leaving for on holiday with my husband, Stella and I enjoyed the highlight of our year galloping across the Montana sagebrush chasing coyotes. The weekend before that we had completed our first FEI event. The day before I left for vacation, I rode her bareback in our new dressage court. When I got home five days later she was lame and I mean lame? I suppose only the sun, the moon and the neighbors' horses know what she did to be that sore over that short of a time. I suspected that she kicked through panel, but can't find a dent. Regardless of HOW she did it, my poor mare needed more help to heal than I could provide at my place. She needed rest from the volcanoes of ice and rutty snow and frozen manure that populated my pastures all winter. She needed a professional rehab facility. So, last week, I made up my mind and drove her 5 hours to Keyser Arena and Rehab in Columbus, MT and placed her in a well lit softly padded stall.

*Fun in the sun just a week before my poor girl became acutely lame.

The nutritional changes necessary to take a performance horse from work to stall rest can be quite dramatic. In Stella's case, she had been out of work for a couple months so the transition to stall rest was minimal, but more often a horse will go from peak fitness to stall rest overnight! It's obvious that you can NOT feed them the exact same way, and I'll explain why in three parts. The three assumptions of rehab nutrition include 1) calorie adjustments, 2) inflammation mitigation and immune support, and 3) protection from gastric ulcers and respiratory problems. Let's explore how we adjust forage, feed and supplementation to meet each of these goals.


The number one nutritional consideration for confinement rehabilitation is a calorie adjustment. In Stella's case (1,350 lb mare), she required around 30-32 Megacalories per day leading up to the 2** FEI event, 26-28 Megacalories per day standing around in pasture in the freezing cold, to maybe 18-20 Megacalories confined to a 60 degree stall. That's a 44% decrease in caloric requirement! Your horse's daily caloric needs will change during rehabilitation for the following reasons...

  • Activity level (exercise duration and intensity) plummets and then increases slowly

  • Stressors change

  • Forage quality might change

  • Environmental changes (Stella went from 20 degree days to a barn heated to 60 degrees!)

  • Nutritional goals change

The next question is HOW do you adjust for this caloric requirement change? Well, the first and obvious answer is to start decreasing or even eliminating the most calorie dense part of the diet which is likely some sort of performance feed high in carbs, fat and protein or maybe a high fat supplement that you're feeding. The second step is to decrease the caloric density of the hay. For example, you might decrease the ratio of alfalfa to grass hay in the diet, replace a high calorie second cutting orchardgrass with a lower calorie first cutting timothy, teff, or coastal bermuda. You might ALSO have to decrease the total volume of hay fed, but decreasing the caloric density of your hay rather than decreasing volume has advantages to be discussed later.

However, it's VERY very important that while you decrease the total caloric density of the diet that you don't also take away the horse's vitamin and trace mineral source. For example, if you were feeding a performance feed to recommended levels at 6-8 lbs per day and you decreased that to 2 lbs per day, you'll need to add back the vitamins and minerals to complete their requirement. That can be very easily done with one in a million trace mineral supplements or ration balancers on the market. Yes, a horse at maintenance (a.k.a. stall rest) typically requires LESS of these vitamins and minerals, but we also need those nutrients for bone, joint, and soft tissue recovery: ultimately that means immune system optimization. This leads us to our second assumption- inflammation mitigation.


We could lose ourselves in the rabbit hole that is inflammation mitigation/ immune support really quickly and you'd prefer not to read a 300 page novel for some answers, so let's suffice to say that FEEDING to mitigate inflammation and support the immune system during recovery can come from the following sources...

  1. A joint supplement with glucosamine, chondroitin, methylsulfonylmethane (MSM), hyaluronic acid (HA) or avocado unsaponifiables (ASU).

  2. A high omega-3 oil source such as flaxseed oil, ahiflower oil, camelina oil or fish oil could act as an anti-oxidant and support the immune system as it tackles the injury.

  3. Yeast cultures have been shown to stimulate positive immune responses. Many ration balancers and trace mineral supplements have yeast cultures already in them, so check the ingredients list first before you add.

These are the three supplement categories that I would explore first for inflammation mitigation and immune support, but you can read more about nutraceuticals touted to have anti-inflammatory properties in my articles "Part I Performance Boosting Supplements: What are they and do they work?" and "Part II: Performance Boosting Supplements".

Finally, I will mention that a proteolytic emzyme call serratiopeptidase was recommended to me for Stella as an anti-inflammatory nutraceutical. A Google Scholar review of articles found a soft pile of unclear information even in the human realm. I wouldn't say no to a FREE trial of this product, because the NIH confirms that it is likely safe (Tiwari, 2017), but I wouldn't spend the $4.83 per day to feed it on top of my other better studied ingredients. If you'd like to read more, you can follow this article link below. At the publication of this article, the company that provides this ingredient in supplement form has not responded to my questions.


Our final consideration for stall rest is the prevention of compounding problems; namely gastric ulcers and respiratory irritation which are negative externalities of confinement stress.

Nutritionally speaking, the first way to prevent gastric ulcers is to keep the horse chewing long stem forage as many hours per day as possible. As I mentioned above, striking a balance between eating fewer calories but more volume lies in the caloric density of your hay source. If you can not change to a lower calorie dense hay, then you'll need a slow feeding device to increase the number of hours chewing fewer flakes of a high calorie hay. For example, an appropriate slow feeding device (Read OCEN's "6 Dangers of Slow Feeders") or automated hay feeder (Read OCEN's "3 Arguments for Automated Hay Feeders") could be a reasonable investment. I'm going to assume that you are already talking to your veterinarian about using an omeprazole product to prevent the worst cases of gastric ulcers, and I prefer to leave the pharmaceutical recommendations to veterinarians. However, you can also feed a nutraceutical acid buffer such as Purina Outlast several times per day along with a pharmaceutical.

Mr. Ralph Young, the owner of Keyser Creek Arena and Rehab in Columbus, MT, suggested some ways to lower stress and prevent ulcers. He said that he keeps a very regimented schedule for feeding which helps to keep the horses happy. Also, I could tell from the moment that I entered the barn, that this was a low stress environment. There were none of those physical signs of excessive horse anxiety that you learn to pick up over the years entering thousands of farms. The horses all had quiet eyes and were in great condition. I think it screams volumes for Ralph's management techniques.

When dust is a problem, either in the hay and/or confined stall environment, I would suggest a few different methods for dust mitigation. You could replace some of the baled hay with a pre-packaged hay (think chopped hay in a bag) that is usually blended and treated in a way to remove airborne dust. You could also wet the hay in a hay net before feeding. Do NOT use a dust blower in confined spaces of any kind and sweep only minimally. There are, however, NO supplements that I recommend to prevent respiratory irritation at this time.


We've got a long ways to go until we know the outcome of Stella's rehabilitation, but it's comforting to know that she is in good hands with a farm manager that cares a lot about nutrition. As you transition your horse from work to stall rest, remember the three priority shifts; calories, immune support, and compounding problem prevention! These three priorities will help ease the transition that occurs at the beginning of rehab and set your horse up for a speedy recovery. If you need help managing your horse's diet in rehab, click the link below to schedule a FREE 15 Minute Discovery Call.



Bhagat, S.,Agarwal, M. and V. Roy. 2013. Serratiopeptidase: A systematic review of the existing evidence. International Journal of Surgery,Volume 11(3): 209-217.

Tiwari M. 2017. The role of serratiopeptidase in the resolution of inflammation. Asian J Pharm Sci.12(3):209-215. doi: 10.1016/j.ajps.2017.01.003. Epub 2017 Feb 1. PMID: 32104332; PMCID: PMC7032259.

Young, Ralph. 2023. Personal interview. Keyser Creek Arena and Rehab. *Find them on Facebook.

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