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Topic:Exercise

Exercise in horses encompasses the physical activities that horses engage in, either through natural behaviors or structured training programs. These activities impact a horse's musculoskeletal, cardiovascular, and respiratory systems, influencing overall health and performance. Exercise can vary in intensity, duration, and frequency, and its effects are studied to understand conditioning, endurance, and recovery processes in equines. Research in this field often focuses on the physiological adaptations to different types of exercise, the prevention of exercise-related injuries, and the optimization of training regimens for various equestrian disciplines. This page compiles peer-reviewed research studies and scholarly articles that explore the physiological, biomechanical, and health-related aspects of exercise in horses.
Effects of clodronate disodium on endocrine regulators of calcium in yearling horses.
Journal of animal science    April 22, 2025   Volume 103 doi: 10.1093/jas/skaf132
Conrad MB, Leatherwood JL, Paris BL, George JM, Martinez RE, Vergara-Hernandez FB, Nielsen BD, Colbath AC, Arnold CE, Glass KG, Welsh TH, Bradbery AN.Extra-label bisphosphonate (BP) use in juvenile horses is anecdotally reported, primarily for analgesic effects, despite the limited scientific understanding of biologic impacts on skeletally immature horses undergoing exercise. The objective of this study was to determine the effects of clodronate disodium (CD), a form of BP, on endocrine regulators of calcium. Thus, 32 yearling Quarter Horses were stratified by age (500 ± 13 d), body weight (BW; 336 ± 26 kg), sex (n = 16 geldings, n = 16 fillies), and initial bone optical density into 1 of 4 treatment groups for a 168-d tr...
Lipidomics and biochemical profiling of adult Yili horses in a 26 km endurance race: exploring metabolic adaptations.
Frontiers in veterinary science    April 22, 2025   Volume 12 1597739 doi: 10.3389/fvets.2025.1597739
Chang X, Zhang Z, Yao X, Meng J, Ren W, Zeng Y.The equine lipid metabolism is activated during and after endurance exercise to provide energy in response to the metabolic and physiological changes in the body caused by prolonged exercise; however, the specific regulatory mechanisms remain controversial and identifying differential lipid metabolites associated with equine endurance is essential to elucidate these regulatory mechanisms. In this study, blood samples for lipid metabolomic analysis and biochemical indices were collected before and after a 26 km race from 12 Yili horses with different endurance performance. The biochemical res...
Welfare assessment of racehorses provides a baseline for continued monitoring.
Equine veterinary journal    April 21, 2025   doi: 10.1111/evj.14510
Annan R, Trigg L, Allen K, Hockenhull J, Valenchon M, Mullan S.Racehorse welfare continues to be a focus of stakeholders both within and outside of the industry, and there is a need for evidence-based animal welfare data. Objective: To gather data on racehorse welfare through a combination of animal-based observations and information about management practices, and to ascertain the feasibility of trained industry assessors carrying out a racehorse welfare assessment. Methods: Cross-sectional. Methods: Sixteen trained industry assessors conducted individual observations of 737 racehorses in 21 Flat racing (F), 27 National Hunt (NH) and 26 Dual-purpose (D) ...
Agreement between subjective gait assessment and markerless video gait-analysis in endurance horses.
Equine veterinary journal    April 21, 2025   doi: 10.1111/evj.14516
de Chiara M, Montano C, De Matteis A, Guidi L, Buono F, Auletta L, Del Prete C, Pasolini MP.Subjective evaluation of gait by official endurance veterinarians (OEVs) is used to determine 'fitness-to-compete' in horses participating in endurance competitions. Objective gait analysis systems could aid in quick and verifiable judgements. Objective: To assess the agreement between objective analysis of head and pelvis vertical movement asymmetry performed with a markerless artificial intelligence motion tracking system (AI-MTS) and subjective lameness assessment performed by an accredited FEI OEV to judge horse gaits. Methods: Cross-sectional. Methods: During three endurance competitions,...
Dynamic Adaptation of Heart Rate and Autonomic Regulation During Training and Recovery Periods in Response to a 12-Week Structured Exercise Programme in Untrained Adult and Geriatric Horses.
Animals : an open access journal from MDPI    April 13, 2025   Volume 15, Issue 8 1122 doi: 10.3390/ani15081122
Wonghanchao T, Sanigavatee K, Poochipakorn C, Huangsaksri O, Chanda M.Changes in resting heart rate (HR) and HR variability (HRV) are utilised to assess training effects in horses. However, limited research has examined how these variables reflect training effects during exercise sessions and recovery periods, particularly in horses of different ages. This study investigated how HR and HRV changed during exercise sessions and recovery periods in untrained adult horses (UAHs; = 9) and geriatric horses (UGHs; = 9). HR and HRV were measured before and during a 54 min exercise bout over a 12-week training programme. Mixed-effects model with Greenhouse-Geisser corr...
The application of the pyramidal training model for conditioning thoroughbred horses.
Journal of equine veterinary science    April 9, 2025   Volume 149 105567 doi: 10.1016/j.jevs.2025.105567
Davie A, Beavers R, Denham J.The purpose of this review was to analyze the scientific background and practical application of a very successful human training methodology, the pyramidal training model, to the Thoroughbred racehorse. Despite years of research and accumulated knowledge on human training methods to enhance endurance performance, Thoroughbred training programs have lacked significant change. This review introduces the pyramidal training model, explains the science that underpins this training concept and outlines one approach to translate this science into the equine field. It also discusses the importance of...
Detecting Equine Gaits Through Rider-Worn Accelerometers.
Animals : an open access journal from MDPI    April 8, 2025   Volume 15, Issue 8 doi: 10.3390/ani15081080
Schampheleer J, Eerdekens A, Joseph W, Martens L, Deruyck M.Automatic horse gait classification offers insights into training intensity, but directsensor attachment to horses raises concerns about discomfort, behavioral disruption, andentanglement risks. To address this, our study leverages rider-centric accelerometers formovement classification. The position of a sensor, sampling frequency, and window size ofsegmented signal data have a major impact on classification accuracy in activity recognition.Yet, there are no studies that have evaluated the effect of all these factors simultaneouslyusing accelerometer data from four distinct rider locations (t...
Comparison of Rein Forces and Pressure Beneath the Noseband and Headpiece of a Snaffle Bridle and a Double Bridle.
Animals : an open access journal from MDPI    April 5, 2025   Volume 15, Issue 7 doi: 10.3390/ani15071058
MacKechnie-Guire R, Clayton H, Williams J, Marlin D, Fisher M, Fisher D, Walker V, Murray RC.Information describing forces applied to the horse are needed to inform regulatory decisions regarding equine health and wellbeing. This study compares forces exerted beneath the noseband and headpiece of a snaffle bridle (SB) and a double bridle (DB). Horses were fitted with the same type of SB and DB. Forces were measured by pressure mats under the noseband (nasal/mandibular) and headpiece (occipital) of the bridle and by force sensors inserted bilaterally between the bit(s) and reins. The noseband was adjusted to 2 finger-equivalents using a tightness gauge. Data were recorded for eleven hi...
Identification of key genes in immune-response post-endurance run in horses.
Journal of equine veterinary science    March 31, 2025   Volume 149 105418 doi: 10.1016/j.jevs.2025.105418
Akçay S, Gurkok-Tan T, Ekici S.Intense physical activity in endurance horses triggers complex immune and inflammatory responses, yet the molecular mechanisms underlying these adaptations remain unclear. This study investigated immune-related transcriptomic changes following a 160 km endurance ride, focusing on sex-based differences. Using a bioinformatics approach, differentially expressed genes (DEGs), pathways, microRNAs (miRNAs), and transcription factors (TFs) were analyzed before (T0) and after (T1) the ride. A protein-protein interaction (PPI) analysis was conducted to identify key regulatory genes. Pathway enrichment...
Plasma Lipidomics and Proteomics Analyses Pre- and Post-5000 m Race in Yili Horses.
Animals : an open access journal from MDPI    March 30, 2025   Volume 15, Issue 7 doi: 10.3390/ani15070994
Wang J, Ren W, Li Z, Li L, Wang R, Ma S, Zeng Y, Meng J, Yao X.The impact of exercise on human metabolism has been extensively studied, yet limited research exists on the effects of high-intensity racing on equine metabolism. The aim of this study was to screen the effect of a 5000 m race on lipids and proteins in the plasma of Yili horses for the breeding of racehorses. Blood samples were collected from the top three finishers, and lipidomics and proteomics analyses were performed. Lipidomic analysis identified 10 differential lipids. Compared to pre-race levels, phosphatidylethanolamine (18:0/16:0) (PE (18:0/16:0)) and phosphatidylcholine (18:0/18:2) (P...
Running a genetic stop sign accelerates oxygen metabolism and energy production in horses.
Science (New York, N.Y.)    March 28, 2025   Volume 387, Issue 6741 eadr8589 doi: 10.1126/science.adr8589
Castiglione GM, Chen X, Xu Z, Dbouk NH, Bose AA, Carmona-Berrio D, Chi EE, Zhou L, Boronina TN, Cole RN, Wu S, Liu AD, Liu TD, Lu H, Kalbfleisch T....Horses are among nature's greatest athletes, yet the ancestral molecular adaptations fueling their energy demands are poorly understood. Within a clinically important pathway regulating redox and metabolic homeostasis (NRF2/KEAP1), we discovered an ancient mutation-conserved in all extant equids-that increases mitochondrial respiration while decreasing tissue-damaging oxidative stress. This mutation is a de novo premature opal stop codon in KEAP1 that is translationally recoded into a cysteine through previously unknown mechanisms, producing an R15C mutation in KEAP1 that is more sensitive to ...
Risk factors for superficial digital flexor tendinopathy in Thoroughbred racehorses in South Korea (2015-2019).
Equine veterinary journal    March 19, 2025   doi: 10.1111/evj.14493
Choi Y, Parkin T.Superficial digital flexor (SDF) tendinopathy is one of the most common musculoskeletal diseases in Thoroughbreds and a major cause of retirement from racing among racehorses in South Korea. However, there are no previous epidemiological studies on SDF tendinopathy-related risk factors for racehorses in South Korea. The interventions derived from such a study could reduce the occurrence of SDF tendinopathy and, therefore, extend horses' racing careers. Objective: To identify the risk factors associated with SDF tendinopathy for Thoroughbreds in South Korea. Methods: Retrospective case-control ...
Evaluating Pelvic Floor Dysfunction in Female Horse Show Jumpers Using the Australian Pelvic Floor Questionnaire.
Medical science monitor : international medical journal of experimental and clinical research    March 16, 2025   Volume 31 e946830 doi: 10.12659/MSM.946830
Cygańska AK, Giżewska B, Zdunek K.BACKGROUND Pelvic floor dysfunction (PFD) significantly reduces quality of life. During horseback riding, the movement of the horse's back affects the tension of the pelvic floor muscles. This study aimed to compare reported symptoms of pelvic floor dysfunction in women with past, current, and no history of horse show jumping. MATERIAL AND METHODS We examined 160 women (age 23.69±3.96 years). The cohort group consisted of 74 women training currently and training in the past, and a control group of 86 women not practicing horseback riding. The study used the original questionnaire and the Aust...
Effects of Age, Sex, and Exercise on Measurement of Serum CTnI Levels and Some Parameters Related to the Cardiovascular Capacity of Caspian Horses.
Veterinary medicine and science    March 11, 2025   Volume 11, Issue 2 e70202 doi: 10.1002/vms3.70202
Mehrazin H, Sakha M, Safi S.Due to their high specificity and exclusive cardiac myocyte sensitivity, cardiac troponins T and I (cTnT, cTnI) are currently regarded as ideal biomarkers to identify cardiomyocyte damage, myocardial injury, myocardial infarction, and chronic heart failure. In fact, cTnI is considered the most reliable biomarker for diagnosing heart-related issues. This study aimed to investigate the effects of age, gender, and exercise training on serum cTnI levels and various parameters related to the cardiovascular capacity of Caspian horses. For this purpose, 50 adult Caspian horses over 3 years old, both ...
Effects of pre-exercise cooling in hot environments on performance and physiological responses in Thoroughbred horses.
Journal of equine science    March 10, 2025   Volume 36, Issue 1 19-23 doi: 10.1294/jes.36.19
Ohmura H, Ebisuda Y, Takahashi Y, Mukai K.Pre-exercise cooling may prevent exertional heat illness in horses. We hypothesized that pre-exercise cooling before warm-up in a hot environment would not affect performance but would mitigate reductions in body weight and increases in body temperature following exercise. Six trained Thoroughbred horses were studied using a randomized, crossover design with three pre-treatments: 30-min walk on a treadmill at 1.7 m/sec (WALK), 30 min of standing (REST), and a 10-min pre-cooling shower at 26.2 ± 0.8°C (SHOWER). All horses underwent each pre-treatment, followed by a warm-up and main exercise i...
Absolute Quantitative Lipidomics Reveals Differences in Lipid Compounds in the Blood of Trained and Untrained Yili Horses.
Veterinary sciences    March 10, 2025   Volume 12, Issue 3 255 doi: 10.3390/vetsci12030255
Wang T, Meng J, Wang J, Ren W, Yang X, Adina W, Bao Y, Zeng Y, Yao X.The purpose of this study was to explore the relationship between blood lipid levels and the differences in cardiac structure and function of trained and untrained Yili horses as related to exercise performance. We utilized quantitative lipidomics technology to elucidate how the differences in lipid compounds in the blood influenced performance outcomes. Sixteen 18-month-old Yili horses were selected, ten of which received a 15-week training regimen, and six were kept as untrained controls. Cardiac structure and function were assessed by echocardiography, while plasma lipid metabolites were de...
Regulatory Mechanisms of Yili Horses During an 80 km Race Based on Transcriptomics and Metabolomics Analyses.
International journal of molecular sciences    March 8, 2025   Volume 26, Issue 6 doi: 10.3390/ijms26062426
Wang J, Ren W, Li Z, Li L, Wang R, Ma S, Zeng Y, Meng J, Yao X.Equine endurance exercise induces physiological changes that alter metabolism and molecular pathways to maintain balance after intense physical activity. However, the specific regulatory mechanisms remain under debate. Identifying differentially expressed genes (DEGs) and differential metabolites (DMs) associated with equine endurance is essential for elucidating these regulatory mechanisms. This study collected blood samples from six Yili horses before and after an 80 km race and conducted transcriptomics and metabolomics analyses, yielding 722 DEGs and 256 DMs. These DEGs were primarily enri...
Acute whole-body vibration as a recovery strategy did not alter the content of gluteus medius monocarboxylate-transporters, lactatemia, and acidosis induced by intense exercise in horses.
Frontiers in veterinary science    March 6, 2025   Volume 12 1538195 doi: 10.3389/fvets.2025.1538195
Carvalho JRG, Sales NAA, Littiere TO, Costa GB, Castro CM, Polisel EEC, Orsi JB, Ramos GV, Santos IFC, Gobatto CA, Manchado-Gobatto FB, Ferraz GC.Several studies have explored alternatives to enhance the performance, health, and safety of sports horses. One promising method involves the use of vibrating platforms (VP), which offer passive exercise stimulation via mechanical oscillations distributed throughout the body. This type of exercise is referred to as whole-body vibration (WBV) and is an emerging strategy for accelerating muscle recovery. This study examined the dynamics of proteins responsible for transporting monocarboxylates (MCT1 and MCT4), and their relationship with lactatemia and acid-base balance in connection with WBV re...
Renin-Angiotensin-Aldosterone System Profiling in Horses Before and After Exercise.
Journal of veterinary internal medicine    March 6, 2025   Volume 39, Issue 2 e70036 doi: 10.1111/jvim.70036
Holbrook T, Hernandez J, McCarrel T, Lester G, Sleeper M, Domenig O, Adin D.The impact of exercise on the classical and alternative renin-angiotensin-aldosterone system (RAAS) pathways has not been studied in horses. Objective: We hypothesized that exercise would activate both RAAS pathways and that endurance exercise would cause more activation of the classical pathway compared to short-duration, high-intensity exercise in horses. Methods: Twenty-five horses (21 client-owned and 4 research) were included in 4 exercise groups (10 Arabians, 50-mile ride [A-E]; 4 thoroughbreds, 1-mile treadmill exercise [TB-TM]; 5 thoroughbreds, 1-1/16th-mile race [TB-R]; and 6 quarter ...
Exercise as a welfare strategy? Insights from horse (Equus caballus) owners in the UK.
Animal welfare (South Mimms, England)    March 4, 2025   Volume 34 e14 doi: 10.1017/awf.2025.11
Naydani CJ, Coombs T.Obesity and its comorbidities (e.g. laminitis) are identified as major welfare issues among domestic equids in the United Kingdom (UK) and abroad. Weight-management typically focuses on restricting consumption (e.g. limiting pasture grazing), often facilitated through stabling. This leads to social isolation, prompting other welfare issues. Increased exercise may be a preferable solution for equine obesity, if viable. The aims of this study were to explore horse (Equus caballus) owner perceptions regarding the importance of exercise, and to investigate how exercise provision related to welfare...
Respiratory Rate Recovery After Submaximal Lunging Exercise Is Delayed in Asthmatic Horses with Neutrophilic Airway Inflammation.
Animals : an open access journal from MDPI    March 2, 2025   Volume 15, Issue 5 doi: 10.3390/ani15050713
Röschmann J, Naef J, Doras C, Gerber V.Equine asthma is a common cause of poor performance, but little is known about its impact on submaximal exercise. The aim of the present study was to evaluate the effects of equine asthma and potential confounding factors on recovery of respiratory rate (RR) and heart rate (HR) after a lunging exercise test. Thirty-seven horses completed a standardized 15 min lunging exercise including HR and RR recording pre- and up to 30 min post-exercise and venous blood lactate measurement. Endoscopy was performed and bronchoalveolar lavage fluid cytology was used to categorize horses as controls or asthma...
Association of heart rate variability, exercise intensity and exercising arrhythmias with competition results in eventing horses.
Equine veterinary journal    February 26, 2025   doi: 10.1111/evj.14491
Navas de Solis C, Ramseyer A, Stefanovski D, Haughan J, Solomon CJ, Kirsch K.Exercising arrhythmias are common in horses participating in eventing competitions. Heart rate variability (HRV) and a specific measure of the degree of heart rate fluctuation (Detrended Fluctuation Analysis alpha1; DFA-α1) are proposed as exercise intensity and fatigue markers. Objective: (1) To describe exercising arrhythmias and DFA-α1 values during 2-4* level eventing cross-country competitions in horses from two European countries; (2) to identify associations between exercising arrhythmias, DFA-α1 and competition results and (3) to evaluate whether markers of the intensity of exercise...
Proteomic analysis emphasizes the adaptation of energy metabolism in horses during endurance races.
BMC veterinary research    February 15, 2025   Volume 21, Issue 1 67 doi: 10.1186/s12917-025-04518-0
Gotić J, Špelić L, Kuleš J, Horvatić A, Gelemanović A, Ljubić BB, Mrljak V, Bottegaro NB.Long-term aerobic exercise during endurance racing places high demands on equine homeostasis. This study aimed to use proteomic analysis to elucidate complex biological responses during endurance exercise. It was hypothesized that different serum proteome changes would be noted, reflecting physiological processes as a response to race. The serum has been taken before and after an 80 km race from 13 endurance horses. Proteomic analysis of samples has been performed by TMT-based quantitative method. Apolipoprotein and haptoglobin values have been validated by enzyme-linked immunosorbent assay a...
The Impact of the Competition on miRNA, Proteins, and Metabolites in the Blood Exosomes of the Yili Horse.
Genes    February 15, 2025   Volume 16, Issue 2 224 doi: 10.3390/genes16020224
Yuan X, Yao X, Zeng Y, Wang J, Ren W, Wang T, Li X, Yang L, Yang X, Meng J.Horse racing may cause stress-induced physiological changes and tissue damage in horses, but the changes in miRNA expression, protein expression, and metabolic substances in the plasma exosomes of the horse after racing are still unclear. This study detected miRNA, protein expression, and metabolic substances in the plasma exosomes of horses before and after competition, providing new insights for post-race recovery and care of horses. Methods: Eight three-year-old horses that had undergone training were selected as the research subjects, with four horses that had not competed as the contr...
Evaluating plasma lactate running speed derived parameters for predicting maximal lactate steady state in teaching horses.
Journal of equine veterinary science    February 14, 2025   105385 doi: 10.1016/j.jevs.2025.105385
Littiere TO, Costa GB, Sales NAA, Carvalho JRG, Rodrigues IDM, Ramos GV, Ferraz GC.In humans, there is an ongoing academic discussion about measuring plasma lactate concentration ([La]) during an incremental exercise test (IET) to establish thresholds that can predict the maximal lactate steady state (MLSS). Training studies on horses have utilized the onset of [La] (OBLA), also known as V, the velocity at which the [La] of 4 mM is reached. This study assesses the effectiveness of four methods for estimating the MLSS in teaching horses. Ten teaching horses underwent a single IET to determine four exercise intensity thresholds for predicting MLSS and performed several constan...
Return to Athletic Activity of a Shetland Pony Mare with Coxofemoral Luxation Treated by Femoral Head Ostectomy.
Animals : an open access journal from MDPI    February 10, 2025   Volume 15, Issue 4 497 doi: 10.3390/ani15040497
Carnevale L, Tagliabue T, Rabbogliatti V, Bona R, Cavallier F.Femoral head ostectomy is considered a salvage procedure in the treatment of chronic coxofemoral joint luxation in small equids. Permanent lameness of varying degrees, largely depending on the animal's weight, and potential contralateral limb deformity may occur. The purpose of this study was to report the outcome of a small equid that, despite undergoing a femoral head ostectomy for a chronic coxofemoral joint luxation, was able to return to being ridden by children and to athletic activities. Methods: An 8-year-old Shetland pony mare (180 kg) was presented for a chronic right hind limb lamen...
Gait kinematics at trot before and after repeated ridden exercise tests in young Friesian stallions during a fatiguing 10-week training program.
Frontiers in veterinary science    February 10, 2025   Volume 12 1456424 doi: 10.3389/fvets.2025.1456424
Siegers EW, Parmentier JIM, Sloet van Oldruitenborgh-Oosterbaan MM, Munsters CCBM, Serra Bragança FM.Appropriate training is essential for equine athletes to improve fitness and ensure welfare. Young Friesian stallions must complete a 10-week training program for acceptance as breeding stallions. Earlier, this training program was demonstrated to induce overtraining. Unassigned: To evaluate how this training program affects stallions' trot locomotion variables in relation to fatigue. Unassigned: Prospective analytical study. Unassigned: 3 or 4 years-old (n = 16) Friesian stallions performed three ridden indoor standardized exercise tests (SETs) in week-1 (SET-I; n = 15), week-6 (SET...
Investigation of the role of exercise in the detection of selected respiratory pathogens from nose wipes collected from healthy horses.
Journal of equine veterinary science    February 8, 2025   Volume 146 105377 doi: 10.1016/j.jevs.2025.105377
Wright CA, Lawton K, Barnum S, Craig BW, Farwell BR, Blea J, McCook C, Pusterla N.This study aimed to determine if exercise increases the frequency of selected respiratory viruses/bacteria shedding in non-clinical horses using nose wipes. Nose wipes were taken pre- and post- exercise from 133 healthy horses of various ages and disciplines. Wipes were assayed for the presence of selected common (equine herpesvirus-1 (EHV), EHV-4, S. equi spp equi) and commensal (EHV-2, EHV-5, S. equi spp zooepidemicus) respiratory pathogens. The frequency of detection increased significantly (p < 0.05) in the post-exercise wipes for EHV-1, EHV-2, EHV-5, and S. zooepidemicus. EHV-4 and S. equ...
Effects of Combined Transcriptome and Metabolome Analysis Training on Athletic Performance of 2-Year-Old Trot-Type Yili Horses.
Genes    February 4, 2025   Volume 16, Issue 2 197 doi: 10.3390/genes16020197
Yang L, Li P, Huang X, Wang C, Zeng Y, Wang J, Yao X, Meng J.Training is essential for enhancing equine athletic performance, but the genetic mechanisms that regulate athletic performance are unknown. Therefore, this paper aims to identify candidate genes and metabolic pathways for the effects of training on equine athletic performance through multi-omics analyses. Methods: The experiment selected 12 untrained trot-type Yili horses, which underwent a 12-week professional training program. Blood samples were collected at rest before training (BT) and after training (AT). Based on their race performance, whole blood and serum samples from 4 horses were ch...
Therapeutic Exercises for Rehabilitation of Muscle Injury.
The Veterinary clinics of North America. Equine practice    January 31, 2025   Volume 41, Issue 1 213-225 doi: 10.1016/j.cveq.2024.11.011
King MR, Colla S.Successful rehabilitation of muscle injury requires a comprehensive understanding of the injury process, healing phases, and resources to be employed. The initial phase is characterized by acute inflammatory signs, followed by the regenerative and remodeling phases. Therapeutic exercises can be utilized in all 3 phases, progressing from isometric exercises to aquatic therapies. The classification and phase of injury and the individual response to the applied therapies will guide the progression of the therapeutic exercises through the rehabilitation program.