Chapter 3 Physical Restraint of

Restraint is the term used to imply control of an animal and may be necessary for medical and nonmedical procedures. The two types of animal restraint are physical restraint and chemical restraint. Sometimes both must be used to accomplish a procedure. Physical restraint refers to methods that are applied to the animal with or without use of special equipment. Chemical restraint refers to the use of pharmaceuticals to alter the animal's mental or physical abilities.

Restraint is more of an art than it is science. Skilled restrainers know the behavior and nature of the species they work with. This level of savvy takes time to acquire and is often best learned by watching experienced personnel. Good restraint involves understanding the natural instincts of the , being able to read an individual's temperament, and recognizing the extent of handling and training that an individual has (or has not) had. Several key points must be made regarding restraint of horses.

• Each animal is an individual, and each has a different background. A method of restraint that is totally effective for one horse may be completely ineffective for another. Avoid a cookie-cutter approach where all animals are treated similarly.

• Be flexible. When the selected method of restraint is not working, go to “plan B.” Realize that you cannot force restraint on an animal that is intent on not accepting it, especially when the animal outweighs and outmuscles you many times over.

• In the world of nature animals are either predators or prey, and much of their behavior relates to this fact. Horses are prey. Their natural instinct when placed in a fearful situation is to run away. Sometimes this instinct is so strong that they will injure themselves in their effort to flee. Very few horses become aggressive in a fearful situation, but this does occur. Precautions must be taken with these individuals.

• Another strong natural instinct to remember is that horses are herd animals and often resist attempts to separate them from others in their group. Sometimes a buddy system approach—taking a second horse along—is helpful if the horse needs to be taken away from the group.

• Horses are naturally suspicious and respond best to a calm, deliberate approach. Using the voice and touch in a calm manner helps to gain their trust. Good horsemen typically maintain vocal and physical contact with the animals they are handling. Approaches are usually best made from the front end of the horse rather than from behind, and initial hand contact with the neck or withers makes a good introduction before moving on to other areas of the horse's body.

• Be careful when working in the horse's visual blind spots. Because of the location of their eyes, horses cannot see directly behind their hindquarters, directly in front of the tip of their nose, directly between the eyes in the forehead area, and directly above the head between the ears. If you must work in these areas, avoid unannounced or rapid movements.

• Use the least amount of restraint necessary to do the job safely and do not apply it any longer than necessary.

• Horses are traditionally handled primarily from their left side (also called the near side). Unless the horse has not been handled, it will most likely be accustomed to a left-sided approach.

• The horse's head should always be attended. Control of the head usually enables control of the horse. For most procedures, the person “on the head” stands on the same side as the person performing the procedure and has the greatest responsibility for restraint of the animal and the safety of his or her coworker.

• Never stand directly in front or directly behind a horse during a procedure, unless protected by a barrier or mechanical device. Horses may strike with the front legs or kick with the hind legs in response to pain or fear. Horses may also throw their heads violently, causing injury. Even a normally “good horse” may display these responses when in pain or fear. Assume that all horses are capable of these responses when placed in certain situations.

• Take good care of your personal safety. Avoid getting into a position that you cannot leave quickly, such as stall corners or between the horse and a fence or wall. Also, do not be afraid to speak up if you are uncomfortable with a given situation or not up to the task. Your safety is of the utmost importance.

• The horse should be protected from dangers like sharp objects, hooks, buckets, loose boards, and light fixtures in case it rears, kicks, or throws its head or body. There is little point in risking serious lacerations or fractures from restraint for an otherwise simple procedure. Survey the area for potential hazards before beginning a procedure. The best prevention is to take the horse to an area without potential hazards or remove the hazards where possible.

• Patience is a virtue, and your virtue will be tested. Some procedures simply cannot be done safely on certain individuals in certain situations. Be sure to plan ahead for the procedure. Few things are more frustrating than struggling to get a horse properly restrained, only to realize that a piece of equipment is out of reach or not working properly.

Another consideration is the possibility of professional liability lawsuits. The veterinarian is recognized legally as an expert and is responsible for anticipating the responses of his or her patients to veterinary procedures. Sometimes the veterinarian's choices of restraint may be influenced by this consideration and may even to refusal to perform certain procedures. The safety of the horse and the safety of the people handling the horse must be not only legal but ethical responsibilities.

Finally, realize that any form of restraint can become abusive. Applying a restraint method improperly or for too long can cross the line of humane restraint.

METHODS OF PHYSICAL RESTRAINT

HALTER AND LEAD ROPE

One of the most basic acts of horsemanship is placing a and lead rope (also called a lead shank) on a horse. It is also the first step in gaining control of a horse's head, which is the key to controlling the horse.

The horse should be approached from its left side; avoid standing directly in front of the horse. Usually, the halter is placed first, and then the lead rope is attached to the halter. Some horses need to have the lead rope placed around the neck first for initial control while the halter is being placed (Fig. 3-1, A). The halter has a small loop, which is placed around the nose, and a larger loop, which is placed over and behind the ears. Buckles or snaps are used to open and close the loops. As a courtesy to the horse, try not to drag the halter over the eyes and ears. Rather, spread the halter apart to avoid the eyes and lift or unbuckle the halter to avoid the ears. Once the halter is positioned and the buckles/snaps secured, the lead rope is attached (Fig. 3-1, B and C).

Once placed, the halter and lead rope may be used to lead the horse. The horse should not be led by grasping the halter; if the horse moves its head up or away, the operator may lose his or her grip, and if the horse bolts or runs, there is a risk of being dragged and seriously hurt (Fig. 3-2, A). Use the lead rope to lead the horse (Fig. 3-2, B). Hold the lead away from any buckles or chains, and never coil the lead around the fingers, hand, or arm (Fig. 3-2, C and D). If the horse bolts or runs, coiled rope may tighten around body parts; serious injury and death have resulted from this practice. Another practice to avoid is letting the lead rope drag on the ground; the horse may step on the rope, or the handler may become tangled in the rope, also resulting in injury.

To lead the horse, walk purposefully in the intended direction and do not look back at the horse. Some horses resent being held tightly by the lead rope, and giving it some slack may encourage it to follow the handler. Most horses respond best when the handler walks to the side of the head or neck. Fig. 3-1 Placing a halter and lead rope. A, Lead rope placed around the neck to get initial control of the horse. B, Attachment of the lead rope to the halter. C, Alternate attachment of lead rope to halter.

Fig. 3-2 Leading the horse using the halter and lead rope. A, Fingers should not be placed through the buckles or snaps of the halter. B, Proper hold of the lead rope. C, Improper coiling of lead rope around the arm. D, Improper coiling of lead rope around the hand.

Avoid walking far in front of the horse, where control of the horse is minimal.

When controlling the head for a procedure, the person on the head should realize that his or her first responsibility is his/her coworker's safety. If the horse becomes fractious, it is usually best to move the horse's hindquarters away from the clinician. This is done not by moving the hind end of the horse directly but by moving the head; the hindquarters usually move opposite to head movement. In other words, turning the head to the left usually results in the hindquarters moving to the right, and vice versa.

Lead ropes are made from many materials (e.g., nylon, leather, hemp, cotton) and have two basic designs: with or without a chain. Without a chain, the rope serves only as a lead, but the addition of a chain provides possibilities for several degrees of physical restraint. Note that using the chain portion of a lead to restrain foals as described later is not appropriate.

Chain shanks can be purchased with varying lengths of chain and thickness of the chain links. When a simple lead rope does not provide enough control, the chain portion of a chain shank can be placed over the nose or in the mouth for increasing restraint. In order to use the chain in this fashion, the halter must have side rings to slide the chain through and fasten the chain snap.

Placing the chain over the nose is a mild form of restraint. The chain is passed through the left ring of the nosepiece and over the nose to attach (1) to the right nosepiece ring (Fig. 3-3, A) or (2) through the right nosepiece ring and continuing to the right upper ring (Fig. 3-3, B) or (3) through the right nosepiece ring and continuing under the halter to attach to the large nosepiece ring between the mandibles (Fig. 3-3, C). Care should be taken to cross the chain over the halter so that the noseband can act as a protective interface between the chain and the horse's skin (Fig. 3-3, D). A light, quick snap of the lead usually gets the horse's attention.

Placing the chain under the chin is not recommended—many horses will throw their heads or rear to avoid pressure from a chin shank, possibly causing injury to themselves (Fig. 3-4).

The chain can also be placed in the mouth as the next level of restraint. There are two basic positions for the chain. It can be positioned like a mouth , although the links of the chain tend to pinch the tongue and cheeks when pressure is applied, causing many horses to resist any pressure on the lead (Fig. 3-5). The chain can also be positioned to contact the gingiva above the upper incisors underneath the upper lip; this is called a lip shank. There is an acupressure point at this location on the gums, and constant pressure encourages release of natural endorphins in the brain, helping to calm the horse. The chain is passed through the left nosepiece ring, directly over the nose, and attached to the right nosepiece ring. The chain over the nose is slackened enough to allow the upper lip to be elevated, and the chain is placed carefully well above the incisors against the gums (Fig. 3-6, A to E). Gently take up the slack in the lead to obtain contact of the chain against the tissue. The lip shank is difficult to position, and once in place, constant pressure must be kept on the lead rope to keep the chain in position. A more recent modification of the lip shank is a commercial device that fits over the gums and behind the poll (another acupressure point) and is adjusted with small pulleys to the desired tension; instead of chain, nylon rope is used, making it less traumatic to the gums. Whenever a chain or any other device is placed in the mouth, it should never be snapped, jerked, or pulled on excessively; the tissues of the mouth are very sensitive, and it is easy to cross the line of humane restraint.

The lead rope can be used to tie the horse's head to a secure object, though this is rarely necessary and may have disastrous consequences if the horse panics and tries to run away. For most veterinary procedures, tying the horse does not justify the risks involved. If it is necessary to tie the head, use only a modified slip knot that can be released in an emergency (Fig. 3-7) and allow the horse enough slack to allow some movement of its head and neck. The less ability the horse has to move its head, the more Fig. 3-3 Chain shank for increasing restraint. A, Chain shank attached to right nosepiece ring. B, Chain shank attached to right upper ring. C, Chain shank attached between the mandibles. D, The chain should cross the nosepiece to provide some protection for the horse.

(B from McCurnin DM, Bassert JM: Clinical textbook for veterinary technicians, ed 6, St Louis, 2006, Saunders.) Fig. 3-4 Placement of chain shank under the chin.

likely it is to resist. Also, a horse should never be tied with a chain over its nose or in its mouth. Never leave a tied horse unattended. Be sure that whatever object the horse is tied to will not break and get dragged by the horse if the horse breaks free.

COVERING THE EYES

This is a time-honored method that can be applied to one or both eyes. Sometimes, when the horse cannot see the area being worked on, it will be submissive. Covering the eye on the same side as the procedure is the most common method but is often applied incorrectly. Placing the hand completely over the eye to force it shut is usually unnecessary and is often met with resistance (Fig. 3-8, A). All that is necessary is to block vision of the procedure, using an open hand like a curtain but allowing the horse to keep its eye open (Fig. 3-8, B).

Some horses respond favorably to blindfolding. These individuals and situations must be carefully selected, since not all horses accept a blindfold. Blindfolding is usually done by placing a towel over both eyes and tucking it underneath the halter. Blindfolds should be able to be removed easily if the horse panics, and the handler should have quick access to the blindfold if this occurs. Fig. 3-5 Placement of the chain shank through the mouth.

ELEVATING A LEG

Elevating a leg is a mild form of restraint that is basically intended to discourage a horse from moving around or kicking, such as when trying to place leg bandages, taking radiographs, or clipping hair. It is not as useful for painful procedures but can be combined with other forms of restraint for increased effect. Elevating legs is also a common procedure for cleaning and examining the feet and legs.

Before elevating any leg, the horse should be standing “square,” meaning that all four legs should be directly underneath the horse, with the weight evenly distributed. If a horse is standing with its legs sprawled or is balanced awkwardly, it is physically difficult for any horse to pick a leg up. Fig. 3-6 Placing the lip shank. A, Holding the chain for placement of the lip shank. B, Slack is given to the chain. C, Elevating the upper lip to position the chain. D, Elevating the upper lip to position the chain. E, Proper position of the chain against the upper gum. Note that the chain lays flat against the gums.

Fig. 3-7 How to make a halter tie (quick release knot).

Fig. 3-8 A, Improper method for blocking vision. B, Proper method for blocking vision.

Fig. 3-9 To lift a forelimb, the hand is run down the back of the leg and the tendons or suspensory ligament gently squeezed.

As with other horse-handling procedures, contact with the horse is helpful in communicating intentions. To elevate a forelimb, one hand is placed on the withers or shoulder area and the other hand is run slowly down the back side of the leg to be lifted. When the sliding hand gets to the digital tendons, a gentle squeeze of the tendons usually results in lifting of the leg (Fig. 3-9). If squeezing alone doesn't work, try pressing your shoulder into the horse's shoulder to shift its weight onto the opposite forelimb; once the weight has shifted, the horse will be more inclined to elevate the leg. If you are lifting a front leg to discourage a horse from kicking with a hind leg, lift the forelimb on the same side as the “threatening” hindlimb.

To elevate a hindlimb, face the rear of the horse, and maintain contact with one hand on the horse's hindquarters. Slide the other hand down the leg to the digital tendons, and squeeze the tendons. As with the forelimb, shoulder pressure into the horse's hindquarters can help shift its weight to the opposite hindlimb and encourage lifting the leg.

Once a leg has been lifted, it can be held with the hands or cradled in the lap/thigh area, depending on the procedure to be performed (Figs. 3-10, A to C and 3-11, A and B). Do not support the leg so well that you become a substitute leg for the horse, allowing it to kick or move at your expense, or rest so hard on your legs that muscle fatigue or bruising occurs. Horses tend to resist having their legs pulled away from the median plane (abduction) and will stand better when a leg is held as close to its normal position as possible directly underneath it.

TAIL RESTRAINT

Tail restraint is effective for foals and small ponies but not adults. The tail is grasped near its base, and the tail is elevated straight up Fig. 3-10 A, The forelimb can be supported with one hand. B, The forelimb can be stabilized between the thighs. C, The forelimb can be supported between the thighs to free up the hands.

and slightly over the back. At the same time, use the other arm to encircle the shoulders or base of the neck. Be aware that many foals have a tendency to rear when restrained; therefore the restrainer should keep his or her head out of the area immediately above the head and neck to avoid being struck.

TWITCHES

Twitches are among the oldest and most commonly used methods of restraint. Why twitches work has been debated for many years; some people believe that they divert the horse's attention through creating pain that exceeds less painful procedures being Fig. 3-11 A, The hindlimb can be supported with one hand. B, The hindlimb can be supported on the thighs to free up the hands.

performed elsewhere on the body, and others believe that acupressure points may be activated, releasing natural endorphins in the brain. Whatever the mechanism, their effectiveness cannot be argued.

There are two classifications of twitches: natural and mechanical. Natural twitches are applied with the hands directly on the horse; no special equipment is required. Mechanical twitches are manmade devices that are placed directly on the horse. Twitches of any type are not appropriate for foals.

Natural twitches are the shoulder (skin) twitch, the ear twitch, and the lip twitch. The shoulder twitch (“shoulder roll” or “skin twitch”) is actually applied to the skin over the lateral aspect of the neck. This skin is loose and can be picked up with the fingers and pinched firmly (Fig. 3-12, A and B). For added effect, the skin can be picked up with all of the fingers and rolled like a motorcycle accelerator; this can be done with one or both hands (Fig. 3-12, C and D). This twitch is a mild form of restraint and loses its effectiveness after a few minutes. If applied tightly for long, some horses swell locally after releasing the hold, which produces a welt. Such welts disappear within 24 hours with no special treatment and are not a physical problem but may give the client a bad impression.

The ear twitch is very effective for some horses, but others vehemently resist it. To apply this twitch, do not grab the ear directly; this may startle the horse. Rather, place the hand on the neck and slide it to the Fig. 3-12 Shoulder twitch. A, Placement of the hand. B, The skin is grasped and pinched firmly. C, Placement of both hands for a two-handed twitch. D, The skin is grasped and rolled.

base of the ear. Slowly grasp the base of the ear, squeeze it, and rotate the ear slightly, again like a motorcycle accelerator (Fig. 3-13, A to D). Like the shoulder twitch, the ear twitch loses its effectiveness in a short period. Grasping at the base of the ear, not in the middle or tip (Fig. 3-14), is important. Realize that the cartilage of the ear pinna can be broken, resulting in permanent deformity, and the nerves to the pinna can be damaged, so if the horse elevates its head or rears, it is best to let go and try another approach.

Biting the horse's ear is still accepted in some parts of the country as a restraint method, but it is not commonly accepted and is not recommended for use by medical professionals. The upper lip can be twitched with either hand. The lip can simply be grasped and squeezed and jiggled back and forth if necessary. Grabbing a lip may be enough restraint for many horses. For more force application to the upper lip, mechanical twitches are necessary.

Mechanical twitches can be homemade or commercially bought (Fig. 3-15). They are designed to “pinch” the upper lip. The traditional twitch is constructed from a wooden handle with a rope or chain loop attached to one end. To place the twitch, first control the twitch handle with a hand or tuck it under an armpit while placing the twitch loop; otherwise, the handle is free to swing and hit the handler and/or the horse and cause injury. The upper lip is grasped with the hand, and the loop is transferred from the hand to the lip by sliding the loop over the fingers (Fig. 3-16, A to E). Once the lip has been Fig. 3-13 Ear twitch. A, The ear is approached by maintaining contact with the horse. B, The base of the ear is grasped. C, The ear is squeezed. D, The ear can be rotated for added effect.

Fig. 3-14 Improper grasping of the ear tip for an ear twitch.

Fig. 3-15 Mechanical twitches. Long wooden handle with rope loop (top). Short wooden handle with chain loop (middle). Aluminum humane twitch (bottom).

Fig. 3-16 Placing a mechanical twitch. A, Proper positioning of the loop of the twitch. B, Place the hand on the nose and slide it toward the upper lip. C, Grasp the upper lip and elevate it slightly. D, Elevate the hand and wrist to help transfer the loop from the hand over the lip. E, Transfer the loop onto the upper lip. F, Avoid blocking the nostrils while placing the twitch.

placed through the loop, the twitch handle is rotated to twist the loop firmly around the lip. The handle should be rotated as if it were being rolled up the nose toward the ears, not downward toward the lower lip. Avoid occluding the nostrils while placing the twitch; horses cannot mouth breathe and tend to panic when the nostrils are blocked (Fig. 3-16, F). By twisting the handle, the loop can be tightened or loosened for varying degrees of control.

The twitch handle comes in various lengths; however, the shorter the handle, the less useful it is if the horse rears, and it places the operator closer to the front feet. Many horsemen prefer a handle 30 to 40 inches long.

The other type of mechanical twitch is called the humane twitch; it consists of two arms that function as a scissors-type “clamp” on the nose. Pressure is controlled by opening or closing the arms of the clamp. This type of twitch is usually made of aluminum and has a string with a clip attached to it so that it can be “self-retaining” by clipping it to the halter. In reality, the humane twitch is limited in usefulness; the arms are short (≈12 inches), and if the horse elevates its head, it is difficult to maintain a grip on the device. When applied as a self-retaining twitch, the string tends to loosen; if the horse then swings its head, the arms become a potential weapon, injuring the horse or the handler. The humane twitch is useful in some situations but ineffective and potentially harmful in others (Fig. 3-17, A to D).

After the twitch is in place, one person should hold the twitch handle and the lead rope, being careful not to wrap the lead around the handle or any part of the hand or arm (Fig. 3-18). The twitch does not replace the lead rope. The person on the head still has primary responsibility for control of the horse and the safety of coworkers. The pressure of the twitch is adjusted by twisting the twitch handle to tighten or loosen the chain/rope loop or by squeezing the handles of the humane twitch. Apply only enough pressure with the twitch to accomplish the procedure and only as long as necessary. Fig. 3-17 Placing a humane twitch. A, Approach to place the humane twitch. B, Grasp the upper lip. C, Proper placement of the humane twitch, with the lip between the straight portion of the twitch arms. D, Improper placement of the humane twitch, with the lip between the rounded portion of the twitch arms.

Fig. 3-18 Proper way to hold the twitch. The lead rope is not wrapped around the twitch handle.

Sometimes jiggling the twitch helps to get the horse's attention without having to crank down tightly on the twitch. Also, be aware that the upper lip can become numb after prolonged application. When the lip turns blue and cool to the touch, the twitch has usually lost its effectiveness and should be loosened or removed.

Mechanical twitches should never be applied to foals and should never be applied to the ears. Twitching the lower lip is possible but not advisable, since many horses rear or throw their heads in response.

TAIL TIE

The tail of a horse is considerably more substantial than the tail of a cow; it is strong enough to be used to move, lift, or support the hindquarters. Horses with neurological or musculoskeletal diseases may need assistance to stand and/or remain standing, and horses recovering from anesthesia may need assistance standing. The tail tie can be helpful in these situations; it provides a means of safely securing a rope to the horse's tail, which can then be placed over a supporting beam or through a pulley or block and tackle, where it can be positioned for support. The tail tie is performed just beyond the end of the last coccygeal vertebrae (Fig. 3- 19). No part of the vertebral column should be included in the tie; only the tail hairs are incorporated into the knot.

A tail rope should never be tied to an immovable object. The tail rope is also not a substitute for the hindquarters; if the horse demonstrates that it cannot provide any support of its own rear bodyweight, the horse should not be left dangling by a tail rope.

STOCKS

Stocks are rectangular enclosures made of wood or metal (Fig. 3-20). They are designed to confine the horse to a small area with restricted movement, usually only 1 to 2 feet of lateral movement and 1 to 2 feet of front-to-back movement. Because of the varying sizes of horses, stocks may be adjustable for the width and length of the patient. The side panels or rails of the stocks usually adjust to allow access to the body parts being worked on. Horse stocks typically are open above (i.e., have no ceiling).

Horse stocks and cattle stocks are different in construction. Cattle stocks are purposefully designed to firmly squeeze the cow's neck and sometimes have panels that can be used to firmly squeeze the cow's body. Horses cannot tolerate this type of tight, rigid confinement and typically violently resist it. Therefore horses should never be placed in cattle-type stocks.

Stocks are not necessary for all procedures. They are most often used to protect the clinician from being kicked when working on the hindquarters. Stocks are also useful for standing surgery procedures where the horse must be prevented from wandering. Horses are naturally suspicious of stocks and may need to be tranquilized before leading them into the stocks. Some horses may vehemently resist entering or staying in stocks; therefore they are not suitable or safe for every patient. Good judgment must be used. Fig. 3-19 Tail tie.

Stocks usually have two gates, one at each end. Both gates are opened, and the handler leads the horse through the rear gate into the stocks. Once the horse has cleared the rear gate and the handler has cleared the front gate, an assistant quietly closes the rear gate. The handler or assistant closes the front gate. Any adjustments to the side rails can then be made, if necessary, though it is generally best to have adjustments done before the horse enters, since the noise and movement may startle the horse. Occasionally it may be dangerous for the handler to walk through the stocks with the horse. If sedation is not effective or feasible, the handler can remain outside the stocks and carefully try to guide the horse through the gates. Fig. 3-20 Typical horse stocks.

(From Speirs VC: Clinical examination of horses, St Louis, 1997, Saunders.)

Temporary makeshift “stocks” can be made on the farm by stacking straw or hay bales to prevent personnel from being kicked or to limit a horse's motion.

Horses should never be left unattended while in any type of stocks.

RESTRAINT OF FOALS

Capturing and restraining foals always begins with catching and controlling the mare. Foals naturally follow their dams, so leading the mare essentially results in leading the foal. Having assistants walk calmly behind the pair encourages the foal to move forward and stay close to the mare. Older foals may be accustomed to a halter and lead rope but naturally want to follow and be near the mare. Controlling the mare is also important for the safety of personnel because some mares may be aggressive in attempting to protect their foals. Therefore someone should always be responsible for restraining the mare. In general, mares become more resistant as the distance between them and the foal increases; best results with the mare usually come when she is allowed to be as close as possible to the foal, able to see and hear what is happening. Sometimes the mare must be sedated to assist working safely on the foal.

Once the mare is controlled and the foal is in the desired enclosure (e.g., stall, paddock), the foal is approached slowly from the side. Touching the foal on the neck or withers simulates the natural approach of the mare, but human touch is seldom appreciated at this age, and most foals instinctively try to escape by bolting forward, rearing, kicking, or “hitting reverse.” Therefore once contact is made, it should be quick and purposeful. Foals are properly restrained with one arm around the shoulders or base of the neck; the hind end is controlled by placing the arm around the hindquarters or by using a tail hold with the hand (Fig. 3-21). The restrainer should avoid putting his or her head directly above the head or neck of the foal, since Fig. 3-21 Proper foal restraint.

many foals rear or throw their heads in an effort to resist being held.

Try not to oversupport a foal's bodyweight. Foals have a tendency to sag toward the ground when this is done. For procedures that need to be performed with the foal in lateral recumbency on the ground, the foal should be sedated first and then gently laid on the ground by lifting the foal's body up and over. Unsedated foals should not be thrown to the ground unless it is medically contraindicated or impossible to sedate them first. Once on the ground, three people can provide ideal restraint. One person keeps pressure on the foal's neck to keep it from struggling to rise; this person may use hand pressure or gentle pressure by kneeling along the crest of the neck (never the ventral aspect of the neck, which could obstruct breathing). Another restrainer is responsible for the front legs and grasps each with the hands just above the carpus; the hindlimb restrainer grasps both hindlimbs just above the tarsus. Grasping the legs below the carpus or tarsus runs the risk of growth plate fractures of the lower leg if the foal struggles. If the lower legs need to be further controlled, the restrainers may straddle the lower legs and firmly secure them between their own legs, while keeping their hold above the carpus/tarsus.

SUGGESTED READING MA Ball: Restraint techniques. The Horse. Sept 1998, 34–37. DD French, TN Tully: Restraint and handling of animals. In DM McCurnin, JM Bassert (Eds.): Clinical textbook for veterinary technicians. ed 6, 2006, Saunders, St Louis. JR Leahy, P Barrow: In Restraint of animals. 1953, Cornell Campus Store, Inc., Ithaca, NY. TF Sontsthagen: In Restraint of domestic animals. 1991, Mosby, St Louis.

(Hanie, Elizabeth A.. Large Animal Clinical Procedures for Veterinary Technicians. Mosby, 092005. p. 46).