Extended box rest requires proactive enrichment to prevent psychological deterioration and the behavioral problems that accompany enforced confinement in horses.
Box rest enrichment is not optional welfare enhancement but a necessary component of welfare-appropriate medical management. The behavioral changes that occur in unenriched horses on extended box rest - stereotypy development, redirected aggression, weight loss from stress - represent genuine welfare harm that compounds the welfare cost of the underlying injury. Proactive enrichment from the first day of box rest prevents the development of behavioral problems that may persist after return to work. The veterinary team and owner share responsibility for ensuring that the medical management plan includes an enrichment plan - welfare and successful healing are not competing priorities.