Equine tendon and ligament injuries are extremely common in the industry, being created as a result of many factors. Despite being very common in the industry, the recovery rate is dismal with a high percentage of horses either experiencing a recurrence of the injury or being forced to retire to a lower level of work due to persistent lameness. This doesn’t have to happen and through a better understanding, either you can reduce the incidence of tendon and ligament injuries through prevention or enhance your recovery rate with proper supplementation.
Equine tendon and ligament injuries can be a real challenge to heal, for both the horse owner and veterinarian. There are many factors that are associated with their injury and truth be told, I believe it goes far beyond just a simple misstep by the horse or ‘over-exertion’. The stage needs to be set and in most cases, that structure, being the tendon or ligament, was stressed already and potentially in a weakened state. Thus, considering this ‘pre-existing’ state, when pushed harder or that misstep occurs, the tendon or ligament becomes damaged. Then, again due to the fact that the structure was weakened or compromised to begin with, healing can be slow or not occur at all.
I discussed tendon and ligament injuries and connecting factors in another article.
First Steps to Healing the Equine Tendon & Ligament
The first thing that needs to be addressed in any case, is to determine pre-existing conditions which may have created the weakened structure. Something created a weakness and it is your job to find out what that is, so that it can be corrected, otherwise you will likely be spinning your tires in mud, hoping for complete healing, but failing to find it.
Contributing factors include:
- Conformational flaws – puts undue stress upon the tendon or ligament
- Improper foot care and balance – puts undue stress upon the tendon or ligament
- Poor diet – improper nutrient provision to support tissue health and integrity
- Poor digestive health – creates systemic inflammatory response and impairs nutrient digestion and absorption, which both impact tendon and ligament health
- Stress – increases rate of tissue breakdown and creates weakness
These are the main factors that I personally see in tendon and ligament injury cases. One factor may be present, but more commonly, there are 2 or more factors involved. These must be corrected to the best of your ability because these factors are what are setting the stage for injury. I realize that conformational flaws cannot be corrected, but if you look closely, there are usually compensational imbalances created in the hoof capsule, which are then further adding to the problem and undue stress upon the tendon or ligament. Thus, there is always something that can be helped and improved.
A failure on the part of the owner, farrier, or veterinarian to address these factors is what creates the long-term healing of these injuries. This is why many horses are stall bound for 6 months or longer, failing to heal, and often just developing other problems. This shouldn’t be the scenario and it is in your power as an owner to change this.
Second Step to Healing the Equine Tendon & Ligament
The contributing factors are the first step. Recognize them and make plans to address them, not in the future, but now, if at all possible. The second step is to address the inflammatory events that are unfolding. In order to do this, you must determine if the injury is acute or chronic. An acute tendon injury ‘just happened’ or within the past few days. A chronic tendon injury is one that happened a month or longer ago, is festering, and failing to heal or mend.
An acute tendon or ligament injury results in lameness, often to a high degree, and the area of injury is warm if not hot to the touch, and painful with pressure. This is the acute inflammatory process and one of the five cardinal signs that go along with it; redness, heat, swelling, pain, and loss of use. Your job or goal in this immediate time frame is to reduce that inflammatory event, which will reduce the pain and restore comfort for your horse. Additionally, remember that this inflammatory event must be controlled, because it is a destructive event, and if left unmanaged, more tissue damage can occur. On the same side of the coin, this inflammatory event should not be obliterated because it is needed on a lower-level to heal or mend that tissue.
Inflammation in the acute phase can be a double-edged sword!
How does one control that inflammatory event in the acute phase? Good question and it depends upon your approach and philosophies.
In my hands, I rarely get the acute tendon or ligament injury, but more so am dealing with the chronic cases. When I did encounter the acute injuries, I would utilize topical sweats (DMSO/Dexamethasone) and/or poultices to pull that heat and swelling from the tissue. Cold hose therapy is also employed, generally once daily in order to help reduce the heat and also remove the topical sweat or poultice from the limb. Oral anti-inflammatory medications can be your ally in these cases, when used sparingly, such as phenylbutazone. Then, the horse is stalled or restricted to a small paddock, depending upon their level of injury and pain.
It would not be uncommon for me to start herbal therapy at this stage, helping to counter the inflammatory events, support nutrition and the digestive system. In most cases, the horse is improved clinically after a few days and then the approach is shifted over to the ‘healing and support’ phase for further support of that tendon or ligament in the horse.
Third Step in Healing the Equine Tendon & Ligament
Now, you are through the acute phase and are entering the healing phase. Hopefully, your horse is feeling better and walking better. Usually by day 3-4, the oral medications are no longer necessary and there is no need to continue them. They have done their job, helping you to control that inflammatory response, but they can be too effective at their job and result in side effects, including stomach ulcers and contribute to failure to heal. So, the sooner you can cut them out of the regimen, the better.
Your goal in this phase is to get that tendon or ligament to heal in your horse and become stronger. As mentioned above, in order to do this you must first address contributing factors. If you do not do this properly, then recurrence rate or failure to heal rate can be very high. Very important!!
Considering that the contributing factors have been addressed, your goal now is to support that inflammatory response on a lower level, provide for the tissue and allow your horse to heal. I choose herbs for this phase, mainly because they offer tremendous benefits to overall health, as compared to medications, which can be heavily focused. Through herbs, you can counter inflammatory events, provide antioxidant support, nutritional support for cellular health, and enhance circulation to the area of injury.
My approach for tendon & ligament support includes:
- Cur-OST EQ Total Support – for the easier keeper with tendon/ligament issues
- Cur-OST EQ Plus – for the leaner horse
- Cur-OST EQ Topline – provides protein and amino acids for tendon/ligament health
- Cur-OST EQ Bone Support – provides support for bone and tendon/ligament health
Now, outside of that inflammatory event and managing it through the formulas above, one critical area that is often neglected is digestive health. This is one of the main contributing factors as outlined above and in the prior article. Digestive health is critical because not only can it contribute to systemic inflammation and weaken the tendons or ligaments, but poor digestion also leads to low nutrient absorption, which creates further problems.
When it comes to digestive health and support, there is only one formula:
If you are able to modify contributing factors and put together the right herbal regimen for your horse, based on their needs, recovery should be fairly smooth. That tendon or ligament is waiting to heal. It wants to heal, but you must provide the fertile soil for it to heal. You have to create the proper environment, or problems will tend to linger.
It is not uncommon for an owner to still be contending with a tendon injury in their horse after six month’s of stall rest. As unreal as that sounds, it is very common. If you find yourself in this situation, step back and regroup. Evaluate the problem and look closely at your horse. The answer is there. If you find yourself considering ‘regenerative’ therapies such as PRP or stem cells, think again. While these therapies can be helpful, first, I do not believe they are necessary, and second, you need to have the right environment for them to be of benefit. Injecting stem cells into any tissue is like planting seeds into soil. If that soil is not fertile, growth will not occur. Do not be misled by these therapies! There is a reason your horse is failing to mend and return to soundness. You just need to find it.
The final question comes regarding stall rest. Do you do it? How long? I will stall a horse for a few days in the acute phase or if their degree of lameness is significant. Otherwise, if they are lightly sore, I will prefer to turn them out into a small paddock or arena. I feel that the benefits of being outside far outweigh any risks. Can they become over-active? Sure, but in most, give them a short period of time and they settle down. That energy is likely just been stored from days being cooped up in a stall. Let them get it out and they will settle down. Secondly, having them out instead of stall bound will greatly reduce your incidence of stress induced ulcers.
In my experience, acute or chronic, when properly addressed, most horses are back in light work within 2 weeks or 14 days. It is not uncommon to have them back in the saddle within 30 days with the right approach. Tendons and ligaments are meant to heal, but the right situation must be present for them to mend and recover. Through the right approach almost every tendon or ligament injury can benefit.
Author: Tom Schell, D.V.M, CVCH, CHN