Last Updated on February 19, 2022 by Allison Price
To give your horse the best chance of a complete recovery after a tendon tear, learn what to do at each stage.
9-12 months. Your veterinarian has advised that your horse will be kept in the hospital for a minimum of nine to twelve months because he has broken one of his major tendons. It sounds more like a sentence in prison than a prognosis.
The horse’s back is connected by cables that run down the digital flexor tendons. Illustrated Atlas of Clinical Equine Anatomy and Common Disorders of the Horse
It can be frustrating and difficult to get a horse home after a tendon injury. These injuries are not always successful and can even end a horse’s career. How you handle your horse’s injury will make a big difference in its outcome. This article will walk you through the recovery process and show you how and when you can help. You will also be able to see some of the pitfalls and problems you might encounter. There are some new methods that can help your horse heal faster, but unfortunately not as quickly.
Although it may feel cold, you still have plenty of company. Key tendons, which run like cables down the back side of the lower leg, are prone to injury. These tendons are the deep and superficial digital flexibility tendons. They run from the muscle at the ankle to the foot and contract when they are contracted. They are also used to support the leg and can be subjected to great stress when horses do any kind of athletic maneuvers, such as galloping, jumping, or other forms of exercise.
While I will be focusing on tendons, I’ll also cover injuries to ligaments. Both ligaments and tendons have different functions. Tendons transfer the action from muscles to the skeleton while ligaments lash bone against bone and prevent joints from wobbling. However, tendons and ligaments are made of the same tissue and are damaged by similar stresses. They heal in the exact same way.
Why is it taking so long?
The healing process for ligaments and tendons is similar to that of skin, but it takes a longer time because they are constructed differently. The connective tissue that makes up both structures is dense and elastic, rich in collagen, and it’s organized. The network is maintained by living cells, called fibroblasts.
The collagen fibers run along the length of the tendons. They are flexible enough to support the horse’s weight and then spring back as rubber bands when it is taken off. The fibers can become damaged if the horse puts too much weight on the leg, or if the foot is placed wrongly on uneven ground. The damage can occur instantly or over time, depending on how repetitive loads exceed the fibroblasts’ ability to repair it. These injuries heal slowly because there are fewer of them than the collagen in a tendon and ligament. Additionally, the blood supply to tendons and ligaments is poor.
A severe tear may take longer to heal than one that is milder. Also, a horse aged 20 years old might heal slower than a horse of the same age. Although ligaments tend to heal faster than tendons, you still have to expect to wait nine to twelve months for any of these injuries. These injuries are often less effective than long-lasting collagen fibers. Instead, you end up with a disorganized mess of scar tissue, which is more elastic and more susceptible to reinjury.
You will get the best results by following a rehabilitation and management program that is closely matched to your horse’s progress in healing. Your veterinarian can help you create a program that suits your horse’s injuries. Many vets are able to perform diagnostic ultrasound scans at short intervals using portable equipment. This can help you manage your horse’s recovery and increase your chances of success.
Initial ultrasound will reveal the extent of the injury. Ultrasonic waves are beams of sound into the leg by the machine and captured as they bounce off tissues. You might notice a tear in a tendon as a gap or an area with less intense echoes. You can adjust your horse’s training program by having repeat exams to show how healing is going. Depending on the severity of your injury, stage of rehabilitation, and how long it took to heal, your vet might recommend that you schedule the examinations at 30, 60, or 90 days intervals.
The first step: Cool down
Blood and lymph fluid can leak into the area where a tendon is torn, and then -enzymes, as well as other chemicals, are released. Inflammation increases, causing heat, pain, and swelling. While it is part of the healing process, it can also have detrimental effects. It can cause tissue damage to the injury. Your first steps should be to cool down the injured leg and reduce inflammation.
- Chill: Cold water hosing is the best way to get heat out of an injury. Ice water works well if the horse is able to stand in it. Ice horses and devices such as Game Ready and Ice Horse keep the cold from getting around the leg. Because of the inconsistent surface contact between the ice on the leg and the crushed ice, ice boots may not be as effective. Sessions should last between 20 and 30 minutes. It takes about that long to cool down the leg. Cold hosing may prolong this time. You’ll know that the area has cooled down when you feel it. The treatment should be repeated twice daily. If the injury is very severe, you can continue cooling but it’s best to allow at least 30 minutes between each session.
- Wrap: After completing cold therapy, dry the leg with a standing wrap ( secured with a trackbandage). This will support the leg and reduce swelling. To draw out heat, you can use a mild Poultice along with the bandage. However, avoid any agents that could cause irritation to the skin or increase inflammation. For support, you can also bandage the opposite leg. At least once per day, reset the bandages.
- Medicate Your veterinarian might prescribe medication, which is usually flunixin meglumine or phenylbutazone. These drugs can reduce inflammation and make horses more comfortable. You can also use a topical nonsteroidal lotion (Surpass).
- Stall Rest: It is usually best to keep your horse in a stall for the first time. If your vet allows it, your horse may be allowed to come out of his stall and receive cold-therapy sessions. You can also take him out for hand-grazing if necessary. You may begin hand-walking if your horse is not injured and is not disabled. He should not be turned out or exercised if he isn’t already. You should adjust the feed to suit your needs. He will need to be fed plenty of grass hay, but not high-energy concentrates.
The cooling down process can take anywhere from a few days for a minor injury to several weeks for a serious tear. Your horse will be able to walk well and you’ll notice that his leg is not as hot or tender. He is now ready to move on to the next stage of healing.
The injury heals and fibroblasts begin to produce new collagen. As the collagen fibrils begin to fill in the wound, ultrasound should reveal their work.
Many ancillary treatments can be applied at this point. They are most effective when they are given following cool-down and early in the healing process. The cool-down period is a good time to look into these treatments and talk to your vet about whether they might be appropriate for your horse’s injury.
Good management is key to early recovery, regardless of whether you choose one of these treatment options.
- Start a controlled exercise: Loading the tendon with light pressure stimulates collagen formation and encourages collagen fibers alignment in a way that maximizes strength. Overdoing it too quickly can lead to reinjury. Begin short, controlled exercises with your veterinarian’s approval. This could be hand-walking for a few minutes each day. This should be done on a level, smooth and not too deep footing. After two weeks of good results, you can gradually increase your time. In two weeks you might be adding five minutes per day, and in the next two weeks, five more.
- Take as much medication as you need: Reinjury can also occur if your horse acts playful while being walked. Talk to your veterinarian about using sedative medication to manage bad behavior. After cooling down, horses should be free from anti-inflammatory medications. Long-term side effects can occur with NSAIDs, and some evidence suggests that they can slow down healing.
- Stall rest is a must: Horses are capable of doing crazy things even in small yards. To avoid reinjury, keep him on stall rest. Keep him on standing wraps for 3 to 6 weeks depending on the severity of his injury. Then, gradually reduce the amount of time he is in wraps.
- Repeat the ultrasound. Your vet may request a repeat of the ultrasound after a period of six weeks or more. A new scan will show that collagen has been added to the injured areas. The fibers that were initially disorganized and tangled should now be aligned in a way that helps the tendon resist stress.
Collagen continues to be created as healing progresses. It also remodels, meaning it becomes denser and more organized when subjected to mild stress. Remodeling strengthens the tendon and makes it more resilient to greater loads. Increasing the load in conjunction with healing helps keep the remodeling process moving.
- You may be able, with the approval of your vet, to replace one of your hand-walking sessions by walking under tack. Make sure that your horse is properly shod and trimmed. You should continue to practice smooth, level footing in both straight lines and large circles.
- Vet Check: Have your veterinarian check the progress of your horse after six weeks. If your ultrasound shows that healing is continuing, it might be time to…
- Trot: In the first week, it might be possible to add five minutes of trot into your exercise routines. To ensure that the tendon is warm, you should walk for at least 15 minutes. If everything is fine after a few weeks, you can add another five minutes, then another interval about a week later. You can keep the work simple, large circles are fine, but avoid any sharp turns or lateral moves. Do not linger–repetitive circles can cause damage to the healing tissues. You also have very little control over the behavior of your horse as a handler.
- Continue the ultrasound: Your horse may be able gradually to increase his work if he continues to trot in straight lines and circles. Before you increase the exercise of the first canter or jump, or the first gallop, get new scans. Ultrasound will show that fibers are becoming denser and aligning parallel to one another, which will strengthen the tendon.
- Turnout If your horse is doing well in his exercise program, you may be able to let him out in a small area. You should take him out alone, and at a time when other horses are not acting up. After months of being in a stall, any horse can explode so make sure to talk to your vet about medication to calm him down for at least a few days. Do not leave your horse unattended. Be ready to take him in if he acts up.
Your veterinarian should be contacted if your horse feels sore from exercise, or if there is any pain, swelling, or heat return. It’s not always a sign of a problem. However, your veterinarian may need to visit your horse and possibly do an ultrasound exam to determine what is going on. There are two options:
Adhesions – Adhesions refer to strands made of fibrous scar tissue. They form in places they shouldn’t, restricting a tendon’s ability to move and stretch. These tend to form in injuries below the knee, in the area above, around, and below the fetlock. The tendon crosses the joint and is encased within a sheath which secretes lubricating fluid. Adhesions may form between the tendon, the sheath, or between different parts of the sheath. This is more common if there is an infection in the sheath. Adhesions that are higher in the leg are uncommon; however, they can form in severe injuries such as tendon lacerations.
Horses can become very sore from adhesions. However, you can fix this by continuing with your restricted exercise program. This will slowly stretch and remodel adhesions so that they don’t bother him. You can also use passive manipulation to help. This includes gently picking up the injured leg, and gently flexing his foot, fetlock, and knee (or the hock). It can be done while grooming him, or any other time during the day.
Reinjury Too much too soon is the leading cause of a setback in healing. It’s tempting to ask your horse for more after he’s started to trot soundly after a few months of his rehabilitation. His tendon is still healing. It doesn’t take long to break it again.
This is where a continuation of exercise can do more harm than good. Reinjury, depending on the extent of damage done, can reset the clock and put you back where you were. It’s crucial to speak to your vet if you feel sore. To determine if there has been any tendon change, your vet will compare previous and new ultrasounds.
Make a comeback
When can your horse resume competition? It depends on the severity of his injury, how quickly it heals, and what your plans are for him. If he isn’t showing any lameness, heat, swelling, or pain in his tendon after completing his nine-to 12-month rehabilitation program and his ultrasound shows that he’s healthy, then he might be ready to go. Reinjury can always occur in ligaments and tendons because the new tissue that fills the injury isn’t as strong or elastic as the original. It is basically scar tissue. This weakness can lead to the old injury giving way under stress.
Researchers are looking for ways to help ligaments and tendons heal “good-as-new.” But we are not there yet. Despite these injuries, many horses can return to work with good treatment and a lot of patience.
Linda Dahlgren, DVM and PhD is assistant professor at the Virginia-Maryland Regional College of Veterinary Medicine’s Department of Large Animal Clinical Sciences. Her research interests include tendon healing and healing, wound healing and tissue engineering, as well as adult stem cell biology.