Page 71 - November 2020

DIAGNOSIS
In a serious tendon or ligament injury, there is usually heat, pain and swelling soon after the injury. With a bowed tendon, there may be severe lameness, and the leg is held in a flexed position because the horse is reluctant to put weight on it. If the tendon is severely torn or stretched, the fetlock joint drops. If the injury is not fresh and has become chronic (fibrous tissue already formed), there will be a hard swelling at the back of the leg. In a horse with a mild, fresh injury, and is not showing classic signs of heat and swelling, ultrasound can diagnose early inflammation and define the degree of damage.
Flexion tests can be helpful in detecting soreness - sometimes before a horse actually tears a ligament. Flexing the fetlock joint is a test the trainer can do if the horse’s gait is off. If you put a certain amount of pressure on the fetlock joint in a flexion test for 30 to 60 sec- onds, and he goes off lame afterward (and the other leg not lame) this is a clue. Or you can flex the knee to detect high suspensory injury. If you hold the knee up tightly for 60 seconds, with the fetlock joint out to the side of the forearm or even up above the forearm, you can then jog the horse to see if he favors the leg.
A horse will tend to have a similar flexion test month after month and it should stay the same.
We can use physiotherapy (cryotherapy, lasers, ultrasound, poultices, etc.) or injections into the tendon sheath. Injections may use steroids, hyaluronic acid or a variety of regenerative therapies—everything from stem cells to IRAP to conditioned serum to amniotic fluid concen- trate, etc.” says Peters.
Supportive care with icing, cold therapy, bandaging, liniments, etc., can be helpful. “On the racetrack, many people have their own spe- cial formula that they use for keeping tendon sheaths tight. All of these probably have some benefit to some degree, and may be variable. Sometimes a person tries a variety of things to see what may work best with a certain horse. You have to know your horse,” he says.
The time it takes for a horse to come back from a tendon injury will depend on the injury. “Racehorses have only a small window of performance, compared with a jumper or dres- sage horse that will have a long career, so with
a racehorse the owner or trainer may want to push the envelope a bit. We may try injections into the core lesions with regenerative therapies. There is a synthetic compound called genipin, which helps to bind collagen that is broken down and can help the tendon regain strength. This doesn’t necessarily mean the horse can go back to work quicker but it may help improve the healing by not having further breakdown.
Flexing the knee is a way to detect a high suspensory injury. Flexing the legs periodically can give clues on changes and the ability to catch small issues before they progress.
“By the time a horse tells us that the leg hurts, there is damage done. This is the most dif- ficult aspect in terms of rehab on any of these injuries—being able to monitor and determine whether the exercise is enough or too much. You want to put some load on those tissues
as they heal because this will ensure a more normal healing process and a more functional healing, but at the same time you don’t want to overdo it and break down those tissues.” We walk a fine line on rehab exercise, and it may be a little different for each horse. Every injury is a little different.
EQUINE HEALTH
Get to where you can recognize what is normal for him (for instance, a horse might not flex so well in the right knee, but is not lame). If a person flexes all the legs periodically, it gives a clue about any changes. You can often catch a small problem before it gets to be a big problem.
TREATMENT
There are many things that can be used in treating tendon and tendon sheath injuries, de- pending on the type of damage. “If it is strictly an inflammatory process, and micro-damage, it may be just a matter of managing the horse to get rid of the inflammation with icing, bandaging, use of emollients, laser therapy, ultrasound therapy, etc., and backing off on the exercise and stress on the limb,” says Peters.
Sometimes changing the shoeing will help, especially if a lot of the stress is due to confor- mation of the horse that puts extra strain on one part of the leg. A good farrier may be able to do something mechanically to help remove some of that stress. “If we have a deep flexor injury, we would do some different shoeing (raise heels slightly) than if it’s a superficial flexor injury (lower the heels slightly), to try to support those specific tissues. Similarly, mechanical farriery support can be used to support sesamoidean ligament injuries down around the pastern and fetlock,” he says.
“The seriousness of the injury will deter- mine how aggressive we get with treatment.
There are also some surgical options available for tendon injuries (tendon splitting, check ligament desmotomies),” he explains.
Time is probably the biggest factor with racehorses in terms of when they may be able to come back to work. “This can vary anywhere from 4 months to 10 months, and some don’t make it back in time to continue racing. The performance horses and sport horses have more time to allow the injury to fully heal, so a lot of those horses can get back to their previous level of activity or close to it. Most of the owners and trainers of those horses tend to be a little more conservative and give them more time to heal. The horse may take a year off and come back strong, whereas a racehorse can’t be given that much time. They may have to find a new home or be retired for breeding,” says Peters.
“By contrast, a sport horse may go to a rehab facility where there will be a variety of therapies available and spend four to eight months there before they get back to some early riding work. Treatments available include underwater treadmills, cold therapies and spas, laser treatment, ultrasound, pulse magnetic field treatments, etc.”
One of the most important things with re- habbing a tendon injury is a controlled exercise program as the horse comes back into work.
A gradually increasing exercise program can keep strengthening the tendon without creating more damage by doing too much too soon.
This is the challenge for bringing these hors- es back to work—determining the proper rehab process and gradually-increasing exercise load. We want the horse to get back to the previous level of work, but must do it in a way that takes enough time to successfully accomplish this.
Tendons are attached to muscles--attaching the muscle to the bone. If you can keep the muscles strong and keep everything strong around that tendon, this gives the tendon more support. Many tendon injuries are due
to fatigue when the horse is working. When
the muscles get tired, the tendons take more load and more stress. If you can keep the horse fit and the muscles strong, there’s less risk for tendon injury. And when coming back from
an injury, you want to rehab the horse with controlled exercise rather than letting the horse run and buck and possibly reinjure that tendon.
Dr. Mark Cassells (Homestead Veterinary Hospital, Villa Ridge, Missouri) says that it is helpful if you have the option of keeping the horse in a stall and gradually increasing the exercise with hand-walking, treadmills, etc. “Controlled is the key word. You can’t just give the horse four months of rest and then suddenly go back to work. There needs to be a program that fits the horse and the situation the horse is in, and the rider’s level of capability.”
An overactive horse is not helping himself. “When you take that horse out of the stall,
he wants to run and buck, and lunging is not
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