Tendon injuries in horses

Tendons consist of strips of fibrous connective tissue that sit at either end of a muscle and attach the muscle to the skeleton. Overloading a tendon leads to fibres in the tendon being stretched too much and thereby being damaged or torn.

As with lots of types of injuries, the body responds with inflammation. The symptoms of inflammation are heat, swelling, pain and reduced function (lameness). Tendon injuries primarily affect the flexor tendons and hamstrings.

What are the symptoms?

• Heat in the area of ​​the injured tendon
• Swelling in the area of ​​the injured tendon
• Pain on pressure over the damaged tendon
• Lameness

What causes a tendon injury?

Repeated overloading of a tendon leads to small micro-damages in the tissue. With continued overloading, this can eventually lead to more extensive tendon damage. Worst case scenario, the tendon can break off, this is called a rupture. A tendon injury can also occur acutely if the horse steps crookedly.

There is a greater risk that an untrained horse that exerts itself hard will suffer a tendon injury, than an individual that has been successively trained for the task. Through well-balanced young horse training, the tendons are strengthened and the risk of future injuries is reduced. At the same time, it is important not to train the horse too much, as this also increases the risk that the horse will later suffer a tendon injury.

Tendons that are often affected by tendon injuries are the superficial flexor tendon and the fork ligaments. The deep flexor tendon, the deep flexor tendon reinforcement band and the extensor tendons can also be damaged. 

Different breeds suffer from different types of tendon injuries, because we use them in different ways. Riding horses are primarily affected by injuries to the superficial flexor tendon, while trotters are more often affected by fork ligament injuries.

Consequences of a tendon injury

Tendon injuries heal slowly, partly because tendons have a poor blood supply. It's important to let the healing take its time. A horse that has had a tendon injury runs a greater risk of being injured again, because a tendon that has once been damaged will never be as durable and elastic as a healthy tendon. The more serious the injury, the greater the risk that a horse will have permanent pain, which may affect performance in the future.

It is common horses to suffer from a chronic thickening in the injured area due to scar tissue. Another consequence is adhesions with surrounding tissues. Persistent lameness can also occur.

How is usability affected?

A tendon injury often means a long convalescence period before a horse can be used as usual again. Depending on how serious the injury was, you should expect anywhere from a few months of convalescence, up to a year. In some cases it will take even longer before the injury heals. Some horses never turn out well.

How do I prevent a tendon injury?

Physiology

Tendons are a type of tissue that requires a long time to adapt to increased load. In order to have a durable horse, it is therefore important that a young horse is allowed to move around a lot, preferably in large hilly paddocks, together with horses of the same age. Early training is also good, provided that the type of training and the amount is adapted to the horse's age and level of maturity.

A horse that has been trained for a task since it was a young horse has a skeleton, muscles and tendons that can handle more load and is therefore less likely to suffer a tendon injury. However, it is important that it is not trained too hard, as this can cause changes in the tendon tissue that instead increase the risk of tendon damage.

Environment

Daily outings in large hilly paddocks together with more horses gives the horse a natural opportunity to move around a lot and strengthens the skeleton, tendons and muscles.

Build your paddock so your horse is forced to pass natural obstacles to get from one part to another.

Young horses should go in herds with horses of the same age. It is best if they can run freely, as this gives maximum freedom of movement.

Inspect the surface of riding tracks and in stables. A good surface is soft enough, not too deep and not slippery. It is important that the surface is maintained regularly so that deep ditches don't occur where the horses often walk. If you have problems with the surface, or if you are going to build a new track, you should contact a professional.

Handling and use

Visit your horse every day. Feel the bones and pay particular attention to signs of inflammation such as heat, swelling or tenderness. By doing so, you have a good chance of detecting injuries early and can quickly institute the right treatment in the event of an injury. This increases the conditions for good healing.

When taking part in activities such as jumping, use tendon protection for extra support.

It is important that your horse has a good grip and does not slip.

Be sure to vary the training and to train on different surfaces. It strengthens the tendons and reduces the risk of injury in the future. Avoid letting your horse walk a lot on overly soft or deep surfaces. From time to time put in sessions with walking exercise on hard surfaces, such as asphalt.

Excessive training or too high a training dose for an untrained individual increases the risk of tendon injuries. It's relatively quick to train a horse's condition and to increase muscle mass, it takes significantly longer for tendons and bones to adapt to the new load.

 All changes in training should be made gradually, to reduce the risk of setbacks in the form of injuries. How much and in what way a horse should be trained is individual. Factors such as the horse's age, level of education, the horse's ability to reach the goal you want to achieve and your own level of knowledge must be taken into account. Through cooperation with a good trainer or instructor, you get help to train your horse in the best way so that it will last in the future.

Some things to consider:

• Go forward slowly and gradually increase the load with a young horse
• Also gradually accustom an adult horse to increased load
• Let your horse be outside as much as possible, preferably in large hilly paddocks together with other horses
• Make use of natural obstacles in the paddock
• Let young horses run loose in herds
• Avoid too much training on one-sided surfaces - especially avoid deep, soft surfaces
• Make sure the feed state is balanced
• Visit your horse every day
• Use tendon protection if and when necessary
• Exercise adequately
• Work with a skilled trainer who can help design an exercise program

Diagnosis and treatment

How will I know if my horse has a tendon injury?

• Heat or swelling in the area of ​​the injured tendon
• Pain with pressure over the damaged tendon
• Contour disturbance in the area of ​​the injured tendon
• Lameness

With a more minor tendon injury, the symptoms may not be as obvious. A slight increase in heat and swelling over the affected tendon, which quickly disappears, may be the only sign.

More serious injuries produce more heat, more severe swelling and pain when pressure is applied to the injured tendon. In the case of severe damage, you often see a significant contour disturbance in the area. It is common for the horse to become lame, but the lameness usually diminishes significantly already after a few days. In case of more severe tendon damage, the lameness risks becoming chronic.

What should I do if my horse has an injured tendon?

The first 48 hours after an injury, it is useful to cool the horse's legs. Do this 3 to 4 times per day for about 20-30 minutes each time. You can use running cold water or some form of cooling bandage. Cooling the injury can decrease swelling and help with healing.

Bandage your horse's leg. Use a pad and a regular non-elastic leg wrap, then wrap from the front knee up to, and including, the vertebra. Or alternatively from the hock joint up to, and including, the vertebra. Bandaging the leg improves healing by reducing swelling. If your horse is in a lot of pain in its injured leg, the leg on the opposite side should also be bandaged, to avoid them getting overload injuries in that leg. The bandage should be changed daily.

Rest your horse until it has been examined and  the severity of the injury has been assessed by a professional.

Always contact a veterinarian in the event of a suspected tendon injury. Your horse needs to receive the correct treatment quickly. Your vet may offer anti-inflammatory medication to try and speed up the healing process.

Injured tendon quick steps:

• Cool the leg
• Bandage the leg
• Let the horse rest until it has been examined by a veterinarian
• Contact a veterinarian

What will the vet do?

Your vet will feel the affected leg to look for signs of inflammation. That is, heat, swelling, pain. They will also examine whether the horse is lame.

In the event of a suspected tendon injury, the best examination method is ultrasound. With the help of the ultrasound, the suspected damaged tendon can be studied both along the length of the tendon and in cross-section. The ultrasound can also be used to follow the healing process.

Many minor injuries heal well even without treatment in the tendon itself. However, your vet may recommend different treatments with anti-inflammatory drugs or cortisone, local injections into the tendon with hyaluronic acid or stem cells, or surgery with stylet or splitting of the tendon tissue. This means making longitudinal wounds in the tendon, in several places. The aim is to increase the blood supply in the area and thereby bring about healing. Treatment with shock waves is also common. 

To provide support for the injured tendon, your vet will usually recommends different types of support bandages. The aim of the treatment is to reduce the inflammation as quickly as possible to reduce the formation of scar tissue. This should increase the chance of a good healing so your horse can recover.

Rehabilitation and aftercare

The acute stage is over, what do I do now?

Tendon injuries heal slowly. To achieve the best possible healing, it is important to follow your vet's advice on how to treat and train your horse.

As soon as possible with regard to the injury, the horse should start moving in controlled ways, on a hard and even surface. This can be done by walking the horse or letting it walk in a walking machine. You'll then gradually increase the training. By following the injury with repeated ultrasound examinations, it is checked that the healing is progressing as it should and that the training level is increased at an appropriate pace. It is important that you avoid worsening the damage as this will result in poorer healing.

For a period after the injury, it is good to bandage the injured leg to counteract swelling and provide support to the injured tissue. If your horse is in a lot of pain, the opposite leg may also need to be bandaged to avoid overuse injuries there.

In the acute stage, you can advantageously use zincaband, a zinc adhesive bandage that becomes a little hard when it dries. If zinca tape is used, it is very important to only apply the bandage and absolutely not to tighten it. These can easily become too tight and can cause pressure injuries. It is also good to apply a proper stable bandage with a pad and non-elastic leg wrap. A zinc bandage should be changed every three to four days depending on how swollen the leg is, or according to veterinary prescription. A regular stable bandage should be changed daily. Follow the attending veterinarian's advice regarding bandaging.

It is important to be patient with tendon injuries and not start training the horse too quickly.

Healing quick points:

• Follow the vet's current convalescence period
• Train the horse slowly
• Follow the healing through repeated checks with a veterinarian
• Contact the vet again if there are signs of recurrence
• Use a support bandage
• Have patience