Tendon, ligament rehabilitation
Rehabilitation of tendons and ligaments can take even longer because of the specialized physiology of these tissues. A poorer
blood supply and slowed pattern of fiber regrowth can keep a horse from returning to athletic use for many months (conservatively,
six to eight months) after injury to these structures. New technologies, such as stem cell injections, the use of platelet-rich
plasma, shock wave therapy and others, can help shorten the healing time in some cases.
Established research has shown that tendons and ligaments heal more rapidly and with a stronger, more correct fiber pattern
when low-level loading stress is applied to these recovering tissues. Consequently, hand walking is usually encouraged early
in the rehabilitation process. But overly aggressive exercise can be detrimental, and reinjury of tendons and ligaments is
often worse and more lasting than the initial damage.
The key to bringing these injured athletes back more quickly is being able to determine which horses are healing well and
can safely be pushed to the next stage and which horses aren't progressing and should be maintained at present activity. Ultrasonographic
and thermographic monitoring of tendon and ligament repair can help owners and trainers with their decisions. Ultrasonography
will show changes in healing fiber patterns and an increase or measurable decrease in fluid within a tendon or ligament.
Tracy Turner, DVM, Dipl. ACVS, an equine surgeon and pioneer in the use of infrared imaging in the horse, notes, "Thermography
has been shown to indicate inflammation and trauma to tendons and ligaments nearly two weeks before such lesions are detectable
with ultrasound. Using thermography to monitor the rehabilitative phase of soft tissue healing also makes sense because this
very sensitive modality provides the clinician with a means of quantifying the stage of repair and then making the appropriate
The removal of guesswork from tendon and ligament healing assessment translates into more aggressive but more correct rehabilitation
and a quicker return to function.
Equine joints are often damaged and require surgical repair. The intense forces placed on the joints of equine athletes generally
dictate that longer time be spent on rehabilitation. The exact nature of joint damage is sometimes unknown, and the types
of trauma are so varied that each joint rehabilitation case should be looked at individually, and postsurgical exercise programs
also should be unique.
Consistent monitoring with a number of modalities and the correct application of pressure and range-of-motion exercises based
on that monitoring will help shorten healing time in these types of injuries as well. Yet the question remains: Exactly how
hard can we push the rehabilitative process in a healing horse?
Stuck in the past?
There seems to be little scientific evidence to back up the rehabilitation programs currently advocated. Rehabilitative recommendations
appear to be based more on tradition, past policies and safe, perhaps overly conservative thinking rather than on research
and current knowledge. Some excellent recent data suggest that a different, more accelerated approach to getting postsurgical
horses back to activity is reasonable, yet many clinics and equine hospitals still advocate 30 days of stall rest, 30 days
of hand walking and controlled hand grazing and 30 days of small pasture turnout before resuming work.
While certainly no one is in favor of pushing horses into work too early, and each case is individual, aggressive postsurgical
rehabilitation is realistic for some horses and may make it possible for a safe, earlier return to competition.
Anthony Blikslager, DVM, PhD, Dipl. ACVS, professor of equine surgery at North Carolina State University, says, "The critical
problem is that horses laid up after surgery begin to lose muscle strength, cardiovascular endurance and the ability to perform
athletically at an increasing heart rate." The longer the period of inactivity, he says, the longer it will take for the horse
to come back.