Bowed Tendons: Time And Cold Therapy

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Bowed tendons are arguably among the worst injuries of performance horses. They require long lay-ups and may permanently reduce the athletic potential of the horse. As with any injury, it is natural to focus on the acute treatment phase, looking for ways to treat/fix the horse. However, bowed tendons have no miracle cures or even topical, injectable or surgical treatments that will significantly change the bottom line: Bowed tendons need time to heal.

The key to success in treating bowed tendons is not in the hands of your veterinarian. Best outcomes are obtained when a knowledge of how tendons heal is combined with a carefully planned and executed daily treatment plan.

If you commit yourself to allowing the needed amount of time and working with the horse on a day-to-day and week-to-week basis, the results can be truly amazing and rewarding.

In rare cases, you will know a horse has injured his tendon during or immediately after work. There will usually have been a fall, misstep or rough landing after a fence that stands out as a precipitating factor. However, most tendon injuries are not discovered until the day after the horse was last worked. You may or may not have realized that the horse was “off” in the leg before the appearance of the bow.

A common history is that the horse had an ongoing problem in the opposite leg for quite some time (bow resulted from the chronic strain of trying to compensate for pain in the opposite leg).

The horse’s body is much more efficient at pouring cells, fluids and inflammatory chemicals into the injured tendon area than it is at removing them. Some inflammation is needed to clean up damaged tissues, but the inflammatory reaction can be a self-perpetuating process that ultimately results in excessive scarring. There is one all-important rule for dealing with acute tendon injuries: cold, cold and more cold.

It is almost impossible to overdo cooling a fresh tendon injury, and this is definitely not a time to cut any corners. Modern orthopedic surgeons will often use 24-hour cooling to control bruising and limit scarring. (See cold therapy, September ’97.)

The only precaution is to avoid applications of cold that are extreme enough to damage the skin. This can happen with some chemical gel packs. Most horses can tolerate traditional ice applications with nothing between the skin and the ice more substantial than the plastic of a sandwich or food-storage bag.

The more cooling done in a 24-hour period the better. The MacKinnon Ice Horse cold therapy machine is unsurpassed for providing continuous cooling without the associated watery mess. The gentle compression offered by this device is a plus in controlling swelling.

Cold-water hosing is an acceptable alternative to icing, but the water must be very cold, not tepid. Fabri-Tech’s Hydra Therapy boot can be a real time and manpower saver. It is essentially a sleeve that attaches above the knee with Velcro. The hose end attaches to the boot, and water flows continuously into the boot and out the bottom.

If you do not have the benefit of a cooling “device,” wraps will still provide reliable cooling. Most cold-therapy wraps that are activated by soaking in water and precooling or use ice cells in the pockets will only provide reliable cold for about 20 minutes. An exception is the Dura-Kold wrap, which lasts up to an hour or more, even on a very hot leg.

Bottom line, though, is that you will need a constant supply of ice to get this job done. Shaved ice is easier to pack and mold to the leg but melts far more quickly than larger pieces. Minicubes are ideal. Either pack the ice into large food-storage bags and secure with a standing wrap or use the compartments of a cooling/ice wrap to hold the fresh ice after the gel packs/ice cells of the wrap warm.

For prolonged cooling effect when the horse can’t be treated, keep a quilt soaked in alcohol in the freezer and use this for your standing wrap at the end of the day.

Medications: Acute Stages
Although this is a call for the treating veterinarian, you will find that aggressive cooling is the best anti-inflammatory therapy and usually obviates the need for phenylbutazone or other anti-inflammatory drugs.

Further decisions regarding other therapies (see ”Injecting Bowed Tendons” at end of story) should be made after the initial ultrasound examination has localized and categorized the injury.

Bandaging: The horse with an acute tendon injury will benefit greatly from proper bandaging. In fact, it is almost a must to control swelling. No special technique beyond a correctly applied standing wrap is needed, unless specifically directed by the veterinarian. However, all standard precautions must be followed meticulously. The quilt/cotton must lie flat, without wrinkles or ridges. Begin and end at the side of the leg along the cannon bone, not directly over the tendons. The material used in the outer wrap (flannel or polo type) is not as important as the controlled application of pressure.

Apply even, light pressure with each turn of the wrap and avoid beginning directly over the injured area. Do not end the wrap high on the fetlock. Extend it down under the sesamoids to provide support and stability.

Base of Support: The entire lower leg needs an adequate and normal base of support to avoid abnormal stress/pull on the injured area. Low heels/angles are a common contributing cause to bowed tendons and will continue to strain the area during the healing process. Horses with very under-run heels should have an egg-bar shoe applied to extend the base of support under the fetlock, where it should be.

If the angle of the foot is very low (under 52 degrees or at any measurement that obviously breaks the pastern/foot axis of the individual), heel wedges/degree pads should be used to restore the foot to a normal angle. This is sound, basic shoeing that should be continued religiously for the life of the horse.

Rehabilitating The Bowed Tendon
The First Few Months: The initial week or so after the injury is a frantic time — intensive cooling, ultrasound examination, injection therapy if used. However, if the horse is to make a successful return to competition, the process has barely begun. Only a strong commitment to careful rehabilitation and the horse’s daily care over the next 10 to 12 months will get the job done.

Early institution of controlled exercise is important to maintain flexibility of the tendon and help prevent adhesions/scarring. Adhesions between the tendon and sheath or other structures will limit the movement of the tendon and are also prone to reinjury. For the first four weeks, the horse should be hand walked for 30 minutes twice daily.

You may have to build up to this interval gradually, beginning at 10 to 15 minutes. Gauge the appropriateness of the exercise by the response of the tendon. If heat and swelling reappear or worsen, institute aggressive icing again and cut the exercise by five minutes. Once the area has been stable for a week, increase by five minutes or so again.

There is no set formula for bringing back these horses. Every horse will show individual tolerance to exercise. The important part is to begin at a reasonable starting point and monitor the leg closely, making adjustments as needed. Ultrasound examinations are usually recommended every four weeks or if an unusual flare-up should occur.

During weeks four through eight, assuming progress is being made on ultrasound exams, exercise will increase to 45 minutes of hand walking twice a day. At the eight- to 12-week mark, horses healing well on ultrasound may be increased to five minutes or so of slow jogging once a day, then 10 minutes a day for weeks 12 to 16. Turnout in a small paddock is usually permitted after 16 weeks, if the horse is healing well.

Formal trotting intervals may be extended to 15 to 20 minutes between 16 and 24 weeks. At 24 weeks, more variety can be added to the flat work but always avoid ing sudden changes in speed, work in deep footing or over uneven surfaces, or excessive lateral work.

Throughout this time, and indeed for the rest of the horse’s life, the tendon should be monitored on a daily basis. Occasional flare-ups of heat or swelling are to be expected but should be relatively minor if a proper exercise program is used.

Treat it with cooling and bandaging until the leg appears tight and cool again. Hold exercise at current level during this time or drop to the previously well-tolerated level. Monthly ultrasound exams will help greatly in modifying the exercise program, but there is no substitute for the information you gain by working with and observing the horse daily.

The Six-Month Mark: At six months, horses with mild or moderate injuries may appear externally to be healed, and ultrasound exams are also often encouraging.

This is a dangerous time in terms of bringing the horse back to full work safely. The conservative route is to give the horse another three to six months at pasture to fully heal and regain his flexibility. This is still probably the best course in terms of long-term results, but it often is not a practical option for the owner. With attention to cooling and wrapping and regular ultrasound monitoring, it is often safe to continue on with a modified conditioning schedule at the six-month point.

Daily turnout to keep the horse gently moving the leg is a big plus. Formal exercise must be carefully controlled, steady and preceded by adequate warm-ups.

If everything progresses perfectly, the horse may be able to achieve a return to full duty in 10 to 12 months. However, giving in to the temptation to do too much too soon may quickly result in a reinjury that sets you back several months.

Also With This Article
Click here to view ”Beware Of Miracle Products.”
Click here to view ”Bowed Tendon Sonogram.”
Click here to view ”When A Bow Is Not A Bow.”
Click here to view ”Support Boots For Injured Tendons.”
Click here to view ”Injecting Bowed Tendons.”

Contact Your Local Tack Store Or:

MacKinnon Ice Horse
4408 Ocean Valley Lane
San Diego, CA 92130
800/786-6633

Hydra Therapy Boot
Fabri-Tech
13333 Britton Park Road
Fishers, IN 46038
800/332-4797

Dura-Kold
1117 Cornell Parkway
Oklahoma City, OK 73108
800/541-7199
www.dura-kold.com