Any horse can suffer a soft-tissue injury, such as a ligament or bowed tendon. Rough terrain and deep footing are leading causes, but so is a lack of fitness. And, sometimes, injuries just happen. Even horses standing in stalls have been reported to sustain soft tissue injuries.
The terms "tendon" and "ligament" are often used interchangeably, but in reality, they're very different. Tendons act as points of attachment between a muscle and bone, whereas ligaments connect bone to bone. There are far more ligaments in the body than there are tendons, since several ligaments involved with each joint in the body.
Ligaments are elastic bands of tough, densely arranged fibrous connective tissue. Because they connect bone to bone, they serve as a functional component in joints. Naturally, ligament health directly affects the range of motion of a joint, and ultimately, athletic ability. That's because ligaments are viscoelastic, meaning they gradually lengthen when under tension, and return to their original shape when the tension is removed.
If stretched beyond their range, however, ligaments can't retain their original shape. Thus, strained or torn ligaments mean double trouble. Not only does an owner have to contend with the ligament injury itself, but they must also be prepared for the joint to destabilize. Research shows that if a ligament loses its viscoelasticity due to injury, it can permanently compromise a joint.
Destabilized joints are at a greater risk for arthritis, which is one reason why athletes, gymnasts, dancers, and martial artists perform stretching exercises to lengthen their ligaments before they begin. They're decreasing the chance of injury and making their joints more supple. Does that mean we should be spending time stretching a horse's joints and ligaments before athletic workout?
WARM-UPS ARE A HOT TOPIC. That recommended 15- to 20-minute walk warm-up is actually a pitiful excuse as a primer to your horse's workout. For those of us who are lucky enough to allow our horses to live in pasture or be turned out for long periods of time, it's somewhat helpful, since they're already stretched out a bit from being able to self-exercise.
But for horses living in a stall, taking them out and walking for a few minutes prior to jumping just doesn't cut it. Imagine getting up out of bed and immediately sprinting over hurdles . . . you're asking for injuries!
You can improve your warm-up practices and help ligaments to be strong and flexible by:
Stretching: when you bring your horse to the cross ties to be groomed and tacked up, the stretches should become habit.
Effective Warm-Up Stretches
Warm-Up before your Warm-Up: Users of Back On Track(www.backontrackproducts.com, 888-758-9836) ceramic blankets and wraps sing their praises for good reason. They're made of fibers of polyester and polypropylene (some of the products are mixed with cotton fibers) with a ceramic powder fused into the fibers.
The ceramic gives the fabric its unique property, which reflects body heat in the form of infrared heat radiation. Allowing the joints and body to heat up a bit before a workout benefits the horse by increasing blood circulation and aiding in shaking off the stiffness and coldness that comes with standing still in a stall.
Back-On-Track makes support boots, blankets, saddle pads and leg wraps to fit all horses. The products are reasonably priced (therapeutic leg wraps are around $89 and exercise sheets are about $269). Cared for properly (no machine drying), they hold up well over time.
Spend some quality time with your horse's ligaments: In addition to stretching and Back On Track products, revamp your warm-up effort to focus on joint and ligament stretches. Consider wearing a watch with a timer set for 25 to 30 minutes. Yes, we know you want to get to the good stuff, but this is a much more appropriate amount of time to warm up your horse.
To make the most of your warm up, we suggest you:
Stretch your horse's head and neck from side to side when you walk them by pulling the reins to the right and left in an attempt to get the horse to bring their nose around to the tip of your boot.
Make your horse walk over a single trot pole every few minutes to get him to stretch his ligaments and flex his joints beyond the normal comfort level.
Take up collection and then let it go in order to stretch the neck and topline and to prepare the horse for the workout to come. Alternating between collection and loose rein for 100 feet at a time is recommended (about the length of the long side of the arena).
Practice "side passes," leg yields, and backing at the walk. All of these movements will stretch ligaments in a way that simple forward walking may not.
Although there are hundreds of ligaments in the body, our chart outlines some of the more common ligaments that are reported to be injured in horses.
MANAGING LIGAMENT INJURIES.
Ligament injuries can take many months to heal, and in some instances, their architecture and appearance never return to normal. Herein lies a challenge to keep owners motivated to rehab their horses that have ligament injuries. They work diligently for months, only to be told by the veterinarian that the ultrasound still shows abnormal ligament fibers. Well, do not despair! Many horses never do show completely "normal" fiber patterns after an injury, yet go on to lead sound and productive riding careers without injury recurrence.
The fact is that the number of months that veterinarians use to outline a ligament rehab schedule are just estimates. The actual time that it will take depends on several factors which include:
- The severity of the ligament injury (meaning how much of the ligament is injured and to what extent it's injured),
- Which ligament is injured (since some heal faster than others based on their workload),
- The location of the injury inside the ligament (injuries on the edge of a ligament can heal faster than injuries in the core of the ligament due to better blood flow),
- The weight of the horse,
- The disposition of the horse during rehab,
- The compliance of the owner in performing prescribed therapies and keeping the horse out of work,
- Accurate diagnosis,
- The supplements and/or therapies given to the horse to aid healing.
Ligament Injury Healing and Prognosis
OK, the first three factors are out of our control, but the rest we can influence. The further you deviate from these ideals, the longer healing time you'll face. While time is a major positive factor in ligament regeneration, you can shave off some of it, and hopefully improve the quality of ligament healing. let's take a closer look at the last six factors that we can make a difference in:
Weight Control: For every pound that a horse's frame must support, ligaments must work that much harder to transfer load. If a horse is overweight, that excess puts unwanted strain on ligament fibers, and causes them to stretch more than they would if the horse shed a few pounds.
Unfortunately, without the ability to exercise (you need to keep your ligament-injured horse quiet), it's difficult to keep pounds off. To make matters worse, horses are usually so bored standing around for months on end that owners tend to feed them extra to keep them busy.
If you're considering that, use liberty feeding. This involves stuffing specialized perforated hay bags, often called "slow feeding" bags, and allowing the horse to forage on a 24/7 basis at will. It keeps a horse busy and simulates a natural eating pattern. Liberty feeding hay bags can be purchased with different-sized perforations to control how much hay a horse can pull out of the bag. Horses take a couple weeks to adjust to it, but then settle right in and eat a bit here and there.
Horse disposition during rehabilitation: We can't stop a horse from being a horse. However, avoiding rough-housing during rehab does favor ligament repair. The most common occurrence in which horses put unwanted strain on their ligaments is during hand-walking. Owners should consider the following advice to minimize "blow ups" when walking:
- Avoid walking the horse in areas that are unfamiliar as spooking is more likely in unknown places.
- Walk in an enclosed area (like an arena) so that if the horse does get loose, it is running for a finite distance and on good footing.
- Try to hand walk during quiet times in the barn. Generally, these don't include feeding time or times when there are several people riding. Morning and windy times are primers for many horses becoming "high." Avoid them.
- If your horse is unruly, consult your veterinarian about the use of tranquilizers (acepromazine tablets are popular) to aid in keeping all four feet on the ground.
- Ask the barn workers to feed your horse first to minimize "horse play" while waiting for the feed cart to come by.
Owner compliance: This is perhaps the largest contributing factor that helps or hinders a horse's healing. Many owners become impatient and don't stick with the rehab recommendations made by their veterinarian. The most helpful hint we can offer here is communication. If you can't comply with your vet's recommendations, get it out in the open so that you can strategize alternatives. Precious time and money are lost when your veterinarian assumes that you are doing one thing, but you're actually doing another.
Environment: Having a stall/paddock combination can be useful when trying to rehabilitate a damaged ligament. However, many owners report that their horse is calmer and quieter in an open pasture. It's true that horses can do a good deal of damage to a ligament in a 12x12 stall, so the decision to have him "in" or "out" should depend on available options as well as his disposition.
Generally, if a horse lives out in a pasture, he will run from time to time. This definitely won't help a ligament injury. If your horse does live out in pasture with an injury, try to pair him up with a quieter, calmer (and maybe older) horse. Youngsters tend to fuss and play at will much more than mature horses. Make sure that your horse gets along with his pasture mate, and if needed, feed the horses separately to avoid drama at feeding time.
Diagnostic Accuracy: Allowing your veterinarian to ultrasound your horse's ligament injury will provide vital information that will shape the rehab plan.? If a veterinarian has to make an educated guess at the extent of a ligament injury, the results of the rehabilitation may not be as ideal as if an ultrasound took away the guess work. Further, allowing rechecks of the ligament on a 60- to 90-day basis will help your vet determine if the ligament is healing or tearing more. This information can change the aggressiveness of your rehabilitative therapy as well as the estimated healing time. An ultrasound can run $300 or more.
Supplements and Therapies: When we discussed tendons in March, we suggested feeding supplements such as vitamin C and vitamin E, as well as several high-tech therapies that you and your veterinarian may choose to speed the healing of a soft-tissue injury.
Therapies include interlesional injections of regenerative substances such as insulin-like growth factor, thrombin, stem cells, platelet rich plasma, bone marrow, or interleukin receptor antagonist protein. In addition, physical therapy modalities such as extracorporeal acoustic ultrasound shockwave, microcurrent, and GameReady (www.gamereadyequine.com, 510-868-2100) can be useful. Read about our trial with Game Ready here.
Recommended High-Tech Treatment Options
Ligament injuries are commonly reported as causes of lameness in horses. However, they aren't the end of the world. The most important factor for a successful return to athletic work is adequate time for healing. But management techniques and therapy modalities also contribute greatly.
Optimal nutrition is important, too, so give the horse the "tools" needed to heal. We suggest: Vitamin C - 3000 mg/day; Vitamin E - 800 IU/day; Selenium 1 mg/day. Check your horse's current diet to see if he's receiving these levels prior to adding a supplement, and consult your veterinarian if you're not sure.
As is often said, prevention is best, so take the time now to implement careful warm-up, prudent discretion when riding, and weight control/routine exercise to minimize the chances of a ligament injury in the first place.