Healing tendons: Some common questions

Rather than continue the longer account of Derby’s tendon injury, which I find rather difficult to write at the moment, I thought I would sum up a few things I learned whilst looking after him. People seem to come across this blog searching on particular queries about tendon injuries in horses, which has given me an idea of the questions to which people want answers.

The key thing, as soon as you suspect a tendon injury, is to get your vet involved. Yes, this is expensive but a tendon injury can easily end a horse’s working life. If it is a tendon injury, you will need frequent visits and preferably repeat scans. If your horse is not currently insured for vet’s fees then think very seriously about it.

I should make very clear that I am not a vet. This is a personal account of what I learned which might provide food for thought. But it bears repeating: call your vet and act on their advice. This is what is best for your horse and ultimately what is best for you. If the worst does come to the worst, knowing you did everything possible helps. A little.

How can I tell if my horse has a tendon injury?

The surprising, and unfortunate, problem with tendon injuries is that what you can see on the outside often gives little indication of what is going on with the tendon itself. When I finally made the decision to have Derby put down, the ‘good’ foreleg looked much more suspect on the outside than did the injured leg. In fact I had to point out to the vet that he was inspecting the wrong leg. Though in all honesty by that stage, the good leg had had to take so much extra strain that it was quite swollen and it was the knock-on effects as much as the injury itself that pointed me towards the decision I made.

Essentially your horse might not be very lame even with a severe injury. Until the last 48 hours of his life, Derby was always pretty much sound in walk. He was probably never really more than 4/10 lame in trot, and then only for about a week. Heat and swelling around the tendon are obvious indicators that you need to get in touch with your vet. My vet palpated the tendon and got a pain response when it was injured – personally I don’t feel that I know enough to do this myself.

The only way you will really know is if your vet performs an ultrasound scan (USS).

What does a USS entail?

A big vet’s bill, mainly. More seriously, it’s precisely the same technology used to scan pregnancies. No really. The machine has different settings and one of them is for pregnancy.

Essentially it’s a way of seeing inside the leg. It’s a little like taking an x-ray picture except instead of using x-rays it uses ultrasound – sound outside of the range of normal human hearing. It’s technical but basically the different structures in the horse’s leg absorb that sound to differing degrees. This enables a picture of the inside of the leg to be taken.

It’s not painful and the machine is fairly small and quite portable. The vet will shave the site of the injury, put gel on it, run the scanning widget up and down the horse’s leg, just like the obstetrician does in very different circumstances. He or she will squint, peer at it, hum and haw a bit and generally wind you up before telling you what they think is going on. It depends on you as to how technical they are in their explanations. I quite liked learning about anomalies and the different sound absorbencies but then I’m odd like that and to be honest, I valued the distraction.

It isn’t an exact science but the ultrasound picture will give a good idea of the size of the tendon and the extent and nature of any damage to it. What looks minor on the outside can unfortunately turn out to be a bloody great tear in the tendon. Though the flipside is I suspect also true – the injury that looked awful on the outside might turn out to be relatively minor.

How can I get the tendon better?

Sheer bloody mindedness and a lot of hard work. Make no mistake about it – you are probably there for the long haul. And the longer and slower you take it, the more likely the recovery will last. Another problem with tendon injuries, perhaps in some ways the worst, is that the horse will run up sound in trot long before the tendon is really ready to return to full work. In fact the horse should not be back being ridden before it is sound, but once you can start riding you still have months to go.

There are various new treatments now about which I’m afraid I know very little. I think for many horse owners things like stem cell treatments are probably beyond the range of the practical. Again, discuss this with your vet.

Those things aside, you have two basic choices: turn the horse away for several months or a quiet, controlled exercise plan. Which you choose will depend on your horse, time, budget and veterinary advice. Turning away is obviously cheaper and if your horse is happy living out all year round might be better for you and them. The horse will make the injury seem worse initially but as it moves around on the leg over a period of months, it should get better. I opted not to do this for two reasons: Derby would never have wintered out and also the tendon may not heal quite so well. According to my vet when a horse is turned away the tendon may heal in a less organised fashion so that tendon fibres are bunched together, lumpy and less elastic. This will mean it is more likely to be re-injured. Again, talk to your vet about yours and your horse’s circumstances so you can decide what is likely to work best.

Slow and steady work is expensive and more time consuming – which brings me to my next point.

What are the recovery stages?

I was initially given a 6-month recovery plan. You start with box rest, move on to walking out in hand, then riding in walk on the roads, riding in walk and trot on the roads and finally a gradual introduction to school work and other surfaces before turning them out. You shift between stages according to the stage of the injury. The advantage with this is that it is more likely that the tendon will heal as an organised structure and so may well be stronger than if you had turned the horse away.

How long should I box rest for?

ASK YOUR VET, NOT SOME INTERNET HALF WIT. I was told that box rest was necessary throughout the time that there was heat, swelling and lameness in walk. When a horse first injures a tendon the damage might actually be quite minor. However, due to that initial damage, the tendon swells and becomes hot. Since the tendon itself is encased in the tendon sheath, which has a degree of rigidity, this swelling causes further damage. Think about how much a bad bruise can swell when it isn’t restricted – but the tendon is restricted. So the tendon structure can start to break down. This is why cold hosing is so important at this stage. If you keep the horse on box rest you limit the increase in damage. Cold hose until the pair of you are bored and want to wee. 10-20 minutes three times a day with a minimum of two hours in between sessions is ideal.

Consult with your vet as to how long you continue the box rest and the cold hosing. Once the tendon is healed and you are strengthening it the cold hosing might not be necessary. However, the second time Derby injured his tendon I kept cold treatment going as a preventative measure. He might have done some micro-damage and the cold treatment helped stopped this from turning into something more. And whilst he did eventually injure the tendon for a third and final time, I’m convinced that the frequent cold treatment both got him over a tear that the vet said wouldn’t heal, and kept it healed for longer than by rights it should have been.

Are there alternatives to cold hosing?

Personally I didn’t mind the cold hosing but then you could sit and read whilst cold hosing Derby and he would occasionally chew your hair or give your knee an experimental nibble. Other people would sit on a stool cold hosing him and smoking a rollie, not something I recommend in stables but at least there was plenty of water around if they set light to anything. In the event of extreme boredom I could lasso the nearest available child and make them hold the hose. Other horses are less inclined to stand still and a lot less safe with children. God how I miss that horse.

You can buy boots that you plug a hose into, in theory leaving the horse tied up and being cold hosed whilst you get on with other things. In practice you plug the hose in and return 15 minutes later to find it unplugged and your horse looking at you as if to say ‘And? Your problem is?’ Your problem being that you have no idea whether the horse has spent 15 minutes being cold hosed and has only just unhooked itself or whether it unhooked itself 2 minutes in and you’ve poured water straight down the drain for the other 13.

Eventually, given the length of time the injury went on for, I invested in a pair of hot and cold therapy boots from Premier Equine. These were wonderful and personally I’m convinced they helped a great deal in healing the tendon the second time Derby injured it. They included ice packs which I would leave on for about 10 minutes and gel pads which were soaked in water and which could be left on for up to 3 hours. These seemed to provide intensive physiotherapy for the leg.

Again, ask your vet – mine said that anything that cooled the leg was an acceptable substitute for cold hosing but yours might have other ideas. Also, be careful about the horse’s leg continually being wet. In the end, the ice packs were wonderful as they cooled Derby’s leg whilst also allowing me to keep it dry.

When can I start trotting?

Ask your vet. I would also, personally, insist on a scan before moving up to the next stage. I trotted when the vet said so. Basically the initial plan I was given was 4-6 weeks walk in hand, 4-6 weeks ridden walk and then a build up of trot work.

The second time Derby injured his leg I built the trot work up over a period of 8 weeks. It was annoying for both of us to take this time, but it did work. Or at least it worked in that the leg did heal, against the vet’s expectations, and stayed healed for a good 6 months. I knew the build up needed to be gradual but wasn’t sure how to measure the length of trot work. I couldn’t time it since I didn’t have a nice big, digital eventing watch and trying to read the second hand on my watch whilst discussing with Derby the fact that we were trotting was not really a viable option. You can’t measure the distance of trot work and increase it gradually unless you always trot in the same place, a sure-fire recipe for disaster. So I counted his strides. Heck, it worked. Weeks 1-2 we did 2 dozen trot strides. I added one dozen strides per week. Derby being a clever chap, he liked to count along. It kept him occupied and meant he anticipated stopping after 4 dozen (or whatever) strides. This is handy if you have a crazy horse on restricted exercise.

In sum: consult with your vet. Don’t be tempted to do too much too soon. And fight for your horse – whatever the ultimate outcome, they will repay you.

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10 thoughts on “Healing tendons: Some common questions

  1. Thank you for leaving this info and I’m very sorry for your loss he sounds like he was a lovely horse

    1. Thank you, Sarah. He was lovely and I do still miss him. As horrible as it was to lose him to a tendon injury, nursing him through it did give me a chance to get to know him even better.
      I hope if you have a horse with a tendon injury that you can get him/ her through it. Many horses get through and have happy lives afterwards.

  2. My mare has torn DDF Tendons in both her hind legs. The first tendon healed well following box rest and cold hosing followed by limited turn out and a gradual return to work as you describe. The second tendon is not healing so well despite following the same regime prescribed by my vet. She is sound in walk and when cantering around the paddock but in trot she is showing signs of definate lameness. My vet is back out to see her this week. Your article is really interesting and it’s good to know that you your vet approach rehab of tendon injuries the same way me and my vet do.

    1. Thanks, Maxine. Horses do tend to show lameness much more in trot than in canter. I think, though I don’t know, that there are good evolutionary reasons. Canter presumably is a good way to run fast, even if you are a bit lame, thereby giving horses a good way to escape from predators.
      Good luck with the rehab!

  3. that’s a very moving account about Derby. Sorry about your loss. I have a hyper horse who has just tossed his head and bucked and hoolied although meant to be on a filed rest…oops….field rest……………perhaps file under leave out in rain as will rest under ree rather than feel sorry and attempt to bring in . colleen

  4. Sorry to hear about Derby , I have horse that had suffered a tear to his tendon sheath. It will be two years next month. I called the vet and we gave him time off ie box rest etc for so long then after a while and more investigation he had an op and it showed that he had a 3cm tear. They gave him an 80%chance to come back into full work. I did exactly what was asked of me to bring him back to fitness weeks of walking starting from 5mins twice a day ..in hand to 30 mins which was over 8 weeks plus. He came back good until he somehow became lame again and it was the same problem so then decided to give six months off !!!! Then brought him back slowly in walk for several weeks with then introducing a very small time of trotting …..now he’s gone lame again!!!!!!!
    I’m at my wits end, but what’s strange is that one day he’s not so lame like you really wouldn’t notice it (but I not sure if I’m expecting it to happen ).if that makes sense I do put a cold pack on after each ride ……
    Is there any pain relief for horses that suffer with this kind of lameness ie
    An injection etc. I’ve got the vet coming next week to give him his flu jab so will consult with him … But thought you might know
    Thank you for your time
    Siobhan

    1. Hi Siobhan. Thanks for the comment. I’m sorry but I don’t know of any specific pain relief. I think if it’s a tendon problem you’re almost better off leaving the pain sensation as it will stop them doing too much and potentially causing more damage. But if your vet was prepared to operate it sounds like they’re up to date with the latest things so they might know of something.
      It’s so difficult with tendons and so frustrating. Maybe the answer is gentle work, keep ice packing and monitor the situation? It depends what your horse can cope with and what you’re prepared to cope with. I hope things work out for you and your horse!

      1. Hi Helen thank you for your prompt reply
        I’ll wait and see what the advice I get from
        the vet
        Again thank you
        Siobhan

  5. I am going through this now with my horse Charlie, he is only 5, he has ruptured the tendon in his thigh (gaskin area) my vets by their own admission are unsure how to treat it, as it is a really unusual injury for a horse to sustain, we are 5 months down the line, and I have turned him out in a small paddock now, I done the box rest, cold hosing, applying gels, liniment, had scans xrays done, walking him out, I ended up with a really depressed bad tempered boy, he had rubbed all his mane and tail out with boredom, and managed to re injure himself twice whilst on box rest, I am still applying compagel,and he has a danilon every 2nd day, he is much happier now, he is a bit stiff, the area is still swollen and firm, I am just hoping and praying he comes good, no matter how long it takes.

  6. I have a colored cob that ruptured both front leg tendons. The diagnosis for the future was poor but the vet suggested stem cell therapy and three months later we are on the road to recovery. The tendons are straight, the fibres are growing well but it is such hard work. We are up to an hour a day walking in hand and i am told this must continue for another two months before we start to trot. It is very scary walking along roads with a horse that will suddenly squeal and then try to run but that is her nature. we start ridden walk next week, five minutes a day and fifty five minutes walk increasing the ridden work by five minutes each week. I guess its worth it and the stem cell treatment was not as expensive as i had expected, but then we will do pretty much anything to get them right.

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