rehabbing horse tendons

It’s not unusual for equine researchers and veterinarians to take a page from human medicine when it comes to treating challenging conditions in horses. Some of the tendon-healing philosophies and therapies doctors use in human patients might apply to equine ones, as well.

During the 2018 British Equine Veterinary Association Congress, held Sept. 12-15 in Birmingham, U.K., Seth O’Neill, PhD, MSc, PGCE, HE, MCSP, MMACP, of the University of Leicester’s College of Life Sciences, in the U.K., discussed how tendon rehab techniques in humans might transfer to horses. O’Neill works with “a mixed bag” of elite and nonelite human athletes.

He described tendinopathy (tendon injury) as “an imbalance in the rate of wear and repair.” While some stress on a tendon during training is good—the transient changes that occur after exercise cause the tendon to adapt and become more resilient—overstress can cause it to degrade. The resulting structural changes to the tendon then put it at risk of failing catastrophically during normal loading, he said.

“Repetitive training without enough rest leads to degradation,” said O’Neill.

Risk factors for wear, which he said apply to both humans and horses, include training load, previous injuries, muscle weakness, training surface, and footwear.

O’Neill explained that in human sports training, elite athletes use tools such as GPS data to monitor loading and other variables. These might be transferable to equine athletes.

“Monitor tendon load during training,” he suggested. “And know when to continue, reduce, or stop exercise.”

If a horse is recovering from an existing tendon strain, O’Neill cautioned against resting the animal completely, but rather focusing on strength training.

“Rest is harmful for tendon and will cause it to waste,” he said. “We try to not rest human athletes. In humans we use strength training to rehab muscle, which controls stress on the tendon.

“It may be time to reconsider the muscle and the role of strength and conditioning in equine athletes,” he added.

Strengthening exercises for horses might include steps and hill work over the course of three to six months. “It you return to sport too fast, you will have problems,” said O’Neill.

Recovery methods he cautions against include stretching, rubbing (which is irritating), non-steroidal anti-inflammatories, and cryotherapy (icing), which “may be triggering a higher incidence of tendinopathy or preventing successful intervention.”

Stretching is counterintuitive, he explained, because we need tendons to be stiff, not loose.

With cryotherapy, the ice actually slows the tendon’s metabolic response to exercise. “Don’t use it in training,” said O’Neill. “Just for immediate recovery after a competition.”

In summary, he said, tendon rehab in horses should include heavy and slow loading; pain monitoring (which, he admitted, can be challenging in horses); and progressive resistance.

“Monitor tendon health, load, and recovery during the season, and track data in your horses (e.g., with accelerometers),” said O’Neill. “Don’t rest. Strengthen.”