Prevention of Tendon and Ligament Injuries

A beautiful grassy field unrolls in front of you, carpeting the countryside, adorned with strokes of woodland and wonder. The breeze picks up and dandelion seeds drift between the ears of your trusty mount, mixing aromas of wild lavender with the sweet scent of horses. You survey the path downhill, and squeeze your legs as your equine partner leaps into a gallop, sprinting through the tall grasses and racing the breeze across this dreamy landscape. Little do you know, that within the thunderous legs of your horse their tendons and ligaments dance with danger at every stride. At a gallop, the tendons and ligaments in our equine partners work near their breaking strength. While broken bones haunt our ideas of safety for our equine companions, it’s the tendons and ligaments who exist much closer to failure, and on a regular basis.

16% of equine athletes will sustain a soft tissue injury significant enough to cause a break in their training every year.

As equestrians, we often underestimate the effect that soft tissue injuries have on our equine athlete companions. Looking closer, 16% of equine athletes will sustain a soft tissue injury significant enough to cause a break in their training every year. These types of injuries range in severity, with many requiring at least 8 months of treatment and controlled exercise to heal. Over time, unresolved soft tissue injuries can cause repeated lameness for short periods. These repeat injuries will cause performance to deteriorate indefinitely, causing our horse’s most athletic years to be wasted.

Repetitive Overstrain

When we think of what causes these injuries, many imagine a stumble, footing that is too deep, or a bad landing after a long jump. Despite our dark imaginations, the real culprit of soft tissue injuries is not a singular villain to be avoided, but repetitive overstrain common in many training regimens. This overstrain stems from three major causes.

Fatigue
Lameness elsewhere
Conformation

Fatigue

Finishing a ride overtired means you have already crossed into the territory of potential injuries.

What does fatigue look like in horsemanship? It has historically been recognized by the labored breathing, frothy sweat, and heaving sides of an overworked mount. While yes, these are telltale signs in some instances, the fatigue we’re talking about here is a bit more systemic.

Let’s take the adult amateur for instance. In an expensive sport, long hours at the office are sometimes necessary to garner the freedom for weekend rides. When you line up multiple weeks of this practice, suddenly your horse is no longer getting the exercise necessary to maintain their fitness levels. Our innocent weekend-warrior is inadvertently opening their horse up to injury caused by fatigue.

Then there’s the young professional. Lacking the patience that comes with experience, the young pro develops an ambitious conditioning regimen for their athletic partner. Hill-conditioning, trot sets, and more fill the calendar of this rider’s road to the ribbons. While they imagine these exercises are building their partner up to the successes they dream of, without careful monitoring, this type of ambitious conditioning can create the paradigm of fatigue that leads to soft-tissue injuries.

This can also occur with young horses under professional training. When attempting to teach a new skill or master a specific drill it’s easy to succumb to the temptation of pushing past the point of exhaustion for both rider and horse. “One more circle” you say to yourself, yet that one more circle may be the difference between riding your sound horse back to the barn or dismounting your lame horse in the arena to call the vet.

When fatigue sets in, the muscles struggle to keep the horse’s tendons and ligaments within safe operating ranges. As the muscles lean into the tendons and ligaments for support, these two critical elements become overloaded. This feeds into a feedback loop, spiraling towards injury as the fatigue also leads to decreased precision of limb placement, ultimately increasing the risk of that injury-causing misstep all riders fear.

When working with your mount, aim for a strong finish to every ride. Finishing a ride overtired means you have already crossed into the territory of potential injuries.

Lameness Elsewhere

As we learned about fatigue, when a horse is moving in ways that are contrary to it’s optimal locomotion, injury becomes a very real possibility. In perfect conditions, at a gallop, the tendons and ligaments are working close to the breaking point. If that’s in perfect conditions, what happens when the conditions aren’t perfect? To answer that question, just count the number of horses without any lameness issues.

Some other ways that horses can be put into harm’s way through working under suboptimal conditions is when there is existing lameness elsewhere in their bodies.

A horse with sore feet will compensate by shifting its weight onto the feet that aren’t sore.

A horse with sore hocks will suffer from poor placement of its hind feet, putting additional stress on the soft tissues there.

A horse with a painful back will compensate in all sorts of ways that are contrary to ideal locomotion.

A horse with a painful neck will hold its head in a way that puts additional strain on the soft tissues.

The takeaway here is that when your horse is experiencing pain, even if that pain does not seem to cause acute lameness, there are still risks of causing a soft tissue injury by putting that horse into work without alleviating its discomforts.

Environmental Factors

As well as lameness elsewhere, there are some environmental conditions to consider when evaluating lameness risk. Particularly for horses who spend time in stalls, those who have a tendency towards stall-kicking or getting cast have an increased incidence of soft tissue injuries.

Conformation

It should come as no surprise to any rider that conformation plays a big role in a horse’s long term soundness. There are some specific conformational issues that will put a horse at greater risk for soft tissue injury that need to be considered when deciding what type of career a horse may successfully lead.

Prevention with Equipment

Knowing the causes of lameness is only half the battle. With horses, lameness is an inevitable challenge throughout their lifetime. However; we are not helpless to combat these issues, and aside from avoiding known precursors to lameness, carefully selected equipment can be a critical aid in safe training.

Prevention with Conditioning

Hill work is not a safe way to build your horse’s stamina.

Conditioning is a topic that is rife with strong opinions from all disciplines and experts. From a young rider’s early days with their trainer to professional programs that have been operating for decades, there are a number of poor conditioning practices that we need to discuss.

Let’s start with a common favorite conditioning practice that needs to be removed from your training program.

Hill Work

If you walked into five different training facilities and asked them what practices are at the core of their conditioning regiment, you are likely to get five answers of “hill work.” There are even multimillion-dollar thoroughbred farms that have specifically constructed conditioning tracks on hillsides for this purpose.

The risk far outweighs the reward, and this practice can be a significant source of soft tissue injuries.

So what does the research say about the effects of hill work?

Hill work increases strain on hind suspensory ligaments.
Hill work increases hip joint strain.
Hill work increases incidence of bleeding from the lungs.

Strained ligaments, joint strain, internal bleeding from the lungs — all situations that any compassionate horseman would be aiming to avoid by any means.

Hill work is not an effective way of building your horse’s stamina while also building resilience to soft-tissue injuries. It may in fact be the very cause of those injuries in the first place.

So we leave the hills behind. Surely there is some other intensive form of conditioning that will allow us to reach our performance goals?

Cross-Training

Have lunch with any pro athlete and they will all give you a similar refrain of “train harder than you’ll need to compete so that competition day is easy.” While I won’t provide any conjecture on the effectiveness of this attitude for human training, I can say with certainty that this attitude is dangerous in horsemanship.

So what’s the message here?

There is no reason to train your equine partner harder than your intended athletic goal. In fact, doing so puts them at greater risk for a soft tissue injury, and that certainly doesn’t put you closer to your goals. Said a bit more explicitly, avoid work that is harder than intended athletic use.

Avoid work that is harder than intended athletic use.

Or your equine partner might pay the price.

Cardiovascular vs. Musculoskeletal

We have discussed what not to do, but let’s dive into the foundations of what a good conditioning program looks like. The foundational belief behind safe conditioning is based on what we know from the research.

Cardiovascular fitness is achieved well before musculoskeletal.

What does this mean?

To answer that, we must consider how one measures effective conditioning. In many programs, the cardio-respiratory response is the base methodology for this. Check your horse’s breathing and heart rate, if they come down in a reasonable timeframe, they must be well-conditioned, right? Not necessarily.

Just because your horse has cardiovascular fitness, does not mean that their musculoskeletal systems are operating at the same level. Tendon and ligament fitness is nearly immeasurable for the rider who doesn’t happen to have an ultrasound machine in their tack room.

Just because your horse is able to catch their breath, doesn’t mean their tendons and ligaments are as strong as their stamina.

Starting from this knowledge, we can build a conditioning program that accounts for the lag between these two systems while we pursue our competitive fitness goals.

Best Practices for Conditioning

There are 6 base principles that we know make effective conditioning programs.

Base Fitness
Weekly Frequency
Before & After
Rest
Gradual Increase
Tailor

Base Fitness

Having a base level of fitness is essential before beginning a conditioning program. Pulling Mr. Ed out of the pasture after he’s been off all summer is not a safe level of fitness before starting a conditioning program.

Just like the Couch to 5k program for people, gradual progression is critical. Once you’ve achieved a base level of fitness, then you can consider a more serious conditioning program.

Weekly Frequency

As in most things, consistency is key to successful results. With horses, it is even more key, as consistency serves as a buffer against soft tissue injuries by avoiding abnormally intensive training sessions.

Imagine walking into the gym only 2 days a week and putting in 2-3 days’ worth of workouts in that single session. You would be at risk for injury yourself, and terribly sore in the days following.

Give your partner the consistency they deserve to perform their best.

Before & After

If ever there were a practice that should be integrated into every program, it is a greater frequency and duration of walking. Both as a before-session and after-session practice, walking works wonders to protect and refresh soft tissues.

Taking 15 minutes before a training session to walk allows the tendons and ligaments to warm up. Getting the tendons and ligaments to stretch before a session makes it much less likely that they will experience ruptures at higher forces.

Walking also moves fluids around the joints, lubricating them and allowing more comfortable work for your horse.

After the session, taking 10 minutes to walk and cool your horse down metabolizes waste products that can build up within your horse’s legs during exercise. That post-ride cooldown can mean the difference between a sore horse and a sound horse for tomorrow’s ride.

Rest

Training sessions should not be incessant drills of intensity that conclude in a grand ending before leaving the ring. Giving your horse frequent short breaks during sessions allows the soft tissues in their legs to relax and stay within safer operating margins.

Over-repetition of training exercises will continuously put the same types of strain on your horse’s legs. Knowing what we learned earlier in this article about overstrain; over-repetition is one of the major culprits of soft tissue injuries.

Gradual Increase

Looking back to what we just learned about cardiovascular and musculoskeletal progress, it is easy to understand why a gradual increase, rather than a rollercoaster of intensity, is the best way forward for your equine partner.

From the research, we know that an increase of 5% per week is generally the best practice for gaining condition while maintaining a low risk of injury.

What that 5% looks like will vary from program to program. It is your responsibility as a rider and horseman to find a metric or multiple metrics to gauge that 5% increase from. Your horse’s legs depend on it.

Prevention with Regular Care

Many professionals have already taken this into account, but it does only good to be repeated: a holistic approach to your horse’s care is just as — if not more — important as athletic ability when determining competitive success.

Nutrition

Like most living creatures, nutrition is at the core of the horse’s growth and well-being. As you have come to understand by this point, prevention of soft tissue injuries requires looking at the full picture of what your horse is experiencing on a daily basis. We learned that fatigue plays a major role in repetitive overstrain and one of the ways we can prevent fatigue is by maintaining a healthy body weight with significant energy reserves.

Not only is it critical to maintain energy reserves to ward off fatigue, but proper nutrition is also critical for tissue health itself. With a well-structured diet, you can promote tissue adaptation, growth, and repair.*

When developing the diet for your equine athlete, it is important to consider the type of work they will be doing. Endurance, cross-country, dressage, will all require specific considerations when choosing feeds and supplements. Finding the right balance is vital to using nutrition as a prevention practice for soft tissue injuries.

*Reference: Equine Sports Medicine and Surgery; 815-835

Body Condition

When thinking of the ideal body condition, know that your horse should have enough muscle mass and fat to perform well without excess weight to carry.

Suspicion Index

There is a certain wariness among horsemen when it comes to leg injuries. We hope to never experience one, yet acknowledge their somewhat inevitability. One way to reduce the chances of a serious soft tissue injury is to operate from a heightened level of suspicion of injury.

On the day-to-day, this means giving greater merit to minor lameness and signs of soreness in your equine partner. That minor lameness may turn into a not-so-minor soft tissue injury if ignored and trained over, or left uninvestigated for too long.

Early Diagnosis

Soft tissue injuries can be minor. If diagnosed early, they heal faster and better. Work with your veterinarian to try and diagnose any issues early on. The emotional and fiscal cost of a major injury will be much greater than the costs of consistent diagnostics.

Better healing
Shorter rehabilitation time
Fewer long-term side effects

Re-Injury Rate

The published re-injury rate for soft tissue injuries averages 40-50% depending on the injury site regardless of the treatment protocol.

This does not have to be the case.

With an accurate diagnosis of all the problems and a whole-horse approach to treatment, this can be greatly improved. Building a comprehensive rehabilitation plan from clinical exams and sequential imaging is key. It requires working with a partner veterinarian who has extensive experience in soft-tissue injuries.

Schedule a Veterinary Consultation

Prevention with Supplements

The Role of Arthritis

Arthritis means the inflammation of one or more joints. In horses, this can be a major cause of soft tissue injuries.

Your horse having chronic low-grade pain from arthritis leads to overloading other parts of their body. It disrupts the delicate balance of the athletic horse. This chronic tendon and ligament overload can and will lead to injury.

What is often called ‘Arthritis’ is the bony changes that can be seen on x-rays. Unfortunately, by the time arthritis shows up on an x-ray it is too late to provide any lasting cure, only management of the condition.
Earlier recognition of joint inflammation and its causes can prevent development of the bony changes that make arthritis a permanent condition.

Mechanism of arthritis

Synovial lining secretes inflammatory products and excess fluid.
Excess fluid stretches the joint and causes pain.
Inflammatory products damage the cartilage.
Bone spurs or osteophytes form.

At this point, we recognized *arthritis*.
Symptoms
Lameness
Swollen joints
Pain on flexion

How Arthritis Affects Soft Tissue

By now, you have learned that any lameness can put the horse at risk of soft tissue injuries. When considering the sources of that lameness and the likelihood that it will cause soft tissue injuries, it comes down to how much that pain is affecting the overloading of tendons and ligaments.

Arthritis affects the joints. All of the joints have connecting and supporting tendons and ligaments.

The joints themselves, and arthritis by association, can have one of the most significant impacts on overloading.

Treating Arthritis

Arthritis often affects multiple joints within the horse, so a systemic approach is preferable when choosing a supplement. Ideally, we can affect all of the horse’s joints with one supplement.

4 main factors go into selecting a supplement.

Is it safe?
Is it effective?
Is it affordable?

Problems with Supplements

Too many supplements take the kitchen sink approach, mixing in a bit of everything without researching the blended effect on the horse.

The interactions amongst these blended supplements are unknown.

The purity and concentration of the base ingredients are unknown.

So what works?

Supplements for Equine Arthritis

Choosing a supplement that is based on research is the best way to make sure that you are giving your horse the best possible product and also making a responsible investment of your horse-care budget. The two most researched and clinically proven supplements are:

Glucosamine
Hyaluronic acid

We will also discuss another common supplement that is less clinically proven, but still in popular use today:

Chondroitin sulfate

How Glucosamine Works

Glucosamine performs multiple roles in the protection of joint health.

Blocks IL1 (Interleukin) inflammatory products in cartilage and synovium.

Remember that arthritis is caused by inflammation. Blocking the causes of inflammation is one way to prevent and treat arthritis in your horse.

Provides both material and stimulation for proteoglycan synthesis.

This means that glucosamine is the building block for some important things that go into a healthy joint. Proteoglycans help the cartilage in your joints to stay strong. When inflammation occurs in the joint, the proteoglycans get degraded, which can lead to a feedback loop spinning straight towards arthritis.

Not only do proteoglycans get degraded by inflammation, but they are also reduced by steroids. Steroids are often given to reduce inflammation in the first place, but without something to reinforce the proteoglycans, they can lead to further inflammation down the road.

Protects cartilage from a decrease of proteoglycans production caused by steroids.

With glucosamine in the system, steroids can be safely administered without fear of degrading cartilage.

Increases bone metabolism to counteract bone resorption similarly to bisphosphonates like OSPhos or Tildren.

Bone resorption is this nasty effect where your horse’s bones break down into their bloodstream, weakening their skeletal system. Glucosamine is shown to prevent that by helping the bones get the resources they need from the body to stay strong and healthy.

Why Glucosamine is an Effective Choice

Glucosamine has been shown to be effective at an oral dosage of 1000mgs per 100lbs horse weight daily. This means that the lovely thoroughbred on your farm only needs about 11-12 grams per day.

The side effects have been shown to be similar to placebo in all clinical trials. This is a scientific way of saying nearly non-existent side effects.

It’s very cost-effective.

How Hyaluronic Acid Works

Joint fluid is largely crafted from hyaluronic acid and is what provides that critical lubrication to keep joints functioning efficiently. This goes a long way to prevent joint pain in your horse.

It also has a self-generated rapid anti-inflammatory response. This means it is one more preventative measure against inflammation and arthritis.

In veterinary operations, it has been shown to be effective at reducing post-operative stifle effusion (swelling) in 24 hours at 10mgs per 100lbs horse weight via oral dose.

Issues with Chondroitin Sulfate

While an important component of joint health, it has not been shown to be effective independent of glucosamine in clinical trials. More studies are showing that glucosamine is proving to be the real active ingredient in these trials.

Chondroitin sulfate is also quite expensive.