Equine Ownership

Coming Back From Soft Tissue Injuries

A bowed tendon or similar ligament damage can be frustrating for horse owners, but there is a path to recovery.

Closeup of a horse's legs galloping and turning.

This injury usually occurs when the digital flexor tendons in the lower leg are placed under intense strain, resulting in torn collagen fibres, and is often seen in racing and performance horses – but can even happen just walking in a muddy paddock. (peterzayda - stock.adobe.com)

By: Caelan Beard | March 27, 2024

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you're listening to an article from horse sport.com. coming back from soft tissue injuries by: caelan beard. ebony lowther had only owned her eight-year-old quarter horse mare, maisy, for a month when the mare turned up lame in the pasture at the stable where she is boarded in millarville, near calgary. just two hours earlier, maisy had been fine. but when lowther went to catch her from the field, maisy was severely lame – almost completely non-weightbearing – on her right hind leg, with significant swelling and heat localized to her hock. maisy was examined within an hour, but radiograph imaging found nothing significant. the recommendation was strict rest in a small paddock, compression bandages for the first week to reduce swelling, and phenylbutazone once daily for pain and anti-inflammation treatment. advertisement scroll to continue with content maisy’s lameness significantly improved within a day, and kept improving. within five days she was sound at a walk – but the swelling wasn’t going down. lowther opted for further diagnostics with an ultrasound to evaluate her tendons and ligaments. the ultrasound revealed the problem: maisy had damaged her short collateral ligament. soft tissue injuries, from bowed tendons to ligament injuries, are a nightmare situation for most horse owners. recovery can take months and can be marked by frustrating unknowns about whether your horse will be able to return to work, and if so, what level of work. “i think every veterinarian has come across various tendon lesions, being bows or strains…. and every one is a little bit different,” says dr. jackie kaufman, dvm. dr. kaufman is a board-certified large animal surgeon focusing on equine at king animal hospital in king city, ontario. her focus is equine surgery across both orthopaedic and soft tissue, and she has an interest in lameness evaluation. dr. kaufman chatted with us about healing times, prognoses, and what can be done to help your horse recover from a bowed tendon or similar soft tissue injury. early diagnosis. if you’re concerned that your horse has sustained a potential tendon injury, it’s important that you “get your vet involved early, for an early diagnosis,” dr. kaufman says. in the acute stage of injury, you should follow the advice of your veterinarian. to keep inflammation down, “most vets will recommend icing and bandaging in those early weeks,” dr. kaufman says. from there, a controlled exercise plan should be followed, along with regular checks with your vet. again, it’s important not to go too fast, but to gradually increase regular work – for example, introducing short periods of hand-walking, limited turnout in a small pen, to ridden work at the walk for days or even weeks before increasing the exercise to trot and canter. “having a good working relationship with your veterinarian is going to be helpful,” dr. kaufman says. she says that typically you will want to have re-checks with your vet around the time of when you’re increasing the exercise. additionally, she recommends getting ultrasounds done at these transition points, to make sure the injury is healing. “you don’t want to see the lesion getting larger or going backwards,” dr. kaufman says. healing timeline. healing time can vary quite a bit, dr. kaufman says, depending on the severity of the injury. “really, what it comes down to is what structure is affected and how severely it’s affected,” dr. kaufman says. “that determines prognosis for healing, and the timeline.”. it could take a few months for mild injuries to heal, dr. kaufman says, but for a properly bowed tendon (a tearing of the superficial digital flexor tendon, in the middle of the cannon bone region), it can often require 12 months of healing before the horse can return to full athletic activities. sometimes, it takes up to a year and a half. “we have to be patient and cautious or we’re risking a re-injury, and that will increase the length of healing time again,” dr. kaufman warns. helping recovery along. there are a few things that owners can do to help their horses heal. “everyone always recommends icing or cold hydrotherapy,” dr. kaufman says. “i do think early on in treatment, that’s really important.”. additionally, dr. kaufman says that “passive mobilization exercises and stretching are always great ideas for horses that are rehabilitating, just to keep them moving and stretching, especially early on in these treatments.” this should be part of the rehabilitation plan that your veterinarian discusses with you, as far as what to do at what stage of rehab. shockwave therapy is also often commonly used, specifically for treatments of suspensory ligament injuries. shockwave therapy works to increase blood circulation to the targeted area, breaking down tougher scar tissue and promoting new tissue growth. regenerative medicine can also be employed. platelet rich plasma (prp) injections deliver a high concentrate of platelets in the form of blood plasma into a lesion, increasing the amount of growth factors at the site to help stimulate tendon injury repair. prognosis. although the prognosis for recovery depends on the particular case, dr. kaufman says that “generally speaking, mild tendon lesions tend to heal with good prognosis.”. once you’re looking at a moderate-to-severe injury, “we’re discussing prognosis in regard to what type of performance the horse can do going forward, or even pasture soundness being the goal.”. dr. kaufman emphasizes the need to take the time required for a full recovery. “one thing i’ve found as a roadblock to recovery is a lack of patience and commitment,” dr. kaufman says. the horse needs to follow a gradual path back to recovery. when the horse is rushed back to work, the risk of re-injury comes with long-term consequences, including reduced performance or even retirement. “tendons heal with scar tissue that’s not quite as functional as regular tendon issue,” dr. kaufman says. scar tissue won’t ever be as elastic or stretchy as regular tendon tissue. “following a controlled exercise program is really key,” dr. kaufman says. on the mend. lowther’s mare, maisy, had a very good prognosis for her injury, based on lowther’s intended use for riding (recreational and trails). but it was going to take time. “i was advised it would be three to four months minimum of paddock rest with a gradual return to work,” lowther says. she was presented with several regenerative and alternative therapy options, and in discussion with her vet decided to do prp combined with shockwave therapy. the prp couldn’t be injected directly into the short collateral ligament, so it was injected into the tibiotarsal joint with the hope that the close contact to the collateral ligament would facilitate treatment of the injury and inflammation. shockwave therapy was also used to address inflammation, and to treat the hock as a whole, just in case there was further damage not yet evident on radiographs. maisy was also put on a low dose of previcox, an nsaid used to control pain and inflammation, once daily. maisy responded really well to her first prp and shockwave treatment, lowther says, with swelling significantly improved within a few days. the mare also seemed to be a lot more comfortable. lowther’s vet recommended to continue solely with shockwave therapy for two more treatments, done two weeks apart. maisy’s injury occurred on december 6, 2023, and the prp and shockwave treatments began december 28. she’s still healing. although maisy has been “very tolerant of the paddock rest,” lowther says, “there were times at the beginning of her recovery when the effect on her mentally was evident as she became more anxious.” maisy was at a new barn, with a new owner, and had just recently become well integrated with her herd when the injury occurred. “it was a lot of change for her in a short period of time,” lowther says. through her recovery, lowther has continued to spend a lot of time with maisy, which hasn’t been easy in “the dead of alberta winter.”. “i am lucky that she is a very sweet and easy-going horse to begin with,” lowther says, “but i truly think providing ample mental stimulation has been key to her recovery.”. lowther takes maisy for short walks to different places around the ranch, does stretching exercises with her, and gives her puzzle toys. in addition, maisy has a group of horses that she can interact with across the fence, and receives all of her meals in hay nets and a hay slow feeder ball. while there are times when maisy “bounces around her paddock a bit more than i’d like,” she hasn’t come up lame again since the initial injury and continues to improve. at her latest recheck, on february 22, maisy wasn’t showing any lameness on evaluation, her x-rays looked good, and the disrupted tissue in her ligaments is starting to rejoin. “she’s been cleared to start a rehab plan with a slow reintroduction back into exercise.”. nevertheless, lowther says, “there is no doubt that it is devastating and frustrating to be told it’ll be months before you’ll be able to ride your horse.”. the time spent with maisy as she recovers, however, has had an unexpected benefit. “it’s allowed me to really slow down and spend a lot of undemanding time with my horse, just simply enjoying each other’s company,” lowther says. “i think too often as riders we can get wrapped up in our exercise programs, coming up to the barn just to tack up our horses, ride and turn them back out,” lowther says. “i’m grateful for all the time i’ve been gifted to spend with her, just getting to know one another.”. the evidence of their growing relationship is apparent: maisy now calls to greet her, every time she pulls up the drive. looking to the future. currently, there’s a limited body of research that looks at scientifically proven methods to help treat tendon and soft issue injuries. more research is needed and could help determine additional methods for treating these injuries. one method that’s been recently examined, however, is the intralesional administration of mesenchymal stem cells for treating superficial digital flexor tendon (sdft) and suspensory ligament (sl) injuries. the use of stem cell therapy is being explored for treating everything from equine asthma to equine osteoarthritis. a recent study, published in 2023 by researchers from belgium, the netherlands, and germany, looked at the safety and efficacy of using stem cells to treat naturally-occurring sdft and sl injuries. the study found that intralesional injections of equine allogeneic peripheral blood-derived mesenchymal stem cells (tpmscs) was not only safe, it “improved the quality of healing and long-term outcomes in sports horses.”. &&>

Ebony Lowther had only owned her eight-year-old Quarter Horse mare, Maisy, for a month when the mare turned up lame in the pasture at the stable where she is boarded in Millarville, near Calgary.

Just two hours earlier, Maisy had been fine. But when Lowther went to catch her from the field, Maisy was severely lame – almost completely non-weightbearing – on her right hind leg, with significant swelling and heat localized to her hock.

Maisy was examined within an hour, but radiograph imaging found nothing significant. The recommendation was strict rest in a small paddock, compression bandages for the first week to reduce swelling, and phenylbutazone once daily for pain and anti-inflammation treatment.

Scroll to continue with content

Maisy’s lameness significantly improved within a day, and kept improving. Within five days she was sound at a walk – but the swelling wasn’t going down. Lowther opted for further diagnostics with an ultrasound to evaluate her tendons and ligaments. The ultrasound revealed the problem: Maisy had damaged her short collateral ligament.

Soft tissue injuries, from bowed tendons to ligament injuries, are a nightmare situation for most horse owners. Recovery can take months and can be marked by frustrating unknowns about whether your horse will be able to return to work, and if so, what level of work.

“I think every veterinarian has come across various tendon lesions, being bows or strains…. and every one is a little bit different,” says Dr. Jackie Kaufman, DVM. Dr. Kaufman is a board-certified large animal surgeon focusing on equine at King Animal Hospital in King City, Ontario. Her focus is equine surgery across both orthopaedic and soft tissue, and she has an interest in lameness evaluation. Dr. Kaufman chatted with us about healing times, prognoses, and what can be done to help your horse recover from a bowed tendon or similar soft tissue injury.

Early diagnosis

If you’re concerned that your horse has sustained a potential tendon injury, it’s important that you “get your vet involved early, for an early diagnosis,” Dr. Kaufman says.

A typical bowed tendon. If caught early and treated vigilantly, most horses can return to their previous performance level. (Photo courtesy Western College of Veterinary Medicine)

In the acute stage of injury, you should follow the advice of your veterinarian. To keep inflammation down, “most vets will recommend icing and bandaging in those early weeks,” Dr. Kaufman says.

From there, a controlled exercise plan should be followed, along with regular checks with your vet. Again, it’s important not to go too fast, but to gradually increase regular work – for example, introducing short periods of hand-walking, limited turnout in a small pen, to ridden work at the walk for days or even weeks before increasing the exercise to trot and canter.

“Having a good working relationship with your veterinarian is going to be helpful,” Dr. Kaufman says. She says that typically you will want to have re-checks with your vet around the time of when you’re increasing the exercise. Additionally, she recommends getting ultrasounds done at these transition points, to make sure the injury is healing. “You don’t want to see the lesion getting larger or going backwards,” Dr. Kaufman says.

Healing timeline

Healing time can vary quite a bit, Dr. Kaufman says, depending on the severity of the injury. “Really, what it comes down to is what structure is affected and how severely it’s affected,” Dr. Kaufman says. “That determines prognosis for healing, and the timeline.”

It could take a few months for mild injuries to heal, Dr. Kaufman says, but for a properly bowed tendon (a tearing of the superficial digital flexor tendon, in the middle of the cannon bone region), it can often require 12 months of healing before the horse can return to full athletic activities. Sometimes, it takes up to a year and a half. “We have to be patient and cautious or we’re risking a re-injury, and that will increase the length of healing time again,” Dr. Kaufman warns.

Helping recovery along

There are a few things that owners can do to help their horses heal.

“Everyone always recommends icing or cold hydrotherapy,” Dr. Kaufman says. “I do think early on in treatment, that’s really important.”

Additionally, Dr. Kaufman says that “passive mobilization exercises and stretching are always great ideas for horses that are rehabilitating, just to keep them moving and stretching, especially early on in these treatments.” This should be part of the rehabilitation plan that your veterinarian discusses with you, as far as what to do at what stage of rehab.

Shockwave therapy is also often commonly used, specifically for treatments of suspensory ligament injuries. Shockwave therapy works to increase blood circulation to the targeted area, breaking down tougher scar tissue and promoting new tissue growth.

Regenerative medicine can also be employed. Platelet rich plasma (PRP) injections deliver a high concentrate of platelets in the form of blood plasma into a lesion, increasing the amount of growth factors at the site to help stimulate tendon injury repair.

Prognosis

Although the prognosis for recovery depends on the particular case, Dr. Kaufman says that “generally speaking, mild tendon lesions tend to heal with good prognosis.”

Once you’re looking at a moderate-to-severe injury, “we’re discussing prognosis in regard to what type of performance the horse can do going forward, or even pasture soundness being the goal.”

Dr. Kaufman emphasizes the need to take the time required for a full recovery. “One thing I’ve found as a roadblock to recovery is a lack of patience and commitment,” Dr. Kaufman says. The horse needs to follow a gradual path back to recovery. When the horse is rushed back to work, the risk of re-injury comes with long-term consequences, including reduced performance or even retirement.

“Tendons heal with scar tissue that’s not quite as functional as regular tendon issue,” Dr. Kaufman says. Scar tissue won’t ever be as elastic or stretchy as regular tendon tissue. “Following a controlled exercise program is really key,” Dr. Kaufman says.

On the mend

Lowther’s mare, Maisy, had a very good prognosis for her injury, based on Lowther’s intended use for riding (recreational and trails). But it was going to take time. “I was advised it would be three to four months minimum of paddock rest with a gradual return to work,” Lowther says.

She was presented with several regenerative and alternative therapy options, and in discussion with her vet decided to do PRP combined with shockwave therapy. The PRP couldn’t be injected directly into the short collateral ligament, so it was injected into the tibiotarsal joint with the hope that the close contact to the collateral ligament would facilitate treatment of the injury and inflammation. Shockwave therapy was also used to address inflammation, and to treat the hock as a whole, just in case there was further damage not yet evident on radiographs. Maisy was also put on a low dose of Previcox, an NSAID used to control pain and inflammation, once daily.

Maisy responded really well to her first PRP and shockwave treatment, Lowther says, with swelling significantly improved within a few days. The mare also seemed to be a lot more comfortable. Lowther’s vet recommended to continue solely with shockwave therapy for two more treatments, done two weeks apart.

Maisy’s injury occurred on December 6, 2023, and the PRP and shockwave treatments began December 28. She’s still healing. Although Maisy has been “very tolerant of the paddock rest,” Lowther says, “there were times at the beginning of her recovery when the effect on her mentally was evident as she became more anxious.” Maisy was at a new barn, with a new owner, and had just recently become well integrated with her herd when the injury occurred. “It was a lot of change for her in a short period of time,” Lowther says.

Through her recovery, Lowther has continued to spend a lot of time with Maisy, which hasn’t been easy in “the dead of Alberta winter.”

“I am lucky that she is a very sweet and easy-going horse to begin with,” Lowther says, “But I truly think providing ample mental stimulation has been key to her recovery.”

Lowther takes Maisy for short walks to different places around the ranch, does stretching exercises with her, and gives her puzzle toys. In addition, Maisy has a group of horses that she can interact with across the fence, and receives all of her meals in hay nets and a hay slow feeder ball.

A horse in the snow with a bandage on its leg.

Maisy on the mend. (photo courtesy Ebony Lowther)

While there are times when Maisy “bounces around her paddock a bit more than I’d like,” she hasn’t come up lame again since the initial injury and continues to improve. At her latest recheck, on February 22, Maisy wasn’t showing any lameness on evaluation, her x-rays looked good, and the disrupted tissue in her ligaments is starting to rejoin. “She’s been cleared to start a rehab plan with a slow reintroduction back into exercise.”

Nevertheless, Lowther says, “There is no doubt that it is devastating and frustrating to be told it’ll be months before you’ll be able to ride your horse.”

The time spent with Maisy as she recovers, however, has had an unexpected benefit. “It’s allowed me to really slow down and spend a lot of undemanding time with my horse, just simply enjoying each other’s company,” Lowther says.

“I think too often as riders we can get wrapped up in our exercise programs, coming up to the barn just to tack up our horses, ride and turn them back out,” Lowther says. “I’m grateful for all the time I’ve been gifted to spend with her, just getting to know one another.”

The evidence of their growing relationship is apparent: Maisy now calls to greet her, every time she pulls up the drive.

Looking to the Future

Currently, there’s a limited body of research that looks at scientifically proven methods to help treat tendon and soft issue injuries. More research is needed and could help determine additional methods for treating these injuries. One method that’s been recently examined, however, is the intralesional administration of mesenchymal stem cells for treating superficial digital flexor tendon (SDFT) and suspensory ligament (SL) injuries.

The use of stem cell therapy is being explored for treating everything from equine asthma to equine osteoarthritis. A recent study, published in 2023 by researchers from Belgium, the Netherlands, and Germany, looked at the safety and efficacy of using stem cells to treat naturally-occurring SDFT and SL injuries. The study found that intralesional injections of equine allogeneic peripheral blood-derived mesenchymal stem cells (tpMSCs) was not only safe, it “improved the quality of healing and long-term outcomes in sports horses.”