Tendon and Ligament Health

SmartPak strongly encourages you to consult your veterinarian regarding specific questions about your horse's health. This information is not intended to diagnose or treat any disease, and is purely educational.

Brief Description

A “bowed” tendon is the term used to describe inflammation (tendinitis) of the superficial digital flexor tendon, the tendon that runs down the back of the leg. Most “bows” involve only the superficial digital flexor tendon but can also involve the deep digital flexor tendon. A “pulled” suspensory is the term used to describe inflammation (desmitis) of the suspensory ligament, the ligament that runs down the back of the leg, right next to the cannon bone. Inadequate training, conditioning, conformation, trimming, shoeing and footing are the most common factors leading to both of these types of soft tissue injuries. Horses with “bowed” tendons are usually lame with pain, heat and swelling in the affected area. Unfortunately, horses with “pulled” suspensories may not have obvious signs, showing only an intermittent lameness or no lameness at all.

Possible Diagnostic Tests

It is important to have a veterinarian perform a complete lameness examination at the first sign of unsoundness. This exam may include flexion tests, palpation and nerve blocks (diagnostic anesthesia) to try and identify the exact cause of lameness. While x-rays may be taken, ultrasound is the imaging tool of choice for soft tissue injuries. MRI and CT scans are also now being used to visualize damaged structures.

Prescription Medications Available

In the early stages, your veterinarian may prescribe a non-steroidal anti-inflammatory (NSAID) to relieve pain and reduce inflammation. Examples of NSAIDs include: bute (phenylbutazone), Banamine® (flunixin meglumine), Surpass® and Equioxx®.

Supplements that May Lend Support

It is important to supply the building blocks for tissue re-growth while at the same time provide protection against free radicals, enzymes and other destructive compounds. Many horse owners offer a traditional joint supplement containing Glucosamine, Chondroitin Sulfate and Hyaluronic Acid because these ingredients have been shown to stimulate healthy tissues while inhibiting unhealthy substances. Silica and Hydrolyzed Collagen (Gelatin) have evidence supporting their use in the development of healthy connective tissue. Other ingredients which may support healing tendons and ligaments include antioxidants like Vitamin E and Grape Seed Extract and natural anti-inflammatories like MSM and Omega 3 Fatty Acids. And some horses benefit from a calming supplement containing Vitamin B-1, Magnesium or certain herbs during times of stall rest or hand-walking.

Other Management Suggestions

A carefully designed rehabilitation program is the cornerstone of soft tissue recovery. Use a journal to record your veterinarian’s recommendations for stall rest, hand-walking and return to riding then regular work. Your vet may also prescribe cold therapy—such as hosing or icing—and support bandages. Ask about products which combine the two and may save you time and effort. Also find out if newer therapies such as IRAP (interleukin-1 receptor antagonist protein) and ESWT (extracorporeal shock wave therapy) may help your particular horse.

Questions to Ask Your Veterinarian

• Will my horse return to his former level of performance?
• How long will it take my horse to heal?
• Will this area be a weak spot that my horse is prone to reinjure?

Additional Resources

Further Reading for You

From our Site:

• Tendon Trouble, Ligament Lameness, and Muscle Misery

From our Ask the Vet Blog:

• "Bowed" Tendons and "Pulled" Suspensories
• Best Way to Wrap a Horse

From The Horse Journal:

• Bowed Tendons: Time and cold therapy, May 1999
• Plan Treatments And Time For Lay-Ups, November 2004
• Shock-Wave Therapy Has Its Limits, October 2005
• Watch Those Tendons and Ligaments, November 2005

Further Reading for Your Veterinarian

Jorgensen AJ, Diaz OS, Reef VB. Ultrasonographic diagnosis—desmitis of the accessory ligament of the deep digital flexor tendon in a hindlimb in a horse. Vet Radiol Ultrasound. 2008 May-Jun;49(3):303:306.

Fortier LA, Smith RK. Regnerative medicine for tendinous and ligamentous injuries of sport horses. Vet Clin of North Am Equine Pract. 2008 Apr;24(1):37-51.

Kersh KD, McClure SR, Van Sickle D, Evans RB. The evaluation of extracorporeal shock wave therapy on collagenase induced superficial digital flexor tendonitis. Vet Comp Orthop Traumatol. 2006:19(2):99-105.

About Dr. Lydia Gray