Tendon injuries in horses are common and commonly feared due to long recovery and rehabilitation periods and susceptibility to re-injury.
Tendons and ligaments are fibrous connective tissues essential for stability and movement. They are primarily composed of collagen. Tendons attach muscle to bones while ligaments attach bones to other bones.
The tendons most commonly injured are in the lower forelimb. The three structures most at risk are the Superficial Digital Flexor Tendon (SDFT), the Deep Digital Flexor Tendon (DDFT) and the Suspensory Ligament.
Tendon and Ligament Injuries
The most common type of injury is overstrain which is characterised by an unsustainable amount of stress on the tendon that results in tiny breaks in the tendon. When there is even more pressure, we may end up with complete transection of the tendon where all of the fibers will fail. This shows in a sudden onset of lameness initiated, for example, by an unexpected step, unbalanced footing, landing in a hole, etc.
Other factors relevant in tendon and ligament injuries are degeneration as well as trauma and infection.
Rehabilitation and Recovery
Tendon healing occurs in 3 phases:
- Inflammation;
- Proliferation; and
- Remodeling.
During the remodeling phase very disorganised tissue gets reorganised. This happens over 6 to 12 months or even longer. This is a long time and tendons are not very good at healing so they very rarely regain their original strength. Often there is scar tissue and they are weaker and less flexible.
For best recovery outcomes, diagnosis by a veterinarian should be performed early and most clearly localise the problem. Rehabilitation is a very important part of recovery.
To best support the rehabilitation outcome, an integrative approach should be taken guided by your veterinarian involving your farrier and other professionals such as bodyworkers or physiotherapists.
Due to long recovery periods and horses being prone to re-injury, the focus should be on prevention where possible. Contributing factors to tendon and ligament injuries are inappropriate shoeing, training on ground that is too deep and soft, and overstraining the body and a lack of preparation for the workload. The workload does not necessarily need to be too high. Unilateral and repetitive movements can have harmful influences too.
Equine Acupressure in Tendon and Ligament Rehabilitation
Equine acupressure is an effective way to support the prevention as well as the rehabilitation and recovery of tendon and ligament injuries.
In Traditional Chinese Medicine, tendons and ligaments are associated with the element of Wood. Wood governs the organ systems of Liver and Gallbladder and Liver-Blood nourishes the sinews, i.e. tendons and ligaments. This supports movement, flexibility and strength. Stagnation or deficiency in relation to Liver-Blood can result in a weakening of these structures. Also, Qi is responsible for movement and transport and flows together with Blood through the vessels. If blood flow is restricted, Qi equally does not move harmoniously through the body.
Such stagnation of qi and/or blood that causes pain and lameness in the affected area can be addressed with acupressure and complement conventional veterinary treatment. When Qi and blood flow freely again, inflammation can subside, swelling is reduced and the tissue is once more supplied with the nutrients it needs to heal. Recovery is supported by this approach.
Through a thorough assessment that includes the palpation of Shu* and other relevant acupoints, an equine acupressure practitioner will identify the underlying pattern of disharmony.
In the case of tendon and ligament injuries, we often deal with external excess heat and Qi and potentially blood stagnation, or external Qi and phlegm stagnation potentially together with cold. This can be related to underlying Liver-Blood and Yin-deficiency. In case of internal deficiency this can become chronic and result in tendon-Bi-syndrome.
Based on this pattern identification and other relevant factors, the practitioner will then select the acupoints most suited to address the condition in the particular horse in front of them. Working with these points will help to resolve the underlying imbalances and support recovery.
*Shu points or Association points are acupoints on the Bladder meridian on the horse’s back lateral to the dorsal midline. These acupoints have associations to the whole body and all of its organ systems and functions. Therefore, they are commonly used to assess a horse’s condition.
Reference: Eul-Matern, Christina. Akupunktur bei Pferdekrankheiten: Westliche Indikation – chinesische Diagnostik und Therapie (Acupuncture for Equine Conditions: Western Indications – Chinese Diagnosis and Therapy).
Note: Equine acupressure is a complementary modality and is not a substitute for veterinary care. Always consult with a veterinarian or a certified equine acupressure practitioner before beginning an acupressure program.