Treating Tendon/Ligament Injuries

The first 48 hours is a very crucial time when considering treatment. The main goals are to:

1.Reduce inflammation
2.minimize scar tissue
3.promote healing and restoration

Inflammation can be controlled through cold therapy, bandaging and drugs.


Cold Therapy





With cold therapy cold water and/or ice is applied to the leg for a short period of time. The easiest and most practical way to do this is to hose the leg. Ideally you should hose the leg for 15minutes, allow the leg to heat up and then repeat 3 times. Ice packs work better, though, because it is cooler Ice packs should be applied for no longer than 30 minutes. The most effective method is to have the leg soaked in an ice- slurry (mixture of ice and water) for a maximum of 30 minutes, because it gets the leg cool enough to make a difference. Take note that long exposure can be harmful to the healing process, by encouraging blood flow (results in
swelling).


Bandaging





Correct bandaging will help reduce and control swelling in the injured leg. Decreasing the swelling is an important part of preventing further damage to the tendon. Support bandages can be applied between each period of cold therapy. Care must be taken when bandages are applied, because if incorrectly applied they can cause further damage. Here are a few tips for making sure the bandaging is correct:

1.Use adequate padding to ensure pressure gets distributed evenly
2.Left legs should be wrapped anti-clockwise and right legs clockwise, so that the pressure runs from bone to tendon.
3.Don't apply the bandage too tight or too loose.

Bandaging should be checked regularly and I prefer re-bandaging at twice a day (morning and night).


Drugs





Consult a vet when having to use drugs. Corticosteroids should be avoided if possible, because they delay healing and weaken the tendon. Calcification or hardening can also occur at the injection site, impeding stretching ability of the tendons.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Examples of NSAID drugs are bute (phenylbutazone) and Banamine (flunixin meglumine). These drugs help to reduce inflammation, swelling and pain. They are best used in the initial stages of injury.

Dimethyl Sulfoxide (DMSO)

DMSO is used to decrease inflammation. It also neutralizes molecules released by the inflammatory cells, preventing further damage. It can be administered intravenously, orally or be applied under wrap. DMSO is used by vets as a vehicle to carry other substances, like corticosteroids, into the body. It is very volatile and latex gloves should be warn when being handled.

Polysulfated Glycosaminoglycan (PSGAG)

Glycosaminonglycans (GAGs) are a component of joint cartilage. PSGAG is a special GAG that contains extra sulfates and is used in the treatment of joint diseases. It reduces inflammation and inhibits enzyme production associated with inflammation. PSGAGs help to reduce pain and swelling and may improve the outcome of therapy. It is suggested that PSGAG therapy aid tendon healing. It should be administered within 28 to 48 hours after injury, every four days up to seven doses. The drug will either be injected around the tendon or into the muscle.

Rest




Rest is very important for healing. How long a horse should be stall rested depends on the severity of the injury. The main reason for stall rest is to minimize movement thus preventing further damage to the injured tendon/ligament. A period of stall rest will be followed by a period of controlled exercise as guided by the vet.

Controlled exercise

The purpose of controlled exercise is important for strengthening the tendons/ligament fibers. Controlled exercise will usually start with about 10 minutes of walking, working up to 40 minutes of walking. Exercise will slowly be worked up until the horse is strong enough to return to work. This can take up to a year or more, but depends on the extent of the injury.






Platelet-Rich Plasma (PRP)

This is a new treatment that can reduce the healing process from 6 months to just one month. The vet will take blood from the horse, spin it in a centrifuge to isolate platelet-rich plasma and inject it into the site using ultrasound as a guide. These platelets release growth factors that will stimulate the healing of the damaged tendon/ligament. Although, the procedure is useful in most cases, PRP is not suitable for all injuries, such as acute lesions and inflammation (because the injected PRP gets flushed away by the high blood flow).