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Graded Exercise Protocol for Tendon & Ligament Healing

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Tendon, muscular and ligament injuries tend to heal better with consistent light and gradually increasing exercise that starts soon after injury. Progressively increasing load on these structures provides the best chance for optimal healing.

Consistent forced exercise stimulates blood flow to healing areas. Movement reduces adhesion formation of tendon to tendon sheath and other tissues. Increasing load encourages tendon and ligament strengthening as long as overload does not take place. Exercise is also always good for a horse’s psychological well-being.

Strict stall confinement does not encourage healing in the same way, and can result in poor outcomes for tendon and ligament injuries and re-injury when the horse is returned to work or turnout.

Pasture turnout provides inconsistent and uncontrolled load, and tends to result in overload of healing structures and re-injury. While pasture turnout works in some cases, it has a higher failure rate than controlled exercise. Horses put out to pasture tend to protect the injury for several weeks, then after the pain dissipates they exercise at speed, resulting in overload and fiber tearing, and re-injury.

So neither stall or paddock rest, nor pasture turnout are equivalent to progressive increase in controlled exercise.

On average, significant tendon and ligament injuries take 6-12 months to heal to the point that the structure can tolerate full load of the horse at speed with a rider up.

YOUR VET’S ROLE

Your vet makes an accurate diagnosis and determines the degree and severity of the injury. Based on this, the horse is prescribed one of several different specific exercise protocols.

Periodically, your vet rechecks the injury using clinical exam (and ultrasound in most cases) to assess healing progress. They then modify the plan as needed according to the horse’s response to exercise.

YOUR ROLE

Your role in this treatment plan is very important. You must work very closely with your vet to ensure careful adherence to the protocol and to monitor the horse’s progress. In addition, you must ensure that the horse’s other needs are being met – including basic stall care, appropriate nutrition, grooming and socialization.

Know Related Treatments

Consider Potential Side Effects & Complications

A main pitfall of this approach is premature overload of the tendon fibers and re-injury.

Should this treatment plan fail, you may unnecessarily waste time with no significant results to show for your efforts.

Consider Reasons Not To Use This Treatment

There are injuries, such as fractures, for which strict stall confinement is indicated.

Horses wearing casts and certain types of bandages cannot be exercised.

Is It working? Timeframe for effect

There are several parameters that need to be monitored in any horse undergoing a graded rehabilitation protocol.

The first is lameness. Is the horse lame? If so, is the lameness improving? Is there swelling? is the swelling improving? Heat in the overlying skin, and pain to pressure over the injured area are also indicators of re-injury. These parameters should steadily improve over time.

Generally, over weeks there should be gradual reduction in swelling, lameness and pain to pressure over the area. This should not worsen during the course of treatment.

When there is worsening in any of these parameters, immediately reduce exercise and contact your vet.

Questions To Ask My Vet

  • Can you provide a specific exercise protocol or calendar to explain the details of the rehabilitation period?
  • How can I ensure the best results from this treatment plan?
  • What should I look for and how often should we talk?
Author: Doug Thal DVM Dipl. ABVP

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