Ask the Vet: Lameness and Rehabilitation

Answered by, Lisa Borzynski, DVM, Wisconsin Equine Clinic and Hospital
Courtesy of AAEP

Question: I am trying to rehabilitate a 28-year-old half Arabian with a tear in the front SDFT (small, of unknown etiology). I have been recommended both shock wave therapy and therapeutic ultrasound therapy. What is the difference and which might be the most beneficial? He has been used consistently for light pleasure until this summer.  

Answer: I’m sorry to hear about your old guy! It’s a testament to good care that you are still riding him at that age!

There are numerous injections such as stem cells and PRP and physical therapy modalities available now to help with healing of tendon and ligament injuries in horses. Choosing which therapy or combination of therapies to use depends on the size, chronicity, and location of the lesion, as well as the availability of each treatment and your budget!

Of course, the most important is tincture of time! Most tendon and ligament injuries will heal with time and some degree of controlled exercise. Cold hosing, anti-inflammatory treatments, and a support wrap are also beneficial in the early stages.

There is some controversy over the use of injections and physical therapy modalities and what advantages they provide. The goal of most of these is to try and improve the quality of healing to have the most physiologically normal structure when healed. They do not necessarily speed the time of healing. Many of the physical therapy modalities such as shockwave, therapeutic ultrasound, and therapeutic laser have been adapted from human medicine.

Since I have not seen the ultrasound, I can’t make a specific recommendation either way. I would say that in my hands, if there was just a very small tear, I would probably just recommend the cold hosing, wrapping and an anti-inflammatory such as a bute or topical diclofenac. I would restrict the turn out space, so that he can’t get up too much speed and further injure the tendon. I would hand walk him for 20–30 minutes per day until a recheck ultrasound at about four weeks.

If you are interested in adding one of the other treatments, I would probably go with therapeutic ultrasound or therapeutic laser rather than shockwave in this case. I use all three to some degree in my practice. They all produce a type of wave (ultrasound uses sound waves, laser- light waves, shockwave-pulse waves) that in theory stimulate and activate cells and cellular activity. I do not use shockwave for acute cases. I tend to use it for more chronic conditions and for bony lesions. It is also the most expensive.

At his age, there can be some complicating factors that can delay healing such as overall health, nutritional status, and metabolic concerns such as Cushing’s, so be sure to address these if present.Good luck to you! Hopefully, you will  be out riding again next summer!

Question: What would be your suggestion for rehabilitation for a serious hamstring injury?  

Answer: The rehabilitation process will depend a great deal on the extent of the damage, so you should work with your veterinarian to come up with a specific time line for the rehabilitation process. It also depends on how well your horse is healing. An ultrasound exam can help with determining the extent of the damage and for monitoring the rehabilitation.

In general, these require 6-12 months to heal. If there is a large tear in the muscle, he may need complete rest for a period of time to allow the muscle fibers to heal.