7 Steps to Recovery: Our Bowed Tendon Story

April 2017 to February 2018

April 2017 to February 2018

As promised, in this post I wanted to write a little more about Hawkins journey up to this point, which, I’ll be honest, has been slow. Excruciatingly slow in fact. Slower than molasses on a cold day, one might say. And it will continue to be slow, all the way up to the makeover. Because of one simple fact, our boy Hawkins was retired due to a tendon injury.
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Now let me put this disclaimer out there… I am NOT a vet. I would not by any means consider myself a top expert on the subject of tendon health. In this blog I am speaking as to my experience with tendons, and what I know to have worked for me and for Hawkins. If you think your horse has a tendon injury, please consult a veterinarian! With that being said, let’s talk about what I know!

As someone who has been in this business for a while, and who has specifically been rehoming off the track thoroughbreds for several years at this point, tendon injuries, specifically bowed tendons, are one of the more common things that I see. For those of you who don’t know, a bowed tendon is a tear in a tendon. It can happen to varying degrees, in various tendons. Most commonly it occurs in the Superficial Digital Flexor Tendon, which runs along the back of the leg behind the cannon bone. With the swelling it causes, it gives the appearance that the leg “bowing” out like a string being pulled back from a bow, hence the common name: A Bowed Tendon.
 
Contrary to popular belief however, a bowed tendon DOES NOT mean your horse won’t make it as a competition horse. Again, the severity of the injury will effect what levels your horse can and cannot do and they may never return to the upper levels, but for the most part, horses can come back from it. It just takes two very important things… patience and time.

When I am rehoming a horse with an injury like this I get all sorts of questions ranging from “What does that mean?” to “Can I take him to the upper levels?”. So what I would like to do here is go through a little rundown on what to do when you think your horse has hurt a tendon, specifically how I dealt with Hawkins.

Here are 7 steps to rehabbing tendons:

1. Identify the problem

It seems obvious but the first order of business is to identify that your horse has injured a tendon, and where the injury has occurred.
The most common signs of a tendon injury are heat and swelling, and this injury is often, but not always accompanied with lameness. If you have a horse that seems to have an odd swelling, an unusual amount of heat in one leg, or seems to be limping… they may have a tendon injury.

To further identity if a tendon is injured, you can also palpate the swollen/hot leg.  The most common tendons injured are the ones that run down the back of each lower limb: The Superficial Digital Flexor Tendon, the Deep Digital Flexor Tendon, or the Suspensory Tendons. These tendons run down the back of the horses’ legs in a tight rope. When you pick up the horse’s hoof, these tendons will relax and you will be able to palpate them.  Gently pinch these tendons, slowly moving from knee to ankle. If you pinch a spot that is painful, the horse will react by pulling their leg away. If this reaction is repeatable, it will help you or the vet zero in on the exact location of the injury. If you feel heat, swelling or pain and your horse appears lame, the best thing to do is to call your vet out for a lameness exam.

I was lucky enough to obtain Hawkins through the Parx Racetracks retirement program, Turning For Home. Turning For Home, does a quick history and veterinary analysis on the horses they send out, and was able to tell me exactly what was injured, where the injury was located, and when it happened. In his case, his Superficial Digital Flexor Tendon was partially torn.

2. Analyze the severity

Once you have identified there is lameness and generally located where the pain is coming from (either by feeling for heat/pain or performing a lameness exam with your vet), an ultrasound is the only way to determine the severity of the injury. The severity will then determine both the prognosis (the chances of your horse returning to work) and how to treat the horse.

Tendon injury severity can range anywhere from a simple strain to a large tear. In the case of a strain, the tendon is just overstretched not torn and the horse can be back up and running with just a few months of rest. A large tear can of course hinder the horse a lot more, and will need more rest, rehab and general maintenance than a sprain. Horses with large tears can come back to work, but are less likely to return to higher levels.

When the vet performs the ultra-sound, he or she will be looking up and down the tendons for tears. The vet will be looking at the integrity and alignment of the tendon fibers, taking cross-sectional views and evaluating the density of the tendon. These tears can show up in the ultrasound in a variety of ways depending on the damage. Tendons usually appear as very dense white structures. When there is a tear the tendon can appear thickened, the color can look grey, or you could even be able to see a black hole.  

In Hawkins case, his SDFT was only partially torn and thus his likelihood of returning to work was very good. What exactly his capabilities would be were then determined by how the tendon healed.

3. Rest

The best treatment for a tendon injury is rest, ideally wear they are moving as little as possible. The typical time for stall rest for a partial tear like Hawkins had is 6-8 months, and then continued rest in small paddocks for several more months. Less severe injuries may require less time, but first and foremost in these cases, the most important thing to do is limit their movement. There is nothing else to do except sit and watch your horse stand still. It is probably one of the most frustrating things I have ever done in my time with horses. But this is where our patience kicks in!

Hawkins arrived at my farm and the injury was about 2 or 3 weeks old, so he and I were in it for the long hall… 6 full months of stall rest. Luckily as I had said in my previous post… Hawkins didn’t mind stall rest! I was all ready for a horse who would destroy their stall, cause a scene, and pace himself into oblivion. But Hawkins just sat, happily, munching on hay as he watched all his friends leave him each night and return in the day.

The less they move the better, but if you have a quiet horse, it really helps their mental state to set aside time to hand graze them. Luckily Hawkins was happy to graze quietly and I was able to take him out 2 to 3 times a day for 10-15 minutes. As you get closer and closer to that 6 month mark, you can also start going on short hand walks. In the 5th month we started with 5 min walks, once a day. Then we slowly increased our time until he was walking for 10 min a day by the end of the 6th month.

During this time, depending on the severity, your vet may recommend that the injured leg stays wrapped in standing wraps to help support the leg. In Hawkins case, I kept him wrapped for 4 months. I would change his wrap twice a day so that it never shifted or pulled differently against his tendon. In between wrappings I would also cold hose his injured leg for 20 min to help reduce heat and swelling. There are also a lot of topical and alternative therapies that can be used to speed healing. Examples include wrapping with poultices with cooling properties, laser therapies, or shockwave. But at the end of the day, you cannot beat simply allowing your horse to rest and limiting movement.

4. Re-ultrasound.

At the end of 6 months, we are all very excited; FINALLY our horse can go out! He can enjoy the sun and frolic and he has healed! BUT WAIT! BEFORE you toss your horse out, you MUST re-ultrasound. Again, it’s the only way to tell what is going on beneath the skin, to make sure the tear is fully healed, and be able to say that your horse is ready for turnout and a slow return to work.

When you re-ultrasound the vet will be looking to make sure those black holes where the tear was are completely filled in and there are no new injuries to be seen. Luckily, Hawkins tendons appeared to be completely healed after 6 months!

Some may recommend taking ultrasounds more frequently, especially if you are returning the horse to light exercise. This is to ensure that the tendon does not get re-injured, and if it does to return to stall rest. Since I knew I wanted to use Hawkins for the makeover, I kept him on stall rest for the full six months and then took an ultrasound at the end.

Keep in mind, if you had a serious tear, the tendon may never return to the size it was before the injury. Tendons heal with scar tissue, which can be seen or felt as a lump. This scar tissue will never go away, so while the legs will get much smaller they may never be completely clean as they were before. Scar tissue tends to be stronger than normal tendon tissue, but is not nearly as elastic. Which means going forward we have to be very careful about how we return the horse to work so the injured tendon is not over-worked too quickly.

5. Turnout

The next step in the process is turnout. I highly recommend sedating your horse and turning them out in a small paddock for the first time. Remember the tendon has just healed… you don’t want them galloping around their first day out and reinjuring the weaker tendon. I usually sedate my horses the first few days and turn them out in a space where they cannot pick up a whole lot of speed, either a round pen or small paddock. After a few days I will leave them in a small paddock for a few hours at a time, slowly increasing the amount of time they are out until they can prove they will be sane for longer turnout times.

Hawkins started with an hour in the round pen a day, then across the course of 4 months moved to a small paddock and slowly increased his time out to 8 hours. He was always a very sane horse, however I always made sure if I saw him start to run around he would come inside immediately. By November he was ready for large paddock turnout, and fit right in with the pack in a typical routine of 12 hours out with a group and 12 hours in his stall.

6. Slow Return To Work
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This is the stage we are in currently. Unfortunately even if your horse has a clean ultra-sound you cannot just jump right back into work. They have has 6-8 months of zero work on that tendon, and while it has been healing, it has also been weakened from lack of use and presence of scar tissue. As such, if you just jump right back into regular work you have a high risk of re-injury. Instead, the better plan of action is to start slowly, and patiently work up to full work. In our case I started with 15 min of walking under saddle.

After two weeks I introduced small amounts of trot. Our schedule ended up looking something like this over the last few months:
Week 1-2: 15 min walk
Week 3-5: (5 min walk, 2 min Trot) x 2
Week 6-8: (3 min walk, 4 min trot) x 2
Week 9-11: (2 min walk, 5 min trot) x 3
Week 12 – 13: (2 min Walk, 5 min Trot, 1 min Canter) x 2

When I ride him, I like to use SMB boots or polo wraps to help support his tendons as he slowly increases his works.

This may seem excruciatingly slow, but as I am hoping for him to be a sport horse and we have a limited time line with the makeover approaching, I would much rather be safe than sorry! Again it is difficult for me to hold myself back from trying more and more, but I know in the end my patience will pay off when we make it through without a re-injury to set us back.

7. Return to full work

In my case I am giving myself a solid 3 to 4 months to return to full work in prepping for the makeover. But once you have followed through these steps, and been cleared by a vet, you should have little trouble returning to full work!
 
Hopefully this has helped some and reinforced others beliefs on the subject! Again, I cannot claim to be a vet, but this is what I know has worked for Hawkins, and I am happy to share! Next week I will be talking about a common setback Hawkins has experienced and how we are going to over come it!