Tendinitis Management & Rehabilitation
Tendon injuries take a long time to heal (6-12 months depending on the severity) and there is very little that can speed this up. Over the years, a range of ‘therapies’ have been used to treat tendinitis. Many have been shown to have no benefit whilst others are actually harmful. Strict box rest, anti-inflammatories and cold therapy are essential immediately after a tendon injury. Tendon splitting, which involves making small incisions into the injury to reduce the inflammatory process and injection of PSGAG’s into the tendon may be appropriate in some cases. Check ligament desmotomy (surgery to cut the check ligament) reduces the strain on the SDFT but has been linked with an increase in suspensory ligament desmitis so is less commonly performed these days.
Once the initial acute inflammatory phase (first couple of weeks) is over it’s time to start moving! Studies show that the better organised the tendon fibres are when the horse returns to full work, the better the prognosis. Early mobilisation using a graduated exercise program to put the tendon under very mild strain while it heals, aims to reduce cross linking between fibres as they heal, improving the alignment and strength of repair.
Close monitoring and repeat ultrasound exams are crucial to ensure the tendon is healing well and assess when the horse is ready for the next exercise level. Individually tailoring the program to suit the horse’s purpose, temperament and facilities is also important. Careful, integrated use of water walkers and underwater treadmills can also be beneficial and the key throughout is avoiding uncontrolled exercise so box rest or small yard confinement are recommended for most horses.
Exercise on water walkers (above) and underwater treadmills (below) can be useful additions to controlled exercise programs. Photo Credit: Wild Oaks
Regenerative medicine techniques offer promising options for the treatment of tendon injuries, stimulating regeneration of new tendon tissue rather than repair and formation of scar tissue:
Platelet rich plasma is harvested from the horse’s own blood and contains high concentrations of growth factors which trigger cell proliferation and matrix synthesis. It is injected directly into the lesion itself using ultrasound guidance.
Stem cells have the ability to differentiate into tenocytes (the cells that make up tendon) within the injured area. Like platelet rich plasma, they are also injected straight into the lesion and can either be harvested from the bone marrow of the horse to be treated or grown in a laboratory. Neither of these therapies reduce the duration of rehabilitation but are thought to increase the quality of repair.
Shockwave and laser therapy have been used with some success in tendon injuries. Both increase blood supply to the area, thereby promoting regeneration and repair of the injured tissue. They are also thought to improve tendon fibre alignment and have been shown to have a stimulating effect on regenerative therapies.
In summary, a graduated and well monitored exercise program is widely considered the single most important factor in tendinitis rehabilitation with regenerative medicine techniques offering additional benefits in terms of strength of repair. If you would like more information on tendon injuries or any of these therapies, chat to your vet today.
