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The Complete Guide to Tendon and Ligament Injuries in Horses

The Anatomy of Tendons and Ligaments in Horses

Tendons and ligaments are crucial components of a horse’s musculoskeletal system. Tendons connect muscles to bones, while ligaments connect bones to bones. They work together to provide support and stability to the horse’s limbs during movement. Injuries to tendons and ligaments are common in horses, and they can cause severe pain, lameness, and even permanent damage.

This article will explore the anatomy of tendons and ligaments in horses, common types of tendon and ligament injuries, and how they can be prevented.

Composition of Tendons and Ligaments

Tendons and ligaments are made up of collagen fibers, which are arranged in a way that provides both strength and flexibility. Collagen is a protein that gives tendons and ligaments their rigidity and tensile strength.

The fibers are arranged in parallel bundles, which give tendons their strength and flexibility. Tendons are thick, fibrous cords that attach muscles to bones. The primary tendon in a horse’s leg is the superficial digital flexor tendon. It is a long, thin tendon that runs down the back of the leg from the knee or hock to the fetlock.

The deep digital flexor tendon is located deeper in the leg and attaches to the bottom of the coffin bone. It is responsible for flexing the horse’s hoof.

Ligaments, on the other hand, are highly elastic structures that connect bones to other bones. The suspensory ligament is the most crucial ligament in a horse’s leg. It runs down the back of the leg from the knee or hock to the fetlock, supporting and stabilizing the fetlock joint. Check ligaments are located on the back of the lower leg and help to limit overextension of the fetlock joint.

Collateral ligaments are located on either side of a joint and provide stability to the joint.

Common Types of Tendon and Ligament Injuries

Bowed Tendon

A bowed tendon occurs when there is swelling and inflammation in the superficial digital flexor tendon. It is a relatively common injury in horses and is often seen in racehorses. It is caused by excessive strain on the tendon, leading to small tears in the fibers. Symptoms include swelling, heat, and lameness.

Deep Digital Flexor Tendon Injuries

Injuries to the deep digital flexor tendon are less common than superficial digital flexor tendon injuries. They are caused by trauma or excessive strain on the tendon. Navicular disease can also cause injuries to the deep digital flexor tendon. Symptoms include swelling, heat, and lameness.

The navicular bone can also be affected in these cases.

Suspensory Ligament Injuries

Suspensory ligament injuries are a common cause of lameness in horses. They are caused by repetitive stress on the ligament, poor conformation, or inappropriate training. The suspensory ligament is essential in supporting the fetlock joint, and damage to the ligament can lead to instability and lameness. Symptoms of a suspensory ligament injury include swelling, heat, and lameness.

Check Ligament Injuries

Check ligament injuries occur when the ligament is overstretched or trauma is inflicted directly onto the ligament. Symptoms include swelling, heat, and discomfort. Treatment usually requires rest and anti-inflammatory medication.

Collateral Ligament Injuries

Collateral ligament injuries are caused by acute trauma or chronic overloading of the joint. These injuries can cause significant instability in the joint, leading to lameness. Symptoms include swelling, heat, and pain. Treatment usually involves rest and anti-inflammatory medication.

How to Prevent Tendon and Ligament Injuries in Horses

The best way to prevent tendon and ligament injuries in horses is to ensure proper conditioning and training. Horses should be slowly and gradually conditioned to a new activity to avoid overloading the muscles, tendons, and ligaments.

Good nutrition is also essential to maintain the health of these structures. Regular veterinary checks and a proper hoof care regime can also help to prevent injuries.

Causes of Tendon and Ligament Injuries in Horses

Tendon and ligament injuries are common in horses and can range from minor strains to severe injuries that can lead to permanent damage or even retirement from athletic activity. The two main causes of tendon and ligament injuries are acute and chronic injuries.

Acute Injuries

Acute injuries refer to injuries caused by trauma and typically result in partial or complete tears to the tendon or ligament. This type of injury is often a result of direct impact or overloading of the tendon or ligament beyond its capacity.

Sprains and strains are common types of acute injuries in horses. Sprains occur when a ligament is stretched beyond its limit and can lead to tearing of some or all of the fibers within the ligament. They most commonly occur in the fetlock joint, and the symptoms include lameness, swelling, heat, and pain.

Strains are similar but occur in tendons, and partial or complete tears to the fibers can occur. Strains often occur in the superficial digital flexor tendon, and the symptoms include lameness, swelling, heat, and pain. These injuries require immediate veterinary attention and rehabilitation.

Chronic Injuries

Chronic injuries, on the other hand, develop slowly over time as a result of overuse and repetitive stress on the tendon or ligament. Chronic injuries can be the result of multiple small injuries, micro-damage from overuse, or inflammation with accompanying fibrosis.

Overuse injuries are frequently seen in horses used for endurance, racing or jumping, where repetitive high-impact forces are placed across the tendon or ligament. The injury may initially present itself as a mild lameness that appears to resolve with rest but becomes more severe and persistent over time.

The inflammation associated with chronic overuse can cause changes to the collagen fibers within the tendon or ligament leading to increased stiffness, reduced flexibility, and a reduced tendon’s ability to function correctly. These horses may take longer to warm up properly and may take longer to recover after exercise.

Risk Factors

  • Age: Older horses are more prone to these injuries due to the natural changes that occur in the tendon and ligament structure with age.
  • Conformation: The type of conformation and the way the horse moves can also contribute to the risk of injury. Horses with a long back and short legs are more likely to suffer from injuries to the suspensory ligament. Horses with straight forelegs may be more prone to injury in the superficial digital flexor tendon.
  • Training: Training and environmental factors may also contribute to the risk of injuries. Horses that are trained on uneven surfaces or work on surfaces that are too hard or too soft can be more prone to injuries. Also, horses that are exercised excessively without proper fitness levels are at greater risk.

Prevention of Tendon and Ligament Injuries

  • Proper Conditioning and Training: A well-planned and progressive conditioning program that includes regular exercise, with sufficient recovery time, can help to increase the fitness level of the horse and minimize the risk of injury. It is essential to incorporate a variety of exercises in the training program and cross-training to target different muscle groups.
  • Appropriate Shoeing and Hoof Care: Regular trimming, balancing, and appropriate shoeing can help to maintain proper alignment, footing, and biomechanics of the horse’s legs. It is important to have a skilled farrier that understands the importance of proper hoof care and shoeing.
  • Regular Veterinary Check-ups: Regular veterinary check-ups can help to identify early signs of injury and intervene before the injury worsens. A veterinarian can assess the horse’s structural soundness and recommend appropriate interventions or care if needed.
  • Safe and Well-Maintained Training and Competition Environments: Consistent footing, safe surfaces, and well-maintained surfaces can help to minimize the risk of injury and ensure a safe and comfortable environment for the horse.


Moist clay-based or herbal preparations may be used as a complimentary treatment for tendon and ligament injury. Poultices work to reduce inflammation, promote healing, and provide pain relief.

Tendon Boots

Tendon boots and fetlock boots are commonly used for protection and support. They provide stability and absorb and distribute impact forces during exercise, reducing the risk of damage to the tendons and ligaments.

Signs and Symptoms of Tendon and Ligament Injuries

Tendon and ligament injuries are a common cause of lameness and pain in horses. It’s essential to recognize the signs and symptoms of an injury early on to prevent further damage to the area.

Physical Signs

Swelling, heat, and lameness are the most common physical signs of a tendon or ligament injury. The swelling may or may not be visible, depending on the location of the injury, but the area may feel warm to the touch. Lameness is often present in horses with tendon or ligament injuries, and the degree of severity can vary depending on the type and extent of the injury. Inflammation is a common response to injury, and it can cause tissues to swell and become painful. This can lead to pain in the area, which may cause the horse to limp or appear stiff. Tenderness, pain, and swelling may be felt in various locations along the tendon or ligament, depending on the location and extent of the injury.

Behavioral Signs

Horses with a tendon or ligament injury may show signs of reluctance or unwillingness to carry out specific tasks or activities. They may be reluctant to move forward or be resistant to being ridden. Changes in gait, such as a shortened stride or uneven weight distribution, may also be apparent. A horse may appear to be traveling along fine, and then suddenly become lame or present with a decrease in performance.

Owners and trainers need to be vigilant in monitoring their horses behavior to detect early signs of injury.

Monitoring for Signs of Injury

Horse owners and trainers need to be vigilant in monitoring their horses for signs of injury. Regular checks of the horse’s limbs may be necessary, paying close attention to the legs’ tendons and ligaments. A consultation with your veterinarian may be needed to determine if a horse is at risk of developing an injury or to monitor recovery from an existing injury.

Diagnostic Methods for Tendon and Ligament Injuries

If a tendon or ligament injury is suspected, prompt veterinary attention is necessary to prevent further damage. Specialist equine veterinarians have the necessary skills and tools to diagnose the injury accurately.

Physical Examination by a Veterinarian

The veterinarian will start with a physical examination, in which they will assess the area for swelling, heat, pain, and any other physical signs. Palpation, gait analysis, and flexion tests may also be carried out to determine the location and extent of the injury. Specialized assessments may also be required to establish a diagnosis. For example, a lameness specialist may use combinations of joint blocks, ultrasound-guided injections, and other advanced diagnostic techniques.

Imaging Techniques

  • Ultrasound: Ultrasound enables soft tissue assessment and is particularly useful for diagnosing tendon injuries.
  • MRI: MRI offers a higher resolution image and is useful for imaging ligaments, cartilage, bone-related issues, and other soft tissues.
  • X-rays: X-rays are useful for ruling out potential bone-related issues.

Thermal Imaging

Thermal imaging or thermography is a non-invasive diagnostic technique that can detect temperature variations associated with increased metabolic activity in tissues. It can be a useful tool for assessing the severity of an injury and monitoring recovery.

Advanced Diagnostic Techniques

Advanced diagnostic techniques including nuclear scintigraphy and bone scans are useful for identifying injuries that lie beneath the surface. Nuclear scintigraphy involves injecting the horse with a radioactive substance that collects in areas of increased metabolic activity, such as the bone, the processes of which can be detected to provide a good overall assessment. Bone scans are fairly similar in application using different detection methods.

In conclusion, timely recognition and management of tendon and ligament injuries are crucial to prevent permanent damage and lameness. Physical and behavioral signs can indicate an injury, and owners and managers should be vigilant when monitoring their horses health. Veterinary diagnosis commonly comprises of Palpation, Gait analysis, Flexion tests, and various imaging techniques.

A team approach between the owner and veterinarian will allow the most effective treatment, management, and future prevention of injuries.

Treatment and Rehabilitation of Tendon and Ligament Injuries

Tendon and ligament injuries are a common cause of lameness and pain in horses. Prompt and appropriate treatment and rehabilitation are crucial for minimizing further injury and ensuring a successful recovery.

Early Management

The first step in treating a tendon or ligament injury is to provide adequate rest, as this helps minimize exacerbation of the injury. The horse will need to be removed from exercise and confined to a stable. Restriction of movement is a mainstay in tendon injuries to prevent further inflammation and damage. Minimizing inflammation and excessive motion will contribute to reducing the scar tissue formation that develops with the healing process.

Veterinary Interventions

Veterinary intervention is necessary in tendon and ligament injuries. Specialist equine veterinarians can diagnose injuries accurately and develop a targeted treatment and rehabilitation plan specific to the injured horse’s needs.

Treatment and management with anti-inflammatory medications such as NSAIDs and corticosteroid injections may help to reduce pain, inflammation, and swelling. In some cases, surgical intervention may be necessary, particularly for severe tendon or ligament injuries. Surgery may be used to repair torn ligaments, remove damaged tissue, or stabilize the joint.


Rehabilitation is an essential part of the recovery process after a tendon or ligament injury. The goal of rehabilitation is to restore the horse’s function and strength and minimize the risk of re-injury. Rehabilitation programs are tailored to the individual horse’s needs and the severity of the injury.

Rehabilitation may include a combination of the following therapies:

  • Controlled exercise: Gradually increasing the horse’s activity levels can help to strengthen the injured area. The exercise program should be carefully monitored and adjusted as the horse progresses.
  • Physical therapy: Therapies such as massage, stretching, and cold therapy can help to improve circulation, reduce inflammation, and increase range of motion.
  • Supportive therapies: Supportive therapies such as bandaging, poultices, and tendon boots can help to reduce swelling, support the injured area, and prevent further damage.

Rehabilitation programs can take several months, and patience and consistency are essential for a successful outcome. The horse’s progress should be carefully monitored, and the rehabilitation plan should be adjusted as needed.

In conclusion, tendon and ligament injuries in horses can be complex and challenging to manage. Prompt and appropriate treatment and rehabilitation are crucial for minimizing further injury and ensuring a successful recovery. Early management, veterinary interventions, and a comprehensive rehabilitation program are key to returning the horse to full function.

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