Bowed Tendon Injuries (tendonitis)

Bowed Tendon Injuries are a common occurrence and account for a third or more of injuries to young horses in training.

The condition occurs most frequently in racing Thoroughbreds and Quarter Horses, but Hunters, Jumpers, Barrel Racers, and Endurance horses are not immune. Recovery is frequently long and difficult — but the key solution to any bowed tendon injury is prompting it to heal with minimal scar tissue formation (Type 3 Collagen) and with as much realignment of tendon fibers as possible.

The term “bowed tendon” refers to tendonitis, or severe inflammation, of (usually) the superficial digital flexor tendon in the area between the carpus and fetlock, usually in the foreleg. While the deep digital flexor tendon can be involved, it’s much less common than the superficial digital flexor tendon (SDFT). A good anatomy chart will help you identify these specific tendons.

When a bowed tendon occurs, inflammation results from damage to the tendon tissue. This inflammation includes heat, swelling, pain, and lameness. The condition may also cause the lower leg above the fetlock to have a convex or bowed appearance — hence the name.

A tendon is a dense cord of fibrous connective tissue that attaches muscle to bone. Tendons are extremely strong, and their function is to transmit the muscle’s force to the bone, which causes the limb to move. The tendon structure consists of the tendon tissue itself, the tendon sheath, and fluid that surrounds and lubricates the tendon tissue inside the sheath.

The tendon itself is a complex structure of collagen fibers that are strong and highly elastic, and it’s the arrangement of the fibers that provide for the elasticity. Tendons typically have a good blood supply at either end of the structure, but it diminishes toward the center. The reduction in circulation results in a propensity for the middle portion to heal slowly and with the significant build-up of scar tissue, or weaker type 3 collagen.

The source of a bowed tendon is usually exercised or trauma, specifically excessive weighting, stretching and tearing of a fatigued tendon that’s caused by the application of repeated forces. Inadequate training leading to muscle fatigue at the end of a race or performance, uneven, slippery, or muddy work surfaces, and abnormal angulation of the fetlock resulting from poor conformation or muscle weakness all increase workload on the tendon and contribute to bowed tendon injuries.

Other causes can include direct trauma, as in a blow to the area, such as may occur if a horse interferes during a race, lands a jump improperly, or gets a leg tangled in a fence or other object. Since these tendons are covered only with skin, they are highly susceptible to traumatic injury.

A bowed tendon usually spells the end of a career for a racehorse due to the time, cost, and low rates of success in traditional treatments. But there are plenty of successful therapies that will allow your horse – be he a trail horse or a competitive performance animal – to recover fully.

Current therapy includes first, ICE a/k/a Cold Hydrotherapy. Remember the R.I.C.E. principle? Rest, Ice, Compression, and Elevation. Ok, it’s going to be tough to get your horse to elevate his leg, but let’s address the other aspects: Rest: Goes without saying. Give him a break and don’t work the poor animal. ICE: Plenty of it; cold wraps are also available from your veterinary supply outlet. Ice reduces swelling and the heat that is so prevalent in a bowed tendon. COMPRESSION: Compression bandages also help to reduce swelling by providing support to the bowed tendon area and by helping to transport fluid from the injured tissue.

As soon as you’ve begun cold hydrotherapy, look for a local practitioner of Low Energy Photo Therapy (LEPT). LEPT, also known as LED light therapy will help reduce swelling and increase circulation to the bowed tendon, which will speed healing and help minimize the formation of type 3 collagen. We use and sell systems from Sumerel Therapeutic Systems.

The STS-2 system includes a scanner and a treatment device. The scanner allows you to locate the exact center of the inflammation and enables to you treat it with pinpoint accuracy – remember, our goal is to heal the bowed tendon as quickly and completely as possible in order to guard against the growth of excessive type 3 collagen tissue.

This technology was pioneered and patented by CEFCO Electronics in the early 1980s and is widely used by veterinarians in the US, Europe, and Australia.

Pulsed LEDs have also been studied and used by NASA and The US Military to speed wound healing. LEPT has been the subject of countless published research studies by organizations such as the Wisconsin School of Medicine and the Mayo Clinic. We have received countless testimonials from average horse owners, Veterinarians, rodeo riders, jockeys, and show stars.

Acupuncture has also been used extensively and successfully to treat Bowed Tendons. In this type of treatment, which has been used for thousands of years, specific points on the animal’s body are stimulated by various means. These may include manual pressure, electrical stimulation, LED Therapy, and the traditional dry needles. A key concern is to be sure that your therapist is properly certified, since she may be planning to stick those needles into your horse.

Old School tactics like firing, splitting, or cutting of the tendon are unsupported by any scientific evidence. Firing has been associated with the formation of adhesions, and Dr. L. A. Silver of the University of Bristol has concluded from his studies that tendon splitting has actually delayed repair. These treatments hinder the normal growth and alignment of the collagen fibers, so when pressure is put on the tendon after these therapies, the tendon is likely to bow again. There has been some report of success reported with an experimental injection of various drugs into the tendon, but additional clinical studies are required.

For more information on bowed tendon injuries consult, a good book on Equine Veterinary care. And as always, please contact your veterinarian for expert medical care for your horse. Remember, nothing is a substitute for a well-trained professional veterinarian.

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