Equine Tying Up Syndrome

Also known as exertional rhabdomyolysis, Azoturia, Monday morning disease, Set-fast, Paralytic myoglobinuria and Polysaccharide storage myopathy.

What is Tying up?

This is a muscular problem in the horse caused by the inability within the muscle tissue to eliminate the lactic acid that builds up during exercise quickly enough and thus allows it to reach toxic levels. This typically manifests with varying degrees of discomfort ranging from stiffness and mild cramps to severe cramping and inability to move to recumbency in severest cases.

What are the clinical signs?

Manipulating back points with acupuncture needles

In mild cases, hind leg stiffness and a shuffling gait may be seen. Pain may be elicited on palpation of the back and gluteal muscles.

Transient mild to moderate gait abnormalities may be observed.

Severely affected animals may suffer marked muscle cramping or inability to move.

Affected horses become very anxious, they may sweat profusely, have elevated heart and respiratory rates. Signs of extreme pain may be evident if it is attempted to move the horse.

If the horse urinates, the urine may be discolored red with myoglobin, a breakdown product of muscle.

What are the predisposing factors?

Diet and level of exercise are very important. Many cases result when a horse on a certain level of exercise are rested for a few days and kept on the same plane of nutrition. On return to exercise these horses frequently show the signs of tying up.

Training: Horses on a certain level of training that are suddenly increased to a higher level placing a much higher demand on metabolic status may tie up.

Fillies and mares that are nervous or highly-strung appear to show increased susceptibility to the condition.

Genetic factors: There does appear to be a correlation with certain genetic lines.

Post recovery from respiratory viruses horses appears to have increased susceptibility to the condition.

Back points in tying up cases.

Diagnosis of tying-up

The clinical signs are always very suggestive of the condition. However, some conditions may appear similar such as laminitis, tetany or aortic iliac thrombosis.

Laboratory back up is very important. With muscle cell damage, various enzymes are released into the circulation and can be measured to assess the condition and severity of the episode. Creatinine Kinase is one such enzyme that rises rapidly post an episode.

What should you do when encountering a case?
Stop exercise immediately.

Do not keep him walking.

Moderate to severe cases should be seen by your vet.

Provide the horse with water and add electrolytes if the horse will drink the solution.

Anti-inflammatories and intravenous fluids may be necessary as myoglobin is toxic to the kidneys.

How may one prevent it?

Point distribution along back.

Diet and exercise are very important. Maintain a regular level of exercise and any increases to level of training should be gradual.

Susceptible horses should have less grain and increased fat in the diet.

A balanced source of electrolytes and minerals is important. Calcium, phosphorous, vitamin E and selenium are important in the diet.

After a tying up episode, the horse should be rested until the muscles have repaired. This should involve limited turn out as complete box rest may be counterproductive.

The horse should then be brought back to the same level of exercise slowly.


An eight year old TB gelding in National Hunt training called “Bobby”

Acupuncture of the equine back.

A number of years ago, I examined this horse. It had a history of severe tying up episodes that despite all previous therapies was refractory to treatment. The tying up had persisted for one year. This horse was impossible to train as even in light training it was tying up. The trainer decided to send him home for a year in the hope that a year in a paddock might sort it out. As everything in the conventional cabinet was tried, I suggested to a skeptical trainer that I would try some veterinary acupuncture and the supplementation with Chinese herbs as the last chance before retiring him to the fields. On initial examination, there was significant tenderness in the muscles along the dorsal midline on either side of the backbone. A blood sample was taken to assess muscle damage. The levels of Creatine Kinase, an enzyme released from the damaged muscle, was over 2000, normal being in the range 100 to 250.

Various acupuncture points were selected along the back, paying particular attention to local tender spots and also specific points relating to the kidneys. Electroacupuncture was used and it was repeated for 20 minutes once weekly for six weeks. After the first treatment, the stable jockey riding him noticed an improvement in his action and willingness to ride out.

A course of Chinese herbs, Aniease, consisting of Tang Kuei, Peony, Rehmannia, Carthamus, and other herbs were used to compliment the acupuncture.

After three weeks a blood sample was taken and we got the confirmation of what we were seeing on the gallops. The Creatine Kinase had dropped to 250 for the first time in months.

This horse suffered no recurrence of its tying up problem in the following two years, after which I lost contact with him as he was retired with an unrelated illness.

It is my opinion that the acupuncture and herbs had a substantial effect in helping this horse recover from tying up. By relieving pain and improving muscle blood supply is how I expect they affected this improvement.

In summary, I hope you the reader have a better understanding of this condition called Tying up and can appreciate how such natural therapies such as acupuncture and herbal medicine can have such a tremendous role to play in our treatment of this and similar stubborn chronic illnesses.

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