“Football players tear up their knees—it’s what they do. Hunters, jumpers and equitation horses are also athletes and they will get athletic injuries,” says Elizabeth Davidson, DVM, who focuses on equine sports medicine at the University of Pennsylvania’s New Bolton Center. In this article, Davidson explains how some common injuries happen, how they’re treated and how they could affect your horse’s career.

Any horse can get hurt at any time, of course. But hunter, jumper and hunt-seat equitation disciplines include demands that set horses up for certain injuries.

• Jumping stresses tendons and ligaments that support the leg during both push-off and landing. The impact of landing can also damage structures in the front feet. The bigger the jump, the bigger the stress.

• Speed increases the stress of jumping, so risks are higher for jumpers who are against the clock. Tight turns also raise the odds of a misstep that could lead to injury.

• Repetitive stress takes a toll. Many horses in these sports show year-round—and when they’re not showing, they’re schooling. “With repetitive stress, minor damage can build up in ligaments or other structures,” Davidson explains. “Then something tips it over the edge.”

What’s most likely to bench your horse? Hard statistics on injury rates in hunters, jumpers and equitation horses are limited, Davidson notes. “At any horse show you’ll see horses of different ages and breeds in different training programs and with riders at different skill levels. The variables make research difficult,” she says. Still, at a large referral clinic like New Bolton Center, many horses in these sports come in with problems in three areas that we’ll discuss below.

Suspensory Ligament Tears

The suspensory ligament acts like a sling, supporting the ankle joint as it sinks under weight and helping the joint return to normal when the weight is removed. Tucked behind the cannon bone, this ligament starts just below the knee (or hock), splits into two branches that pass around the back of the ankle and ends on the front of the long pastern bone below.

What happens: If the strain is too great, the tough fibers that make up the ligament may tear. “This is an area that undergoes repetitive stress, so it’s a common site for athletic injury,” Davidson says. “In horses that jump, both front and hind injuries occur.” Although fibers can tear at any point on the ligament, proximal (high) injuries are common. The injury may be mild with just a few torn fibers, but in severe cases, the ligament may rupture or even fracture bone as it tears away.

What you see: “Your horse may suddenly be lame, but usually damage has been building up as a result of recurring stress,” Davidson notes. “Identifying the problem as early as possible, before severe injury, gives the horse the best chance of recovery.” Early detection isn’t easy with high suspensory injuries, though. A horse with a mild injury may be barely off and because the top of the ligament is hidden under other structures, you won’t find heat, swelling or sensitivity at the site.

What to do: Your veterinarian can find the problem with local nerve blocks and a hands-on exam. An ultrasound scan will show the exact site and degree of injury to the ligament, and X-rays can show if bone is damaged. Magnetic resonance imaging (MRI) can also identify damage to the ligament. “MRI is often helpful in hind-limb suspensory injuries, when ultrasound can be difficult to interpret,” Davidson says.

Every case is different, so your vet will help you work out a treatment plan that suits your horse’s injury. Treatment usually includes these steps:

• Cool down. To reduce inflammation, your vet may prescribe cold therapy (icing or cold-hosing several times a day) and a nonsteroidal anti-inflammatory drug, such as phenylbutazone or Banamine® (flunixin meglumine).

• Stall rest to let healing begin. Your vet may advise standing wraps for the injured leg and the opposing leg.

• Hand-walking. Once inflammation is down, controlled walking encourages proper healing. Follow your veterinarian’s advice, starting with as little as 10 minutes a day and gradually increasing the time.

• Gradual return to exercise. Working closely with your vet, set up a program that eases your horse back into work over several months, using ultrasound exams to monitor the ligament and adjust the program as needed.

Your vet may suggest other therapies, such as shockwave treatments. Stem cells or platelet-rich plasma can be injected at the injury site with the goal of improving healing. Research into these new regenerative therapies is ongoing.

Surgery—neurectomy of the deep branch of the lateral plantar nerve and fasciotomy—is an option for hind-limb proximal suspensory injuries that are reluctant to heal, Davidson says. In the hind limb, a band of connective tissue traps the top of the ligament in a sort of compartment and swelling within the compartment causes chronic pain. The surgeon cuts the connective tissue (fasciotomy) and the deep branch of the lateral plantar nerve (neurectomy), relieving pressure and pain. This nerve branch serves only the top of the suspensory, so the operation doesn’t otherwise affect the horse. Your veterinarian can help decide if surgery might be the best option for your horse’s case.

What to expect: Ligaments heal slowly—anywhere from two to 12 months, depending on the location and extent of the damage. The process can’t be rushed. Re-injury is a risk even after healing because scar tissue that forms isn’t quite as strong as the original ligament tissue.

“Front proximal suspensory ligament injuries tend to heal well with treatment, but hind injuries often don’t respond so well,” Davidson says. “With conservative treatment only, less than 20 percent of horses with hind proximal suspensory ligament injuries return to previous levels. Surgery greatly improves the odds.” Keep in mind, though, that current rules bar horses from FEI competition after any neurectomy.

Sore Feet

The front feet take the brunt of landing after a jump and structures in the hoof capsule work together to handle the shock. The coffin joint—the meeting point of the small pastern bone, the navicular bone in the heel and the coffin bone in the toe—disperses the force. Ligaments that lash the joint together stretch then spring back. So does the deep digital flexor tendon (DDFT), which runs behind the joint and helps support the navicular bone.

What happens: The feet are designed to handle great forces, but jumping fence after fence takes a toll. Common problems include:

• Strains and tears in the DDFT or the ligaments in the foot

• Inflammation in the coffin joint or in the navicular bursa, a fluid-filled sac that helps cushion the navicular bone from the pressure of the DDFT

• Deep bone bruising, which can appear in any of the foot bones

• Inflammation and degeneration of the navicular bone

“Sometimes there are multiple problems,” Davidson says. “Again, these are injuries that occur through wear and tear—damage builds up until it hits the tipping point.”

What you see: “Because the injured structures are hidden by the hoof capsule, you don’t see swelling or other signs,” Davidson explains. “Often these problems are bilateral, involving both front feet, so the horse may not be obviously lame. He may begin to move with shorter strides, but the gait is still symmetrical.” Or the horse may be lame and improve with rest, but be sore again when he goes back to work. He may rest a front foot or shift weight from one foot to the other when standing.

What to do: A lameness exam and diagnostic nerve blocks will help the vet determine the general site of soreness. Often it’s in the heel, or caudal, region, where several key structures come together. But to treat the problem, you need to know which structures are injured.

X-rays can reveal bone damage, but they won’t show soft-tissue injuries. Ultrasound is great for imaging soft tissues in the leg, but it’s hard to get a clear ultrasound image in the hoof capsule. The best tool, Davidson says, is MRI. “With MRI we are able to look inside the hoof capsule and sort out these problems much better than in the past,” she notes. The results will help your veterinarian target treatment to fit the injury.

• A tendon or ligament injury needs a long period of rest, six months to a year. You’ll follow more or less the same program as you would with a suspensory injury with stall rest followed by a gradual return to work. The vet may recommend directed injections of platelet-rich plasma or stem cells.

• Inflammation in the coffin joint or the navicular bursa may respond to directed injections of corticosteroids, which are powerful anti-inflammatories, and hyaluronic acid, which is a natural component of cartilage and joint fluid.

• A bone bruise needs rest. This injury isn’t as serious as a fracture, but there is microscopic damage to the bone and fluid builds up within it. Healing can take three or four months depending on the degree of bruising.

• When the navicular bone is chronically inflamed, it responds by remodeling, losing mineral content in some areas and developing lumps of new growth in others. This pattern of inflammation and degeneration is often called navicular disease, and it doesn’t heal with rest.

What to expect: A horse with a mild injury has the best chance of recovery, but Davidson notes that rehabilitation can be challenging. “In sporthorses, significant pathology in the foot doesn’t have a good outlook. When the horse goes back to work, he stresses the same structures—so reinjury is likely,” she says.

Good trimming and shoeing are essential to keep the horse comfortable, regardless of what structures are involved. It’s important to keep the hoof trimmed at the correct angle, so the bones are properly aligned and the foot breaks over easily. Wedge pads or bar shoes can help take pressure off the heels. When problems persist, though, the horse may have to switch to a lighter work program.

Joint Problems

Elite horses are especially prone to joint problems. “Jumping a lot of big jumps—and jumping every weekend—stresses joints and eventually triggers degenerative joint disease (DJD),” Davidson says. Common sites include the hocks and ankles, but DJD can develop in any joint that comes under stress when the horse works.

What happens: Chronic inflammation in the joint from injury or simple wear and tear sets off a destructive chain of events. The viscous fluid that fills the joint becomes thin and watery, so it doesn’t lubricate the cartilage that cushions the working surfaces so well. Under pressure, cartilage starts to wear away and the joint stiffens. There’s more concussion on the bones, which respond by remodeling. Lumps of new bone growth appear in the joint.

What you see: Joint problems often creep up gradually. At first your horse may be mildly sore or stiff or just seem less fluid or less forward, especially at the start of work. The soreness may improve with rest, but it returns. Over time it worsens and begins to affect his performance over jumps. You may find heat or swelling in the affected joint.

What to do: Your vet can perform a lameness exam and other tests to diagnose DJD. X-rays can show damage to bone and cartilage, but by the time this damage shows up the destructive process is well under way. Damage to the joint can’t be reversed, but you may be able to slow the progress of the disease by managing inflammation. Anti-inflammatory medications like phenylbutazone can help the horse weather a flare-up, but for long-term management there are other options.

Management Options

Regardless of which modalities an owner and veterinarian elect to use when approaching equine joint health, it’s important to approach DJD or osteoarthritis (OA) not just as a cartilage or even a joint issue but, rather, a “whole-horse disease.”

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These ubiquitous drugs, such as phenylbutazone (Bute), help keep horses with inflamed joints comfortable and are widely used as part of the approved multimodal treatment approach to OA. In older horses who do little to no work, NSAIDs can help control comfort and maintain quality of life. In performance horses, however, experts agree that NSAIDs should not be the base of your treatment program.

“I think that NSAIDs can have a place in performance horse management,” says José M. García-López, VMD, Dipl. ACVS, ACVSMR, associate professor of large animal surgery at the University of Pennsylvania’s New Bolton Center. “These can safely be used at a low dose and while monitoring the overall health of the horse, either during conditioning or rehabilitation from an injury.”

Intra-Articular Therapies: In lieu of relying on NSAIDs to help maintain joint health, veterinarians often use intermittent intra-articular therapies to control joint discomfort in performance horses. In a recently published survey, 407 equine veterinarians provided information regarding some of the more popular therapies currently being used in performance horses. Based on that survey, corticosteroids—primarily triamcinolone and methylprednisolone—are still one of the first-line, intra-articular therapies. Practitioners frequently co-administer hyaluronic acid with those intra-articular corticosteroids.

Despite these tried-and-true articular therapies, Kyla Ortved, DVM, PhD, Dipl. ACVS, ACVSMR, assistant professor of large animal surgery at New Bolton Center, says the tides are changing.

“I think using orthobiologics early in the disease process is better because they are designed to prevent further damage and promote healing,” she said. “If I have a horse with lameness or pain attributable to a particular joint, I won’t hesitate to use orthobiologics in the early stages of disease. And I feel more comfortable using these before jumping to steroids as I think they are more protective of the cartilage.”

Other Intra-Articular Therapies: Another intra-articular product available for horses is Polyglycan®, which is essentially a synovial fluid replacement product. “I use Polyglycan®, which is made of a patented formulation of hyaluronic acid, chondroitin sulfate and N-acetyl-D-glucosamine, at the end of any elective arthroscopic procedure and also as my hyaluronic acid fluid replacement product of choice,” said García-López, citing a 2009 study out of Colorado State University that showed Polyglycan® to have the potential to have both symptom- and disease-modifying effects.

Polyacrylamide hydrogels are also available for horses with OA and gaining popularity. Polyacrylamide gels are synthetic products, not orthobiologics, injected into the joint to provide lubrication and shock-absorbing properties. In one study of a 2.5% polyacrylamide hydrogel product, researchers reported that 83% of treated horses were lame-free at four, six and 12 weeks following administration.

Despite study findings, García-López believes more unbiased research is needed on these products.

“There is subjective evidence that these gels can create fibrosis of the synovium and granulation tissue formation that, in turn, can affect the composition of the synovial fluid, which is the main source of nutrition to the cartilage in adult articulations,” he said. “This family of gels could be considered in end-stage cases of OA but maybe not in early or moderate cases of OA.”

Intramuscular Therapies: It’s important to keep in mind that OA management is multimodal, and intramuscular (IM) polysulfated glycosaminoglycan (Adequan®) is still recommended by veterinarians.

“I like to use Adequan® in performance horses,” Ortved said. “I generally recommend 500 milligrams IM every four days for seven treatments every six months or at time of injury.”

García-López agrees with Ortved, adding, “In horses that have either early signs of joint inflammation or OA without significant morphologic changes, I like to place them on a course of IM Adequan® for the one dose every four days for seven treatments. This has shown good objective evidence for helping restore the ‘steady state’ between production and destruction of cartilage components. Basically, it is quite helpful to keep what is good, good.”

Physical and Alternative Therapies: Many other therapies can help round out a performance horse’s joint management plan. “Physical therapy is a huge part of management and something we need more data on and help from specialists integrating into practice,” Ortved noted.

Examples of such physical therapies include postural exercises and exercises designed to improve coordination and proprioception, target muscle atrophy/weak muscles (potentially secondary to joint discomfort and disuse) and increase joint stability through conditioning. Additional therapies you might consider to help keep your performance horses’ joints comfortable include extracorporeal shock wave therapy (ESWT), laser and acupuncture/electroacupuncture.

Oral Joint Health Supplements: Many owners give their horses joint supplements, making these products one of the most popular types of equine supplement on the market. Of the studies performed in horses, evidence does support the use of some ingredients, such as (but not limited to), glucosamine hydrochloride, chondroitin sulfate and avocado-soybean unsaponifiables (ASU). Glucosamine is believed to play a role in the formation and repair of cartilage, chondroitin sulfate helps give cartilage its elasticity, and hyaluronan helps lubricate joints and form the matrix of articular cartilage. Some studies also suggest that ASU may reduce inflammation and protect cartilage.

But García-López cautions that data regarding the use of oral nutraceuticals in horses is lacking. “Nutraceuticals should not replace treatment with other products such as Adequan®, Legend®, Polyglycan® or intra-articular therapy, whether it is with an orthobiologic or corticosteroid,” he noted.

Nutraceuticals are not required to meet the same standard for Food and Drug Administration approval as drugs are, and so their efficacy has not been studied as extensively. However, equine and human research suggests that some of these substances have protective effects. Your veterinarian can help you decide what’s best for your horse.

Appropriate Conditioning: Adjusted work levels can help. Moderate exercise is good for joint health, but too much can trigger inflammation. Increase the horse’s turnout, give him longer warm-ups and let him be your guide in how much work you do. As long as he stays comfortable, you’re probably on the right track.

“Conditioning cannot be overlooked,” adds García-López. “Equine athletes have their entire weight, which biomechanically increases exponentially during exercise, transferred through one or two limbs at a time. They need to be properly conditioned in order for all musculoskeletal components, including muscle, tendon, ligament, bone and cartilage, to share the load adequately.”

No matter which strategies you and your veterinarian ultimately integrate into an athletic horse’s joint-health plan, as a team you must critically evaluate and reevaluate that plan regularly to make sure you’re optimizing each individual horse’s treatment to his particular needs, balancing equine ability with fragility.

Keep Him Sound

“Injuries happen because of what these horses do,” Davidson says. You can’t eliminate the risk entirely and you can’t stop the clock when it comes to aging. “Most of us have one horse and we invest a lot of time, energy and money in that horse,” she notes. “We ask horses to be athletes, but we forget sometimes that they can’t keep performing at the same level forever.”

Still, many factors that increase the risk of injuries are in your control. Take these steps to help your horse stay sound for many years to come:

• Don’t overtrain or overface him. Keep his work within his ability and be sure he’s in shape for what he’s asked to do. “Fitness—respiratory, cardiovascular, muscle, tendon, ligaments and bone fitness—helps avoid injuries,” Dr. Davidson says.

• Keep up with shoeing. Long toes and low heels put stress on the feet and on the joints, ligaments and tendons in the legs. Be sure feet are trimmed regularly so toes are kept short and use shoes with rolled toes to ease breakover if necessary.

• Use good sense on bad footing. If horses are sliding around in the ring, ask yourself: Is this class or this schooling session worth the risk?

• Stay alert for subtle trouble signs. Do a daily hands-on leg check, comparing opposite legs to detect heat, swelling or sensitivity. Watch for shortened strides and other markers of soreness. Give the horse a few days off if you suspect a problem. If the signs return when he goes back to work, ask the vet to check him out. A mild problem can blossom into a career-limiting condition if it’s ignored.

This article originally appeared in the June 2016 issue of Practical Horseman, but was updated in 2025.

One day there was a menacing blue manure bucket in the corner that Rio was sure contained a variety of monsters. Another time, two geese outside the arena got into a honking contest, and the gelding ran for the hills. Most offensive, however, was a lesson following a Halloween-themed show. The three straw bales and small scarecrows that comprised a jump were more than Rio could handle and resulted in a snorting, pawing bucking hissy fit.

To ensure there weren’t any underlying health issues going on, including his eyesight, Neth had her veterinarian out, who gave Rio a clean bill of health. Occasionally, she and her trainer tried giving him a calming paste, but didn’t see much of a difference, so after hearing about cannabidiol (CBD) products for horses, she decided to give it a try.

While the results weren’t instantaneous, Neth said within a few weeks, she did start to see a noticeable difference in her gelding. Every once in awhile, something out of the ordinary still startled him, but overall Rio seemed much happier and more chill about situations that would normally have set him off.

You’ve probably heard about the benefits of CBD for humans and dogs, but in recent years a number of companies have focused their research on CBD in horses. As a result, it’s gained popularity as an alternative or complementary treatment for a variety of equine issues, particularly those involving pain, inflammation and anxiety. Researchers, however, are still working to fully understand how CBD works in equines.

To help you determine whether a CBD-based product might be beneficial for your equine partner, we’ll explain how it affects horses’ physiology, the best modes of administration and the various types of products on the market.

Cannabis Connection: What Is CBD Exactly?

Holistic veterinarian Joyce Harman, DVM, a leading authority on equine acupuncture and alternative medicine, explains that CBD is derived from cannabis plants, a genus cultivated around the world for thousands of years. Archeological evidence suggests that cannabis plants, which originated in Asia, were used by humans as early as 2800 BCE.

There are two main species of cannabis, and many strains within those related species. Hemp-type cannabis includes varieties traditionally cultivated for their fiber (rope, twine, etc.), seeds (for food) and oils. Other types of cannabis, classified as marijuana strains, have been used for centuries for ritual, medicinal and recreational purposes.

The active ingredients in all these plants are chemicals called phytocannabinoids. The marijuana strains of cannabis plants are cultivated to produce high levels of tetrahydrocannabinol (THC), a psychoactive (mind-altering) phytocannabinoid. By contrast, the hemp strains, which contain cannabidiol (CBD), are not considered psychoactive. Studies in people and animals suggest that cannabidiol can relieve anxiety, reduce inflammation and provide pain relief. It’s also prescribed to treat some types of epilepsy.

“The difference between hemp and a marijuana plant is the amount of THC,” Harman said. “The plants we want for our animals are hemp plants. They have been selected and cultivated for high CBD and little to no THC.” 

After the 2018 Agriculture Improvement Act removed industrial hemp from the definition of marijuana in the Controlled Substances Act, hemp was legally separated from its psychoactive cousin and new uses of the plant became economically feasible. Nonetheless, regulations governing CBD are constantly changing, with states taking different approaches to the sale of CBD products, so be sure to stay up to date on your state and local laws.

Benefits of CBD for Horses

Calming Effects:

One of the primary claims made about CBD centers on its calming effects. But unlike the psychoactive “high” produced by THC in marijuana, CBD is believed to soothe stress or anxiety. “Many horse owners and veterinarians have seen positive responses with CBD in animals that have been through stressful periods,” Harman said. “It helps with mental equilibrium.”

CBD interacts with the body’s endocannabinoid system, which regulates many physiological functions, including appetite, mood, pain sensation and immune response. By binding to certain receptors in the endocannabinoid system, CBD can help modulate these functions.

“CBD doesn’t make horses ‘stoned’ like THC would. The brain is still functioning normally,” Harman explained. “The horse is calm but if there is cause to be alert, the horse is still capable of being alert.”

It’s important to note, however, that these calming effects have not been proven in clinical studies, but Harman believes horses are excellent candidates for CBD trial therapies because modern equine management practices tend to put horses at risk of chronic stress. As we know, horses are designed to roam and constantly graze, but unfortunately many horse owners don’t have that option. The United States Department of Agriculture estimates that 6,000 acres of the country’s open land are lost every day due to the increasing demand for urban and suburban development, which translates into real-world hardships for many equestrians and horse owners.

“Equine athletes are sometimes confined in small spaces, separated from their social groups and asked to do things that don’t come naturally to them,” Harman noted. “Many horses are on edge all the time. When we get on them, they spook at everything. CBD can help them stay calm and ‘forgive and forget.’”

Inflammation and Pain:

CBD also shows promise for treating chronic pain in horses. Harman says it may be beneficial for helping with laminitis, insulin resistance, musculoskeletal pain, skin disease, chronic ulcers, uveitis and even Lyme disease.

“Cannabinoids have action in both acute and chronic pain by modulating pain signals in the central and peripheral nervous systems and acting similarly to an anti-inflammatory,” Harman wrote in her 2020 Innovative Veterinary Care Journal article. “CBD can also act as an antioxidant and support immune function.”

While CBD is rarely the only treatment a horse receives, it may offer pain relief without the potential side effects of long-term use of conventional anti-inflammatory drugs like phenylbutazone (bute). CBD’s effectiveness against chronic pain has yet to be scientifically proven and it appears to vary greatly among individual horses. But Harman advocates trying CBD, particularly when traditional treatments have failed to alleviate pain.

Types of CBD for Horses

CBD products for horses are available in pellets, powders and oils. Powders and pellets can easily be distributed in your horse’s grain rations. For powders, Harman advises selecting a product that is 100% hemp with nothing else added; while pellets often contain alfalfa or added mold inhibitors.

CBD oils are extracted from the hemp plant and then mixed with an oil base. “Any type of safe, healthy oil is fine to dilute it in—usually hemp seed oil or MCT oil from coconuts—to get an amount you can measure in a dropper for feeding,” she said.

While some people claim that rubbing the CBD-infused oil into a horse’s gums is the fastest delivery method to get cannabidiol into his system, Harman says it’s often more practical to add CBD to his feed, especially as recent studies suggest that it’s better absorbed when administered with food.

CBD Dosage for Horses

The amount of CBD needed to achieve the desired effects in horses varies, as individuals responds differently to the compound. However, it’s always important to follow the specific manufacturers’ feeding directions.

Fortunately, Harman notes that CBD has a relatively solid safety record in many species and also seems to be well tolerated by horses in preliminary studies. “One thing we know about CBD is that the parts of the brain it works on will not be adversely affected by overdose,” she said.

Still, it’s wise to be cautious about giving your horse too much CBD. Research has shown that higher doses of CBD can change liver enzyme levels in people and animals—although this may not be a problem, according to recent studies. But again, be aware that there aren’t specific studies in horses.

Harman advises to establish the smallest effective amount of CBD for your horse and stick with that. “I recommend starting at about 25 milligrams for about a week or 10 days. If you aren’t seeing improvement in the condition you’re trying to help, then double the amount (50 milligrams) for a while,” she said. “If that’s still not working, you can go higher until you find the level that works in that particular horse. But it’s always best to follow the manufacturer’s instructions as the quality or concentration can vary considerably.”

When administering CBD to combat inflammation and discomfort, Harman says a large loading (initial) dose might be helpful. “You might start at 50 milligrams for a week and increase it if necessary—on up to 200, if need be, and stay there for a few weeks or a month,” she noted. “If the horse becomes sound and is no longer in pain, you could back down until you find a comfortable level.”

If maximum doses of different CBD products don’t produce the desired results in your horse, it’s time to look for other alternatives. Regardless of the hype, Harman stresses that CBD isn’t a cure-all, and it won’t help every horse.

Potential Downsides

The potential benefits of CBD are clear. But there are also possible downsides. One of those concern comes from the fact that rules and regulations governing CBD products are often unclear and still evolving. Although the Food and Drug Administration (FDA) has approved a CBD prescription medication for treatment of certain types of seizures, the agency has declined to issue rules for other CBD products.

“It’s not apparent how CBD products could meet safety standards for dietary supplements or food additives,” said FDA Principal Deputy Commissioner Dr. Janet Woodcock in a statement explaining the decision. “The use of CBD raises various safety concerns, especially with long-term use. Studies have shown the potential for harm to the liver, interactions with certain medications and possible harm to the male reproductive system. CBD exposure is also concerning when it comes to certain vulnerable populations such as children and those who are pregnant.”

The FDA is calling on Congress to establish a regulatory structure to ensure the safety and efficacy of CBD products.

Regulatory Gaps

Until those regulatory gaps are bridged, Harman advises sticking with CBD products offered by well-established companies that are transparent about their ingredients and production standards. “When you see inexpensive CBD products, consider that there is often a reason they are so inexpensive,” she warned.

And especially if you compete with your horse, keep in mind that most equine sports’ organizations prohibit anything that might alter or enhance performance, including CBD. That means horses may be tested for CBD along with other prohibited substances.

To stay in compliance with competition rules, Harman suggests administering CBD between events. “We don’t know yet what a safe withholding time would be for all horses,” she noted. While it’s generally recommended to withdraw a horse from CBD seven days prior to competition, it can vary by individual.

Horses who compete less often, as well as those in rehab or on a break from competition, may benefit from CBD administered during down periods. “Then, if your horse is functioning in a calmer way, you may have improved the condition of his endocannabinoid system,” Harman said.

CBD Shopping Tips

As with any supplement, it’s best to purchase CBD supplements only from well-regarded manufacturers. “Reputable companies use organically grown hemp for their CBD products, but certification of organic status has only recently been granted to the hemp industry,” Harman pointed out. “Some products are grown responsibly, using organic methods, but are not certified as organic yet because the process is expensive and can take several years for a farm to obtain.”

Certificate of Analysis

A reputable company selling CBD products will also publish a certificate of analysis (COA) for each product on its website, verifying that it has paid to have these products tested. The COA lists everything in the product: the cannabinoids, any terpenes (other beneficial plant compounds), any solvent contamination, heavy metals, other chemical residues and microbiology—as well as any molds or bacteria.

It’s also smart to consider how a product was processed. “CBD can be safely extracted using carbon dioxide (CO2) or high-quality, organic ethanol,” Harman explained. “The cheap way is to use nasty chemicals like benzene. Your local gas station or convenience store might sell CBD, but you may be getting other chemicals along with it.” The COA will tell you whether there are residues left over from processing and whether the plants were grown in soils free of heavy metals or other contaminants. It will also tell you the strength (actual amount) of CBD in  the product.

THC Content

In addition, you want to verify that the product contains little to no THC, which can occasionally be present in trace amounts. The legal amount of THC to be in a CBD product is 0.3% and that amount will have no psychoactive effect. While Harman says that THC might be helpful in horses with cancer, dogs are highly sensitive to it, and researchers don’t know enough about THC to recommend its use in otherwise healthy horses.

For More:

SmartPak Equine commissioned a study on the safe use of their CBD ingredient at Louisiana State University School of Veterinary Medicine that was published in the Journal of Equine Veterinary Science, a  peer-reviewed scientific journal. You can read more about it, here. 

About Joyce Harman, DVM

Joyce Harman, DVM, has more than 30 years of experience in holistic veterinary medicine. She is the founder and owner of Harmany Equine Clinic in Flint Hill, Virginia. After receiving her veterinary degree from the Virginia-Maryland Regional College of Veterinary Medicine in 1984, Harman decided to explore alternative approaches to animal health. Over the years, she has incorporated a variety of holistic modalities into her practice, including acupuncture, herbal medicine, homeopathy, CBD and chiropractic care. Her website contains educational material, and she is currently working on an online nutrition and holistic health course. Harman is the author of The Horse’s Pain-Free Back and Saddle-Fit Book and is a sought-after speaker on veterinary topics around the world.

“Textbooks for veterinarians and farriers describe the normal foot, but we don’t really know what a normal foot is,” says O’Grady. What’s normal for one horse may not be normal for another.

Guideline 1: Hoof–Pastern Axis

“We must take breed into consideration, the ground the horse travels on, use of the horse, etc., but we can implement guidelines regarding what is considered a good foot,” O’Grady says. 

To start, reviewing a brief anatomy lesson of the bones that make up the pastern and hoof is helpful: The three bones of the horse’s digit are the long pastern bone (the proximal phalanx), the short pastern bone (the middle phalanx) and the coffin bone (distal phalanx). The horse’s cannon bone (third metacarpal) and the long pastern bone form the high-motion fetlock joint (metacarpophalangeal joint). The long pastern and the short pastern bones form the low-motion pastern joint (proximal interphalangeal joint). And the short pastern bone, the coffin bone and the navicular bone (distal sesamoid) form the coffin joint (distal interphalangeal joint). Furthermore, the hoof capsule is defined as the wall, sole, frog and the bulbs of the heels.

“If we stand the horse on level ground, we want a straight hoof–pastern axis. If you draw a line through the bones of the digit to the ground, it will form a straight line,” O’Grady says. “This also creates a straight line on the surface of the pastern and the dorsal (front) surface of the hoof capsule, which is important for any horse.”

The hoof–pastern axis affects the position and angle of the coffin joint. “Weight is borne most efficiently when it goes through the middle of the joint rather than in front or behind the center of the joint if the angle is out of alignment,” he adds. 

“Secondly, with a straight alignment, the bottom of the coffin bone is parallel to the ground so the entire bottom of the bone bears weight. If a horse has low heels, the bone is tipped up at the toe; more weight is on the back of the foot. If it’s a club foot, the bone is tipped in the other direction with more weight on the toe. A straight hoof-pastern axis provides a good relationship between the bottom of the bone and the ground,” says O’Grady.

Guideline 2: The Bottom of the Hoof 

“Next, we look at the middle of the foot from the bottom—the widest part. You can actually measure it and then know that the center of rotation will be a few millimeters behind that point—toward the back of the foot,” O’Grady says. The center of rotation is a guideline used to find and maintain a proportional foot, as well as distribute weight and stress evenly. “The center of rotation is our starting point for biomechanics and also for the trim. If we draw a line across the widest part of the foot, we know where the center of rotation is and strive to have approximate proportions (though not always equal) of ground surface on either side (front to back) of the middle of the foot. The proportions are important so that weight bearing is distributed evenly on either side of the center of rotation.”

An owner, vet or farrier can look at the bottom of the foot and draw an imaginary line with the eye across the middle of the foot and visualize those proportions. “Two of the biggest issues we see with proportions are long toes and/or heels not trimmed appropriately and short shoes.” This will change those proportions on the ground surface. 

Guideline 3: The Slope of the Coronary Band

To further determine if the hoof has good conformation, look at the hoof from the side and assess the slope of the coronary band. “It should go from toe to heel with a nice, gentle slope. If the coronary band approaches horizontal, the heel is too high (club foot). If the coronary band forms [a severe] angle from toe to heel, nearly to the ground, it’s a low heel,” says O’Grady.

Looking at the horse from the front, standing on flat ground, a line through the coronary band should be parallel with the ground. If the coronary band slopes to one side or the other, the hoof wall on one side is too high or low.

“If you look at the horse from behind and get down low enough to look at the heels, often there will be one foot with high heels and one with low heels. This is a common problem in sporthorses called mismatched feet. Looking at the height of the heels on each foot from behind, if the coronary band on one side is a different length and higher than the other, this is termed a sheared heel, which means the horse is overloading one side of the foot. The farrier should look at the whole horse and assess hoof conformation before he or she starts trimming and shoeing.”

Additionally, one of the first things a person looks at when picking up the foot is the frog. “If the horse does not have a healthy frog, it’s not a healthy foot. Defined, the hoof capsule consists of the wall, sole, frog and the bulbs of the heels. Therefore, if any one of those structures is abnormal, or not healthy, it affects the entire hoof capsule. A horse with any kind of hoof capsule distortion, such as club foot, long toe–low heels or sheared heels, will have a compromised frog,” he says.

In hind feet, there are additional problems. “The low-heeled, bull-nosed conformation, where the dorsal hoof has a rounded or contour shape in the hind feet, is all too common in show horses, and can affect performance,” he says. This hind-foot conformation places excessive weight bearing on the heels leading to discomfort and lack of propulsion.

Guideline 4: Watch the Horse in Motion

After evaluating the hoof when the horse is standing still, watch the horse in motion. “When a horse walks on a firm, level surface, he should have a slight heel-first flat landing. If he lands markedly heel-first, with a toe flip, either the heels are not trimmed appropriately and/or he’s wearing a size smaller shoe than he needs, which decreases the ground surface area of the foot,” says O’Grady. A marked heel-first landing puts extra load and concussion on the heels and related soft-tissue structures, and this concussion travels up the leg.

“Toe-first landing is definitely abnormal. When this occurs, the horse may have pain in the heels, thus avoiding the heel area, and lands on the toe or has a shortening in the muscle–tendon unit in the leg above, which won’t allow the heels to reach the ground during the stride. These horses usually have a higher heel as they try to compensate for shortening of the muscle-tendon above,” says O’Grady.

Conformation Factors

How a horse loads the foot is dictated by limb conformation. In motion, looking at a horse from the front or back and observing how the foot lands, some hooves will land asymmetrically. If you look at that horse from the front, he may have a narrow chest, with the front legs rotated outward. “When he breaks over, he breaks over toward the outside and then the foot has to swing in on an arc and doesn’t allow the foot to land flat. Generally, they land on the outside of the foot and then load the medial [inner] side. If the horse lands asymmetrically, he will have a sheared heel on the overloaded side.

“Yet some farriers think a horse should land flat when looking at them from the front or back. If you attempt to make a horse land flat, you are going against that animal’s conformation [which puts excessive stress and strain on some other parts of the leg]. There are numerous ways we can compensate or manage these horses that land asymmetrically, but we don’t want to make them land flat if their conformation dictates otherwise,” he says.

“Those scenarios are readily distinguished as the horse walks, before the farrier starts to trim the foot, and the combined observations should influence how that horse is shod,” says O’Grady.

How Much to Trim

Shoeing any horse is all about the trim. “The heels should be trimmed to the base of the frog, if possible, so all the structures in the heel share weight-bearing. When you put a rasp across the bottom of the hoof at the heels, it should touch all surfaces on both the frog and the heels. My goal is simply to trim the heels so the frog and the hoof wall at the heels are on the same horizontal plane. In most cases, we can attain that goal,” says O’Grady.

“With some horses, however, you can’t trim the heels that far back because there’s not enough hoof wall or the frog has prolapsed toward the ground. If the frog is located below the wall, we may remove the shoes for a few days so the horse can stand on the frog and reposition it,” he says.

“Some people feel you should not trim the heels, thinking it will make them lower, but it doesn’t. Heels continually grow forward, and the horse loses ground surface on the bottom of the foot. Heels don’t grow tall; they grow forward,” O’Grady adds.

“We tend to over-trim sporthorses. When winter show season starts and horses go to Florida, they’ve usually had a little time off before they arrive and sometimes the shoes were pulled off for a brief period.” This allows the heels to relax, grow and expand, which will improve function and improve the foot conformation.

“However, when the show season starts, horses are shod with pads, impression material, etc. As the horse goes through the season, the work increases, and he is shod every four weeks. The horse will start to lose hoof mass from the increased work combined with continual trimming,” he says.

It may be better on alternative resets to just shape the foot a little, leave the mass on the bottom of the foot and put the shoes back on, instead of trimming every four weeks. “At the next reset, we might need to trim a little more, but we usually don’t give these horses enough time to regrow what we take off, and the horse has less sole. If the soles are getting a little thinner by the end of the season, that’s the time to use a pour-in or put pads on for extra protection, not before,” O’Grady explains.

The Effects of Footing

“Most competition horses work on deformable surfaces [surfaces that change their shape] or synthetic footing. This is usually sand-based with different materials added,” O’Grady says. The footing a horse will be working on is often taken into consideration by the farrier in determining how to shoe the horse.

“Synthetic footing can be too soft or too hard. If it’s too hard, there will be too much concussion when the foot lands, and we have to protect the foot a little more to minimize that concussion. If footing is too deep, the foot sinks in more and puts stress on soft tissues above the foot. Footing can be too deep or too loose,” he says.

“When the foot lands, it slides for a few milliseconds. If footing is too hard or the shoe has too much traction, it stops the foot abruptly. If footing is too loose, the foot slides too much. When footing is too loose, it affects the foot when it lands, bears weight and breaks over. There’s not enough grip to allow the toe to propel the horse forward,” O’Grady says. Loose or very soft footing affects the slide when the foot lands and also affects the horse when he’s turning sharply.

Footing at various competitions may be different, and often arrangements are made to have the horse reshod to try to match the footing. “If the footing is soft, the farrier will use shoes with a ‘flotation’ effect and more surface area like a bar shoe, spider plate or a shoe with wide branches to keep the foot on top of the surface,” he explains.

“A three-day event horse will be on synthetic footing for dressage and show jumping, but cross-country might be grass—and that’s where the farrier may use traction devices or slip a pad between the foot and the shoe to protect it,” says O’Grady. The shoe is adjusted to compensate for different surfaces. The shoe itself forms a rim around the foot with the sole forming a cup, which creates more traction.

Other Issues

“One of the issues with sporthorses is shoeing intervals. Sometimes they are let go too long and sometimes they are shod too often. The optimal interval for farriery would be four to six weeks,” O’Grady explains.

It also helps to know the horse and have a feel for what’s right for that horse. A good rider is in tune with the horse and can tell if something is a little off. “If an accomplished rider or trainer tells the vet or farrier the horse is not right, they need to pay attention. The rider can feel things we can’t see,” O’Grady says. 

“Many things can be done with farriery, but we all need to be working together on the same page,” he adds. Vets, farriers, horse owners and riders need to evaluate the horse together, using guidelines that apply to any horse’s foot. “These guidelines can be used for evaluation and to apply appropriate farriery,” he says. 

“If a horse is well shod and has strong, comfortable feet, he will last a lot longer and be able to perform at the top of his game and is less likely to have lameness problems,” O’Grady says. It’s important to talk with the farrier and know why the horse is being trimmed or shod a certain way.

About Stephen O’ Grady

Stephen O’Grady, DVM, MRCVS, of Virginia Therapeutic Farriery, focuses on foot disease and equine therapeutic farriery. He combines his skills as veterinarian and farrier to better understand and treat problems of the foot. O’Grady has written book chapters and many peer-reviewed papers in veterinary and farriery literature. His career has been devoted to competition horses and farriery. He maintains an informational website devoted to footcare and therapeutic farriery: www.equipodiatry.com.

This article originally appeared in the Winter 2024 issue of Practical Horseman.

“DSLD is seen in the suspensory ligament—a degeneration of the ligament itself,” says Sabrina Brounts, DVM, MS, PhD, professor of Large Animal Surgery at the University of Wisconsin-Madison, School of Veterinary Medicine.

The suspensory ligament starts just below the knee in a horse’s front legs and the hock in the hind legs. It runs down the back of a horse’s cannon bone—the bone from the knee or hock to the fetlock—between the splint bones. About halfway down the length of the cannon bone, the suspensory ligament splits into two branches that continue down and then pass around the back of the ankle—the fetlock joint—and end on the front of the long pastern bone below. Its job is to support the fetlock as it sinks under weight and returns to normal when the weight comes off.

In a horse with DSLD, leg conformation gradually changes; gradual rupture of the suspensory ligament tissue allows the fetlock to drop. “The pastern becomes more horizontal and parallel to the ground and less upright,” Brounts says. “When the fetlock drops, it changes the angles of the hocks and stifles, giving the leg a straighter appearance.”

Jaroslava Halper, MD, PhD, a professor in the Department of Pathology, College of Veterinary Medicine, University of Georgia, adds, “DSLD is not well defined but affects mostly tendons and ligaments, which are connective tissue. It affects the fetlocks and suspensory ligaments when the horse puts weight on the leg, creating stress and pressure.

“This problem seems to run in certain families and bloodlines, but we have not yet identified the genetic component that results in these changes,” Halper continues. “There are more cases being diagnosed now than in earlier years, but I don’t know if it’s become more prevalent or if people are noticing it more today because they are more aware of it.”

Signs and Diagnosis

There are several reasons for suspensory problems, especially in sporthorses like warmbloods or horses who compete in dressage, jumping and eventing. They can twist an ankle or overstretch a ligament, for instance. With DSLD, the horse starts to get a little stiff, but he “usually has no history of trauma, no previous injury or anything a person could pinpoint as a cause,” Brounts says. “This is the classic picture of DSLD; it just gradually develops.”

Another indication as to whether a horse has DSLD is to determine whether it’s just one leg versus multiple legs. “With DSLD, usually more than one leg is affected. In most cases, it’s both hind legs,” Brounts says. “If it’s just one leg, it’s probably not DSLD, but you should still evaluate all legs since one side can be more severe (and more painful) than the other.”

Horses affected by DSLD may shift weight back and forth on the hind legs or be more comfortable on one than the other. These horses might not like having a foot picked up and don’t want to hold it up very long for the farrier or to have the foot cleaned—they don’t want to stand on one foot very long.

The lameness that develops gets worse over time. There may be swelling or thickening of the suspensory branches around the fetlock and pastern area and scar tissue develops around those branches. “Owners might mistake this for windpuffs, but windpuffs are associated with the fetlock joint. With DSLD, the suspensory ligament in the fetlock region is affected, outside the joint,” Brounts explains.

More Diagnosis

In a horse with DSLD, the suspensory ligament’s collagen fibers are disrupted. These fibers are made up of proteins that provide strength and structure to the body’s connective tissues. Normally, proteoglycans (large molecules of proteins and carbohydrates) “are very complex molecules that are important for the collagen to assemble properly in the tendon or ligament,” Halper says. But “if there is too much [proteoglycan], the tendon is not as strong as it should be. Sometimes the proteoglycans become cartilage.” Cartilage is weaker than collagen, and it does not stretch and bend, so as this tissue accumulates in the tendons and ligaments, these structures become progressively weaker, and the fetlock drops toward the ground.

The problem may appear at different ages in different horses but most commonly becomes obvious between 7 and 13 years old. It rarely starts in horses older than 15.

“It’s easy to detect accumulated proteoglycans and damaged collagen fibers with a post-mortem examination, but that won’t help the horse,” adds Halper. Instead, in addition to getting the horse’s medical history, a veterinarian will examine the legs and palpate the tendons and ligaments to detect thickening of the area. 

Halper also noted that some horses with DSLD also have changes in the arteries and skin. “I’ve found that the easiest thing to do is a skin biopsy to see changes in expression of certain genes,” she says. “We published a paper last year describing what we found—that these genes are more expressed in horses with DSLD.” (See “The Role of Genetics,” below). 

Another method of diagnosis is ultrasound, says Brounts. “Ultrasound of the whole suspensory ligament can help with diagnosis, especially in the fetlock area since that is where we see most of the changes,” she says. “If there’s a chance the horse may have DSLD, have an ultrasound done. If an injury doesn’t heal or a lameness doesn’t improve or gets worse over time, then you have an initial exam as a baseline for comparison later.”

Environment and Management

Progression of DSLD is unpredictable. “I’ve had some horses that took 10 years to finally get to an end point, and other horses had to be put down within just one or two years after the disease was diagnosed,” Brounts says. “We don’t know why DSLD develops quicker in some horses than others, but I think the environment comes into play.” Some of those factors may have more impact on certain horses.

“In the Peruvian Horse, we know heritability of DSLD is approximately 25%,” Brounts says. “This means that 25% of the risk of developing DSLD is genetic and the remaining 75% of the risk is attributed to environmental risks, such as the environment the horse grows up in.” 

She adds, “A human example might be a person with risk of getting lung cancer, increasing that risk if they smoke.” There are multiple factors, such as moderate heritability that influence DSLD. The health management in high-risk horses should be focused on modifying environmental risk factors so the likelihood of DSLD development is minimized in those horses.

“Every horse owner who participates in our research fills out a long questionnaire,” Brounts says. “We ask about everything—what the horse eats, what it does for work and how often, the shoeing, any medication and what age it started in training. These things are important because some of them might make a difference.” 

Risk factors may include physical activity and diet, for instance. “Maybe if we know we have a horse with increased risk, we shouldn’t start riding it as a 2- or 3-year-old; maybe we should start at 4 or 5,” Brounts says. “Or we should change something in their diet; less grain, or less fat or starch. We hope to discover environmental risk factors that we can modify for a horse that is high risk for DSLD. We can then make recommendations, so the environment and management becomes more favorable for that horse, and it might have less risk of manifesting DSLD.”

Treatment for DSLD

For affected horses, treatment needs to focus on easing pain and discomfort and this may vary from horse to horse. “Every horse presents at a different stage. We can’t cure the disease but can try to slow it down or at least make the horse comfortable. Common treatments include phenylbutazone (bute) or flunixin meglumine (Banamine^®) and supportive boots or wraps for the lower legs,” Brounts says.

Some horse owners use methylsulfonylmethane, glucosamine, polysulfated glycosaminoglycan (Adequan^®), etc. to try to aid the health of connective tissue. “Special/corrective shoeing to give the limb more support may also help. Other treatments that may help ease pain include laser therapy, shock wave, magnetic therapy, acupuncture, etc.,” she says.

Some owners investigate regenerative medicine like stem cell treatment and platelet-rich plasma. “These therapies can be helpful for tendon and ligament injuries, but DSLD is a progressive degenerative disease. Treatments might delay the inevitable process but are still experimental for horses with DSLD,” Brounts says.

A research group at Louisiana State University looked at the effect of exercise and athletic conditioning. Exercise didn’t seem to exacerbate the disease and helped horses with comfort. “We’ve learned that not exercising the horse at all is not wise in mild or moderate cases. Research showed that moderate exercise—like 30 minutes three times a week—can be helpful, if it’s not in deep footing or strenuous,” Brounts says.

The Future

“Once a horse is no longer comfortable and in a lot of pain, a tough decision must be made,” Brounts says. “This point may be different for each owner. Some make that decision sooner than others. This is a personal decision; the horse is part of the family and saying goodbye can be a process rather than an instant decision.” Information about DSLD may help an owner make an informed decision.

There is no cure; DSLD is a progressive degeneration and decline. “The only way we can prevent it is if we can find some changes with various tests,” explains Halper. “Then we won’t breed those horses.”

The Role of Genetics in DSLD

The best way to prevent future cases of degenerative suspensory ligament desmitis is to avoid the condition by investigating a horse’s genetic history and to have a thorough examination performed by a veterinarian. This might influence the decision of the owner regarding whether to breed that horse. 

“Our research can hopefully help owners decide what to do with an affected horse or a horse with increased risk,” says Sabrina Brounts, DVM, MS, PhD, professor of Large Animal Surgery at the University of Wisconsin-Madison, School of Veterinary Medicine. 

The challenge is that DSLD is known as a complex polygenic disease. “Most genetic diseases and screening tests in horses have been simple diseases, however,” Brounts says. “This means that a DNA mutation can result in a horse having the disease or being a carrier, depending on the mode of inheritance [dominant or recessive].”

DSLD is not as simple as a single dominant or recessive gene. “We were hoping it would be, but it’s not. It is the result of multiple genetic variations in the animal’s genetic material, in addition to environmental risk factors that have an influence,” Brounts says.

“We have collected [skin] biopsies from horses with DSLD and did some sequencing of the RNA [ribonucleic acid, which executes the instructions of DNA],” says Jaroslava Halper, MD, PhD, a professor in the Department of Pathology, College of Veterinary Medicine, University of Georgia. “We found changes in so many genes [more than 1,500]. Some are overexpressed or more active and some are underexpressed or less active than normal. Even though we didn’t have a lot of horses to test, these findings were pretty consistent.” The research showed that these genes are more expressed in horses with DSLD.

Halper hopes to expand her research on DSLD and “add more horses to the study, some with DSLD and some without it, and also horses that have skin diseases and horses with other tendon problems besides DSLD,” she says. “We would like to see if this approach could be more specific for DSLD than for other skin diseases or other musculoskeletal problems. Eventually we might have a test that could be commercially available to owners and veterinarians,” she says.

Selective breeding and identification of affected horses and horses at risk will be needed to help reduce cases. “The more horses we can test, the more we will learn. Some horses that appear to be normal can still have these changes,” Halper says.

“We try to help owners with our research, so they can make an educated decision. We’d like to continue our research in other breeds since a genetic component could also be present,” Brounts says. 

“We hope to make a connection with the human side,” she continues. “There is a type of tendon degeneration that occurs in people that is similar to DSLD [tendinopathy of the Achilles tendon in the human ankle]. Maybe the horse can be a model for human research and both species can benefit.”

One Owner’s Experience with DSLD

Karen Adams is a retired U.S. Equestrian Federation “R” dressage judge, instructor and coach in Keedysville, Maryland, and has had experience with degenerative suspensory ligament desmitis in a horse named Cordova (“Wild Bill”). 

Bill was the product of a test breeding between a Swedish stallion and a mare that was a mix of Mecklenburger (a warmblood type bred in the Mecklenburg-Vorpommern region of northeastern Germany), Thoroughbred and Paso Fino. At that time in the late 1980s, stallions had to be bred to test mares to make sure they weren’t carrying contagious equine metritis. “He had a huge, lofty trot, and a big, uphill, rolling canter but was oversized for his age,” she says.

Bill, who grew to about 17 hands before he was 3 years old, ended up with three problems: He was operated on before he was 2 years old with osteochondritis dissecans lesions in both hocks. When Adams started riding him when he was nearly 5, she discovered he was a roarer. “I wanted to make him into a competitive dressage horse, but with the hock issue I decided to just ride him for fun—teach him the exercises but not overly demanding work,” Adams said. 

In Bill’s early teen years, Adams noticed that occasionally his left hind ankle would swell a bit and look puffy. “Sometimes when I dismounted, one or both of his hind legs would quiver a little. … His left ankle began to sink lower to the ground,” Adams says.

She took him to an equine clinic in Maryland for a diagnosis. The vet there did several tests on his hind legs, and Bill was diagnosed with desmitis. The vet used shock wave laser treatments to strengthen the tissue.

Then Bill had a couple episodes becoming stuck in his stall, unable to get up. “This was scary, but he was still very sound. I just made sure he got turned out at night so he had plenty of room if he had trouble trying to get up, and made sure he was ridden by me or someone else who didn’t demand too much of his hind legs. I could do leg-yields and shoulder-in but didn’t try to do much that required pushing off with the hind legs,” she says.

Bill stayed sound until he was about 20 years old. Then his vet put him on a daily prescription nonsteroidal anti-inflammatory, which helped to ease discomfort. 

One day in August 2013, when Bill was 25, Adams got a call from the barn where he was boarded. “It was really hot, and Bill didn’t want to get up out in his pasture. I rushed out there and the vet came immediately, but none of us could get him up. We tried hosing him and a variety of things but he wouldn’t get up. I don’t know if he didn’t have the strength, or maybe something had torn loose, or maybe he just didn’t have the heart to try, so we put him down.”

Adams is not sure where DSLD came from in Bill’s bloodlines. She suspects that back before much was known about DSLD, she knew three Swedish warmbloods, including Bill, that had the condition. “I think big, large-jointed horses are probably more susceptible to many kinds of leg problems. With my horse Bill, there’s no way to know if it was his one-eighth Paso Fino blood or if the Swedish half contributed. It’s a degenerative disease that takes a long time to become evident,” she says.

“With Bill, it started with that puffy ankle. In some of my old photos of him I can tell that the left ankle is a little bigger, and also lower. With DSLD the deterioration is gradual and until you see the symptoms you wouldn’t suspect it,” Adams says. 

Fore More:

Learn how to manage other common sport horse injuries here.

This article was originally published in the Fall 2024 Issue of Practical Horseman Magazine.

A hoof abscess is a painful infection that occurs when bacteria make their way into the sensitive tissue of the foot, causing a pocket of pus to form and pressure to build within the relatively rigid hoof capsule.

Causes

Bacteria normally present in a horse’s environment or on the surface of the hoof gain access to the sensitive structures within through a variety of routes, which include:

• a puncture wound
• a sole bruise
• a corn (a specific type of bruise that occurs at the back of the sole in the angle between the hoof wall and bars)
• a nail prick from a recent shoeing
• an injured or diseased white line (the soft, fibrous inner layer of the hoof wall)

What’s at Stake

Prompt diagnosis and treatment of a mild abscess will relieve a horse’s pain and restore soundness so he’s able to return to work in a few days to a week. Deep infections require a more extensive course of care and can take weeks to months to heal. Left untreated, a hoof abscess can alter the way the hoof grows or lead to laminitis or an infection and deterioration of bone that will have a lifelong effect.

Signs of Hoof Abscesses

Not all hoof abscesses are exactly alike, but the most common signs include:

• pain and lameness, appearing gradually or suddenly and ranging from mild to so severe that a horse may be reluctant to bear weight on the affected limb; it may look like he has broken a leg
• swelling, perhaps involving the heel bulbs, coronary band and/or pastern and extending to as high as the knee or hock
• heat, detectable by touch, in the hoof wall or limb
• increased digital pulse, which can be felt near the pastern
• a foreign object—a nail, screw, shard of glass, stone, etc.—embedded in the sole. Don’t remove any item you may find. Give your vet the chance to evaluate the location, depth and angle to determine the extent of damage and infection within the hoof and ensure that the entire object is removed so it won’t cause any more trouble.
• tracts in the sole or coronary band draining gray or black pus
• foul odor emanating from the hoof

Diagnosis

A veterinarian will look at the horse’s history and recent activity and do a lameness evaluation. She’ll clean and examine the foot, then use hoof testers to apply pressure to various points on the sole to identify any sensitive spots that could point to the site of the infection. A radiograph may be necessary to reveal the exact location and extent, which will show up as a dark area on the image.

Treatment

Draining the abscess is priority one. Some will break on their own through the coronary band or sole. But that can take time—which means prolonged pain for the horse as the infection continues to grow. Instead, your vet likely will initiate drainage by using a hoof knife to pare out the abscess through the sole. That way, gravity can aid in clearing the pus.

She’ll pack the sole to protect against infection and allow for continued drainage. Products containing iodine, chlorhexidine or ichthammol are commonly used. Then she’ll apply a bandage and often additional protection, such as a hoof boot or treatment plate secured to a shoe. Based on the horse’s needs, she may recommend a nonsteroidal anti-inflammatory medication for pain. In some cases, an antibiotic may also be prescribed. The bandage will need to be changed daily until the drainage stops, the exit hole is dry and the horse shows no sign of lameness.

In cases where the location and depth of an abscess make it difficult to drain, first soak the hoof in a mixture of warm water, Epsom salts and povidone iodine or other antiseptic solution may help to draw the infection closer to the sole for treatment. Some veterinarians may recommend soaking as part of follow-up care. But it’s important to avoid oversoaking, which can weaken and harm the hoof.

Lookout For

Most hoof abscesses resolve without complication. But a horse requires additional veterinary care if he:

• is still experiencing pain two days after treatment
• has lost his appetite
• is noticeably shifting his weight or lying down more than usual

Additional signs of trouble include:

• drainage that persists more than 48 hours after treatment
• proud flesh that grows out of the drain hole

Preventing Hoof Abscesses

To reduce the chances of your horse developing a hoof abscess:

• Keep his environment as sanitary, dry and hazard-free as possible
• Clean hooves daily and examine them closely for signs of injury or trouble brewing, such as bruises and wounds.
• Schedule regular farrier visits to maintain good hoof condition, especially if a horse is genetically predisposed to poor hoof conformation or quality.
• Be mindful of the effects of weather on hooves. Footing that transforms from dry to wet or wet to dry, often with the change of season, can soften the hoof or make it brittle, increasing susceptibility to injury and infection.
• Consider applying a hoof dressing or hardener to improve and protect hoof condition. Your vet and farrier can advise on product selection based on your horse’s specific situation.
• Evaluate your horse’s feed to ensure it is providing adequate nutrition. A supplement may be beneficial. Your veterinarian can offer insights on choosing one with ingredients most likely to benefit your horse.
• Look for an underlying cause if a horse seems especially susceptible to hoof abscesses. For example, pituitary pars intermedia dysfunction can weaken the immune system, increasing vulnerability to infection. 

About Julie Bullock, DVM

Practical Horseman thanks Julie Bullock, DVM, for her technical assistance in the preparation of this article. A 1989 graduate of the Virginia–Maryland Regional College of Veterinary Medicine in Blacksburg, Virginia, Dr. Bullock has an extensive background in sporthorses and a special interest in equine podiatry and lameness. A four-star FEI veterinarian in endurance, she is also an endurance rider and the huntsman with the Glenmore Hunt Club in Staunton, Virginia.

This article was originally published in the Fall 2024 issue of Practical Horseman.

However, the SI joint is different from other joints, such as the fetlocks or the hocks, in that it has relatively little actual motion itself, has no specific joint capsule, has very little associated joint fluid and is composed of two different types of cartilage. Stability of the SI joint is achieved by a complex ligamentous structure and associated muscles. 

Unfortunately, this important and intricate joint is very difficult to evaluate. Due to its location deep in the pelvis and its protection by thick muscles and fat, the equine SI joint is not possible to see or easily palpate (physically touch or manipulate). The size and density of that part of the horse’s body make it hard to obtain conventional radiographs, and ultrasound imaging can also be challenging. The clinical complaints and signs of potential SI problems can also be caused by any number of other issues and conditions in the horse. Consequently, identifying and accurately diagnosing equine SI problems is a significant challenge for horse owners and their veterinarians.

But understanding how important the SI joint is to the horse’s basic motion and knowing the early signs of problems are the first steps to getting a diagnosis and establishing a pathway back to health.

Signs of Potential SI Issues

All the motions that we ask performance horses to do require a functioning SI joint. These include running at speed, quick stops and tight turns, jumping, lead changes and gymnastic movements. Problems or issues with the SI joint can result in any number of vague motion-related problems. Often riders report feeling or sensing problems that are not visible as a true “lameness” when the horse’s motion is observed. These can include:

• A recent and progressive unwillingness to work with a loss of normal forward motion or impulsion.
• Resistance to collection or rounding through the back. 
• Tightness and stiffness, especially in transitions. 

Additionally, affected horses may begin to have trouble with lead changes, refuse jumps or even begin to buck and kick out. 

Other observations include:

• A mild dragging of one or both hind limbs.
• Asymmetry of the hind end or uneven pelvic motion and muscle development in more long-standing cases. 
• Abnormal tail carriage or unequal tracking of the hind legs especially on a circle. 
• Alterations of a fluid, rhythmic canter.
• A “bunny-hopping” motion of the hind legs. 

It also is always advisable to ask the farrier whether there have been any subtle changes in the horse’s behavior while being shod. Occasionally, very early SI changes are noted by the farrier as the horse may not move over easily when cross-tied and asked to step laterally. Or the horse may have more trouble balancing on a hind leg when the opposite hind is lifted and manipulated by the farrier. 

Since SI issues can be subtle and hard to definitively diagnose, all these seemingly small complaints should be treated with importance. If any of these signs are noted, then a diagnosis of a potential SI problem is justified. But because these signs can also be caused by a number of other conditions, it is important that a complete clinical examination and history be performed on affected horses. 

Diagnosing SI Issues

One category of SI problems can be considered acute. Acute or very recent development of SI-related clinical signs is likely to be trauma-related. Slipping on wet or uneven footing, falling while engaged in “pasture play” or in competition, kicking out or other forceful movements can all cause damage to the ligaments and muscles supporting the SI joint. If the trauma is severe enough, then the joint surface itself can be affected. A thorough history, paying attention to the condition’s timeline, will often reveal a likely underlying traumatic event. 

Another category of SI problems involves a chronic, more subtle, slowly progressing version. Dr. Sue Dyson of the Center of Equine Studies, Animal Health Trust, New Market, United Kingdom, published a review in the Equine Veterinary Journal in 2010 of 74 horses with diagnosed SI pain. Her finding showed that dressage and show-jumping horses appeared to be at greater risk for SI problems than horses used in other disciplines. Older horses, larger horses and heavier horses were also more highly represented, suggesting that “wear-and-tear”inflammation and stress on the SI joint due to long-term use and the demands on the body from a large, heavy frame resulted in more problems. Not surprisingly, warmbloods made up a higher proportion (51%) of affected horses compared to other breeds. Another important aspect of Dr. Dyson’s study was the finding that SI joint pain was seen alone in only 47% of the horses in her study group. Many horses had other problems or issues in other locations that were believed to be contributing to their SI problems. 

Weakness, unevenness or pain in other joints, muscles, ligaments or tendons will affect how the horse moves over time. Because of its location and purpose, the SI joint will be put under increased stress when the horse attempts to compensate for issues like these. 

Dr. Randy Eggleston, clinical professor and surgeon in the Department of Large Animal Medicine, Surgery and Lameness Service of the University of Georgia College of Veterinary Medicine, agrees that many SI problems stem from other issues in the horse. “While the sacroiliac joint has begun to receive much more attention recently and has almost become a trendy ‘popular’ diagnosis, the majority of suspected SI cases seen in our hospital have problems in other areas,” said Dr. Eggleston. 

Careful clinical evaluation of all these potential problems must be done first, according to Dr. Eggleston, and attention to and resolution of these issues often results in the elimination of SI pain. (See sidebar, “Underlying Conditions Contributing to Sacroiliac Issues,” below.)

Diagnosing Primary SI Issues

If no other physical problems are found on clinical examination, then a potential diagnosis of a primary SI condition should be considered and other specific diagnostic tests need to be done. Ultrasound examination of the SI joint is the most commonly used diagnostic procedure and can show evidence of degenerative disease (arthritis) of the joint or can indicate scarring and damage of the supporting soft-tissue structures. Large, heavily muscled horses can be difficult to scan due to the thickness of this area.

Transrectal ultrasound, where the ultrasound probe is inserted rectally, just as when a mare is scanned for pregnancy, may provide an additional “look” at the ventral (bottom) surface of the SI joint and can occasionally provide additional information. 

Radiography of the horse’s pelvis and SI is especially problematic due to both the size and thickness of that area. Conventional X-rays of the pelvis must be taken with the horse anesthetized and lying on his back. This positioning can sometimes allow a film to be taken, which may provide some useful information, but it is not always productive due to the horse’s challenging pelvic anatomy. Many veterinarians are sometimes reluctant to try radiography on these cases because of the stress of anesthesia induction and recovery. This stress can be especially difficult on horses that may already have pelvic instability and problems with their SI joints. 

Thermography, or infrared imaging, can be useful in identifying areas of inflammation or overuse in the SI region. Scanning the horse, then working the horse and rescanning, is especially helpful. This kinetic thermography can show a “before-and-after” change in blood flow and heat to a specific SI area and help confirm a diagnosis of SI injury. Dynamic diagnostic capabilities, or the modalities that can show the current physiological state of structures, are very important in confirming SI injuries because, as Dr. Eggleston explained, “We may see changes to the SI joint or surrounding structures with ultrasound and even radiography, but that doesn’t prove that those changes are significant in that particular horse or that they are even contributing to the horse’s pain and lameness.” Many horses can show old, non-active injuries or other chronic changes that are not related to that horse’s present condition. 

Nuclear scintigraphy is another dynamic modality that can provide evidence that an SI joint is indeed currently inflamed and irritated. A nuclear-labeled product is injected into the horse. This substance circulates throughout the horse’s body and it is picked up or concentrated only in areas where there has been damage and undergoing repair. A specialized scan of the body is done next, and the nuclear material that has been incorporated into these active areas shows up as “hot that horse’s present condition. 

Nuclear scintigraphy is another dynamic modality that can provide evidence that an SI joint is indeed currently inflamed and irritated. A nuclear-labeled product is injected into the horse. This substance circulates throughout the horse’s body and it is picked up or concentrated only in areas where there has been damage and undergoing repair. A specialized scan of the body is done next, and the nuclear material that has been incorporated into these active areas shows up as “hot spots,” or areas of concentration. This alerts the clinician to those active areas that are directly related to that horse’s present problem. 

Research is also currently underway to develop the capabilities to produce a full-body CAT scan in the standing, sedated horse. This technology would drastically improve the way that SI problems are diagnosed and would allow clinicians to actually image the SI joint, with minimal risk to the horse, and to be able to evaluate its soft-tissue connections as well. Though not currently available, these units have been produced and are actively being tested and refined in clinical settings.

Treating SI Issues

Once a diagnosis of an SI problem has been made, there are a number of treatment options available for your horse. The SI joint can be injected with anti-inflammatory medication just like any other joint. This medication is intended to reduce the inflammation and pain in that area. Injections can be coupled with muscle-relaxing drugs and other systemic anti-inflammatory medications designed to allow the horse to move more easily and more correctly. While most horses are rested from hard work and competition while they recover from SI issues, controlled physiotherapy is still also very important. Horses are exercised on a very specific program designed to promote mobility of the supporting structures of the SI area and to help strengthen the muscles that stabilize the joint. Acupuncture, pulsed wave electromagnetic energy, therapeutic laser and ultrasound are all also used to help reduce tightness and spasm through the SI area during recovery. 

Research suggests that horses with primary SI injuries take longer to heal and often don’t return to full athletic function. However, horses with a strained SI joint caused by other problems can do very well once the sore joint, strained ligament, imbalanced hoof or inappropriate riding stress is resolved. Learning about the SI joint and how it influences the horse’s basic motion and knowing the early signs of problems are the important steps to getting a diagnosis and setting up a pathway back to a healthy SI joint.  

Sidebar: Underlying Conditions Contributing to SI Issues 

Because of its location and purpose, the SI joint will be put under increased stress when the horse attempts to compensate for other issues. A detailed history in cases of horses with suspected SI pain will help identify known risk factors. Additionally, a complete physical examination will help rule out joint inflammation, foot balance issues, back conditions and other possible contributing factors. 

Horses with suspected SI problems should be carefully evaluated for the following:

• Hock arthritis can make horses reluctant to switch gaits and round through their backs and may inhibit forward motion. 
• High suspensory ligament desmitis (inflammation of the ligament fibers near the top of the cannon bone that can be from mild to severe), especially in the hind legs, can produce similar signs as hock arthritis. 
• Overriding dorsal spinous processes, or kissing spines, can make horses back sore, inhibit forward motion and may manifest as behavioral responses ranging from a subtle reluctance to work, all the way to flat out refusal to go forward under saddle and kicking out. 
• Negative palmar foot angle is relatively common in warmbloods. The pedal bone, or PIII, is the bone inside a horse’s hoof. It is generally thought that the bottom surface of this bone should be at two to seven degrees relative to the ground surface. This creates a slightly toe downward angle and provides the horse with optimal balance and push off the feet, especially the hind legs. Horses with flat to negative palmar foot angles have a PIII bone that is elevated at the cranial edge (toe) and lower at the caudal edge (heel). These horses are essentially standing and moving from a “rocked-back” position, which places additional stress on the hind leg (high suspensory ligaments, hamstrings and gluteal muscles) and on the SI joint area. 

About Kenneth L. Marcella, DVM

Kenneth L. Marcella, DVM, is a graduate of the New York State College of Veterinary Medicine at Cornell University. For more than 30 years, he has treated sporthorses of all disciplines and levels, including international competitors. Marcella has served as a veterinary official at many events around the world, including national championships, world championships and Olympic competitions. He is board-certified in thermal imaging and is currently a member of the board of directors of the American Academy of Thermology. With an undergraduate degree in English from Dartmouth College, Marcella has also written articles for numerous publications. 

This article originally appeared in the Summer 2024 issue of Practical Horseman.

A horse’s external oblique is a broad, triangular-shaped muscle located over the lower abdominal area of the horse that connects from behind the fourth rib to the point of the hip. There are two external obliques, one on each side of the horse. Its functions are to bend or flex the trunk laterally and compress the abdomen. But when this muscle is tight, it can have major implications for your horse. Fortunately, a basic Sportsmassage technique can easily relieve tightness.

Signs of Tightness

As a Sportsmassage practitioner, I often point out that the most overlooked factor in diminished performance is simple muscle tightness. To understand how tightness develops, knowing how muscles work is important. Every muscle has two ends, and each end is connected to a different bone by a tendon. One end is the anchor, which stabilizes the muscle to the bone. The other end is the insertion, where the motion occurs. The middle part of the muscle, which lies between the two ends, is called the belly. The belly is the power or action of the entire muscle and creates overall movement. 

Muscles are made up of many thread-like fibers that run parallel to each other. A muscle is loose and functioning properly when the fibers have equal and appropriate spaces between them and do not lie very close or touch one another. When the fibers are close together without much space between them, the muscle is in a shortened state and is tight. 

When the muscle is tight, less blood can circulate through the limited space between the fibers. Since blood carries oxygen, the diminished blood flow affects the level of oxygen available to the muscle tissue. Oxygen provides the fuel and energy to the muscle necessary for the required exercise. As the physical exercise increases, the body’s demand for more oxygen increases. Diminished oxygen creates fatigue and discomfort in the active muscles. It is similar to stepping on a hose. The less space in the hose, the less water can flow through.

When muscles are functioning properly, they contract (shorten) and release (lengthen) in synchrony. Muscle tightness affects the release process of the muscle. When a muscle is tight it resists letting go, or releasing, to accomplish the required motion. The tighter the muscle, then the greater the resistance. And the greater the resistance, the harder it is for the horse to move and perform. 

Firsthand Experiences

Olympic eventer Lauren Nicholson and dressage trainer and rider Rebecca Reed have experienced this issue firsthand. 

For Rebecca, she noticed her 13-year-old Oldenburg gelding Simply Sinatra, currently competing in Prix. St. Georges, was having trouble bending, particularly in the left half-pass. 

For Lauren’s 2022 FEI World Championships team silver medalist partner Vermiculus, a 16-year-old Anglo-Arabian, his tight obliques led to him compensate in other areas to keep his balance. This resulted in atrophy of certain muscles that he wasn’t using correctly. “He’s little and everything is quite close together, so when his obliques were out of whack, everything went out of whack,” explained Lauren. 

Identifying Tightness in Horses

A horse with a tight external oblique will not be straight in his body. If the muscle is tight on one side, then the rider will need to use more leg on the side of the tightness. For example, if a horse has a tight left external oblique, he will shift his haunches to the left and will not be able to release the haunches to the right to straighten his body, requiring the rider to use more left leg to keep him straight. Many riders accept this as natural crookedness. The horse will also not back up straight, and he may fall in or out on a circle depending on the affected side.

If both the right and left external obliques are tight, the horse will be quite resistant and have a harder time going forward in all movements and especially in collected work. Jumping horses may also knock down rails.

Causes of Tightness

There are several reasons for tight external obliques. Some of the most common are:

• repetition of lateral work
• cow kicking at flies
• repeatedly kicking in the stall or trailer

Tight external obliques can also be caused by veterinary issues, such as: 

• hindgut or gastrointestinal issues
• problems with the sacroiliac area
• lower lumbar vertebral issues

Gait Analysis and Assessment 

To assess your horse’s motion, have a handler walk him in a straight line about 50–75 feet directly away from you and then turn around and walk back in a straight line. Make sure to do the assessment on soft but firm footing that is flat and even. The walk is the best gait to assess muscle tightness because the slower the horse moves, the more muscle he has to use, and the easier it will be for you to see any resistance in motion. If the horse has external oblique tightness, you should be able to see that he is not straight and is shifting his haunches in one direction. So if he’s putting his hips to the left, it suggests that his left external oblique is tight. 

Relieve Tightness with Cross-Fiber Friction 

Eliminating tightness in this muscle is very easy by using cross-fiber friction. This helps to mechanically break up a spasm or knot by separating the muscle fibers that are stuck together. The entire muscle then becomes more pliable and functional, helping to increase the range of motion and improve specific performance problems.

To locate the external oblique, feel for the bony landmark of the point of the hip, then drop your thumb down on a diagonal in front of the point of the hip about 1 inch. This is where the tendon fibers and muscle fibers meet, at the insertion. Another way to locate it is to imagine the point of the hip is the face of a clock. The insertion can be felt at 7:00–8:00 on the left side, while it is at 4:00–5:00 on the right side. If this muscle is tight, you should feel a small piece of tissue close to the bone that feels like a thick chord or guitar string. If it is not tight, the tissue will feel soft and rebound into your hand. 

Next, I’ll explain the cross-fiber friction technique, but if at any time when applying the technique, the horse threatens to kick, moves away, pins his ears or obviously doesn’t like it—stop immediately. 

Applying Cross-Fiber Friction

Start the technique by using moderate pressure at the insertion with a thumb or two fingers. Cross the fibers diagonally back and forth on the thick chord as if you were going across the grain of a piece of wood. To do this, move your fingers back and forth across the tissue without taking your fingers off of them. Use the cross-fiber friction technique for no more than 10 seconds. Stop and feel the tissue to determine if the chord has softened or changed. If it feels softened or changed, do not repeat the technique. If it still feels tight, repeat cross-fiber friction one more time for no more than 10 seconds. 

Once the technique has been completed, it is best to ride or longe the horse afterward. Exercise may enhance the treatment because it further lengthens the muscle. If you’ve relieved the tightness, you will see new or improved range of motion. The change is immediate. Canter the horse in a connected long and low frame two times in both directions around an arena—as long as horse and rider are safe to do so. The canter is the most concerted exercise in lengthening all of the horse’s muscle groups. That is why the trot always feels better after the canter. You may choose to trot or longe the horse if cantering is not an option. If you cannot ride the horse following the technique, then ride him when you are able—there is always another day.

Proven Results

Both Rebecca and Lauren saw marked changes in their horses after their external obliques were loosened. After the Sportsmassage technique was used on Simply Sinatra, everything became much easier right away. This allowed his right hind to come underneath and cross over to the left. “The [half-pass] was easier, it flowed much better, the connection was better, everything was better,” said Rebecca. Lauren agreed that the effect was instantaneous, but also had benefits over time. “The other muscle groups aren’t compensating and they can develop properly and they get better long-term, too.”  

If your horse continues to have this problem in motion, seek a veterinarian assessment to help address the cause.  

About Jo-Ann Wilson

Jo-Ann Wilson is a licensed massage therapist, clinician, author, teacher and researcher whose work includes serving horses and riders of all levels and disciplines for over 30 years. She was a longstanding associate and partner of the late Jack Meagher, pioneer of Sportsmassage, and is the director of Wilson Meagher Sports Therapy, which offers clinical and educational programs in the Wilson Meagher Method of Equine Sportsmassage.

She has served as the sports therapist for the U.S. and Canadian Eventing Teams at multiple Olympic, World Equestrian and Pan American Games. Wilson also offers online video training on her website and YouTube channel, as well as live workshops. For more information, go to sportsmassageinc.com.Wilson recently wrote and released her book, “Keeping Horses At Their Best: A Hands-On Guide to Equine Sportsmassage.” Parts of this article were adapted from her book. To purchase a copy, click here.

Practical Horseman thanks Kristina Watkins of Firefly Farm in Reddick, Florida, for use of her farm and horse for the demonstration.

This article originally appeared in the Spring 2024 issue of Practical Horseman.

Below are some of our favorite lameness tips from the last 50 years. These tips are excerpted from 50 Health and Management Tips, which was written in celebration of Practical Horseman’s 50th Anniversary.

1. “The knee and fetlock of a sound horse should flex until the shoe touches the elbow; if it can’t, movement is somehow being restricted.”—Dr. Michael Collier, Which Leg is Lame?, November 1983 
2. “The one thing I wish everyone whose horse has performance problems would do is slide the saddle back 3 inches and see what happens. Most horses—in every sport, with the possible exception of some dressage horses—wear their saddles too far forward.”—Joyce Harman, DVM, MRCVS, Seat of the Problem?, January 1994 
3. “Weight-bearing lameness—which causes pain when the horse puts his foot down—is about nine times more common than swinging-leg lameness, which causes pain when the leg advances. This is especially true for horses that jump. Weight-bearing lamenesses include foot bruises, navicular syndrome, hoof abscesses, suspensory tears and fractures. Swinging-leg conditions generally involve pulls or tears in the muscles that move the legs.”—Elizabeth Hammer, DVM, with Elaine Pascoe, Which Leg is Lame?, April 1994
4. “Most lamenesses involve the front legs; of those lamenesses, most involve the foot.”—John Herning, DVM, Five Degrees of Lameness, May 1994
5. [On checking tendons for injuries]: “Your hands are much more sensitive to temperature than you might think. They can accurately pick up variations of a tenth of a degree. The way to confirm your findings? If a tendon on the right leg feels warmer than usual to your right hand, check it again with your left hand. Compare the right tendon to the left. The opposite leg is always your ‘control’ unless something’s going on there as well.”—Mark Rick, DVM, with Kip Goldreyer, Keep Tabs on Tendons, June 2005
6. “By regularly and systematically observing your horse, you’ll learn what’s normal for him, and you’ll be able to quickly recognize when something isn’t right. Monitoring subtle changes, recognizing patterns of soreness and taking action at the appropriate time are the keys to keeping your horse sound.”—Tim Ober, DVM, with Elaine Pascoe, Hands-On Health Check, April 2008
7. “The dynamics of a horse’s motion occur on a diagonal, so tightness in the left poll can reflect a problem in the right hind and vice versa. And because your horse’s body works as a unit that strives for balance, tight poll muscles can also be a secondary issue.”—Jo-Ann Wilson with Sandra Cooke, The Problem Could Be His Poll, January 2013 
8. “Degenerative joint disease cannot be cured. However, you can manage the symptoms and potentially slow the progression of the disease … The primary goals when treating osteoarthritis are to reduce inflammation in order to slow the degradative process and subsequently provide the horse with some pain relief.”—Leslie Threlkeld with Dane Tatarniuk, DVM, MS, DACVS-LA, and Patrick Loftin, DVM, MS, Combating Joint Disease, September 2017 

This article originally appeared in the Winter 2023 issue of Practical Horseman.

This article is sponsored by WeatherBeeta.

You likely consider your horse part of your family—and when they show signs of joint discomfort from the natural wear and tear of training or the aging process, it’s hard to see them working through pain.

Despite the challenges that come with joint disease in horses, regenerative medicine technologies allow veterinarians to approach equine pain management with an entirely different set of tools.

Your horse’s self-healing abilities

Today, veterinarians have the option to manage lameness by concentrating the natural properties found in a horse’s blood or bone marrow with the assistance of regenerative medicine devices (RMDs). An increasing body of evidence reveals that these devices have the potential to modify the course of joint disease by promoting healing and reducing pain and inflammation in horses.¹

Below are three types of horses a veterinarian is likely to recommend for treatment with RMDs:

• Competitive horses with concerns about career longevity, maximizing their joint health or drug withdrawal times
• Young horses whose athletic career you want to maximize while minimizing the negative impact on cartilage from chronic repetitive steroid use
• PPID, metabolic or insulin-resistant equine patients, or those with a history of propensity to develop laminitis

Pro-Stride^® APS device for equine joint pain

Did you know that osteoarthritis (OA) is the leading cause of lameness in horses, affecting more than 60% of them at some point in their life?² To help reduce inflammation and promote healing within the joint, veterinarians may recommend harnessing the unique properties found in your horse’s blood.^2,3 The process below has been shown to improve a horse’s lameness grade for up to one year after a single injection, and in some cases even longer.^3,4,5

• How it works: A veterinarian collects blood from your horse, and then the blood is placed into the Pro-Stride APS (autologous protein solution) device and centrifuged. This allows the device to isolate anti-inflammatory cytokines and growth factors from the blood. The final concentrated solution is then injected back into your horse’s joint(s) to promote healing and decrease pain and inflammation.
• Method: With APS, it’s possible to address the root cause of orthopedic disease, slow disease progression and help reduce the number of maintenance injections your horse receives.³ The goal is to help alleviate pain and prolong your horse’s athletic career beyond masking symptoms. The growth factors contained in the solution accelerate cell growth, enhance cell survival, decrease inflammation and assist in tissue repair.³

Horse-powered healing

This stall-side procedure takes less than 30 minutes to perform right at the farm and can help address existing OA while preventing further disease progression.¹

• Your veterinarian should conduct a complete lameness evaluation to confirm the diagnosis and treatment location, regardless of whether it’s for an injury or maintenance purposes
• Typically, significant positive outcomes can be observed within 2 to 4 weeks, sometimes even earlier, when using Pro-Stride²
• An APS concentration can help regenerate soft tissue and slow the progression of joint disease and has been shown to have a beneficial effect on rehabilitation time, meaning horses can potentially get back to performing sooner^4,5
• The Pro-Stride APS device can also be used after arthroscopy, surgical fracture repair, chip removal or osteochondritis dissecans surgery to help decrease inflammation in the joint post operatively

A Pro-Stride APS solution is safe for use in all joints, including:

• Stifles with meniscal or cruciate injuries
• Coffin bone
• Navicular bursa
• Pastern
• Fetlock
• Carpus
• Elbow
• Shoulder
• Hock
• Stifle
• Hip
• Sacroiliac joint

As with any care decision, a veterinarian’s case selection and early action is important. While Pro-Stride can aid in pain management secondary to OA, your horse may likely see faster and longer-lasting results in mild to moderate cases when used as a first-line approach versus in chronic end-stage joints where no other treatment has improved the outcome. 

Other RMDs to discuss with your veterinarian

Restigen^® PRP is an extensively clinically studied Platelet-Rich Plasma Device with considerable scientific backing, used primarily for soft tissue injuries.^2,6 Additionally, the Centrate^® BMA (bone marrow aspirate) device allows for a rapid concentration of bone marrow aspirate for injuries to soft tissues and areas were soft tissue attaches to bone (for example, proximal suspensory ligament injuries or meniscal injuries in the stifle).

All of these devices can be processed in under 30 minutes stall-side or in the clinic or hospital at the same time as the initial appointment. The resulting cell solution is injected fresh, never frozen, and doesn’t require incubation or a series of injections, making it’s use really convenient and cost effective.

Resources on RMDs

Regenerative medicine is an exciting field with the potential to help manage joint disease and OA in horses. You can learn more about these horse-powered solutions by talking with your veterinarian to discuss whether your horse could be a good candidate for RMD treatment options.

• Here’s a brochure with more information on equine RMDs
• Visit zoetisequine.com/lameness to learn more about RMDs so you can discuss them at your horse’s next veterinary appointment

References

1. Bertone AL, Ishihara A, Zekas LJ, et al. Evaluation of a single intra-articular injection of autologous protein solution for treatment of osteoarthritis in horses. Am J Vet Res. 2014;75(2):141-151. doi: 10.2460/ajvr.75.2.141.
2. McIlwraith W, Frisbie D, René P, et al. Joint diease in the horse (2nd edition). 2016;1. doi: 10.1016/C2012-0-00759-4. 
3. Muir R, Reisbig N, Baria M, et al. The concentration of plasma provides additional bioactive proteins in platelet and autologous protein solutions. The American J of Sports Medicine. 2019;47(8):1955-1963.
4. Linardi RL, Dodson ME, Moss KL, et al. The effect of autologous protein solution on the inflammatory cascade in stimulated equine chondrocytes. Frontiers Vet Sci. 2019;6:1-9. doi: 10.3389/fvets.2019.00064.
5. Gaesser AM, Underwood C, Linardi RL, et al. Evaluation of autologous protein solution injection for treatment of superficial digital flexor tendonitis in an equine model. Frontiers Vet Sci. 2021;8. doi: 10.3389/fvets.2021.697551.
6. Chahla J, Cinque M, Piuzzi N, et al. A call for standardization in platelet-rich plasma preparation protocols and composition reporting. J of Bone and Joint Surgery, Incorporated. 2017;99(20):1769-1779. doi: 10.2106/JBJS.16.01374. 

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