Rehabbing Tendon and Ligament Injuries in Horses
Few phrases strike more fear into a horse owner than: “It’s a tendon injury.”
Tendon and ligament injuries are notoriously challenging, often requiring months of careful rehab, strict management, and, unfortunately, patience. But with the right plan, many horses can return to comfort and even high levels of performance.
This blog takes a deep dive into the stages of soft tissue injury rehab, the milestones to aim for, the common pitfalls to avoid, and the tools and therapies that can truly make a difference in your horse’s recovery.
Understanding Tendon and Ligament Injuries
Tendons connect muscle to bone, while ligaments connect bone to bone. Both are made up of dense, fibrous collagen tissue. In horses, common injuries include:
Superficial digital flexor tendon (SDFT) strain or tear
Deep digital flexor tendon (DDFT) injury
Suspensory ligament desmitis (branch or body lesions)
Check ligament injuries
Unlike muscle, these tissues have limited blood supply, which means they heal slowly and imperfectly. Instead of regenerating like-for-like tissue, they form weaker and less elastic scar tissue prone to reinjury. This is why careful, progressive rehab is essential.
Stages of Soft Tissue Injury Rehab
Rehabilitation typically progresses through several phases, though exact timelines vary depending on severity, location, and veterinary guidance.
1. Acute Phase (Days 1–14)
Goals: Minimize inflammation, pain, and further damage.
Rest: Strict stall rest is often prescribed.
Cold therapy: Ice or cold hosing to reduce inflammation.
Anti-inflammatories: NSAIDs like phenylbutazone may be prescribed.
Support bandaging: Helps control swelling.
Manual therapy: to help control compensatory pain and tension in the rest of the body.
Controlled exercise: core stability, isometric exercises, weight shifting may be appropriate depending on the injury
❌ What doesn’t work: Turning the horse out “to heal naturally.” Uncontrolled movement at this stage can worsen the injury significantly.
2. Subacute Phase (2–8 Weeks)
Goals: Support controlled healing, begin gentle mobilization.
Hand-walking: Short, controlled walks to begin aligning fibers in the healing tendon/ligament.
Ongoing vet checks & ultrasound: Imaging is essential to track progress.
Adjunct therapies: Laser, ultrasound therapy, or shockwave may support healing.
Manual therapy: to encourage fiber alignment in scar tissue and help control compensatory pain and tension in the rest of the body.
Controlled exercise: core stability, range of motion exercises, balance and coordination activities may be appropriate depending on the injury
❌ What doesn’t work: Pushing too quickly into work. Horses may look sound before the tissue is truly strong enough to support the movement.
3. Remodeling Phase (2–6 Months)
Goals: Encourage organized fiber alignment and controlled loading.
Progressive exercise: Progression of core stability, active and passive range of motion, balance and coordination exercises. Gradual increase in hand-walking duration, groundwork, then under-saddle walk work.
Introduction of trotting: Only when ultrasound confirms sufficient healing.
Therapeutic exercises: In-hand poles, gentle hill work (later stages).
Manual therapy: to encourage fiber alignment in scar tissue and help control compensatory pain and tension in the rest of the body.
At this stage, the collagen fibers are still fragile. Controlled stress helps strengthen them, but overloading can cause setbacks.
❌ What doesn’t work: Skipping recheck ultrasounds. You can’t judge tendon strength by apparent soundness alone.
4. Strengthening & Return to Work (6–12+ Months)
Goals: Build resilience, prepare for return to full athletic function.
Gradual reintroduction to normal work: Walk → trot → canter, guided by imaging and vet recommendations.
Sport-specific exercises: Dressage suppling work, small jumps, conditioning sets.
Continued support therapies: PT, farrier care, saddle fit etc. all influence long-term success.
Some injuries may require a full year or more of rehab. Patience at this stage pays off in the horse’s long-term soundness.
❌ What doesn’t work: Assuming once the horse “feels sound,” they’re fully healed. Increasing workload too soon is the number one cause of reinjury.
Key Milestones to Track
Initial ultrasound diagnosis: Establishes baseline.
Reduction in swelling/heat: Within first 2–3 weeks.
First signs of fiber organization: 6–8 weeks.
Introduction of trot work: Often 4–6 months, depending on progress.
Canter/jumping/collection: 9–12 months or longer.
Every horse’s timeline is unique. Ultrasound, veterinary evaluation, and PT assessment are the most reliable markers.
Common Pitfalls in Tendon & Ligament Rehab
Despite the best intentions, certain mistakes can derail recovery:
Skipping or delaying diagnosis. Early imaging is critical.
Too much too soon. Overexertion before fibers are ready causes re-tearing.
Not enough controlled exercise. Complete rest beyond the acute phase leads to weaker scar tissue and disorganized scar tissue fibers more prone to reinjury.
Ignoring hoof balance. Poor trimming/shoeing increases strain on healing tissues.
Neglecting the whole horse. Compensation patterns can cause secondary injuries.
Investigating Root Causes
One critical but often overlooked step in tendon and ligament rehab is identifying the root cause of the injury. Was the strain due to poor hoof balance? Compensation for poor tack fit or rider asymmetry? Conditioning gaps? Uneven footing?
Without addressing these contributing factors, even the best rehab plan may set the horse up for reinjury. As part of the recovery process, your rehab team should evaluate the horse’s conformation, workload, tack, farriery, and conditioning history to identify potential triggers. From there, they can create a plan to correct or minimize those issues - whether through better conditioning, corrective shoeing, postural retraining, or rider-focused changes.
This proactive approach not only helps the horse recover more completely, but also builds long-term resilience and helps to prevent reinjury.
What Therapies Actually Help?
Beyond controlled exercise, many adjunct therapies are used. Some have more evidence than others.
✅ Evidence-Supported & Commonly Used:
Controlled exercise: The single most important factor.
Shockwave therapy: Stimulates blood flow and healing response.
Laser therapy: May reduce inflammation and support tissue repair.
Therapeutic ultrasound: Deep heating to encourage fiber alignment.
PRP (Platelet-Rich Plasma) or Stem Cell Therapy: Injected biologics that may improve tissue healing quality.
⚠️ Mixed or Limited Evidence:
Mesotherapy or alternative injections: Still under study.
Magnetic therapy or boots: Anecdotal support, limited clinical proof.
Turnout-only rehab: Natural movement is beneficial later, but uncontrolled movement early on is potentially damaging.
Bottom line: Controlled loading, imaging, and patience are the gold standards. Other therapies can support, but not replace, the basics.
The Role of the Rehab Team
Successful rehab is rarely a solo effort. A coordinated approach includes:
Veterinarian: Diagnosis, imaging, medical management.
Equine physical therapist: Designing progressive exercise, monitoring posture and compensation.
Farrier: Hoof balance and shoeing to reduce tendon/ligament strain.
Trainer/Rider: Following the rehab plan consistently and carefully.
Final Thoughts:
Rehabbing tendon and ligament injuries is not easy, but it is possible. The difference between successful recovery and chronic reinjury comes down to how well the rehab plan is managed and carried out.
Your horse may never regrow a “perfect” tendon or ligament, but with the right rehab plan they can return to a full, happy, and even competitive life.
Remember: Tendon and ligament healing is a marathon, not a sprint. The investment of time and careful management now pays off in years of soundness down the road.