Have you ever treated a horse for a tendon injury, only to run out of treatment options? You’ve tried shoeing changes, a modified exercise program, hot and cold therapy. In fact, you’ve tried everything you know how to do, and although the horse is better – much improved – he’s not fixed.
From your years of experience, you know this horse will likely improve with rest, but “give it time” is not what your client wants to hear. She wants solutions, and it’s nerve-wracking because she can always go to another vet if she gets too frustrated.
While regular veterinarians run out of options at this point, proactive, integrative, progressive veterinarians have multiple therapies from which to choose. One treatment you should always consider is the laser. In this article, I’ll look specifically at two laser protocols – one reactive and one proactive. Laser for tendon injuries Tendon injuries can be short-lived, debilitate the horse for six to 12 months, or wreck his career. Along the way, they can cause intermittent, nagging lameness, which is frustrating for owners, trainers and veterinarians.
“Many owners and trainers of performance horses have regarded injuries to tendons and ligaments as being potentially more threatening to an equine athlete’s future career than fractures,” writes Carol L. Gillis, DVM, PhD in her book Rehabilitation of Tendon and Ligament Injuries.1 A horse owner’s greatest fear is a tendon injury; laser therapy can be an effective treatment so a horse’s performance life is not curtailed.
“Laser” stands for Light Amplification by Stimulated Emission Rays. Lasers direct highly concentrated light at a specific wavelength to muscles, tissues, organs and connective tissue. As with other veterinary equipment, not all lasers are created equal. Some are technically easier to operate than others. Some work faster and deliver more efficient energy. And some have settings that allow you to simply push a few buttons and wait for the laser to do the rest. Prices vary too, ranging from $7,500 to $25,000. How laser heals Light from a laser induces specific biological changes in the tissue, including:
- Altered electrical activity in the cells
- Increased circulation to affected tissues
- Increased lymphatic drainage
- Increased supply of oxygen and other nutrients to diseased tissue
- Increased microcirculation for healing
Virtually all lasers work their magic through the same mechanism – that is, emission of light at a specific wavelength to facilitate the horse’s innate ability to heal himself. Laser therapy for tendon injuries can be approached in two different ways.
1. Reactive approach to tendon injury
A reactive approach responds to a problem. A client calls with an issue, and you motor out with a solution. With tendon issues, the reactive veterinarian may employ a combination of methods such as NSAIDs or nutraceuticals, hot and cold therapy, and a change in shoeing. Some veterinarians may even use intra-lesional injections such as stem cell, platelet-rich plasma or some other novel technique. As a general rule, I use NSAIDs, laser therapy, and hot and cold compresses on every tendon injury I treat. Only if the response is inadequate do I ever consider intra-lesional injections.
Monitoring is accomplished with your trusty ultrasound. Scanning the injury every three to four weeks helps evaluate the size of the lesion as well as tissue remodeling and overall healing, which guides you in choosing future treatment. Ultimately though, you are left to guess at the best time for this horse to go back to work.
In this situation, using laser therapy aggressively on an every other day schedule can facilitate healing and help this horse recover. Most importantly, though, you are doing something on an ongoing basis to facilitate the healing process, and make the horse and his owner feel better.
Let’s say you have a ten-year-old Quarter Horse that competes in Western pleasure events. This horse has a right front lameness isolated to the deep flexor tendon and suspensory ligament, based on a physical exam.
The following would be my laser recommendations:
- Laser treatments three times weekly for a total of nine treatments. If the swelling and pain are severe, or if the horse fails to respond to the first treatment, I may do the laser daily. As an added incentive, I usually give a package discount for multiple treatments.
2. Proactive approach to tendon issues
The majority of tendon injuries arise from overuse, so using a laser proactively on tendons and ligaments may be the best use of laser in equine practice.
You benefit because you get to examine the horses on a regular basis. The owner benefits by staying ahead of the game as you keep her horse sound. And the trainer looks good because his reputation for keeping horses sound and serviceable remains intact.
In a typical stable, the trainer calls you anytime something seems wrong. The horses are worth a lot of money and the owners view them as not only friends but also as their most important hobby. They do not want their horses laid up. They want to show, compete and have fun, so owners will pay for proactive care.
Horses can benefit from proactive laser treatments every few weeks. Since 43% of horses with one tendon injury have bilateral disease,2 and many have hind leg suspensory issues, lasering all four limbs makes perfect sense.
Since tendon injuries can occur before pain, swelling or even detectable lameness arises, it is even more important to consider proactive laser therapy. You can stay ahead of the game and so can the horses because laser light therapy works at the cellular level, affecting the whole body. Proper organ function is enhanced, further reducing the tendon disease process and helping the legs regain strength and mobility. An unmaintained tendon is an endangered tendon.
The following is an example of a proactive approach:
- First, I laser the tendons on both the front and back legs using the same frequency I would for an injury. The routine is exactly the same as for an injury; the only exception is that the treatment is performed only every two or three weeks. Next, I laser points on the liver meridian. From a TCVM perspective, the liver is responsible for tendon and ligament strength. Therefore, tonifying liver points aids in the prevention of tendon injury. Most lasers would require customized settings for proactive protocols, including laser acupuncture. Reininger recommends 442 Hz along the liver meridian. Applying the laser to the meridian takes about 45 to 60 seconds per point. The specific points are BL 18, BL 47 and LIV 14.
Laser therapy is effective for treating tendon injuries and shortening recovery time, but more importantly, proactive laser treatments can prevent injuries. Caring owners can improve both the comfort and productivity of their horses with regular laser visits.
1Gillis, Carol L., DVM, Phd. “Rehabilitation of Tendon and Ligament Injuries”. A carefully controlled rehabilitation program combined with a regular ultrasound examination provides the best chance for equine athletes to return to full performance following tendon or ligament injury. Author’s address: Dept. of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California at Davis, Davis, CA 95616. 1997 AAEP.
2Smith, Roger K.W. and Avella, Charlotte. “Recent advances in the diagnosis of tendon disease”. Dept. of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatﬁeld, Herts. AL9 7TA, UK.