According to Andris J. Kaneps, a certified vet, prevention is the best treatment when it comes to horses’ health issues. Horses are notoriously prone to injuring themselves and soft tissue ailments in areas of the body like the ligaments and tendons are exceedingly common. As a result, vets are required to be knowledgeable in the treatment and rehabilitation of these ailments.
During the American Association of Equine Practitioners Convention (2016) held in Orlando, Florida from 3rd to 7th December, Andris J. Kaneps, who also operates a veterinary surgery facility in Beverly, Massachusetts assessed the best practices that are applied in the rehabilitation of soft tissue injuries.
He noted that healthy ligaments and tendons comprise of patterned and organized fibers which are torn during injuries, leading to hemorrhage and inflammation. The main objective of the treatment of such injuries is to have the problem area revert to its normal structure.
The first thing to do is to identify the problem and it is often demonstrated by swelling, pain and how the horse responds to touch (palpation). After this, comes the most critical step, namely, stopping the horse from performing all forms of exercise.
Kaneps emphasized that this can be problematic, for example when the horse experiences some swelling during the course of a major competition, but it is necessary.
The next objective is to minimize the inflammation in the area that is affected and this makes diagnosis easier. Kaneps recommends using either cold therapy and NSAID (non-steroidal anti-inflammatory). In addition, a support bandage may be applied so as to stabilize the injured area.
Kaneps advised that it is important to arrive at a diagnosis within two days from the day of the injury. Ultrasound is usually the most effective imaging method when it comes to soft-tissue injuries. He urged attendees at the convention to document the result measures (for example tissue dimensions and lameness grades) during all the examinations because these will help to monitor how the horse is progressing.
After you arrive at a diagnosis, it is time to start the injury rehabilitation process. Kaneps evaluated a number of options that vets can use together in order to realize the best results.
This is one of the simplest yet most effective ways of enhancing tissue healing. According to Kaneps, the ideal tissue temperature for cold therapy is 59 to 66 degrees Fahrenheit.
Ice water immersion, where the injured area is soaked in a mixture of water and ice, is the benchmark for cold therapy. During the procedure, the coldest temperature that the affected limb will experience (thermal plateau) is reached after ten to thirteen minutes and the limb is normally soaked for twenty to thirty minutes. Research indicates that ice water immersion is capable of cooling a horse’s deep tissue by about 16 degrees Celsius.
Kaneps recommended that the cold therapy is repeated thrice to four times daily for the initial two days after a serious injury. The treatment needs to be continued twice or thrice daily for a fortnight. He also added that horse owners can apply the method after exercise once the horse gets back to work in order to minimize inflammation at the site of the injury. Whereas ice packs and ice may be useful, they are generally not as effective as immersion in ice water. Using salt water spas can also be helpful.
Kaneps calls this method the most effective treatment. Research has indicated that using controlled exercises to treat horses had a success rate ranging from 67 to 71 percent. In contrast, treating horses using pasture turnout had a success rate of between 25 and 51 percent.
He advised vets to start hand-walking exercises immediately after injury since ligaments and tendons need some level of stress for proper healing. Kaneps also says that as a general guideline, exercise needs to be increased gradually, by five to ten percent per week and ultrasound and reassessment of lameness should be performed every two or three months.
Kaneps points out that even though the regimen of each horse needs to be personalized to fit each horse individually, the exercise programs should be controlled and should follow the following pattern: slowly increase hand-walking for half-an-hour twice or thrice daily; next, change to walking under tack for 20-25 minutes daily; after about a fortnight, add between three and five minutes of trotting daily, but the horse must first warm-up for 10-15 minutes; gradually increase the horse trotting time to between 20-25 minutes each day; next, add three minutes of cantering progressively increasing this as you go on.
Vets directly inject PRP into the wound or to several areas next to the wound so as to assist in the healing process.He added that the vet should reassess the lameness of the horse before making any increase in the workload.
Regenerative treatment methods
In most cases, controlled exercise, rest, and cold therapy are enough for successful results. But there are also some types of regenerative therapies that can enhance or reduce the time taken to heal. Available alternatives include:
PRP (or platelet-rich-plasma), which carries blood plasma that is rich in platelets to a wound. This increases the quantities of growth factors at the injury site in order to assist in healing. One can buy commercial PRP products, and there is also a stall-side procedure that is capable of separating a horse’s white and red cells fairly quickly. The vet directly injects the PRP into the wound or in diverse areas next to the wound so as to assist in the healing process.
Stem cells can either be derived from the bone marrow or from fat (adipose). According to Kaneps, stem cells boost matrix production and employ growth factors that assist injured body areas to heal better with more elasticity and strength. He adds that one research study indicated that horses experienced a lower rate of getting their soft tissues re-injured after being treated with stem cells than those that did not get stem cells.
Kaneps advises that the best time to inject stem cells and PRP is three to four weeks after injury. It is also recommended that the injection is done under the guidance of ultrasound. Following the injection, exercise should be stopped and the injured limb needs to be bandaged for about a fortnight. The vet should do a follow-up one month after injection.
IRAP (or interleukin-1 receptor antagonist protein) is another form of regenerative therapy that veterinarians use. But it is more often used for joint injuries than in injuries to soft tissues.
Therapeutic ultrasound technique
Kaneps outlined the fact that this type of treatment can help alleviate pain and enhance the healing process in various ways. One, it encourages healing by carrying heat to the tissue that is injured and this, among other things, boosts circulation. Also, it can enhance wound contraction and the disposition of collagen.
He also highlighted the fact that with the right training from a vet, horse owners can conduct therapeutic ultrasound if they can buy or rent a unit. Treatment is done one time each day for 14-28 days.
ESWT (or Extracorporeal Shock Wave Therapy)
This technique is used by many veterinarians in the treatment of soft tissue injuries. Kaneps adds that it has been proved to minimize inflammation and boost growth factors, osteoblasts, and cytokines. All these are instrumental to the healing process. It can also get stem cells to the injured area.
Kaneps said the treatment process should start one or two weeks after the injury occurs it should be followed by 48 hours of stall hours devoid of any hand-walking. The treatments should be repeated every 14-21 days and there should be between three to five treatments during this time. In addition, there should be 10-15 minutes of hand-walking as treatment goes on. The vet should reassess the horse fourteen days after the third treatment in order to determine if the treatment method should be continued or changed.
He warned that tissue damage can happen if the setting that you are using has too much power emission. As such, you should ensure that you use the right energy flux.
Laser therapy method
Lastly, he discussed laser therapy. Whereas there have been numerous advances in laser therapy in recent times, Kaneps points out that there is as yet no scientific research that proves its effectiveness in the treatment of soft-tissue injuries.
Nonetheless, he maintains that modern lasers may have enough energy and penetrative depth to effectively reach and provide energy to the required cells. Severe injuries may be treated daily while recurrent ones ought to be treated after every two or three days.
Kaneps concluded by advising attendees that successful treatment relies on correct diagnosis and having proper knowledge of the available therapeutic alternatives. Further, he urged them to maintain comprehensive documentation relating to the outcome measures in order to keep track of the treatment progress.
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