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“Bowed” Tendons and “Pulled” Suspensories

My 15 yr. old mare has been diagnosed with tendinitis. She has been lame about 2 yrs. I have had her x-rayed, the vet says there are no signs of arthritis. She gets better then she gets worse. I have tried some lite riding. I have put her on SmartFlex Repair. She has been on this product 2 months. She is better now but not well. I have decided not to ride her anymore until she is well. How long should I keep her on this supplement before I can see some results, or will this supplement help a tendon problem? Thank You, BC, North Carolina

Dear BC,

Having just rehabbed one of my horses through a “pulled” suspensory, I can sympathize with you and your horse’s “bowed” tendon. These two soft tissue problems are very similar, so I’ll provide some general information on both of them along with some specific recommendations for your horse’s particular problem.

First, let’s make sure we’re on the same page regarding the anatomy. A “bowed” tendon is named for the bow shape the back side of the lower limb (usually the front) develops because of swelling in the tendon. There are two tendons that run down the back of the leg. The one nearer the skin and the one that usually “bows” is the superficial digital flexor tendon. The one nearer the cannon bone is the deep digital flexor tendon. The suspensory ligament runs from the knee (or hock) to the ankle, and lies between the deep digital flexor tendon and the cannon bone. It provides support to the ankle during the weight-bearing phase of the stride.

Tendinitis, or, inflammation of the tendon, usually occurs at high speeds or when horses are fatigued. Less-than-ideal training, conditioning, conformation, trimming, shoeing and footing are other factors that can lead to a strained or “bowed” tendon. The causes of desmitis, or, inflammation of a ligament, are similar, and can lead to a sprained or “pulled” suspensory. Hint: to remember that tendons are strained and ligaments are sprained, think of straining your muscle (tendons connect bone to muscle) and spraining your ankle (ligaments connect bone to bone).

When a tendon first “bows,” horses are usually lame with pain, heat and swelling in the affected area. Unfortunately, horses with “pulled” suspensories don’t always show these obvious signs of injury. They may simply not feel right under saddle. While x-rays are great to visualize bony structures, ultrasound is the imaging tool of choice when it comes to a soft tissue injury like a “bowed” tendon or “pulled” suspensory. Ultrasonography can provide measurements of just how severe the injury is. Follow-up images are useful in determining how healing is progressing and when a horse can be put back into work. For example, this spring we used ultrasound to initially diagnose my horse with a “pulled” suspensory, then we imaged the leg every 30 days during his rehab to make sure the tears were filling in well. This helped me know when to safely start adding trotting, cantering, circles/corners and lateral work to his regimen.

Early treatment of a “bowed” tendon or “pulled” suspensory may include rest, cold therapy, pressure bandaging and anti-inflammatories Newer therapies include IRAP (interleukin-1 receptor antagonist protein), stem cells and ESWT (extra corporeal shock wave therapy). Oral silica and hydrolyzed collagen (gelatin)–such as in our SmartFlex Repair–also have evidence supporting their use in the development of healthy connective tissue such as tendons and ligaments.

Here’s why no horse owner wants to hear that their horse has a “bowed” tendon or “pulled” suspensory: depending on the severity of the injury, a tendon may require six months or more to heal while a ligament may require nine to twelve months or more to heal. With either type of injury, the horse may not return to its previous level of performance.

My advice is to have a knowledgeable veterinarian sonogram your mare’s leg to determine the extent of the injury and its current status. Then, work with that vet to design a rehabilitation program—that may include a supplement like SmartFlex Repair—to try and return your mare to soundness. Be aware that you may have to do more than simply stop riding her. You may also have to restrict her turnout so that she doesn’t move too much on her own and reinjure herself. I wish you the best of luck!

Lydia F. Gray, DVM, MA SmartPak Staff Veterinarian and Medical Director Dr. Lydia Gray has earned a Bachelor of Science in agriculture, a Doctor of Veterinary Medicine (DVM), and a Master of Arts focusing on interpersonal and organizational communication. After “retiring” from private practice, she put her experience and education to work as the American Association of Equine Practitioner’s first-ever Director of Owner Education. Dr. Gray continues to provide health and nutrition information to horse owners through her position at SmartPak, through publication in more than a dozen general and trade publications, and through presentations around the country. She is the very proud owner of a Trakehner named Newman that she actively competes with in dressage and combined driving. In addition to memberships in the USDF and USEF, Dr. Gray is also a member of the Illinois Dressage and Combined Training Association (IDCTA). She is a USDF “L” Program Graduate and is currently working on her Bronze Medal. Find Dr. Gray on Google+

Posted in Lameness

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5 comments on ““Bowed” Tendons and “Pulled” Suspensories
  1. Ashley says:

    I recently took in a gelding that was to be put to sleep because of a pulled suspensory, he’s an 8 yr old stb and he’s a great horse, this article is very informative to me and I’m glad I stumbled upon it! Although I have the stall rest, leg wraps, cold therapy and vet work underhand, I did not know smartpak had a supplement to help heal and prevent this from happening again by supporting the tendon or ligament, I will be looking into this and talking to my vet about this! Thanks again smartpak for once again going above and beyond to try and help horse owners in every situation!

    • SmartPak SmartPak says:

      Hi Ashley, thanks for your comment, I’m so glad you found this article helpful! You can do even more reading on tendon and ligament health on our website:
      Good luck with your gelding – he’s very lucky to have you! If there’s ever anything we can do to help, please don’t hesitate to let us know. – SmartPaker Sarah

  2. Cary says:

    what kind of treatment would someone give to a bowed tendant

    • SmartPak SmartPak says:

      Hi Cary, thanks for asking! Some of the initial treatment options for a “bowed” tendon or a “pulled” suspensory may include rest, cold therapy, pressure bandaging, and medication. If you’re interested in learning more, check out the blog or the link below which focuses on tendon and ligament health from the Equine Health Library on the SmartPak website: – Dr. Lydia Gray

  3. kylie says:

    My horses front left leg is swollen on the back he don’t limp at the walk he limps at the trot and canter he is 18yrs old is it pulled or bowed

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