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Tendon, Ligament, Muscle Injuries and Running Hard

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  • Tendon, Ligament, Muscle Injuries and Running Hard

    I was asked some things about how ligaments, muscles and tendons fail on another thread so we thought we should open a new thread.

    This is what started the conversation:

    My understanding (and I hope the vets will correct me if I am wrong) is that that kind of "complete" ligament failure happens because the horse is tired, and the muscles are no longer capable of doing thier job, putting all the load on the ligments. (Unlike a broken bone, or a simpler tear to a branch of a ligament, which can be the result of a single bad step.)
    Here are the replies:

    Row Wico Row:

    And re: the ligaments...
    (no I'm not a vet, but I work in ortho. sports med) There is a possibility that fatigue can play a role in such situations, but it's not the only possibility.

    When a muscle is weak, fatigued or overloaded (either by weight or by an extremely rapid acceleration or deceleration), the work is often shifted to to tendons. A human tendon is capable of producing upwards of 18,000 psi of 'pull.' That's just astonishing, especialy considering these structures are typically larger and even stronger in horses, and those of the leg are particularly adept because of their nearly constant role in both postural and dynamic support. If muscle and tendon fail, the next thing to bear the brunt is the ligaments--providers of both dynamic and static stability, the relative %age of which depends on the specific structure, but really a backup mechanism for the more dynamic muscle/tendon in many ways--and static stability provided by the bony anatomy. Unfortunately for the horse, those are some pretty small legs to support the rest of the body--it's really amazing when you think about it. Also remember where a horse's center of gravity lies, typically somehwere around the shoulder-girth area depending on the individual. It could have been the result of severe joint hyperextension when the dynamic support was tuckered out--I haven't stopped to do the math, but when a horse is travelling that fast, there are likely tens of thousands of psi.


    As far as the ligaments, they are the backup protection for a joint. If there is a situation of extemely fast loading, particularly if coupled with an eccentric (or decelerating and lengthening force, typically much weaker than the concentric or shortening force) muscular contraction, ligament failure is a definite possibility because of the decreased ability of the muscle/tendon to provide adequate dynamic control. This could be the result of landing over a fence just wrong. I'm inclined to wonder if he didn't take a bad landing somewhere previously in the course. The point at which he seems to break down appears to be at the top of a rise when he goes to swap leads around the bend, and it seems like it may have been the final insult to a previously damaged structure when it was given a more important role during the new lead.

    There is also the possibility of cumulative damage that finally reared its ugly head. Upper level horses frequently have their legs scanned, but depending on the specific modality used to do so (most typically xray and usound), and the exact parameters used, you will have a different capacity to view structures. I have no doubt, however, that if there was any question whatsoever beforehand about the structural integrity of this horse's leg he would not have been run. A short amount of R&R can prevent catastrophic consequences and any good horse person knows that and is more than willing to bide their time.
    My reply:

    Muscles by themsleves are much stronger than the ligaments. It is believed that ligaments provide a mechanical/neurological feedback attenuating the muscle response. Ligaments gain laxity as time goes on and the feedback to the muscles drops off. The MUSCLES literally tear the ligaments while still supporting the joint so the athelete continues to play. This is why a tendon blow causes a catastrophic failure as Gnep describes but a ligament failure is much more subtle.

    It is very hard to detect ligament failures because of the mechanicosensory system. There are some pain sensors but not as we would think. You can go a long time on failing ligaments without knowing, hence why juman atheletes continue to play in a game until "pop." There are some rather large research studies trying to figure out what is really happening. Hopefully this data can then be used in the equine sports.

    So, let's talk about how the athelete injures themselves and what we can do to help.

    Reed

  • #2
    I am very curious about exactly what loss of ligament means after speaking with an equine vet friend. it's been several days, and I am the old mother of a teenage son, but the jist of it was that ligaments could slip out of position and in that way fail to support the joint as opposed to tear.

    Thoughts - or did I not understand a word of her explanation? (Entirely possible due to the teenage son)
    www.amiddle-agedmadwomantakesthereins.blogspot.com

    www.pegasusridge.com

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    • #3
      Well, poop, I just was asking, should we start a new thread?
      You beat me to it.
      So, I've been hearing more and more to NOT use boots whenever possible because of the heat.
      I've also heard that standing in a tub of cold water still works best. Otherwise ice boots.
      Question: is there some kind of support out there for when a horse twists his ankle? The reason I ask is that we tore a minor check ligament. Vet says it was blunt force. I'm guessing it was a twist.
      Also, what kind of conditioning can be done to condition the muscles, tendons, and ligaments specifically?
      We did some roading during the winter and the second jump school, he gets a splint. How to prevent that?
      Have you guys seen the tendon supplement in smartpak? Would it help?
      Even duct tape can't fix stupid

      Comment


      • #4
        I don't have anything specific to contribute, however I wanted to say that I am glad this thread was started and I look forward to learning from it.
        (]~~[)

        Comment


        • #5
          Originally posted by LisaB View Post
          So, I've been hearing more and more to NOT use boots whenever possible because of the heat.
          So, newbie question, should we use boots to protect the tendon against trauma like overreaching and rubs and knocks of fences, but not support? Or no boots period?

          Comment


          • #6
            I think if you're starting out, you're not going to be generating that much heat and pounding that much. So, yes, boots, especially if you're starting out.
            I generally do conditioning w/o and if I'm really going to pressing the buttons jumping, I'll put them on.
            Even duct tape can't fix stupid

            Comment

            • Original Poster

              #7
              Let's start with a bit of anatomy just to get us all on the same page.

              Ligaments attach bone to bone. The allow for joints to rotate and translate (in other words function) without the bones flying all over the place. Ligaments are more like rubber than steel. They can flex and give. Ligaments have more cells than tendons and thus heal "faster."

              Tendons attach muscle to bone. They are very "rigid." They are more like steel cable. This allows a maximum of the muscle force to be translated to the bone, thus stabilizing or moving the skeleton. Tendons have few cells and take a long time to heal.

              Muscles are very fibrous tissues that can extend and contract. They are like a rope though so that they can not exert a force when they extend (that is the job of the contracting muscles on the other side of the limb) and can exert HUGE forces in contraction. Even the biggest couch potato bicep can be induced to lift 400lbs by itself with proper stimulus.


              Originally posted by pegasusmom View Post
              I am very curious about exactly what loss of ligament means after speaking with an equine vet friend. it's been several days, and I am the old mother of a teenage son, but the jist of it was that ligaments could slip out of position and in that way fail to support the joint as opposed to tear.

              Thoughts - or did I not understand a word of her explanation? (Entirely possible due to the teenage son)
              Yes, ligaments can slip from their "channels" doing exactly what your vet describes. The same sort of thing happens in rotator cuff injuries as well.


              So, I've been hearing more and more to NOT use boots whenever possible because of the heat.
              I've also heard that standing in a tub of cold water still works best. Otherwise ice boots.
              Question: is there some kind of support out there for when a horse twists his ankle? The reason I ask is that we tore a minor check ligament. Vet says it was blunt force. I'm guessing it was a twist.
              Also, what kind of conditioning can be done to condition the muscles, tendons, and ligaments specifically?
              We did some roading during the winter and the second jump school, he gets a splint. How to prevent that?
              Have you guys seen the tendon supplement in smartpak? Would it help?
              Here is my perspective. This is not to say I right but this is based on my work with veterinary surgeons, orthopods and biomechanicists.

              I don't think there is one thing that can support a horse limb, ankle or otherwise, on a horse, outside a cast to imobilize the limb. I did a quick calculation once and found that coming off a 3' fence, a horse puts around 5,000 pounds per square inch of stress on each of its flexor tendons. Outside of metal alloys, nothing can really support that kind of load. A wrap can help support the lateral movement but it has to be pretty thick to allow for easy movement. What we use every day is too flimsy.

              Conditioning is HUGE! Studies have shown that SHOCK loading (that is what you get walking or trotting on pavement or a hard packed dirt road) can stimulate bone, tendon and muscle growth. It does not have to be long. In the work I am familiar with, they shock loaded sheep for only 20 minutes a day for a week and found a significant increase in tendon mass. Basically they walked them on a metal force plate. This is similar to what shock wave therapy does!

              My money is that the splint was coincidence. There is a ligament that can be involved but it is not part of any "joint" per se or can it really be loaded for conditioning.

              From the biochemistry for tendon supplements, I have to be honest, I think it is voodoo. Yes, certain nutrients are needed but again the tendon is relatively avascular and acellular (without cells or blood vessels), so how does the supplement get there?

              That is the challenge of Eventing. You have to be a REAL horse person, figuring out the right balance of conditioning to bring a horse to the right level without breaking them. And that is what scares the crap out of me every season as I get ready.

              Reed

              Comment


              • #8
                Thanks Reed.

                So what that thesis said, that there is basicly a thermal brakedown. That the heat created through hard work brakes down important stuff in the legament or tendon and that that eventual makes it fail ?
                That I have no use for them, does not mean, that I don't know them and don't know how to use them.
                Caveman extraordinair

                Comment


                • #9
                  PSA on boots...

                  Here's my PSA on boots, so maybe someone else can learn from my (bad) experience: in his "Bowed Tendon Book", Tom Ivers recommends NOT booting after a bow because it can cut down the blood supply to the tendon. Never occurred to me (unfortunately) until I read that book. This is not a good thing.
                  The PSA is that this can also happen when you boot too tight, even a little too tight. I was unknowingly putting boots on too tight, and it likely contributed to my horse's torn tendon. Don't want anyone else to go through that, so thought I'd throw my $.02 in.

                  That being said, boots are good for bump/scratch protection, but having read a lot of different opinions, it seems the general consensus is that they will not offer all that much support to the structures of the leg.
                  "This thing we call 'failure' is not the falling down, but the staying down" - Mary Pickford

                  Comment


                  • #10
                    Thanks, guys.

                    Thanks to RAyers and RWR for their concise and clear descritions of what happens.

                    Other than ultrasound, is there a way to check for occult ligament injury that can be done at home by non-professionals?

                    And I concur with your comment that there are limited pain sensors in ligaments. (Skip this part if you don't want to read war stories). I took a misstep while doing barn chores one winter. Minor pain: finished barn chores, no problem. Sat down to watch football with Mr. Frugal, and tried to get up out of chair at halftime. I couldn't walk! I had torn the ligaments that stabilize the hip, per the orthopod who saw me eventually. Not fun, but it did heal.

                    But back to horses: how do we keep them from doing this to themselves?
                    They don't call me frugal for nothing.
                    Proud and achy member of the Eventing Grannies clique.

                    Comment


                    • #11
                      Too cool about the sheep tendons. Now of course I want a followup study with moderately fit sheep - say, ready to run a Training sheep event - and see the gain in moderately fit sheep tendons. At what point does ShortSlowImpact work cease to add tendon strenght?
                      After several iterations of this testing, of course they'll have to do the ethically painful part - running some of the sheep from each fitness group to the point of tendon failure. Will short format or long format sheep fare worse? How will what boots they run in affect the rate of breakdown? And ambient air temperatures?
                      Will we be able to taste the dinner at the banquet afterwards?

                      Seriously, who thought of shock loading sheep, and what was their interest in the subject? Aside from the visual of the sheep training, it's exciting to hear of actual science which might help us keep our horses sound and in work as long as possible...
                      http://wildwoodfarmnc.com

                      http://cantersgutenberg.wordpress.co...g-quiet-goose/

                      Comment


                      • #12
                        Re:
                        But back to horses: how do we keep them from doing this to themselves?

                        Give 'em a psychotrophic drug! The Winston was on some good sh- when he was stall bound because he spins and pings when he's being obnoxious. Couple that with a torn ligament, well, you can guess how he got there.
                        Even duct tape can't fix stupid

                        Comment


                        • #13
                          Jeanette - Someone with too much time and a guv'mint grant on their hands!!
                          www.amiddle-agedmadwomantakesthereins.blogspot.com

                          www.pegasusridge.com

                          Comment


                          • #14
                            I think we all tend to focus too much on the wind-and-heart conditioning (inteval training, speedwork) and not enough on the soft tisue and bone conditioning (LSD).
                            Janet

                            chief feeder and mucker for Music, Spy, Belle and Tiara. Someone else is now feeding and mucking for Chief and Brain (both foxhunting now).

                            Comment


                            • #15
                              Reed, thank you for starting this- it's fascinating. I didn't realize that ligaments healed faster than tendons (or why). But I can attest that I rehabbed my prelim eventer back to prelim after he "did" his inner front suspensory branch. Road work was a big part of this, and has been for this horse since then to assure that his structures are as strong as possible. He was prelim fit when he was hurt, though, and in the pasture with no boots, so we can't blame heat or lack of fitness in his case.

                              Very interesting about the heat and boots - I always notice how hot their legs are after XC - even at BN last weekend when it was barely 60 degrees and wet, her legs were hot when I removed her boots.

                              Comment


                              • #16
                                Boots-
                                1- Boots and "support" -Yes, all boots are good for is protecting from taumatic injury. They can't "support" the joint or the soft tissue without limiting the range of movement- which would simply transfer the force to another part of the anatomy less good at handling it.

                                2- Boots and heat - A year or so ago I read a bunch of the original research on it. My conclusion was that, under "lower level eventer" conditions, there wasn't enough heat build up to be an issue during the competition/schooling session. But you definitely don't want to leave the boots on after you finish.
                                Janet

                                chief feeder and mucker for Music, Spy, Belle and Tiara. Someone else is now feeding and mucking for Chief and Brain (both foxhunting now).

                                Comment


                                • #17
                                  Alot of folks do sets on hard ground if the joints are sound in order to strenghten the soft tissue. We do this at my barn - not with a huge amount of intensity or speed, but we do long walks and some trotting on the roads with some frequency.

                                  Also, there have been some studies regarding the use of boots made of neoprene and other materials that seem to retain heat. So, we often do not use boots unless there is demonstrated interference until about Prelim. Well, I usually do in competition on cross county, because my personal paranoia about knocks on solid objects is more severe than my paranoia about the possibility of soft tissue injury since the studies aren't conclusive, but I think I am in the minority.
                                  Treat Jockey for Spellbound and Smidgeon

                                  Comment

                                  • Original Poster

                                    #18
                                    Originally posted by Gnep View Post
                                    Thanks Reed.

                                    So what that thesis said, that there is basicly a thermal brakedown. That the heat created through hard work brakes down important stuff in the legament or tendon and that that eventual makes it fail ?
                                    It becomes part of the failure mechanism. The thesis is Deeda Randall's! I use it as part of my class notes in my graduate biomaterils class.

                                    Heat builds up in the tissues if there is insufficient blood flow so the local temperature passes the point of keeping proteins intact. Proteins such as elastin (found in great quantity in ligaments but not tendons) easily denature to give the ligament its ability to stretch without breaking also denature readily at temperature not much above body temp.

                                    Part of the hope for conditioning is to increase blood supply to the tissues, not to just strengthen the tissues.

                                    As for the sheep it was a study by Simon Turner at CSU to examine osteoporosis (they have similar body weights and bone physiology to humans) but the tendon/ligament data was and added bonus. We worked with him for a bit as we were looking at spaceflight and how we could figure out ways to help astronauts. And, yes, there was mutton for all at the BBQ.

                                    Other work in horses in the UK has confirmed this looking at horses hacked on cobblestones.

                                    I don't want to sound like the only expert on this topic. I know there are others here such as Wisco and bushkn who have even more understanding so I hope they chime in!

                                    I really have been looking for galloping boots that are vented on the tendons. I am debating cutting vents in my leather boots.

                                    Reed

                                    Comment


                                    • #19
                                      I really have been looking for galloping boots that are vented on the tendons. I am debating cutting vents in my leather boots.
                                      What about using "open front" (jumper) boots? Even though the opening is on the front, I would think they would retain less heat.
                                      Janet

                                      chief feeder and mucker for Music, Spy, Belle and Tiara. Someone else is now feeding and mucking for Chief and Brain (both foxhunting now).

                                      Comment


                                      • #20
                                        Just as a side note, I noticed in the Rolex photo gallery that Ian Stark ran Rolex with bell boots but NO galloping/tendon boots -- at a four-star. That was really interesting to me. Maybe he's heard about all this research.
                                        I event on a horse who came to me free because he bowed -- badly -- on the track at a 3 y.o. I don't understand the physiology of it as well as our other posters, but I was warned long ago -- and it is always, always on my mind -- that I need to make sure he's fit enough to do his job so he doesn't fatigue and put undue stress on that already compromised leg.
                                        I evented just for the Halibut.

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