Q. My horse has a severe laceration involving the biceps femoris and semitendinosis muscles (along the back of the hindquarter). He is 17 and in very good shape, training Prix St. Georges. We were able to suture the site and the incision is healing nicely. My question is on rehabilitation. What would be the best avenue to take to prevent too much scar tissue from forming and limiting the use of these muscles?

Kathy, via email

A. This is certainly an area that is important to a horse expected to perform at this level in dressage. These muscles help stabilize the actions of the hind legs and the horse's power of propulsion. The good news is that, in general, these muscles tend to heal nicely and return to good function. Your attempt to minimize scarring within the muscles is a worthy goal.

The fact that you were able to appose the cut edges and close the wound will be an important factor in getting first-intention healing (when tissues are held together so less of a gap has to be bridged) and reducing the scar tissue formation. The next step is to initially minimize excessive stress on the damaged tissues by limiting movement for the first 12-14 days with stall rest and some short periods of controlled hand walking for mental well-being. During this time, if there is heat and swelling in the area, cold therapy in the form of ice or cold compresses and anti-inflammatory medication can be utilized. Oral supplements that facilitate muscle building and repair might be helpful and started at this time.

Once the inflammation in the area subsides, then the goal should be to increase circulation and remodeling of the soft tissues in the region in order to develop more "normal" functional healed tissue. This is usually within the time period of two to five weeks post-injury. Warm, moist compresses twice daily for 30-45 minutes can be useful in this regard. Therapeutic ultrasound under the guidance of a trained equine therapist is another method to stimulate remodeling efforts in the area. Therapeutic massage in the area may aid in the healing process and be beneficial. Additionally, a graduated increase in controlled exercise is important during this time to return range of motion and elasticity to these muscles. You can increase the time you hand walk and ride the horse at the walk up to 90 minutes daily. A Eurociser-type pen walker can be used if the disposition of the horse is conducive to this therapy.

The "healed" muscle tissue should have good holding power six to seven weeks post-injury, and this is the time to start increasing the load on the tissues with controlled riding at the trot for three to five minutes. Increase this period by five minutes weekly. You can use an AquaCiser (underwater treadmill) to put a measured load on the muscle tissue while utilizing concurrent hydrotherapy. You can add canter slowly around nine to 10 weeks post-laceration and increase as the horse dictates with his movement and attitude toward exercise. If all progresses well with no setbacks, you can resume regular training 12-14 weeks post-injury.

With patience, diligence, and attention to detail, it is my hope that your horse will return to pre-injury performance levels with no evidence of gait abnormality or behavioral resistance to exercise.

About the Author

Duncan Peters, DVM, MS

Duncan Peters, DVM, MS, Dipl. ACVSMR, ISELP, is the co-owner and founder of East-West Equine Sports Medicine and focuses his practice on locomotor pathology and the diagnosis, treatment, and management of sport horse health for optimum performance. A University of California, Davis, graduate, Peters has also served as as director of the Clinical Equine Sports Medicine Program and associate professor of Large Animal Clinical Sciences at Michigan State University’s College of Veterinary Medicine. An FEI veterinarian, he was member of the 2010 Alltech World Equestrian Games' veterinary commission. Peters is an active horse owner and competes hunter-jumpers.

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