Skip to Content

Horse Tendon & Ligament Health: Prevention, Diagnosis, Rehab

Published on: April 14, 2023

By: Miles HenryFact Checked

Any links on this page that lead to products on Amazon are affiliate links and I earn a commission if you make a purchase. Thanks in advance – I really appreciate it!


Horses rely on their tendons and ligaments to perform at their best, whether for competitive sports or leisurely trail rides. As a horse owner, you understand the significance of maintaining your horse’s overall health and well-being. In particular, tendon and ligament injuries can pose a significant challenge to horse owners as they can lead to the premature end of a horse’s career.

Tendons and ligaments are crucial in supporting the joints and facilitating smooth, efficient movement. When these structures are damaged, it can be a long and difficult road to recovery. Therefore, it is vital to be proactive in preventing injuries and addressing any issues at the earliest signs of trouble.

To help you on this journey, I’ve prepared this comprehensive guide covering the fundamentals of equine tendon and ligament health, including prevention, diagnosis, and rehabilitation strategies. No matter your experience with horses, this guide will serve as a valuable resource for the health and happiness of your equine companion.

Anatomy of tendons and ligaments in horses

Understanding the anatomy of tendons and ligaments in horses is essential for proper care and injury prevention. Tendons and ligaments are both types of connective tissue, primarily composed of collagen fibers, which provide strength and flexibility.

Tendons are strong, fibrous connective tissues that attach muscles to bones. Their primary function is to transmit the force generated by muscles to the skeleton, allowing for efficient movement. They are composed of dense, parallel bundles of collagen fibers, which provide strength and flexibility. The structure of tendons also allows them to store energy and release it during movement, acting as a biological spring.

Ligaments, on the other hand, connect bones to other bones, providing stability and support to joints. They are composed of more loosely arranged collagen fibers compared to tendons, allowing for a limited degree of flexibility while still maintaining joint stability. Ligaments prevent excessive joint movement and help maintain proper alignment during motion.

There are several key tendons and ligaments in a horse’s leg that are prone to injury. The superficial digital flexor tendon, deep digital flexor tendon, and suspensory ligament are critical structures that work together to bear the horse’s weight and absorb shock during movement.

The superficial digital flexor tendon runs down the back of the leg, while the deep digital flexor tendon is positioned beneath it, closer to the bone. The suspensory ligament originates from the back of the cannon bone and extends down to the sesamoid bones, supporting the fetlock joint.

The check ligament, or accessory ligament of the deep digital flexor tendon, helps to stabilize the deep digital flexor tendon and minimize excessive stretching. Collateral ligaments are found in various joints, such as the fetlock and coffin joints, providing side-to-side stability and preventing excessive joint movement.

Familiarizing yourself with these structures can help you recognize potential injuries and take appropriate measures to keep your horse in optimal health.

Picture of a bowed tendon
Bowed tendon

Common types of tendon and ligament injuries

In the equine world, certain tendon and ligament injuries are more common than others. One of the most frequent injuries is the bowed tendon, which is the swelling and inflammation of the superficial digital flexor tendon.

This injury typically occurs due to overloading during high-speed activities, resulting in inflammation, micro-tearing, or even complete rupture. A bowed tendon can be visible as a “bowing” of the tendon, causing pain and lameness in the affected leg.

Deep digital flexor tendon injuries, though less common, can also cause significant lameness. They often arise from excessive strain or direct trauma, usually affecting the region near the navicular bone or the distal end of the metacarpal or metatarsal bones. In severe cases, the tendon may detach from the bone or rupture, requiring extensive treatment and rehabilitation.

Suspensory ligament injuries are another common concern, as this ligament supports the horse’s fetlock joint and bears considerable weight during movement. Damage to the suspensory ligament can range from mild strains to complete tears, impacting a horse’s ability to perform. These injuries are often associated with repetitive stress, poor conformation, or inappropriate training methods.

Check ligament injuries, while less common, can result from overextension or direct trauma, leading to swelling and discomfort. In some cases, they may cause the horse to become lame or unwilling to bear weight on the affected limb. Proper treatment and rest are necessary for a full recovery.

Collateral ligament injuries occur when the ligaments that stabilize a joint, such as those in the fetlock or coffin joint, are compromised. These injuries can arise from acute trauma or chronic overloading, causing varying degrees of lameness. Depending on the severity, treatment may include rest, anti-inflammatory medications, or even surgery in some cases.

Additionally, horses can experience other tendon and ligament injuries that may be less common but still require attention and appropriate care. These can include injuries to the extensor tendons, which are responsible for extending the leg, or to the various smaller ligaments found throughout the horse’s body. Early detection, proper treatment, and rehabilitation are essential for successful recovery from any tendon or ligament injury.

Causes of tendon and ligament injuries in horses

Tendon and ligament injuries in horses can arise from various causes, ranging from acute incidents to chronic issues. Understanding these causes can help horse owners implement preventative measures and promptly address potential problems.

A. Acute injuries: Acute injuries are sudden and often result from trauma, strains, or sprains. These injuries can occur due to a single event, such as a misstep, collision, or awkward landing. They can cause immediate damage to the tendon or ligament, leading to inflammation, swelling, and pain.

In severe cases, acute injuries can result in a partial or complete tear of the affected tissue, requiring immediate veterinary attention and possibly surgery.

B. Chronic injuries: Chronic injuries develop over time due to overuse, repetitive stress, or degenerative changes in the tendons and ligaments. Prolonged strain on these tissues can lead to micro-damage that accumulates, ultimately causing inflammation, fibrosis, and reduced function.

Chronic injuries may not cause acute lameness but can gradually worsen if not addressed, potentially leading to long-term damage and decreased performance.

C. Risk factors: Several factors can increase a horse’s risk of developing tendon and ligament injuries. These include:

  1. Age: Older horses may be more susceptible to injuries due to the natural aging process, leading to decreased elasticity and strength in tendons and ligaments.
  2. Conformation: Poor conformation or structural imbalances can place increased stress on tendons and ligaments, making them more prone to injury.
  3. Training: Inadequate or inappropriate training methods, such as overloading or insufficient rest periods, can contribute to the development of both acute and chronic injuries.
  4. Environmental factors: Uneven or slippery surfaces, as well as poorly maintained training or competition environments, can increase the risk of injuries due to missteps or excessive strain on the tendons and ligaments.

Being aware of these risk factors and addressing them proactively can help reduce the likelihood of tendon and ligament injuries in horses, ensuring their continued health and optimal performance.

Picture of my horse with a poultice used to enhance ligament health.
Poultice on a horses legs

Prevention of tendon and ligament injuries

Preventing tendon and ligament injuries in horses is essential to ensure their long-term health and performance. Implementing the following strategies can help reduce the risk of injury and keep your horse in peak condition:

A. Proper conditioning and training: Gradually building your horse’s fitness level through a well-planned conditioning and training program is crucial for injury prevention. This involves progressively increasing the intensity and duration of workouts, allowing sufficient recovery time between sessions, and incorporating various exercises to strengthen muscles, tendons, and ligaments. Cross-training can also help reduce repetitive stress on specific tissues, minimizing the risk of chronic injuries.

B. Appropriate shoeing and hoof care: Proper shoeing and hoof care play a vital role in maintaining your horse’s overall health and reducing the risk of tendon and ligament injuries. Regular hoof trimming and balancing, along with appropriate shoeing, can help maintain proper alignment and biomechanics, thus minimizing strain on the tendons and ligaments. Consult with a skilled farrier to ensure your horse’s hooves are well cared for and to address any specific issues related to conformation or gait.

C. Regular veterinary check-ups: Scheduling regular veterinary examinations is essential for detecting potential issues early and addressing any concerns before they become serious problems. Your veterinarian can assess your horse’s overall health, including tendons and ligaments, and recommend any necessary interventions or changes to your horse’s care and management.

D. Safe and well-maintained training and competition environments: Ensuring that the surfaces your horse trains and competes on are safe and well-maintained can significantly reduce the risk of injury. This involves providing consistent footing, avoiding slippery or uneven surfaces, and promptly addressing hazards that could lead to missteps or excessive strain on your horse’s tendons and ligaments.

E. Poultices: Using poultices can be a helpful method for treating or as a preventative measure for ligament injuries in horses. Poultices are moist, clay-based or herbal preparations applied to the affected area to help reduce inflammation, promote healing, and provide relief from pain or discomfort.

They can be used after a heavy workout or competition to alleviate strain and help prevent injury or used in the treatment phase of an existing ligament injury to manage inflammation and support the healing process.

F. Tendon Boots: Boots can be helpful in both the prevention and rehabilitation of tendon injuries in horses. Fetlock boots, tendon boots, and other supportive boots are designed to provide protection, support, and stability to the horse’s legs, particularly during exercise or competition. They can help absorb and distribute impact forces, minimizing strain on tendons and ligaments, and reducing the risk of injury.

By following these preventive measures, you can help minimize the risk of tendon and ligament injuries in your horse, promoting their long-term health and success in their chosen discipline.

Signs and symptoms of tendon and ligament injuries

Recognizing the signs and symptoms of tendon and ligament injuries in horses is crucial for early detection and effective treatment. Being vigilant about your horse’s physical and behavioral changes can help identify potential issues before they worsen.

A. Physical signs: Swelling, heat, and lameness are common physical indicators of tendon and ligament injuries. Swelling can occur due to inflammation in the affected area, while increased heat may be a sign of active inflammation or infection. Lameness, ranging from mild to severe, can indicate an injury to the tendon or ligament, affecting the horse’s ability to bear weight or move comfortably.

B. Behavioral signs: A horse experiencing discomfort from a tendon or ligament injury may display changes in behavior. Unwillingness to perform specific tasks, such as jumping or sudden changes in direction, can be a sign that the horse is experiencing pain.

Other behavioral indicators may include reluctance to bear weight on the affected leg, sensitivity when touched in the injured area, or a general change in demeanor, such as increased irritability or lethargy.

Regularly monitoring your horse for signs of injury and consulting with your veterinarian if you notice any concerning symptoms is key to maintaining your horse’s well-being and ensuring a successful recovery from any tendon or ligament injury.

Diagnostic methods for tendon and ligament injuries

Accurate diagnosis of tendon and ligament injuries in horses is essential for determining the most effective course of treatment and rehabilitation. A combination of diagnostic methods is often employed to assess the extent of the injury and monitor the healing process.

A thorough physical examination by a veterinarian is the first step in diagnosing tendon and ligament injuries. This examination may include palpation of the affected area to assess for swelling, heat, or pain, as well as evaluating the horse’s gait and lameness. The veterinarian may also perform flexion tests or other specialized assessments to pinpoint the specific structure involved.

In addition, various imaging techniques can be used to visualize tendon and ligament injuries in greater detail. Ultrasound is a common and non-invasive method that provides real-time images of soft tissues, allowing for the identification of inflammation, tears, or other abnormalities.

Magnetic resonance imaging (MRI) can offer a more detailed view of the structures within the horse’s leg, including tendons, ligaments, and bones. X-rays, although primarily used for examining bone, can sometimes reveal changes in soft tissue structures or highlight bone-related issues contributing to the injury.

In some cases, more advanced diagnostic techniques may be employed to assess tendon and ligament injuries. Thermography uses infrared imaging to detect temperature variations on the skin’s surface, which can indicate inflammation or changes in blood flow related to an injury.

Nuclear scintigraphy, or bone scan, involves injecting a small amount of radioactive material into the horse’s bloodstream and using specialized cameras to detect areas of increased metabolic activity, potentially revealing areas of injury that may not be apparent through other diagnostic methods.

Using a combination of these diagnostic methods, veterinarians can accurately identify tendon and ligament injuries in horses, determine the severity of the damage, and develop a targeted treatment and rehabilitation plan to promote healing and recovery.

Treatment and rehabilitation of tendon and ligament injuries

Effective treatment and rehabilitation of tendon and ligament injuries in horses are crucial for promoting healing and preventing further damage. A combination of initial management, veterinary interventions, and rehabilitation techniques can help ensure a successful recovery and return to work.

In the early stages of a tendon or ligament injury, rest, ice, and compression, are essential components of management. Rest allows the injured tissues to begin the healing process, while ice helps reduce inflammation and swelling.

Compression, achieved through the use of supportive wraps or bandages, can minimize swelling and provide support to the affected area. During rehabilitation, the use of supportive boots can help stabilize and protect the injured area while the horse gradually returns to work.

They can also help prevent reinjury by offering additional support to the healing tendons and ligaments. It is important to choose the appropriate type of boot for your horse’s specific needs and to ensure a proper fit.

Depending on the severity and type of injury, various veterinary treatments may be recommended. Anti-inflammatory medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), can help manage pain and inflammation.

In some cases, corticosteroids may be used to reduce inflammation, although their use should be carefully considered due to potential side effects. Regenerative therapies, such as platelet-rich plasma (PRP), stem cell therapy, and extracorporeal shockwave therapy, have shown promise in promoting healing and tissue regeneration in tendon and ligament injuries.

Rehabilitation techniques

A comprehensive rehabilitation program is essential for a successful recovery. Controlled exercise, including hand-walking or gradual reintroduction to work under saddle, can help maintain muscle strength and flexibility while preventing stiffness.

Physical therapy techniques, such as stretching, massage, and therapeutic ultrasound, can aid in healing and restoring function. Hydrotherapy, which involves exercising the horse in water or using water-based therapies, can provide low-impact exercise and promote healing by stimulating blood flow to the injured area.

Long-term management

Careful monitoring and ongoing management are necessary as the horse returns to work following a tendon or ligament injury. A gradual increase in workload, combined with regular veterinary check-ups, can help ensure the horse is healing properly and not experiencing any setbacks.

Adjustments to the horse’s training program, shoeing, and overall care may be required to minimize the risk of reinjury and maintain long-term health.By following a comprehensive treatment and rehabilitation plan, horse owners can promote the successful recovery of their equine partners from tendon and ligament injuries, allowing them to return to work and continue performing at their best.

Advancements in equine tendon and ligament injury rehabilitation

The field of equine tendon and ligament injury rehabilitation has made significant strides in recent years, with many horses making successful recoveries and returning to their previous levels of performance. These advances are supported by a growing body of research and innovative technologies and therapies.

Horses with once career-ending injuries, such as severe suspensory ligament lesions or deep digital flexor tendon injuries, have been able to recover and return to competition after undergoing regenerative therapies, such as stem cell therapy or platelet-rich plasma (PRP) treatments, combined with carefully managed rehabilitation programs.

As our understanding of equine tendon and ligament injuries and their underlying mechanisms continues to grow, researchers and veterinary professionals are developing innovative technologies and therapies to further improve rehabilitation outcomes.

For instance, advances in diagnostic imaging, such as 3D ultrasound and high-field MRI, are providing more detailed and accurate assessments of injured tissues, enabling more targeted treatment plans. Additionally, new therapies, such as gene therapy and biological scaffold materials, are being explored for their potential to accelerate healing and reduce the risk of reinjury.

These emerging technologies and therapies hold great promise for the future of equine tendon and ligament injury rehabilitation, offering the potential for even better outcomes and a higher quality of life for affected horses.

Conclusion: Horse Tendon & Ligament Health

Tendon and ligament injuries in horses are common and can pose significant challenges for both the horse and its owner. However, with a thorough understanding of the anatomy, causes, and risk factors, as well as diligent attention to prevention, early detection, and appropriate treatment, many horses can make a successful recovery.

Advancements in diagnostic methods, innovative therapies, and comprehensive rehabilitation techniques have revolutionized the field, providing new hope for horses with tendon and ligament injuries. By staying informed and working closely with veterinary professionals, horse owners can play an essential role in ensuring their equine partners receive the best possible care and enjoy a long, healthy, and productive life.


How long do ligament injuries take to heal in horses?

The healing time for ligament injuries in horses can vary depending on the severity of the injury, the specific ligament involved, and the individual horse’s overall health and response to treatment. Generally, ligament injuries can take anywhere from several months to over a year to heal.

What is the most common tendon injury in horses?

The most common tendon injury in horses is the injury to the superficial digital flexor tendon (SDFT), which is often referred to as a “bowed tendon.” This injury occurs when the tendon fibers become damaged, leading to inflammation, swelling, and a characteristic bowing appearance.