Concept

Revolutionising the rehabilitation of soft tissue injuries as we know it

Equinetendon.com is the world leader in the management and rehabilitation of soft tissue injuries.

Our multidisciplinary team under the guidance of veterinarian Henk Offereins uses both the Advanced Tendon Tissue Assessment (UTC) scanner and our Dynamic Support System (Equestride) to offer a rehabilitation package far superior to what is currently available on the market. With a strong focus on the tendon and suspensory issues, equinetendon.com has already proven itself by assisting numerous horses to return to top-level competition/use after sustaining minor to severe soft tissue injuries.

Prevention and monitoring

Tendon injuries may be the result of single macro-trauma. But there is growing evidence that tendon lesions are frequently preceded by gradual disintegration going on for months or even longer before injuries become manifest. So, clinical symptoms are frequently only the tip of the iceberg.

The best technology to accurately assess the quality of tendon tissue is called Ultrasound Tissue Characterisation (UTC) scanning. UTC is currently used by leading sports institutes all over the world and is vastly gaining ground as being the golden standard for Equine Tendon Management. It is mobile and the assessment scan doesn’t cost a fortune (like MRI).

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Diagnosing and treating equine tendon injuries to achieve maximum quality healing is not straight forward. Tendon injury diagnostics using conventional ultrasound scanners are limited as the scanner will only "look" at the density of the tissue, thus seeing a visual differentiation between tissue (fibre) types within the tendon is impossible. Furthermore, fundamental research revealed that it is impossible to stage lesions by means of conventional ultrasonography and the technique suffers poor reproducibility. It doesn’t allow reliable monitoring.

A UTC scan offers an extremely accurate diagnosis of the tendon in a way no other machine can. UTC recognises different tissue (fibre) types within the tendon and the differences are clearly shown onscreen by colour coding. This means that it is now possible to differentiate between properly organised, strong and healthy tissue versus organised but weak and unhealthy tendon tissue. UTC is a massive improvement in the capability of assessing tendon quality, healing speed, recovery stage, responsible workload and ultimately reliably assessing when it is safe for a horse to return and competition.

During the intake, we gather relevant information and will carry out the first scans in order to establish the baseline Tendon Tissue Assessment for the horse. This baseline will give us information regarding the general fibre composition and “health” of the tendon and establish the presence and degree of possible scar tissue or overloading effects.

Tendon injuries may be the result of single macro-trauma. But there is growing evidence that tendon lesions are frequently preceded by gradual disintegration going on for months or even longer before injuries become manifest. So, clinical symptoms are frequently only the tip of the iceberg.

This degradation is the result of ageing and of microscopic damage after repetitive overuse.

Early stages of disintegration may be still manageable but when it comes to a tendon rupture, cases with underlying degeneration have by far the worst prognosis.

Research has shown that we can detect changes in racing thoroughbreds immediately after the race and that these changes are of short-duration and fully reversible. Secondly, UTC enables us to monitor exercise effects in high-performance horses, aiming at early detection of overstraining and degeneration.

So, early detection is of vital importance! This requires a Pro-Active instead of a Re-Active approach.

The baseline scan in combination with information on previous injuries, age of the horse, discipline, level, exercise/loading intensity and the programme for the horse through the year, will make it possible for us to create a customised monitor programme.

We offer different packages, each tailored to the needs of your horse(s). Some packages and services are geared towards rehabilitation after injury, others aim to assess and manage tendon health in order to limit the risk of injury. (more about packages)

The protocols we use have been developed and tested by the best in the industry and have proven itself many times over in high-level thoroughbreds and sport horses alike.

Diagnosis of Injuries & Early Prevention

In order to achieve the best possible healing of a tendon we need the best possible diagnoses as early as possible and with the maximum amount of information regarding the injury.

The Tendon Tissue Assessment ability of the technology we use (UTC) is so great that we can see minor injuries in tendon tissue far before the horse develops an actual injury.

The technology allows us to see the effects of ongoing low grade mild overstraining leading to tendon degeneration without symptoms, but also acute undetected injuries. Both findings form the foundation for full-scale injuries at a later stage (studies show between 2-4 weeks later).

Studies showed that race-effects frequently reverse within less than 4 days post-race. In those cases, we believe that there is no damage to the fibre structure, but rather an increased cell metabolism in the tendon.

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When we find subclinical injuries or tendons that don’t cope with the exercise and loading it is put under, there are several options. Sometimes reduced training intensity or only walk/trot exercise for 2 weeks can be enough to settle the tendon.

Much more serious then reversible loading effects are those cases where heavy exercise leads to overload symptoms like the superficial flexor tendon being tender, warm, and slightly swollen. These cases show disintegration (primary tendon failure). Our approach is to reduce exercise, but definitely no rest! We keep monitoring until UTC parameters normalise. Usually, this is within 3 to 8 weeks.

In some of those cases, we advise the use of our Dynamic Support System in order to reduce strain on the tendon while still in light exercise. We also see great benefits in the healing patterns in the tendon by using shockwave, microcurrent, laser and electrotherapy.

Our aim in these cases is to keep the horse mobile. This will have a positive effect on healing and also allows the horse to be kept in the rhythm and routine on the yard. UTC will allow careful monitoring of the tendons in these situations so that the optimal result, with the minimum amount of risk and time, will be achieved.

Rehabilitation & Injury Management

As we all know, it is not easy to get the equine athlete back on track after a tendon injury.

It is not a simple, single-stage diagnosis and there is no cure-all. Treatment and management need to be tailor-made, based on the stage of the lesion and it’s loading capacity.

The schedule below was developed for the staging of repair after injury;

  • during inflammation and demarcation of the lesion, there are mainly black fibre echoes representing fluid and bleeding.
  • during the first organisation (fibrillogenesis), there is a decrease of black echoes and an increase of red ones and this indicates the formation of a new fibre structure.

 

  • during bundle formation, green and blue echoes do increase. At the same time, red and black echoes decrease sharply, indicating the organisation of early fibrils into tendon bundles.
  • during the remodelling stage, a sharp drop of blue echoes can be observed. This means less smooth tendon bundles are remodelled into intact and aligned bundles, coloured green
Staging of Lesions
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In order to achieve best tendon healing it is important that we achieve maximum Type I (green) fibres and minimal amount of type II (blue) and type III (red) fibres. Only then will we end up with a flexible (elastic) tendon or ligament able to react on loading by stretching and adapting and not rupturing (again).

In our experience the key to achieve this result is to implement a very proactive exercise protocol. This will reduce the build-up of scar tissue and length of the “blue stage”. Making use of our Dynamic Support System during exercise allows us to be very proactive with exercise from an early stage (1-2 weeks) after injury.

The device will regulate the maximum amount of loading (strain) on the tendon during exercise and will also avoid sudden peak loads on healing tissue when the horse slips, jumps or runs off. The technology will allow us to gradually increase exercise and loading on the tendon by reducing the support given by the device. Under the guidance of UTC Tendon Tissue Assessment, the device adjustments are based on actual tendon fibre changes. Combining these technologies make that we can offer customised, safe and successful rehabilitation protocols.

Management of Tendons & Ligaments

Through years of selective breeding we have selected horses that best suit our needs. Those needs often include being able to do a type of work, having a pleasant character and be able to do the job without getting sick or injured.

The majority of the horses we deal with are in some way or the other “Equine Athletes”. Per definition athletes push themselves further than others, and that’s why we select them. By pushing that extra bit during the last jump or final sprint, these horses are therefore more likely to get injured.

It is for this reason that we see it as our duty to make sure we look after our equine athletes by being proactive in the prevention and management of injuries.

Tendons, ligaments and muscles are per definition dynamic in nature and management of these structures need to be dynamic as well. We can’t accept tendons to just “blow” or see young potential athletes never make it to their true potential.

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Our Tendon Tissue Assessment (UTC) enables us to be proactive and dynamic! The technology allows us to assess the effects of certain exercise (loading)on tendons and ligaments by analysing fibre composition and organisation. This analysis allows us to make an assessment of the quality and health of the tendon, but also if the horse is actually coping with the current training level or not.

We also developed an applied thermal assessment protocols. The thermal scans are analysed using our data extraction algorithm which allows us to pinpoint areas of interest. The gathered information can be used for further analysis/diagnosis/treatment by a veterinarian, physiotherapist or other experts. (more on advanced equine thermography)

Good clinical assessment by a qualified expert is essential to a functioning management protocol and we are proud to say that our company is based upon a worldwide network of experts, trainers, riders and owners all sharing experiences on dealing with injury prevention and management.

We make all these experiences, treatments, technologies, services and products available to our clients all over the world by offering a wide network of agents and online features. If beneficial we will get your veterinarian or other experts in direct contact with our experts to discuss your horse.

Sharing these experiences with each other and our clients make that we get exceptional results in prevention, diagnosis, rehabilitation and management.

Management

Prevention

Diagnosis

Rehabilitation