I treat horses and ponies for lots of different reasons – many for maintenance and to help ensure that the horse in question stays in optimum health and fitness. But I also see a lot of horses for rehabilitative purposes – ie. to aid the quality of recovery from injury or illness and/or to resolve compensatory issues that have occurred as a result of an injury/illness/box rest etc…
It struck me that not everyone will be aware of the rehabilitative benefits of massage and soft tissue therapy for specific conditions so I thought it would be useful to write a few “Spotlight on…” blog posts and today’s is on splints.
A little bit of anatomy
The splint bones are located on either side of the cannon bone and the interosseous ligament is situated between the cannon bone and the splint bone. This is dense connective tissue which ossifies into bone as the horse matures into adulthood and it ultimately fuses together with the cannon and splint bones. This bony fusion tends to take place by the time the horse is 3 or 4 years old.
What are Splints?
Splints are an inflammatory condition which generally (but not always) tend to affect horses that have yet to reach maturity. They are caused by injury to either the interosseous ligament or to the periosteum (connective tissue which covers the bones) of the splint bones or adjacent bones.
They can result from:
Tearing of the interosseous ligament
External trauma to the bone
Secondary to healing of a fracture
In the majority of cases splints occur in the medial (inside) forelimb splint but they can occur in the lateral (outside) splint of the front or rear legs as well.
A True splint is a fibrous and bony enlargement at the interosseous space which is secondary to inflammation or tearing of the interosseous ligament.
A Blind splint is a fibrous and bony enlargement between the splint bones and the suspensory ligament as such it exhibits little to no external swelling.
Periostitis is secondary to trauma to the periosteum
A Knee splint involves swelling located very proximally (toward the upper part of the splint bone and closer to the knee than a true splint). Due to its position it involves the lower carpus joints often resulting in osteoarthritis.
Causes are multiple but can include
Heavy training in immature horses
Training on hard ground
If you suspect a splint you should not delay in seeking veterinary treatment
Clinical findings will often indicate a splint but your vet may use further diagnostic tools such as radiograph (to rule out a fracture) or ultrasound (if there is concern about compromise to the suspensory ligament). In certain cases more advanced diagnostic imaging may be recommended.
You can expect a prescribed period of box rest which may vary from 2 weeks to 3 months and a programme of conservative management throughout the acute, sub-acute and chronic phases of the injury.
The objective of conservative management is to allow for optimum quality healing. For many owners it is important to try to minimise the size of any long-term bony enlargement which may remain after the injury has settled.
Conservative management can include the following some of which are mandatory and others may be prescribed by your vet depending on the history and clinical findings relating to your horse. It is important to be guided by and follow your vet’s advice
Rest until the splint is no longer painful to palpation
Topical cold therapy in the acute phase (I find cold hosing is by far the most effective method)
Pressure bandaging to reduce swelling
Oral non-steroidal anti-inflammatory drugs to reduce inflammation
Topical anti-inflammatory drugs
Injections of corticosteroids may decrease inflammation and reduce the size of bony swelling.
Laser, ultrasound and PEMF (pulsed electromagnetic field)therapy may reduce inflammation and speed healing
Shock wave therapy may speed healing
Massage and range of motion therapy
How does massage therapy help a horse with a splint?
Once the initial pain has subsided, massage therapy is an effective tool.
It helps reduce inflammation, aid pain relief and improve blood flow to the area whilst simultaneously removing toxins and metabolic “debris” from the area by supporting the circulatory and lymphatic systems.
Localised massage can help to reduce the size of the resulting bony enlargement.
As with any injury, the affected area is not the only part of the horse’s body that is placed under stress. All of the other extremities also experience strain as they compensate for the injured leg and, with the restriction to movement caused by box rest and altered posture caused by pain, we tend to see general muscular tension throughout the body especially in the shoulders and lower back. As such, a programme of full body massage treatments encompassing targeted localised massage and prescribed myofascial release techniques will aid in the horse’s recovery and overall wellbeing.
A knowledgeable therapist will be able to offer protocols to help during the regeneration phases following the injury.
In the first 2 weeks post injury they will be able to offer you (following consultation with the incumbent vet) gentle passive, balance or weight shift exercises designed to MAINTAIN range of motion within a pain free range.
At 2 weeks post injury your horse’s body will be busy repairing itself and collagen synthesis will be at its greatest. It is important that, at this time, a controlled amount of stress is applied in order to “organise” the collagen fibres – an experienced therapist will be able to advise you with a comprehensive programme of exercises to follow during this process
The prognosis of recovery from a splint injury is generally very good. In cases where the enlargement interferes with the knee joint or suspensory ligament, the prognosis may be somewhat more guarded but, whilst you should always take a splint seriously and seek veterinary advice as soon as you can, please try not to worry as most horses will return to full fitness.
If your horse has suffered a splint and you would like any advice do please feel free to contact me, I am always happy to help X