Tendons & Ligaments of the Equine Lower Limb, with Gillian Higgins & Dr.Seth O'Niell

When I saw that Horses Inside out were going to be running an online seminar with Dr Seth O’Niell I was very excited.

My first experience of hearing Seth talk was at the Horses Inside Out conference in 2020, where he presented on Tendons and Tendinopathy Management and his work on how this translates from human athletes to equine athletes. You can read all about this in my previous blog.

I remember finding Seth incredibly engaging and so couldn’t wait for this seminar to come along so that I could learn more from him as well as look forward to the presentation from Gillian Higgins on Understanding the Tendons & Ligaments of the Lower Limb.

As an Equine Massage Therapist, horse owner & rider I already do have some understanding of the structures of the lower limb, and I have been fortunate enough to be able to see some of Gillian’s models of the lower limb, as well as drawings and descriptions in her books.

In my job I sadly often come across horses that are currently dealing with or have previously had lower limb injuries, so having a good understanding of the structures and also how best to try and prevent further injury is really useful to have in order to be able to assist my clients by passing on knowledge.

However, as I have come to learn during my lifetime journey with horses, what we know about horses, their anatomy, biomechanics and also methods of rehabilitation are changing all the time, so I was excited to not only develop my understanding of the structures further but also find out what’s new?

Once the seminar began and Gillian had made introductions she started with a poll that all attendees could answer to see how many of us had experience of lower limb injuries and which were the most common. Interestingly the results showed that the most common amongst the attendees of the webinar were Superficial Digital Flexor Tendon of the forelimb, and Suspensory ligament of the hindlimb.

Then it was time to get into Gillian’s presentation on the anatomy. One of the main things that stuck out to me to start with was that Gillian was not only talking to us about the lower limb, there was also a focus on how the whole body is connected and even though we are looking at the structures of the lower limb we should appreciate the effect these structures have on the rest of the body, the myofascial chains and also the importance of hoof balance and it’s effect on the limb.

Gillian then went on to demonstrate how to palpate some of the structures of the lower limb on the horse. She used her own horse Toby along with a freeze dried horse limb that still has the tendons, ligaments and muscles attached. This is one of my favourite pieces from Gillian’s anatomy collection, it’s fascinating and an amazing learning tool.
It’s incredible just how many structures there are that make up the lower limb. Gillian really helps to demystify what is what in an easy to understand way by showing it on the model and then on Toby.

I also loved this painting of Gillian’s showing the Collateral Ligaments of the limbs. You can also see the Suspensory ligament running down the back of the leg.

Gillian explains in depth how the Suspensory Ligament is more elastic than other ligaments in the body, due to being made up of more collagen fibres, so it is more like an elastic tendon.

Gillian talks about how Tendons can be divided into 2 types.

Positional Tendons – used for precise movements

Elastic Tendons – used to assist with stretch & recoil, suspending the fetlock

She shows some fantastic videos demonstrating and explaining Stretch & Recoil of the lower limb whilst a horse is in motion, and how it contributes to movement. Including the horse jumping and landing at various heights and how this affects and stresses the limbs.

After Gillian’s fabulous presentation my brain was already bursting and then it was time for a short break and a cup of tea before Seth’s presentation.

He started with a great explanation of how “Opathy” simply means a disease process or disease e.g Tendinopathy – disease of the tendon.

In Human athletes there are higher incidences of tendon injury in endurance athletes compared with other sports due to the exposure of the stresses and strains.

Seth talked about the structure of a tendon and how tendon structure is affected by degeneration of the tissue. Degeneration is due to overload and not age. It was so fascinating to learn that tendons are not more likely to be injured due to the age of the tendon, if a tendon is kept ‘fit’ it is only as likely to be injured when it is old and when it was first formed.

He explains how both rest and over exercise can trigger degrading of the tissue and how living tissue needs stress to maintain it’s health.

And therefore the importance of exercise in the ‘Goldilocks zone’ – not too much or too little, to help improve the robustness of the tendon tissue.

Removing the horse from the main activity that has caused the stress but not putting them on full box rest, controlled exercise is key with a graded return to activity.

Also how strengthening muscle control & structure is important for the health of tendons as the muscle will help to shock absorb and reduce the stress on the tendon as well as the importance of recovery time after a hard work day or event, by having a day off or some easy work days.

Even a healthy tendon will go through structural change during exercise, and therefore needs recovery time. If you stress the tendon too much the tissue will degrade and it will be more difficult for it to recover.

Something I had never considered before was how accelerations and decelerations cause more stress on the tendons than staying at the same speed for a distance. Definitely something to think about when riding transitions, turning or jumping.

Seth goes into some studies that have been done in both humans and horses and gives so much in-depth detail. I am so glad there is the option to watch this seminar back on replay to give me the chance to absorb it all!

He includes some ways in which human’s are rehabbed from tendinopathy and how we can transfer that to our horses. Including step work, inclines, jumping down steps & over obstacles, building back up to their planned discipline. And how rehab should be done slowly but we should try and find that ‘sweet spot’ of distance, speed & stress.

Finally he finishes with advising us against some of the common practices in the Equine industry, these really are thought provoking and he goes into detail as to why in the seminar, the ones that stuck out to me are:

·         Icing or cooling tendons – Seth advises that icing reduces muscle (and likely tendon) adaptation – using ice during training will prevent the body’s ability to adapt which can increase the risk of injury as the tissue is not becoming more robust

·         PRP (Protein Rich Plasma) has been shown in humans not to be of any benefit to tendons

·         NSAIDS (such as Phenylbutazone) may possibly useful short term but long term they prevent tissue adaptation

·         Palpating the limb is not a good measure of recovery as pain on palpation does not equal level of tendinopathy

·         Shockwave therapy damages healthy tissue

The main message being exercise based rehab is the key.

Following Seth’s presentation Gillian then shared with us some simple exercises we can do with horses recovering from a tendon injury and explained why these would work for tendons. Discussing the importance of breaking movement down to simple tasks that the horses can do without being able to compensate.

This has been such a fascinating and eye opening seminar, there were also some amazing questions asked by some of the participants and great discussions with Gillian and Seth too.
I would highly recommend going to the Horses Inside Out Academy and checking out this seminar – I will definitely be watching again!

Jess
Jessica Limpkin Equine Massage Therapy