Introduction to Principles of Load control and its effect in Fibre Alignment in Equine Rehabilitation

As you will be aware, the rehabilitation of equine tendon and ligament injuries is a complex process that requires a thorough understanding of the mechanical properties of soft tissues, and in particular the principles of fibre alignment and load limiting. These principles are crucial for promoting optimal healing, reducing the risk of re-injury, and restoring function in athletic horses.

Understanding Fibre Alignment

Tendons and ligaments are composed primarily of collagen, and it is this protein that provides the tensile strength within the tendon. The physical alignment of collagen fibres is critical for the biomechanical function of these tissues. In healthy tendons, collagen fibres are arranged in a parallel configuration, allowing for efficient force transmission during movement. However, injuries disrupt this alignment, leading to malaligned tissue formation. Recognition and collation of four different tissue types within the same tendon or ligament, as provided by UTC examination, enables us to prescribe the desirable load for any given tendon with far greater accuracy than previously possible.

During rehabilitation, exercises that promote proper fibre alignment are essential. This can be achieved through specific loading protocols that encourage the collagen to reorganise along the lines of stress. Mechanical loading stimulates fibroblast activity, promoting collagen synthesis and improving the overall structure of the tissue. Controlled, progressive loading is therefore key to restoring normal fibre orientation and mechanical properties. 

Load Limiting Principles

Load limiting involves controlling the amount of stress applied to injured tissues during rehabilitation. This is particularly important for tendons and ligaments, which can be sensitive to excessive loads during the healing phase. The primary goal is to facilitate healing while minimising the risk of re-injury.

During the initial phase post-injury, load limiting is critical. In humans, this is achieved using devices such as knee and ankle braces, crutches, and moonboots, along with low-intensity exercises to encourage blood flow and cellular repair without over-stressing the tissue. However, until recently, there were no such devices for horses. Aqua therapy is most often utilised in the rehabilitation process for this purpose but  it is challenging to determine the amount of loading on the limb using aqua therapy alone. While difficult, it is not impossible. The loading can be controlled by changing the height of the water. In horses, water at the level of the tuber coxae produces a 75% reduction in body weight, whereas water at elbow height has a 10% to 15% reduction in weight bearing. The increase in buoyancy reduces the effects of load bearing stress on joints and the surrounding soft tissue. Hydrotherapy obviously has other benefits like improved extension, increase cardiovascular fitness, built muscle tone, core strength and balancing of motion. 

Another option for proactive exercise rehabilitation is the TendonPro Dynamic Support System (DSS). This innovative system enables precise, adjustable loading of the injured tissue throughout the rehabilitation process. The TendonPro DSS features four different support settings, allowing for customised support at each stage of recovery. By offering dynamic support, the system promotes active rehabilitation, ensuring safety and protection while significantly reducing the risk of reinjury. Active rehabilitation encourages proper tendon fibre alignment, which accelerates recovery and improves the quality of healing. As the horse’s healing advances, the load on the injured limb is gradually increased with the ultimate goal of allowing the horse to walk unaided.

Understanding the specific biomechanical demands of the horse’s activity is vital. Rehabilitation programs should be tailored to challenge the injured tissues, and eventually reach the functional loads the horse will encounter in sport, allowing for appropriate adaptations in tendon and ligament strength and resilience. The TendonPro DSS makes this possible, at the lower support levels, whilst still offering appropriate support, and reinjury prevention.

Conclusion

The principles of fibre alignment and load limiting are foundational in the rehabilitation of equine tendon and ligament injuries. By promoting proper collagen organisation and controlling the application of mechanical loads, we can enhance healing, reduce recovery times, and minimise the risk of re-injury. A well-designed rehabilitation program, informed by these principles, is essential for the successful return to performance in athletic equines. 

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