What is the evidence for use of physiotherapeutic modalities to address tendonitis in the sport horse?

Clinical question and background

Tendonitis of the superficial digital flexor tendon (SDFT) is a common musculoskeletal injury in the sport horse [1,2], caused by direct trauma or as a result of progressive degeneration due to age or chronic overloading. Clinical treatment and physiotherapy aim to return the horse to at least its original level of performance, whilst minimising the strong risk of re-injury.

Literature search

The evidence for application of different modalities of physiotherapy is scant for treatment and/or rehabilitation of equine tendonitis. The human Achilles tendon is similar in functional and clinical structure to the SDFT of the horse [3]. For this reason, evidencebased practice (EBP) using physiotherapy for the treatment of Achilles tendinopathy (AT) was included in this overview of the efficacy of various therapeutic modalities for this condition. Database searches were carried out in Cochrane Reviews, Medline and PEDro (Physiotherapy Evidence Database). Study types included in the searches were meta-analysis (MA), systematic reviews (SRs) and randomised controlled trials (RCT). Keywords used in the searches included tendonitis, horse, Achilles, physiotherapy, rehabilitation, laser and therapeutic ultrasound.
Conservative management of mid-portion AT was evaluated in a mixed-methods study [4], using SR outcomes from RCT and independent clinical reasoning input from physiotherapists. This review included 47 studies which were scored according the PEDro scale. Modalities were described as being strong, moderate, limited, conflicting or without evidence for use in a physiotherapeutic setting.
A review study into conservative therapy for the treatment of AT yielded 2852 search results which were evaluated using the PEDro scoring system [5]. In total, 23 suitable studies were identified, 19 of which were considered to be free of bias.
To date only one narrative review article [6] has discussed experimental and observational studies in equine physiotherapy. Experimental studies using therapeutic ultrasound showed potential for tendon healing in 3 small experimental studies. Only one study was presented in English [8], but the abstract could not be identified on the database search. […]