Conservative and innovative treatment for desmitis

Collagen fibre bundles align in the direction of tensile forces and the main difference between tendons and ligaments is that ligaments are subjected to varying directions of tensile force so the collagen fibres run in many different directions enabling the ligament to resist forces in more than one direction. The tensile forces on tendons are created by muscle force and tend to be applied in primarily one direction so the collagen fibres are straight and parallel. Tendons and ligaments have a similar composition and basic structure, though the proportions and organisation of extracellular matrix differ (ligaments have slightly more collagen Type 3). But despite these differences, tendons and ligaments appear to heal similarly.

Similar to tendon injury controlled mobilisation is a major part of conservative treatment of a ligament injury as research has shown there to be significantly improved strength, better overall healing, improved orientation and organisation of the collagen fibres and extracellular matrix synthesis compared to box rest alone (‘form follows function’). Little equine literature is available¹ , therefore most of these recommendations are based on common sense and human literature which shows controlled exercise results in better healing of tissues ² and is an effective treatment for musculoskeletal disorders³ . The degree of controlled exercise should be adjusted to the stage of tissue healing and regular evaluation (every 6–8 weeks) should be performed both clinically and through advanced imaging modalities to ensure adequate progress. The programme can then be adapted accordingly. In general, an acute injury (week 1) requires complete box rest and additional treatments to reduce inflammation might be required. In the proliferative stage of healing (week 2–3) immature connective tissue is produced, which is fragile and prone for reinjury. Applying appropriate load during this stage can improve proper alignment of the healing tissue, but it is easy to overload and re-injure the healing tissue. [...]