It’s midway through the season and your show calendar is packed. Maybe you’re hoping to qualify for equitation finals or collect points toward year-end awards in hunter or jumper divisions. Will you reach your goal or will an injury sideline your horse?

“Football players tear up their knees—it’s what they do. Hunters, jumpers and equitation horses are also athletes and they will get athletic injuries,” says Elizabeth Davidson, DVM, who focuses on equine sports medicine at the University of Pennsylvania’s New Bolton Center. In this article, Davidson explains how some common injuries happen, how they’re treated and how they could affect your horse’s career.

Any horse can get hurt at any time, of course. But hunter, jumper and hunt-seat equitation disciplines include demands that set horses up for certain injuries.

• Jumping stresses tendons and ligaments that support the leg during both push-off and landing. The impact of landing can also damage structures in the front feet. The bigger the jump, the bigger the stress.

• Speed increases the stress of jumping, so risks are higher for jumpers who are against the clock. Tight turns also raise the odds of a misstep that could lead to injury.

• Repetitive stress takes a toll. Many horses in these sports show year-round—and when they’re not showing, they’re schooling. “With repetitive stress, minor damage can build up in ligaments or other structures,” Davidson explains. “Then something tips it over the edge.”

What’s most likely to bench your horse? Hard statistics on injury rates in hunters, jumpers and equitation horses are limited, Davidson notes. “At any horse show you’ll see horses of different ages and breeds in different training programs and with riders at different skill levels. The variables make research difficult,” she says. Still, at a large referral clinic like New Bolton Center, many horses in these sports come in with problems in three areas that we’ll discuss below.

Suspensory Ligament Tears

The suspensory ligament acts like a sling, supporting the ankle joint as it sinks under weight and helping the joint return to normal when the weight is removed. Tucked behind the cannon bone, this ligament starts just below the knee (or hock), splits into two branches that pass around the back of the ankle and ends on the front of the long pastern bone below.

What happens: If the strain is too great, the tough fibers that make up the ligament may tear. “This is an area that undergoes repetitive stress, so it’s a common site for athletic injury,” Davidson says. “In horses that jump, both front and hind injuries occur.” Although fibers can tear at any point on the ligament, proximal (high) injuries are common. The injury may be mild with just a few torn fibers, but in severe cases, the ligament may rupture or even fracture bone as it tears away.

What you see: “Your horse may suddenly be lame, but usually damage has been building up as a result of recurring stress,” Davidson notes. “Identifying the problem as early as possible, before severe injury, gives the horse the best chance of recovery.” Early detection isn’t easy with high suspensory injuries, though. A horse with a mild injury may be barely off and because the top of the ligament is hidden under other structures, you won’t find heat, swelling or sensitivity at the site.

What to do: Your veterinarian can find the problem with local nerve blocks and a hands-on exam. An ultrasound scan will show the exact site and degree of injury to the ligament, and X-rays can show if bone is damaged. Magnetic resonance imaging (MRI) can also identify damage to the ligament. “MRI is often helpful in hind-limb suspensory injuries, when ultrasound can be difficult to interpret,” Davidson says.

Every case is different, so your vet will help you work out a treatment plan that suits your horse’s injury. Treatment usually includes these steps:

• Cool down. To reduce inflammation, your vet may prescribe cold therapy (icing or cold-hosing several times a day) and a nonsteroidal anti-inflammatory drug, such as phenylbutazone or Banamine® (flunixin meglumine).

• Stall rest to let healing begin. Your vet may advise standing wraps for the injured leg and the opposing leg.

• Hand-walking. Once inflammation is down, controlled walking encourages proper healing. Follow your veterinarian’s advice, starting with as little as 10 minutes a day and gradually increasing the time.

• Gradual return to exercise. Working closely with your vet, set up a program that eases your horse back into work over several months, using ultrasound exams to monitor the ligament and adjust the program as needed.

Your vet may suggest other therapies, such as shockwave treatments. Stem cells or platelet-rich plasma can be injected at the injury site with the goal of improving healing. Research into these new regenerative therapies is ongoing.

Surgery—neurectomy of the deep branch of the lateral plantar nerve and fasciotomy—is an option for hind-limb proximal suspensory injuries that are reluctant to heal, Davidson says. In the hind limb, a band of connective tissue traps the top of the ligament in a sort of compartment and swelling within the compartment causes chronic pain. The surgeon cuts the connective tissue (fasciotomy) and the deep branch of the lateral plantar nerve (neurectomy), relieving pressure and pain. This nerve branch serves only the top of the suspensory, so the operation doesn’t otherwise affect the horse. Your veterinarian can help decide if surgery might be the best option for your horse’s case.

What to expect: Ligaments heal slowly—anywhere from two to 12 months, depending on the location and extent of the damage. The process can’t be rushed. Re-injury is a risk even after healing because scar tissue that forms isn’t quite as strong as the original ligament tissue.

“Front proximal suspensory ligament injuries tend to heal well with treatment, but hind injuries often don’t respond so well,” Davidson says. “With conservative treatment only, less than 20 percent of horses with hind proximal suspensory ligament injuries return to previous levels. Surgery greatly improves the odds.” Keep in mind, though, that current rules bar horses from FEI competition after any neurectomy.

Sore Feet

The front feet take the brunt of landing after a jump and structures in the hoof capsule work together to handle the shock. The coffin joint—the meeting point of the small pastern bone, the navicular bone in the heel and the coffin bone in the toe—disperses the force. Ligaments that lash the joint together stretch then spring back. So does the deep digital flexor tendon (DDFT), which runs behind the joint and helps support the navicular bone.

What happens: The feet are designed to handle great forces, but jumping fence after fence takes a toll. Common problems include:

• Strains and tears in the DDFT or the ligaments in the foot

• Inflammation in the coffin joint or in the navicular bursa, a fluid-filled sac that helps cushion the navicular bone from the pressure of the DDFT

• Deep bone bruising, which can appear in any of the foot bones

• Inflammation and degeneration of the navicular bone

“Sometimes there are multiple problems,” Davidson says. “Again, these are injuries that occur through wear and tear—damage builds up until it hits the tipping point.”

What you see: “Because the injured structures are hidden by the hoof capsule, you don’t see swelling or other signs,” Davidson explains. “Often these problems are bilateral, involving both front feet, so the horse may not be obviously lame. He may begin to move with shorter strides, but the gait is still symmetrical.” Or the horse may be lame and improve with rest, but be sore again when he goes back to work. He may rest a front foot or shift weight from one foot to the other when standing.

What to do: A lameness exam and diagnostic nerve blocks will help the vet determine the general site of soreness. Often it’s in the heel, or caudal, region, where several key structures come together. But to treat the problem, you need to know which structures are injured.

X-rays can reveal bone damage, but they won’t show soft-tissue injuries. Ultrasound is great for imaging soft tissues in the leg, but it’s hard to get a clear ultrasound image in the hoof capsule. The best tool, Davidson says, is MRI. “With MRI we are able to look inside the hoof capsule and sort out these problems much better than in the past,” she notes. The results will help your veterinarian target treatment to fit the injury.

• A tendon or ligament injury needs a long period of rest, six months to a year. You’ll follow more or less the same program as you would with a suspensory injury with stall rest followed by a gradual return to work. The vet may recommend directed injections of platelet-rich plasma or stem cells.

• Inflammation in the coffin joint or the navicular bursa may respond to directed injections of corticosteroids, which are powerful anti-inflammatories, and hyaluronic acid, which is a natural component of cartilage and joint fluid.

• A bone bruise needs rest. This injury isn’t as serious as a fracture, but there is microscopic damage to the bone and fluid builds up within it. Healing can take three or four months depending on the degree of bruising.

• When the navicular bone is chronically inflamed, it responds by remodeling, losing mineral content in some areas and developing lumps of new growth in others. This pattern of inflammation and degeneration is often called navicular disease, and it doesn’t heal with rest.

What to expect: A horse with a mild injury has the best chance of recovery, but Davidson notes that rehabilitation can be challenging. “In sporthorses, significant pathology in the foot doesn’t have a good outlook. When the horse goes back to work, he stresses the same structures—so reinjury is likely,” she says.

Good trimming and shoeing are essential to keep the horse comfortable, regardless of what structures are involved. It’s important to keep the hoof trimmed at the correct angle, so the bones are properly aligned and the foot breaks over easily. Wedge pads or bar shoes can help take pressure off the heels. When problems persist, though, the horse may have to switch to a lighter work program.

Joint Problems

Elite horses are especially prone to joint problems. “Jumping a lot of big jumps—and jumping every weekend—stresses joints and eventually triggers degenerative joint disease (DJD),” Davidson says. Common sites include the hocks and ankles, but DJD can develop in any joint that comes under stress when the horse works.

What happens: Chronic inflammation in the joint from injury or simple wear and tear sets off a destructive chain of events. The viscous fluid that fills the joint becomes thin and watery, so it doesn’t lubricate the cartilage that cushions the working surfaces so well. Under pressure, cartilage starts to wear away and the joint stiffens. There’s more concussion on the bones, which respond by remodeling. Lumps of new bone growth appear in the joint.

What you see: Joint problems often creep up gradually. At first your horse may be mildly sore or stiff or just seem less fluid or less forward, especially at the start of work. The soreness may improve with rest, but it returns. Over time it worsens and begins to affect his performance over jumps. You may find heat or swelling in the affected joint.

What to do: Your vet can perform a lameness exam and other tests to diagnose DJD. X-rays can show damage to bone and cartilage, but by the time this damage shows up the destructive process is well under way. Damage to the joint can’t be reversed, but you may be able to slow the progress of the disease by managing inflammation. Anti-inflammatory medications like phenylbutazone can help the horse weather a flare-up, but for long-term management there are other options.

Management Options

Regardless of which modalities an owner and veterinarian elect to use when approaching equine joint health, it’s important to approach DJD or osteoarthritis (OA) not just as a cartilage or even a joint issue but, rather, a “whole-horse disease.”

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These ubiquitous drugs, such as phenylbutazone (Bute), help keep horses with inflamed joints comfortable and are widely used as part of the approved multimodal treatment approach to osteoarthritis (OA). In older horses who do little to no work, NSAIDs can help control comfort and maintain quality of life. In performance horses, however, experts agree that NSAIDs should not be the base of your treatment program.

“I think that NSAIDs can have a place in performance horse management,” says José M. García-López, VMD, Dipl. ACVS, ACVSMR, associate professor of large animal surgery at the University of Pennsylvania’s New Bolton Center. “These can safely be used at a low dose and while monitoring the overall health of the horse, either during conditioning or rehabilitation from an injury.”

Intra-Articular Therapies: In lieu of relying on NSAIDs to help maintain joint health, veterinarians often use intermittent intra-articular therapies to control joint discomfort in performance horses. In a recently published survey, 407 equine veterinarians provided information regarding some of the more popular therapies currently being used in performance horses. Based on that survey, corticosteroids—primarily triamcinolone and methylprednisolone—are still one of the first-line, intra-articular therapies. Practitioners frequently co-administer hyaluronic acid with those intra-articular corticosteroids.

Despite these tried-and-true articular therapies, Kyla Ortved, DVM, PhD, Dipl. ACVS, ACVSMR, assistant professor of large animal surgery at New Bolton Center, says the tides are changing.

“I think using orthobiologics early in the disease process is better because they are designed to prevent further damage and promote healing,” she said. “If I have a horse with lameness or pain attributable to a particular joint, I won’t hesitate to use orthobiologics in the early stages of disease. And I feel more comfortable using these before jumping to steroids as I think they are more protective of the cartilage.”

Other Intra-Articular Therapies: Another intra-articular product available for horses is Polyglycan®, which is essentially a synovial fluid replacement product. “I use Polyglycan®, which is made of a patented formulation of hyaluronic acid, chondroitin sulfate and N-acetyl-D-glucosamine, at the end of any elective arthroscopic procedure and also as my hyaluronic acid fluid replacement product of choice,” said García-López, citing a 2009 study out of Colorado State University that showed Polyglycan® to have the potential to have both symptom- and disease-modifying effects.

Polyacrylamide hydrogels are also available for horses with OA and gaining popularity. Polyacrylamide gels are synthetic products, not orthobiologics, injected into the joint to provide lubrication and shock-absorbing properties. In one study of a 2.5% polyacrylamide hydrogel product, researchers reported that 83% of treated horses were lame-free at four, six and 12 weeks following administration.

Despite study findings, García-López believes more unbiased research is needed on these products.

“There is subjective evidence that these gels can create fibrosis of the synovium and granulation tissue formation that, in turn, can affect the composition of the synovial fluid, which is the main source of nutrition to the cartilage in adult articulations,” he said. “This family of gels could be considered in end-stage cases of OA but maybe not in early or moderate cases of OA.”

Intramuscular Therapies: It’s important to keep in mind that OA management is multimodal, and intramuscular (IM) polysulfated glycosaminoglycan (Adequan®) is still recommended by veterinarians.

“I like to use Adequan® in performance horses,” Ortved said. “I generally recommend 500 milligrams IM every four days for seven treatments every six months or at time of injury.”

García-López agrees with Ortved, adding, “In horses that have either early signs of joint inflammation or OA without significant morphologic changes, I like to place them on a course of IM Adequan® for the one dose every four days for seven treatments. This has shown good objective evidence for helping restore the ‘steady state’ between production and destruction of cartilage components. Basically, it is quite helpful to keep what is good, good.”

Physical and Alternative Therapies: Many other therapies can help round out a performance horse’s joint management plan. “Physical therapy is a huge part of management and something we need more data on and help from specialists integrating into practice,” Ortved noted.

Examples of such physical therapies include postural exercises and exercises designed to improve coordination and proprioception, target muscle atrophy/weak muscles (potentially secondary to joint discomfort and disuse) and increase joint stability through conditioning. Additional therapies you might consider to help keep your performance horses’ joints comfortable include extracorporeal shock wave therapy (ESWT), laser and acupuncture/electroacupuncture.

Oral Joint Health Supplements: Many owners give their horses joint supplements, making these products one of the most popular types of equine supplement on the market. Of the studies performed in horses, evidence does support the use of some ingredients, such as (but not limited to), glucosamine hydrochloride, chondroitin sulfate and avocado-soybean unsaponifiables (ASU). Glucosamine is believed to play a role in the formation and repair of cartilage, chondroitin sulfate helps give cartilage its elasticity, and hyaluronan helps lubricate joints and form the matrix of articular cartilage. Some studies also suggest that ASU may reduce inflammation and protect cartilage.

But García-López cautions that data regarding the use of oral nutraceuticals in horses is lacking. “Nutraceuticals should not replace treatment with other products such as Adequan®, Legend®, Polyglycan® or intra-articular therapy, whether it is with an orthobiologic or corticosteroid,” he noted.

Nutraceuticals are not required to meet the same standard for Food and Drug Administration approval as drugs are, and so their efficacy has not been studied as extensively. However, equine and human research suggests that some of these substances have protective effects. Your veterinarian can help you decide what’s best for your horse.

Appropriate Conditioning: Adjusted work levels can help. Moderate exercise is good for joint health, but too much can trigger inflammation. Increase the horse’s turnout, give him longer warm-ups and let him be your guide in how much work you do. As long as he stays comfortable, you’re probably on the right track.

“Conditioning cannot be overlooked,” adds García-López. “Equine athletes have their entire weight, which biomechanically increases exponentially during exercise, transferred through one or two limbs at a time. They need to be properly conditioned in order for all musculoskeletal components, including muscle, tendon, ligament, bone, and cartilage, to share the load adequately.”

No matter which strategies you and your veterinarian ultimately integrate into an athletic horse’s joint-health plan, as a team you must critically evaluate and reevaluate that plan regularly to make sure you’re optimizing each individual horse’s treatment to his particular needs, balancing equine ability with fragility.

Keep Him Sound

“Injuries happen because of what these horses do,” Davidson says. You can’t eliminate the risk entirely and you can’t stop the clock when it comes to aging. “Most of us have one horse and we invest a lot of time, energy and money in that horse,” she notes. “We ask horses to be athletes, but we forget sometimes that they can’t keep performing at the same level forever.”

Still, many factors that increase the risk of injuries are in your control. Take these steps to help your horse stay sound for many years to come:

• Don’t overtrain or overface him. Keep his work within his ability and be sure he’s in shape for what he’s asked to do. “Fitness—respiratory, cardiovascular, muscle, tendon, ligaments and bone fitness—helps avoid injuries,” Dr. Davidson says.

• Keep up with shoeing. Long toes and low heels put stress on the feet and on the joints, ligaments and tendons in the legs. Be sure feet are trimmed regularly so toes are kept short and use shoes with rolled toes to ease breakover if necessary.

• Use good sense on bad footing. If horses are sliding around in the ring, ask yourself: Is this class or this schooling session worth the risk?

• Stay alert for subtle trouble signs. Do a daily hands-on leg check, comparing opposite legs to detect heat, swelling or sensitivity. Watch for shortened strides and other markers of soreness. Give the horse a few days off if you suspect a problem. If the signs return when he goes back to work, ask the vet to check him out. A mild problem can blossom into a career-limiting condition if it’s ignored.

This article originally appeared in the June 2016 issue of Practical Horseman, but was updated in 2025.