A horse's flexor tendons, suspensory ligaments, and their associated structures work continuously and are prone to injury. Following diagnosis and treatment of the acute problems, the injured structure must be slowly brought back up to the previous level of work. In the past this has been based on experience but there was little proof of how slow or fast an injury should be returned to work. This article discusses rehabilitation protocol based on the medical records of nearly 3000 injuries. Some of the injuries that might be treated with the following protocols are:

• superficial and deep digital flexor tendintis
• suspensory desmitis
• check ligament desmitis
• collateral ligament injury
• biceps tendinitis

Specific diagnosis, treatment, and prognosis information is found under the articles on each specific injury.

These rest and exercise protocols should be approved by your veterinarian as they do not apply to all tendon and ligament injuries, particularly those where a structure is completely disrupted or in danger of disrupting. Any exercise should wait until the peracute inflammation is resolving and the horse comfortable to stand on the leg. Ultrasonographic lesions may worsen for the first two weeks following injury so reevaluation should be done at this time. Besides these exercise protocols below there may be additional treatment required depending on individual cases and particularly during the acute stages of the injury, these include:

• NSAID's
• bandaging
• poultice
• hydrotherapy with cold or hot water

Extracorporeal shock-wave therapy (ESWT) may stimulate healing of desmitis in horses. Though the research is preliminary, in what is the best study to date, four mature horses had SUL desmitis induced in both forelimbs. Beginning 3 weeks after induction of the lesions, one ligament per horse was treated 3 times at 3-week intervals with ESWT. After 15 weeks the treated SUL's had a improved the rate of healing as assessed ultrasonographically when compared with the untreated controls. Though this study was specifically done to suspensory ligaments, it's results may be applicable to other ligaments and tendons.