how to stretch a check ligament??

[tillyd]

Hi all, new to posting here but looking for some advice...
My mare has been diagnosed with a minor (hopefully) check ligament problem - has been scanned for my own piece of mind and nothing showed up.
She's been on 6 weeks walk exercise as a precaution, which is now up, so had vet back out to look at her. He has explained that her check ligaments are a little short for the job of work (comp horse/s/j) that she needs to do, and are stopping the deep flexor tendon from extending as much as it needs. Almost like putting the brake on too soon. So has prescribed another 10-12 weeks building up work steadily, to encourage the check ligament to stretch and lengthen slightly.
Now i didn't know it was physically possible for a ligament to be stretched in a good way - has anyone else heard of this? Tips or advice?? Thanks!

 

[Tempi]

Welcome to the forum

I can only assume that by gentle exercise the check ligament will get more 'supple' in a way and therefore enable your horse to work properly.

Its hard to explain, but i can see what your vet means!

 

[Sags_Deer]

get a horse masseur to come out and show you some passive stretches to do there are a few you can do particularly after exercise and build them up so you hold the stretch for longer. i will also look up the name of a book for you to buy if you cant afford a treatment. which part of the country are you in

 

[tillyd]

thanks - there's a physio that has looked at her before for back stuff so that might be a good idea - hadn't thought of it.
At least vet says I can start trotting - am hoping i might have fewer dices with death when she can start doing a bit more!

 

[puddicat]

I think this is a bizarre comment by your vet but short of interrogating them to find out what the basis for their belief that check ligaments can be 'too short' I guess there is nothing you can do.

Ligaments can extend safely but not very much as a percentage of their length. Most ligaments that surround joints are very short so they are effectively inextensible (because a small percentage of a short length is a very very short length). The basic mechanism your vet describes is correct, the check ligament applies force to the deep digital flexor tendon which resists extension of the fetlock joint. To say that the check ligament doesn't allow the joint to extend as much as it needs is nonsense but your vet may have said that as a simplification of what he thinks is going on. Ligaments and tendons don't change length in adult animals to any significant degree so the idea that stretching the ligament might lengthen it is a bit unrealistic.

I think there is absolutely no point in getting a masseur to do anything for this condition as described. The idea that passive stretching the lower leg is going to do anything good or bad is pure fantasy but don't let that put you off!

All the stuff abut building up exercise seems very sensible even though the explanation might be dodgy. Normally what happens is you keep working the horse and eventually it will get better.

 

[verapig]

Passive stretching is a wonderful thing to do with your horse. Here are some of the benefits

Allows for the greatest range of movement
Reduces strain on tendons and ligaments by maximizing tendon and muscle elasticity
Develops a longer stride as shoulders move with greater freedom
Improves the range of motion in hips and shoulders allowing for easier lateral work
Improves flexibility in upper arms thus reducing risk of injury during stressful demands
Causes less fatigue as muscles and joints are more flexible
Improves circulation to all tissues

 

[spaniel]

The 'effects' are on muscles in passive stretching and not on tendons or ligaments. If ligaments were to stretch to any great extent they wouldnt be doing their job properly.

 

[tillyd]

thanks all for your replies.
I have to admit I'm not entirely convinced by what the vet tells me, but he is from a very well regarded equine practice that does a lot of racehorses etc so I think I have to trust him and see what happens. He didn't think we needed the ultrasound scan, but I did it off my own back because I was worrying myself to death! The thing that concerns me most (apart from having to get on a horse that is climbing the walls twice a day!) is that the leg shows some warmth and filling on a regular basis. I did give the vet the third degree about this when he came out and he assured me its a normal reaction to the stress I'm putting on the check ligament and that as long as i take things steady not to worry.
Oh well, we shall see - one day at a time I think! thanks again. If there's anyone else out there whose horse is going through something similar would love to hear your story.

 

[Spot1]

Just to throw a spanner in the works

I believe there is some thought that the check ligament is actually a modified muscle and as such does contain some muscle fiber

However having said that perhaps you could consider the Deep digital flexor tendon (ddft) force as the problem and try to reduce the strain of that. If your vet agrees perhaps use heel lifts, this would transfer some of the strain on to the superficial digital flexor tendon (sdft) and the suspensory ligament (sl) and or a rolled toe to reduce ddft leverage on active break-over.

 

[puddicat]

"The 'effects' are on muscles in passive stretching and not on tendons or ligaments. If ligaments were to stretch to any great extent they wouldnt be doing their job properly."

Absolutely, I agree.

It's a bit confusing that, as Spotties said, the suspensory ligament and check ligaments (a few others) are specially adapted for a role in which they do stretch elastically however not by much. One of the best studies of this is Riemersma et al. 1996 which measured suspensory ligament extension as about 3% in walk and about 5.8% in trot. Given a suspensory ligament is roughly 15 cm long in a 15 hh horse, the actual extension would be 9 mm at trot.

Another interesting point relative to the vet's original comments about stretching the ligament affecting fetlock extension is that even desmotomy of the check ligament (cutting it) doesn't increase the maximal extension of the fetlock joint (Buchner et al. 1996). What happens is that the load is redistributed onto the deep and superficial digital flexors.

 

[puddicat]

Well it might get boring if I explained in detail why your list is nonsense but here's some stuff you (or anyone) could do which would help you realise why it is so.

First learn all the equine muscles, their position and attachments, that will allow us to discuss something like shoulder mobility in terms of which muscles are involved. Next check out their fibre length, size and architecture so for each muscle we can discuss the scope for increasing its resting length by stretching and then by combining that with limb morphology we can have an objective discussion about the possible end result in terms of increased movement. Once we've established what can be done, we then need to move on to the capacity of us humans to invoke a stretch that uses enough force to extend the muscle. So check out the passive force-length relationship for muscle and by combining it with the information described above we can see if we agree on the estimated force required to put any particular muscle into a region that might cause long term elongation. At this point I think we might draw rather different conclusions about the effects of passive stretching than the ones you've given!

Frequently it happens in the horse world that people transfer ideas from humans to horses with no inclination of why it might not be that simple. All the stuff you've said could have come straight out of of a human sports book - infact whoever came up with first probably copied it from one. Most of it is pretty accurate but some of it is a bit dodgy even if we were trying to be objective about the benefits of stretching to humans (the point about fatigue for example).

 

[measles]

Welcome, TillyD. One quick question - how soon after your suspected injury or your first worries was her check ligament scanned? I ask as one of our ponies injured hers and when it was first scaned (the following day)hardly any damage showed up but my vet referred her to the Vet School in our area and when it was re-scanned at 6 days after injury the damage was massive. We were devastated but told that it takes the best part of a week after injury for the full extend of the damage to show on a scan.

Hope that's not worrying but thought I'd share it. It would concern me working a horse with heat and swelling on a site of injury I have to admit.

Good luck

 

[Spot1]

excellent advice. I'm blowing the dust off my text books in eager anticipation

When we talk about elasticity in tendons or ligaments and there ability to stretch it is so valuable to see the amounts involved. As illustrated the change in length is small and the necessary forces very large. This small stretch of the check ligament is important under load, but correct me if I am wrong, in the relaxed state it should return to its original length. Structures that are over stretched can be said to have exceeded there elastic limit and are damaged, such as a strained tendon. We exercise horses, as opposed to work, in order to control the stress applied. I would echo the concerns regarding heat and swelling.

 

[tillyd]

Thanks all for comments - interesting stuff.
Horse wasn't scanned till several weeks after first noticed v v fractionally lame, (though vet came out the day after). Did two weeks box rest and bute to start, then vet back out, by this time slight heat there (wasn't anything to see to start with). Vet said thought was check ligament tweak, said take it slightly easy - ie no jumping but pretty much everything else ok. Did that for a couple of weeks then decided I wasn't really happy carrying on like that and I wanted to know what was really going on, hence scan. So I think any damage would have been done and shown up by time of scan, so that's one positive thing!
All very perplexing - I was brought up to think that what vets said was gospel and not to question it, but when its your horse (and a vet you don't know that well) it changes your mind!!

 

[puddicat]

Yep I think that makes perfect sense. As I guess you know, by definition, 'elastic' describes the behaviour where something deforms under load but returns to its original shape when the load is removed, 'plastic' describes the behaviour where something deforms under load and remains deformed when the load is removed. Most materials behave elastically up to a certain load (elastic limit) then plastically for loads above the elastic limit so the trick is not to overload them if you want them to stay the same shape. Incidentally the ligaments that support the joint between the last two bones of the leg (the collateral ligaments of the distal interphalangeal joint) are about 1.8cm long and so roughly speaking they would stretch elastically about 1mm in use and break if they stretched >2mm.

Sorry this is not really answering the post I'll shut up now.