Suspensory ligament injury in horses: chances of recovery and feeding

Why we find this topic so important: from practice, for practice

Behind nuvallo are Katja and Andrés. With over 20 years of practical experience in equestrian sport, we know all too well that a suspensory ligament injury diagnosis completely turns everyday stable life upside down. Particularly during the long convalescence phase, correct management decisively determines the quality of the healing fibres. That is why we are providing you with scientifically sound and practical answers for targeted feeding on your journey back into the saddle.

Knowledge base: what you need to know about the topic

To understand why feeding is so essential during box rest for a horse with a tendon injury, we need to take a brief look at what the suspensory ligament actually does. The suspensory ligament (M. interosseus medius) is not an ordinary muscle, but a tendinous structure that runs down the back of the cannon bone and supports the fetlock joint like a strong, elastic hammock.

Its main job is to prevent the fetlock joint from overextending under load. Imagine your horse galloping or landing after a jump: in that fraction of a second, the suspensory ligament absorbs forces that exceed the horse's body weight many times over. A suspensory ligament injury in a horse is usually not caused by an acute knock, but is often the result of gradual micro-injuries that accumulate over time – due to overloading, deep riding surfaces, poor conformation or tissue fatigue.

When a tear or strain does occur, many owners face anxious questions. The prognosis for a suspensory ligament injury in a horse is highly individual and depends on whether the origin (at the top near the joint), the body (in the middle) or the branches (at the bottom) are affected. Whether and when a horse will be rideable again after a suspensory ligament injury also depends largely on the quality of the newly formed scar tissue.

Herein lies the crux of the matter: tendon and ligament tissue naturally has an extremely poor blood supply. When a muscle is injured, the body quickly flushes nutrients in via a strong blood flow. With a tendon, this delivery service only works at a snail's pace. This means the repair process is lengthy. If the body lacks the necessary micronutrients and protein building blocks during this sensitive phase, it forms inferior, inelastic scar tissue that can easily tear again under the next load. While a normal maintenance diet of hay and a little mineral feed covers the basic daily requirement, it is often not enough to satisfy the sudden, massively increased demand for structural building blocks for cell renewal.

What does science say about feeding horses with a suspensory ligament injury?

The question of whether and how you can repair tendons and joints via the feed bucket has occupied veterinarians and researchers for decades. The internet is full of miracle cures, but here we want to focus on what science can actually prove – and where the limits lie.

a) What has been proven in studies

When researchers at veterinary faculties examine tissue samples from horses, these are referred to as in-vitro studies (in a test tube or petri dish). Here, the cell biology is absolutely fascinating and clear. It has been proven multiple times that fibroblasts (the cells responsible for producing connective tissue) become significantly more active when fed with specific building blocks.

If you add amino acids from collagen, hyaluronic acid or organic sulphur (MSM) directly to these tendon cells, they measurably begin to produce new connective tissue matrix and collagen fibres. Glucosamine also shows strong inflammation-modulating and structural-building properties in the laboratory. But here we have to be completely honest: an impressive lab result does not mean that 100 per cent of the powder you throw into the feed bucket arrives exactly like that in the suspensory ligament. A horse's digestive tract is a complex system that filters, breaks down or excretes many substances partially unused.

b) What has been studied in the living horse

More exciting and relevant for us are therefore in-vivo studies, meaning research on the living horse. Texas A&M University, for example, conducted studies in which young horses were fed specific cartilage and tendon building blocks over several months. The researchers found a measurable increase in blood biomarkers indicating active tissue development and cartilage metabolism.

In humans, too (where studies are often much larger and more meaningful, with hundreds of subjects over 12 to 24 weeks), it has been shown that the oral intake of specific collagen peptides demonstrably improves the resilience of tendons and supports the healing of microtraumas. Human sports medicine has been utilising these findings for a long time.

We must, however, remain transparent: the evidence from studies specifically on horses often has methodological limits. Frequently, there are only small sample sizes of perhaps 10 to 15 animals, or a proper control group is missing. Furthermore, studies often work with highly pure, isolated active ingredients under ideal conditions, which does not always correspond to standard preparations on the open market.

c) An honest conclusion

In summary: the biological basis for feeding joint and tendon building blocks is scientifically absolutely solid. No feed supplement in the world will heal a suspensory ligament injury overnight, replace the vet or miraculously shorten the necessary months of box and paddock rest. Anyone promising such a thing is simply unprofessional.

Nevertheless, research strongly suggests that these nutrients represent an extremely sensible building block. They support the organism by providing exactly the building material it urgently needs to repair the suspensory ligament. This is particularly valuable when you do not just feed a single active ingredient, but supply the tissue holistically with a well-thought-out combination.

Dosage and practice: box rest and metabolism

When the vet prescribes that the horse must be rested, the feeding puzzle begins for the owner. Box rest for a horse with a tendon injury requires an immediate adjustment of the rations. The horse hardly moves anymore, and its energy requirement drops dramatically. If you continue feeding hard feed as normal, you risk not only a highly explosive horse that jumps around in its stable and damages the freshly healing suspensory ligament all over again, but in the worst-case scenario, also metabolic disorders such as laminitis or EMS.

At the same time, however, the cell metabolism at the injured tendon is working at full speed. The challenge is therefore to design the feeding for a horse with a tendon injury during box rest so that low energy but a very high density of micronutrients is provided.

Let us take a closer look at the dosages that have proven successful in literature and practice. For a large horse weighing around 500 kilograms, daily amounts of approximately 1,500 mg of glucosamine, 2,000 to 2,500 mg of collagen and around 2,000 mg of MSM in high-quality combination preparations have proven to be effective. If you feed pure monopreparations (for example, buying only pure MSM powder), significantly higher dosages of 10 to 15 grams are often recommended, as the synergistic effect of other active ingredients is missing.

In practice, it has proven successful to start with an initial course at double the dosage during the acute phase of an injury (the first two to three weeks after the trauma). This helps the body to rapidly replenish its stores after the shock event and during the peak inflammation phase. After this, you can confidently switch to a normal maintenance dose to accompany the continuous rebuilding of the tendon fibres.

At this point, we need to take a critical look at the supplement market. Many owners buy expensive joint powders in good faith, without knowing whether relevant amounts of the expensive ingredients are included at all. The European Feed Regulation (EU Regulation 767/2009) allows manufacturers to omit the exact declaration of active ingredient amounts per kilogram, as long as they do not make very specific health-related advertising claims. Often, the valuable ingredients are hidden right at the end of the ingredient list, behind large amounts of filler or sugar. As a responsible horse owner, however, you should always have the right to know how many milligrams of an active ingredient you are feeding your horse every day.

Another extremely important practical tip: be patient! As already explained, tendons grow and repair themselves extremely slowly. Supplementing for just 14 days will do very little for a suspensory ligament injury. Consistent feeding over at least 8 to 12 weeks is absolutely essential to give the tissue the time to actually convert the supplied nutrients into stable fibres.

Why individual active ingredients alone are often not enough: the power of combination

When you are at the beginning of such a long rehabilitation phase, you often study countless labels. Should you buy glucosamine? Or rather pure MSM? And what about collagen? Research provides an increasingly clear answer here: the power lies in synergy. A single building block can only help to a limited extent if the body simultaneously lacks other essential tools to complete the repair. The different nutrients target entirely different points in the tendon and joint structure.

Glucosamine is a fundamental building block for cartilage development and tissue firmness. It supports the natural shock absorption function, which relieves the joint and the surrounding suspensory ligament. Collagen, on the other hand, is the primary structural protein in the body. It forms the strong yet elastic framework of the tendons. MSM, i.e. organic sulphur, is in turn absolutely necessary so that the collagen can be cross-linked into firm, tear-resistant strands in the first place. Without sufficient sulphur in the tissue, the newly formed collagen remains soft and unstable. Finally, hyaluronic acid acts as a lubricant, as the main component of the joint fluid (synovia), and keeps the tissue layers supple and able to glide.

A very well-known crossover study by the British Animal Health Trust impressively supports these synergy effects. The researchers were able to prove that a sensibly balanced combination preparation of joint and tendon active ingredients showed significantly more positive and, above all, more consistent effects on the gait and the suppleness of movements in the living horse than isolated individual active ingredients could.

For your everyday life, this means: an intelligently formulated combination product does not require extremely excessive individual dosages, as the substances interlock like well-oiled cogs. It is precisely this scientific finding that we used as a foundation at nuvallo. In our recommended daily ration (6 nuvallo move Snacks) for a 500 kg horse, we combine exactly 2,550 mg of collagen, 2,250 mg of MSM, 1,500 mg of glucosamine and 150 mg of hyaluronic acid. These amounts are coordinated so that they optimally support the metabolism without burdening the organism with massive overdoses of individual minerals.

The biggest challenge in practice: feeding

Here we come to the emotional heart of the entire topic. Because all the beautiful lab values, the best studies in the world and the most exact dosage recommendations are absolutely useless to you and your horse if the product ultimately remains untouched in the feed bucket. And we know that this is exactly the reality in thousands of stable aisles in Germany.

a) Highlighting the feeding problem

You are standing at the stable in the evening after work. Your horse is on box rest, is already dissatisfied anyway, and you want to do something good for it with the outrageously expensive supplement. You mix the fine powder into the small handful of hard feed it is still allowed to have. Your horse sniffs, wrinkles its nostrils and turns its head away in disgust.

The problems with conventional joint powders are profound. They create unpleasant dust in sensitive horse noses and completely alter the familiar consistency of the feed. On top of that, many highly effective ingredients, especially MSM, have an extremely bitter and strong natural taste. Horses, being highly sensitive sensors, smell and taste this immediately.

Of course, we all know the usual tricks of desperation. You try to introduce the powder slowly and in tiny doses. You elaborately stir it into warm mash, try to hide it in a hollowed-out banana or in pieces of apple. You dampen the feed in the hope that the powder will stick to the oats. But often the result is sobering. The horse unerringly sorts it out and meticulously eats around the powder. When you then see the damp, foul-smelling powder residue stuck to the bottom of the bowl, the frustration is boundless. Our hearts would always sink in such moments, because we inevitably asked ourselves: how much of the active ingredient actually ended up in the horse today, and how much are we about to wipe into the bin?

b) Why we got rid of powder

It was exactly out of this deep frustration that nuvallo was born. When we repeatedly faced the same problem with our own horses and in discussions with hundreds of desperate horse owners, we radically rethought our approach. We did not ask ourselves: "How can we make a powder that tastes a little better?" Our crucial guiding question was: "How do we ensure one hundred per cent that every horse reliably and, above all, stress-free consumes the full, exact dose every day?"

The answer to this is our nuvallo move Snacks. We have developed a functional joint snack that you feed directly from your hand like a reward. There is no more annoying weighing, no dusty measuring scoops, no moistening and no leftovers in the bucket. Every single snack contains a precisely defined amount of active ingredients. The dreaded sorting out is simply physically impossible with this format.

To guarantee the highest acceptance with the best possible digestibility, we deliberately avoided fillers and instead developed a highly digestible, stomach-friendly base free from wheat and corn. Our base is formed by linseed cake, rice bran and linseed, complemented by natural ingredients such as banana, apple and carob powder. This does not place an additional burden on the already slowed metabolism of the horse on box rest and ensures a taste that horses love.

For your 500 kg horse, you simply feed 6 nuvallo move Snacks daily (correspondingly fewer for ponies, slightly more for very heavy horses). If your horse has been freshly diagnosed with an acute tendon injury, we recommend simply giving double the amount (i.e. 12 snacks) for the first two to three weeks to initially support the body. After that, you return to the normal maintenance ration.

The most wonderful side effect: your horse no longer experiences the administration of these nutrients as disgusting medicine that has to be forced upon it, but as an affectionate reward and positive attention from you at the stable door. At a time when riding is off the cards and the relationship often suffers under the medical routine, this is a priceless moment. In any case, since we have been feeding nuvallo like this, we have the feeling that our horses go back into movement much more supple and happily after the long box phase.

Because at the end of the day, the best and most expensive supplement is not the one with the longest exotic ingredient list or the highest lab values on paper. The only true supplement is the one that reliably and completely ends up in the horse every day.

Frequently asked questions about suspensory ligament injuries in horses

How long does it take for a suspensory ligament injury to heal?

There is no universal answer to this, as it strongly depends on where the injury is located (origin, body or branches) and how severe it is. As a rough guide, however, you have to think realistically in months, not weeks, with a suspensory ligament injury – a healing period of around six to twelve months is often mentioned, and even longer for severe cases. Tendon and ligament tissue has a very poor blood supply and therefore repairs itself extremely slowly. Your vet will always determine the specific progress and check-up appointments (e.g. via ultrasound).

Can a horse be ridden again after a suspensory ligament injury?

In many cases, yes – especially with an early diagnosis and consistent rehab management, horses do return to work. The crucial factor is the quality of the newly formed scar tissue: the more elastic and resilient it heals, the better the prognosis. However, whether and at what level your horse will be rideable again depends on the individual case and should be decided exclusively based on veterinary follow-up checks. Starting back too early is the biggest risk for a relapse.

What should you feed for a suspensory ligament injury?

The basis remains a needs-based, energy-reduced ration during box rest – the horse is barely moving, so it needs significantly less energy, but a high density of structural building blocks. Nutrients that support the connective tissue during rebuilding are sensible, above all collagen, MSM (organic sulphur), glucosamine and hyaluronic acid. Important: these building blocks provide the body with repair material, but they do not "heal" the suspensory ligament on their own and replace neither box rest nor the vet.

How long should you feed nutrients for support?

At least eight to twelve weeks, probably longer. Supplementing for just one to two weeks does practically nothing for a suspensory ligament injury, because the tissue needs time to actually convert the supplied nutrients into stable, resilient fibres. Patience and consistency are more important here than the highest possible dose.

Does a suspensory ligament injury heal on its own?

A mild, early-detected injury can heal with consistent resting – but "on its own" in the sense of "without management" is risky. Without controlled movement, adapted feeding and veterinary supervision, there is a risk that inferior, inelastic scar tissue will form, which will tear again under the next load. Therefore: it is better to involve the vet once too often than not enough.

How do I recognise a suspensory ligament injury?

Typical signs include swelling or thickening at the back of the cannon bone, heat in the affected area, sensitivity to pressure and – depending on the severity – a more or less distinct lameness, which often worsens on soft or deep ground. Some injuries, however, develop gradually and initially only show unspecific signs such as a loss of rhythm. If you suspect an issue, the leg should be checked by a vet promptly, ideally with an ultrasound – self-diagnosis and waiting can, in doubt, cost valuable time.

Sources

Byron C.R. et al. — Effects of glucosamine and chondroitin sulfate on mediators of osteoarthritis in cultured equine chondrocytes (American Journal of Veterinary Research, Michigan State University, 2003) Link

Dobenecker B. et al. — Specific bioactive collagen peptides (PETAGILE®) as supplement for horses with osteoarthritis: A two-centred study (Journal of Animal Physiology and Animal Nutrition, 2018) Link

Praet S.F.E. et al. — Oral Supplementation of Specific Collagen Peptides Combined with Calf-Strengthening Exercises Enhances Function and Reduces Pain in Achilles Tendinopathy Patients (Nutrients, 2019) Link

Shaw G. et al. — Vitamin C-enriched gelatin supplementation before intermittent activity augments collagen synthesis (American Journal of Clinical Nutrition, 2017) Link

Marañón G. et al. — The effect of methyl sulphonyl methane supplementation on biomarkers of oxidative stress in sport horses following jumping exercise (Acta Veterinaria Scandinavica, 2008) Link

Bergin B.J. et al. — Oral hyaluronan gel reduces post operative tarsocrural effusion in the yearling Thoroughbred (Equine Veterinary Journal, 2006) Link

Safety and quality you can trust

When you feed a product, you must be able to rely on it 100%. That is why nuvallo move Snacks stand for the highest standards:

• ADMR-compliant: Our snacks are absolutely safe for competition and can be fed with no withdrawal period – even when returning to sport after rehab.
• No unnecessary additives: Guaranteed free from wheat and corn, added sugar or cheap fillers that burden the metabolism.
• Highest quality: Manufactured with care in Europe under strict quality controls.
• No risk: We know how fussy horses can be. That is why we offer you a 30-day satisfaction guarantee.