In the bowed tendon and suspensory groups of horses tendon or ligament injury was confirmed on ultrasound with lesions ranging from type 2 or type 3 for superficial digital flexor tendon 8 over 20% to 70% of the length of the tendon in thoroughbreds and mostly discrete areas over 10% to 15% of the length of the mid portion of the tendon in standardbreds. In each of the standardbreds there had been a history of a fall or interference in running. The four suspensory lesions were all core lesions to either the medial or lateral branches of the ligament. There were an equal number of injuries on left and right sides.

The initial visual response to spa treatment was negligible until day 8-10 at which time general swelling was seen to be reduced. After 7 days, changes could be seen on ultrasound examination. Resolution of core lesions had commenced and previously anechoic areas were reduced in size and had become partially echoic.

Progressive changes over the next two to three weeks indicated commencement of healing of anechoic areas by haematoma resolution and decreased inflammatory infiltrate, independent of whether the injury was only three weeks old or up to four months old, together with a reduction in cross sectional area(CSA). Fibre alignment in longitudinal views demonstrated an improvement in parallel configuration after 3 or 4 weeks.

The use of cold in the initial stages of tendonitis and desmitis is well accepted, however, the continued use of cold with concurrent hypertonic water massage is now possible with the controlled temperature spa bath. In comparison with other treatments including tendon splitting, carpal check ligament desmotomy, intralesion injections of beta-aminoproprionitrile(BAPN) or sodium hyaluronate, anti-inflammatory medication or support bandaging, spa bath hydrotherapy appears to offer an effective alternative with or without other therapy. The reported cases resolved much faster than expected with only one case in twelve with type 3 lesions re-injuring during early training. This is much lower than reported by Yovich 4over an unreported time frame.

Horses 1 to 6 successfully returned to training within 12 weeks and 4 raced within 26 weeks, three of which won and placed in their first preparation with two winning in a second preparation after an eight week spell. The response of horses 1 (Fig 1a to 1c) and 2, which were given further rest after spa treatment, suggested future horses could return to long slow training earlier with successful outcomes.

Horses 8 to 17 and horse 20 returned to walking exercise after the 3 or 4 weeks treatment and completed full training over the next 12 to 18 weeks with a return to competition. Horse 15 (Fig2a and 2b) responded well to the spa treatment but had treatment terminated after three weeks when an extra week was recommended. In the case of horses 16 (Fig 3a to 3c) and horse 17(Fig 4a to 4c) where injuries were adjudged more serious training was incorporated with spa treatment on fast work days.

Horses 21 to 23, the horses described by trainers as jarring up exhibited minor inflammation and soreness over middle of foreleg suspensory ligaments on both legs without any evidence of dorsometacarpal disease 9. Each had been described by experienced track riders as having a shorter choppy stride than normal. Each continued training in association with spa treatment. Each horse returned to normal striding within 2 days with horse 21 winning five days later.

Horses 7, 18 and 19 were spelled by owners for 3months and horse 20 for 2 weeks before return to training. Horse 19 (Fig 5a to 5c) was also scanned at the end of the 3 months spell prior to returning to training and the ligament was considerably improved with a return to normal consistency on palpation.

In all cases reduction in paratendinous and tendinous fluid and any haematoma appeared to enhance the healing process. In one case only the injury reportedly recurred after six weeks of training, and horse 1 had two preparations with 3 wins, two at a higher grade, before a severe superficial digital flexor lesion developed in the other leg. One eight year old TB with a type 3 lesion was retired after ten weeks of training to hacking rather than risk further injury. All other horses have returned to competition.

In horses 25 and 26 with skin contusion and oedema but without apparent tendon or ligament damage oedema and pain were alleviated in part immediately. Each horse passed a compulsory competition veterinary examination and competed successfully without lameness 72 hours after injury. This demonstrated the potential value for resolution of contusion injuries in competition horses. The analgesic effect from constant cold and reduction of oedematous fluid allowed both horses to compete successfully drug free. The hypertonicity, massage effect of agitation, cold, and the effect of pressure from the depth of water 10 appeared to aid in fluid dispersal and minor skin and subcutaneous tissue wound repair.

In varying grades of superficial flexor tendon injury or suspensory ligament damage cold spa bath hydrotherapy for 3 or 4 weeks resolved the fluid component of the injury which together with a slow progressive exercise loading over 16 to 18 weeks allowed most racehorses to return to successful racing within six to eight months. In the more severe cases the combination of spa therapy during the training program is believed to have aided recovery and would be the preferred management approach. The response of cases with physical or trauma induced inflammation indicated potential value of spa therapy in any cases involving lower limb inflammation especially where alternate drug therapy was not an option.

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