Equine MLD - Conditions

Equine Manual Lymphatic Drainage works with the body's own processes to promote healing, and should be used as soon as possible after conditions arise. With time tissue changes can take place, which are less responsive to treatment.

Inflammation:

Inflammation is the body's response to damage or irritation, however inflammation can sometimes become excessive, or continue beyond the healing stage and become chronic.

When inflammation is caused by bacteria, viruses, poisons or allergens, EMLD is contraindicated because of the risk of moving these into the blood stream, but when your vet has confirmed that these have responded to treatment, or for inflammation from other causes, e.g. injury, EMLD will quickly remove the products of inflammation, ease symptoms, limit damage and speed up healing, encouraging tissues to return to their normal state.

Idiopathic Synovitis, Tendosynovitis:

Where there is no underlying cause of injury, these conditions (windgalls, bog spavin) are classed as blemishes not requiring treatment. However, if they become very large they may cause a mechanical lameness and owners may also find them unsightly. In these situations EMLD can reduce swelling and soften hardened fibrous tissue without the need for drugs or box rest.

Tendonitis:

EMLD using manual lymph drainage and specialised compression bandaging is an effective auxiliary treatment for tendon injuries. Because bleeding and oedema are reduced, and the transportation of toxic waste products increased, further damage to the tendon tissues is reduced. The treatment also encourages longitudinal orientation of new collagen fibres and recovery times are significantly shortened. It is important as always to start EMLD immediately after injury to take advantage of the body's own processes.

Laminitis:

EMLD is an effective auxiliary treatment to standard veterinary management for acute and sub acute laminitis. Clinical signs of laminitis are usually only apparent after damage to the lamellae has begun, and at the visible ‘acute’ stage, haemorrhage, inflammation and oedema are present within the rigid confines of the hoof capsule, leading to further tissue necrosis, pressure on the increasingly unstable pedal bone, relentless pain and characteristic lameness. When used with acute laminitis, Equine Manual Lymph Drainage stimulates the lymphatic drainage of the hoof, and quickly limits the inflammatory response, drains oedema, removes blood and eliminates toxic substances, limiting the processes damaging the lamellae. In doing so it reduces pressure within the hoof and upon the rotating pedal bone. Necrosis is slowed and damage reduced, leading to a better recovery. EMLD treatment should be intensive and ideally started as soon as laminitis is suspected.

Tying up:

‘Tying-up’ is one of many names for a collection of clinical signs or symptoms that used to be thought of as one condition but are now known to have several causes, although the symptoms, most strikingly muscle cramping, are similar in each.

EMLD increases the elimination of metabolic products from the muscles and is an effective auxiliary treatment for these conditions, resulting in reduced symptoms and quicker recovery. It also has a prophylactic use with high performance horses and research indicates it may be useful in the treatment of horses that repeatedly tie up.

Equine Purpura Haemorrhagica:

Although EMLD is normally contraindicated for acute allergic reactions, it can be safely used with EPH because this condition is systemic from the start. It produces a faster and greater reduction of the massive oedema, which also affects an improvement in the horse’s general health and the clinical picture of the disease. EMLD treatment should begin at the first indication of oedema formation, to control its potential development.

Filled legs (Stocking up):

This condition (‘idiopathic primary lymphoedema’) develops in some horses when their movement is restricted for any length of time, typically after being kept in overnight, with the swelling disappearing once the horse is exercised again. To perform adequately, the lymphatic vessels of the horse’s legs are especially dependent on movement to stimulate their activity and the flow of lymph, and if for any reason the lymphatic vessels are damaged or not formed properly they will not be able to cope with the loss of this support, forcing the tissues to swell.

Filled legs have traditionally been dismissed as harmless but without treatment the condition can worsen over time and the legs become increasingly vulnerable to trauma and risk of infections such as lymphangitis, potentially leading to serious oedema and chronic secondary lymphoedema. Horses with this condition should not be kept in unless this is absolutely necessary, and then only for the shortest possible time.

Stable bandaging is often the response to filled legs, but research has shown that the use of stable bandages inhibits the flow of lymph, preventing the provision of nutrients to the tissues. The apparent lack of swelling is an optical illusion, as fluid disperses above the bandage. The removal of toxic waste products is also prevented, and this stagnation provokes further tissue damage and is thought to cause the development of filled legs in previously unaffected horses when on enforced box rest.

It is a common misunderstanding that high protein feed causes 'filled legs'. Oedema is caused by a very low protein diet, as seen in victims of famine.

A course of EMLD followed if required by the judicious use of specialised compression stockings, is an effective means of controlling this condition. Note: These stockings are not intended to be used without previous treatment.

'Chronic' Lymphangitis (lymphoedema):

Lymphangitis is a distressing and painful inflammation of the lymphatic vessels, usually in the horse’s legs. It can have a number of causes but infection, which may not necessarily show up in tests, is frequently implicated. Lymph nodes close to contain the infection to prevent it spreading through the body, inflammation causes more fluid to enter the tissues, and oedema develops. The limb may be massively swollen, and sebum may leak through the skin which may slough away, and the horse may have a fever and be very unwell.

Prompt treatment by a vet, who will usually prescribe antibiotics, anti-inflammatories, painkillers and sometimes steroids, is essential, and after an initial attack will often clear up lymphangitis completely. However, damage done to the lymph vessels leaves the limb vulnerable to further infections resulting in permanent residual swelling and chronic tissue changes which can worsen and become fibrotic with time – a secondary lymphoedema.

EMLD should not be used until the cause of the inflammation is under control, because it may open lymph nodes, spreading infection, but once this is achieved, Combined Decongestive Therapy (CDT) is the treatment of choice to reduce oedema, soften fibrosis, improve skin health and stimulate blood and lymph circulation. However it is important that this condition is treated as early as possible, as established fibrosis takes longer and is harder to treat and the results may not be as satisfactory as otherwise. CDT should never be treated as the last resource with this condition!

Cellulitis and vasculitis are inflammations of the skin and subcutaneous tissues, and of the blood vessels respectively, and are often implicated with lymphangitis.

For more information on treating severe chronic lymphangitis please see 'Lymphangitis case history'.

Pastern Dermatitis:

Pastern dermatitis is a general term for a number of conditions which affect the skin of the horse’s lower legs, including mud fever, mite infestation, contact allergic reactions and photosensitivity. Oedema is often present and repeated attacks can trigger chronic inflammation which causes recurring damage to tissues, including lymphatic vessels, limiting the local immune system’s ability to respond and increasing the horse's susceptibility to infection. Pastern dermatitis may lead to the development of lymphangitis.

Treating pastern dermatitis can be frustrating, time consuming and expensive which may encourage owners to 'diagnose' and treat conditions themselves. Unfortunately this sometimes does more harm than good. The skin on horses' legs is sensitive and made more so by many conditions, and can be further damaged by the wrong remedies. Conditions may appear similar but have a quite different cause, it is important therefore that this is correctly identified so that appropriate treatment can be started.

EMLD to reduce inflammation and stimulate the immune system can begin as soon as any infection or allergic reaction has been treated. In some cases, treatment can take place while infection is present, if this is performed with careful veterinary monitoring.

Post traumatic and post operative oedema:

EMLD can be used to reduce oedema and scarring and accelerate recovery following trauma to tissues such as contusions, lacerations, burns, blisters and after surgical procedures.

Long term box rest:

Horses on long term box rest, for example when recovering from laminitis, may develop ventral oedema and swelling in the legs, which is quickly eliminated by using EMLD.

My own experience suggests that EMLD may effectively reduce the symptoms caused by Equine Metabolic Syndrome in horses with recurrent laminitis.

Lymphoedema:

Lymphoedema is described in some detail under 'Equine Lymphoedema Complex'. Whatever its cause, it is treated with Combined Decongestive Therapy. If there are secondary infections (e.g. some forms of pastern dermatitis) these are treated appropriately. Lymphoedema is not curable, but can be controlled with CDT. The first intensive phase, involves daily manual lymph drainage, compression bandaging, exercise and skin care. The second, maintenance phase, requires exercise, skin care, and the monitored use of specialised compression stockings to support the effects of the first phase. Follow up EMLD treatments should be given, as required.

CDT can greatly improve the horse’s overall health, the quality of the skin, the appearance of the legs, and the horse’s movement where this is affected. The success of the treatment is very dependent on the commitment of the horse’s carer to the maintenance phase. Exercise and movement are very important to the health of the horse’s lymphatic vessels, and even more so when the system is compromised. Because its function is disturbed, the skin may become very dry, or greasy in patches, and vulnerable to secondary infections. Feather should be kept short to discourage these. The skin should be kept clean and if washed, a soap free, mild, non alkaline product should be used, and great care taken to dry the skin properly afterwards. It is very important to maintain the skin barrier and to moisturise by sparingly using non mineral based products e.g almond and carrot oil, aloe vera or urea based, not Vaseline or paraffin wax, or lanolin. Volatile oils such as tea tree can cause irritation.

Lymphoedema is much more responsive to treatment if this is initiated as soon as possible, e.g. immediately after the cause of lymphangitis has been treated. Results may not be as good in long term chronic cases, but even so, can produce significant improvement.

Please see under 'Equine Lymphoedema Complex', 'Chronic Progressive Lymphoedema' and 'Filled legs'.