Tying-Up in Horses: Symptoms, Treatment, First Aid
- accelerates muscle recovery
- in preparation for athletic performance
- supports natural muscle function
How does tying-up manifest in horses?
Tying-up usually becomes noticeable at the start of exercise – often after the horse had a rest day the day before but still received a normal (or excessive) amount of concentrate feed. At first, the animal may appear restless or show reluctance when being mounted or ridden. The following symptoms typically then appear very quickly:
The croup and back muscles suddenly become rigid. The horse becomes reluctant to move or suddenly stops. It often refuses to move forward at all and won't take another step.
Many affected horses lower their back and place their front legs far forward and their hind legs far back, as if stretching. This unusual posture resembles a wooden sawhorse. The horse adopts this stance to take pressure off the painful muscles and thereby attempts to ease the pain.
The pain can be so severe that the horse shows behaviors similar to colic. It becomes restless, repeatedly looks at its belly, stamps its feet, or tries to lie down because it doesn't know how to escape the pain.
In severe cases, the muscle damage leads to myoglobinuria – the urine turns a brownish-red color, similar to strong black tea or blood in the urine. This change in color occurs because the protein myoglobin from destroyed muscle cells is excreted through the kidneys.
Due to the sudden muscle pain and stress, the horse starts to sweat heavily. Visible muscle trembling in the croup as well as a markedly increased heart and respiratory rate are typical reactions.
The severity of these symptoms can vary. With mild cases of tying-up, the horse merely moves stiffly and reluctantly, but remains responsive. In severe cases, on the other hand, the horse may no longer be able to stand at all and goes down (collapses). It then usually sweats profusely, shows signs of shock (trembling, rapid pulse, shallow breathing), and this is an emergency. Important: even a mild-seeming case of tying-up should always be taken seriously, as it can quickly worsen without treatment.
Why does a horse adopt the sawhorse stance?
"Sawhorse stance" refers to the posture a horse takes when it places its front legs far forward and stretches its hind legs out backward – similar to a set-up sawhorse. This so-called sawhorse stance is a warning sign of severe pain in the back muscles – typically seen in acute tying-up. Due to the cramp-like rigidity of the hindquarter muscles, the horse adopts this protective posture to relieve pressure on the painful muscle areas. If such a sawhorse stance occurs together with sweating, trembling, and reluctance to move, acute tying-up is very likely. The sawhorse stance is therefore an important warning sign indicating serious muscle damage.
First Aid for Tying-Up
If tying-up is suspected, it's important to act correctly right away. Any delay can worsen the muscle damage. The following first aid measures are important until veterinary help arrives:
At the first signs, the horse must be stopped immediately. Under no circumstances should you continue riding or lunging – any additional exertion worsens the muscle damage.
The horse's croup and back muscles should be kept warm with a blanket right away (even in mild weather). Warmth helps relax cramped muscles somewhat and promotes blood circulation in the affected areas.
Notify a veterinarian as quickly as possible and inform them of the suspected tying-up. Until they arrive, someone should stay with the horse to keep it calm – try not to leave the horse alone.
Any concentrate feed must be stopped immediately. The horse should no longer receive any grain or concentrate feed. Fresh water, however, may be given, as fluids help excrete the breakdown products of the muscle damage through the kidneys.
The horse should remain standing as calmly as possible and should not be forced to keep moving. If the incident happens away from home, in the worst case the horse should be picked up with a trailer rather than led home on foot.
These measures do not replace treatment by a veterinarian. However, they can help prevent further damage and stabilize the horse until professional help arrives.
How does the vet treat tying-up?
A veterinarian will first assess the horse's condition closely. An experienced vet can often recognize tying-up based on the described symptoms and a clinical examination alone. The following steps are usually taken to confirm the diagnosis and assess the severity:
The vet checks the horse's posture and palpates the rigid muscles in the croup and back. The heart, lungs, and gut are also examined to rule out other causes for the symptoms (such as colic).
The horse is immediately given medication for pain and for the muscle cramps. The vet usually injects a strong painkiller combined with a sedative to help the horse relax. If needed, antispasmodic agents (muscle relaxants) or anti-inflammatory medications are also given, at the vet's discretion.
The horse often receives an IV infusion to stabilize the circulation and flush the kidneys. The intravenous fluids help excrete harmful substances (such as myoglobin) more quickly, which helps prevent consequential kidney damage.
A urine sample is checked for discoloration – dark brown urine supports the suspicion of tying-up (due to myoglobin in the urine). The vet also draws blood to determine the muscle enzymes (particularly CK and AST). Markedly elevated levels confirm the diagnosis and indicate how severe the muscle damage is.
Once the acute phase has passed, the vet gives instructions for further care. The horse should be given absolute rest in a deeply bedded stall until it recovers. A horse that cannot get up (is recumbent) must be gently repositioned regularly to prevent pressure damage to the muscles. The vet will also discuss how long the horse should rest and what feeding changes are needed to prevent further episodes.
Which blood values are elevated with tying-up?
Typically, in cases of tying-up, certain muscle enzymes are significantly elevated in the blood. Two lab values in particular indicate the extent of muscle damage:
- CK (Creatine Kinase): This enzyme is found in muscle cells and enters the bloodstream when they are destroyed. In healthy horses, CK is below approx. 300 U/L. In horses with tying-up, CK levels often rise extremely – not uncommonly to several thousand U/L. CK reacts very quickly to muscle damage and indicates the severity of the acute injury in the short term.
- AST (Aspartate Aminotransferase): An enzyme from muscle and liver cells (formerly known as GOT). AST also rises with muscle damage but remains elevated longer than CK. High AST values indicate that a serious muscle injury has recently occurred or is still ongoing.
Once these muscle enzymes return to the normal range after a few days, the acute episode of tying-up is considered resolved. Blood values are often monitored over time to track the progress of recovery.
Conclusion
With tying-up, every minute counts. Stop work immediately, keep the horse calm, put a blanket on it, and call the vet right away – these are the crucial steps to limit further muscle damage. Veterinary treatment with pain management, IV fluids, and monitoring of blood values is essential to assess the severity and prevent lasting damage. The faster and more consistently you act, the better the chances of a full recovery.
Feeding: What to feed for tying-up?
Proper feeding plays a major role in recovery and, above all, in preventing tying-up. During an acute episode, the strict rule is: no concentrate feed! The horse should only receive hay and water until it is completely stable again. But even after an episode has resolved – and generally for horses prone to tying-up – the feeding plan needs to be adjusted to prevent further episodes. Important feeding principles include:
Starch- and sugar-rich concentrate feed (grain, muesli) should be significantly reduced or eliminated entirely, especially on days without work. Generous grain feeding without adequate exercise is the most common trigger for tying-up. Instead, only forage should be fed on rest days.
If a horse needs additional energy (e.g. a performance horse or an underweight horse), this should ideally be provided via fat. Oil (e.g. linseed oil or soybean oil) or fat-rich feeds such as rice bran provide plenty of calories without burdening the muscle metabolism with excess starch. Many horses prone to tying-up (such as those with PSSM) benefit from a low-starch, fat-focused diet.
These nutrients are important for muscle function and act as antioxidants in breaking down metabolic byproducts. A deficiency in vitamin E or selenium can contribute to muscle problems. The mineral feed should therefore contain sufficient vitamin E and selenium. If needed, targeted supplementation can be given after consulting the vet, if the regular feed doesn't provide enough.
The horse should receive plenty of hay as its staple feed. High-quality hay largely covers energy and nutrient requirements but provides significantly fewer readily available carbohydrates (starch/sugar) than grain. Pasture grass can also be fine in moderation – it contains fructan, but the movement while grazing has a balancing effect.
Overall, such feeding management can significantly reduce the risk of tying-up. For known at-risk horses (e.g. horses with a confirmed tendency toward PSSM), a low-starch diet must be followed especially strictly.
In addition to feeding, adequate exercise is crucial: at-risk horses should ideally be exercised daily so that excess energy doesn't lead to muscle problems in the first place. If a rest day does come up, turnout or walks help keep the metabolism active. It's also important to always warm up thoroughly, especially in cold weather – cold, unstretched muscles are more prone to cramping. So in low temperatures, warm up at the walk for longer and consider leaving a blanket on the horse while warming up.
How long should the break be after an episode of tying-up?
After an episode of tying-up, the question arises of when and how the horse may be trained again.
The rule here is: the muscles must fully recover before resuming work. The exact length of rest depends on the severity of the episode and should always be discussed with the vet. Roughly, a distinction can be made:
- Mild cases: With a mild episode of tying-up, a few days of rest are often enough. The horse may move freely in its stall or paddock, but no demanding work should take place (no riding, no intense training). As soon as it moves normally again and the vet gives the okay, you can start with the first short walks or a few minutes of hand-walking at the walk.
- Severe cases: If the horse has suffered severely (possibly unable to get up, very high muscle values), several weeks of rest are required. In the first days, absolute stall rest is important. Later, short hand-walking phases may be allowed – but only with the vet's explicit permission. Riding should wait until the horse is completely symptom-free again and the vet gives the green light.
The resumption of training must always proceed slowly and gradually. Start with only relaxed walking work, then carefully introduce short trot sequences, and later, after enough build-up time, possibly canter again. Only once the horse copes easily with lighter workloads can full training or sporting activities be considered. This careful, step-by-step recovery phase significantly reduces the risk of relapse.
PSSM Type 1: What symptoms do affected horses show?
Some horses have an inherent tendency toward recurrent episodes of tying-up, even with otherwise good management, feeding, and training. Often PSSM Type 1 (Polysaccharide Storage Myopathy Type 1) is behind it – a hereditary muscle metabolism disorder that occurs especially in certain breeds (e.g. Quarter Horses, Paint Horses, Appaloosas, and draft breeds). Horses with PSSM1 have a gene mutation that leads to an uncontrolled storage of glycogen in the muscles. The clinical picture resembles constantly recurring episodes of tying-up.
Typical signs in PSSM1 horses are:
The horses become stiff in the hindquarters after only a short time working. They appear as if they've developed exaggeratedly rapid muscle soreness, and often resist moving forward. Even light training can cause the hindquarters to falter.
PSSM1 horses tire quickly and show little stamina. They seem listless or defiant, even though there is no orthopedic problem. They are often mistakenly perceived as “lazy,” when in fact a muscular problem
Under unfavorable circumstances (e.g. after rest and too much feed), PSSM1 horses can suffer acute episodes of tying-up with the classic symptoms: severe stiffness, being unable to get up, reddish-brown urine. Such episodes can even be the first indication of PSSM, if the horse had otherwise only shown mild symptoms.
Even without strenuous exertion, there can be phases of muscle trembling (especially over the croup) and sweating. Sometimes the horses stand there after just a few minutes of work as if they had just run a marathon. These symptoms can occur in episodes, especially when management (exercise/feeding) is not optimal.
For PSSM1, there are genetic tests to confirm the predisposition. Managing these horses is similar to tying-up prevention: a very low-starch diet, plenty of exercise, and if necessary, supplements such as vitamin E and selenium. With the right care, many PSSM horses can remain largely symptom-free, even though they remain susceptible.
What is RER in horses?
The term RER stands for Recurrent Exertional Rhabdomyolysis, roughly translated as “recurring exertion-related breakdown of muscle tissue”. This describes – similar to PSSM – a predisposition to recurring muscle cramps and muscle cell damage . Unlike PSSM1 (which is caused by a known gene defect in certain breeds), RER occurs mainly in Thoroughbreds and nervous performance horses. The exact causes of RER are not fully understood; a hereditary metabolic disorder is suspected, which among other things affects calcium regulation in muscle cells.
Symptomatically, RER presents like a classic episode of tying-up: after brief exertion, stiffness, trembling and sweating occur; in severe cases, the horse becomes unable to get up and produces dark urine. The distinctive feature of RER is that these symptoms can recur again and again – even with optimal management. The horse has, so to speak, a chronic tendency toward tying-up. Through very careful, adapted feeding (little grain, more fat in the diet) and avoiding stress, episodes can usually be significantly reduced. In severe cases, preventive medications are also given (e.g. low doses of sedatives or muscle relaxants before training) so that affected horses remain trainable at all. RER is therefore not a single disease event, but a syndrome of recurring episodes of tying-up in particularly susceptible, often high-strung horses.
How can you recognize blockages in horses?
Many horses suffer from so-called blockages (blocked vertebral joints or chronic tension in the back/pelvic area). However, the symptoms of a blockage present quite differently than those of tying-up – namely, usually gradual and less dramatic. Typical signs of a spinal blockage or muscular tension include, for example: stiffness with certain movements (the horse resists being flexed or bent, sometimes refuses to canter on), defensive reactions when grooming or saddling (pinning ears, dropping the back away), and an irregular way of going (stumbling or rhythm faults, without any lameness being present).
These symptoms differ clearly from acute tying-up, which suddenly comes with heavy sweating, trembling, and a total refusal to move. Important: a blockage is not an emergency. If a horse suddenly stops moving, sweats heavily, and is clearly in severe pain, it's probably not a “simple” blockage but rather an episode of tying-up – in that case, the vet should be called immediately. Chronic back problems, on the other hand, are treated by chiropractors, physiotherapists or adapted work, but can be clearly distinguished from the acute situation of tying-up.
Conclusion
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