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Care Guide

About Care Guides[x] These care guides are written to help your clients understand common conditions, tests, and procedures, as well as to provide basic information about pet care. They are based on the most up-to-date, documented information, recommendations, and guidelines available in the United States at the time of writing. Pharmaceutical product licensing, availability, and usage recommendations are based on US product information. Use the Download Handout button to generate a PDF for printing or e-mailing to your clients.

Tying Up (External Rhabdomyolysis) in Horses

    • External rhabdomyolysis, which is also called tying up, is a disorder of muscle metabolism that results in muscle cramps in horses.
    • Various treatments and preventive measures are available.

    External rhabdomyolysis (ER), which is also called tying up, is a disorder of muscle metabolism that results in muscle cramps in horses. In severe cases, an affected horse’s urine appears red from the release of myoglobin (an oxygen-transporting protein) by damaged muscle and muscle enzyme levels are greatly increased. Most cases of ER occur in horses that have not been in work for several days and are then exercised strenuously. Typically, an affected horse develops a stiff gait with excessive sweating and rapid breathing during or shortly after exercise. The horse’s muscles are hard and painful to the touch.


    This condition may occur sporadically; however, some horses are prone to developing ER. Causes include overexertion beyond the horse’s training level, electrolyte imbalances, a diet with a high level of grain, underlying illness, and vitamin E or selenium deficiency.


    Treatment typically includes stall rest, antiinflammatory medications, sedatives, muscle relaxants, and, sometimes, intravenous fluid therapy, especially in severe cases. The horse is fed a hay diet for a few days and gradually turned out in a small paddock and/or briefly hand-walked until a veterinarian determines that the muscle enzyme concentration has returned to normal. Most horses with ER respond to a few weeks of rest, a hay diet, and a gradual increase in exercise or training. Grain should be fed at the minimum amount needed. If additional calories are necessary, vegetable oil or rice bran can be added to the feed. Electrolyte supplementation of at least 1 oz of sodium chloride (NaCl) is important. Vitamin E and selenium supplementation may also be needed. After an episode of ER, muscle tissue can be repaired within 4 to 8 weeks.


    ER can often be prevented by supplementing the feed daily with an electrolyte supplement that includes at least 1 oz of NaCl and by ensuring that the dietary carbohydrate level is not too high. Affected horses should be kept on a consistent exercise program.