Rhabdomyolysis (Azoturia, Tying Up, Monday Morning Disease)

Equine Rhabdomyolysis Syndrome (ERS) is a metabolic disorder that is linked to glycogen accumulation during rest. It is thought that glycogen accumulation increases muscle cell volume which in turn decreases capillary perfusion of muscle. During exercise a lack of oxygen results in a build up of lactic acid which causes swelling of the muscle cells and therefore capillary constriction. Anoxia (lack of oxygen to the muscles) causes degeneration of muscle fibres. This is why ERS results in muscle pain and in severe cases permanent damage.

The clinical symptoms may include swollen, hard and sensitive gluteal muscles, reluctance to move and progressively shorter strides, pain, sweating, pawing, flanking and general signs of distress. Myoglobinuria may also occur; this is when myoglobin is present in urine. Myoglobin is released as result of muscle damage and reaches the kidneys via the blood stream. This can lead to discoloration of the urine and in severe cases myoglobin may damage the kidneys leading to renal failure.

The onset of ERS usually occurs early on during exercise, after hard exercise or during a period of rest accompanied by high energy intake.

Can Equissage help?

Yes it can – BUT it MUST not be used until your veterinary surgeon has seen the horse. This is because if the massaging effect has a stimulatory effect on the kidneys but kidney function is impaired either by the presence of myoglobin and/or constriction of muscles, then use of Equissage will make the situation worse and cause more distress and discomfort especially if the horse is wanting to pass urine but is unable to do so. However once the vet has administered drugs to relieve pain and help to promote muscular relaxation, and is happy with regard to kidney function, then Equissage can be used to encourage further muscle relaxation - although on a low setting (No. 2-No.3) to as not to have an over-stimulatory effect before the body can cope. Once blood tests are satisfactory, then normal usage can commence. Using Equissage will help to promote correct kidney function, work to eliminate any remaining excess lactic acid and promote repair to damaged muscle fibres and capillaries.


Use the Pad for its 20 minute cycle but for just once a day. Using too often could over-stimulate kidney function and you do not want to put these already compromised organs under additional strain until such function is fully restored or you know how severe any permanent damage may be. The setting wants to be low to medium as a higher setting could cause too much activity within the body and encourage excess urination; treatment is aimed at restoring normal kidney function and muscular relaxation. Equissage by its very design is a stimulatory tool so it is important in ERS cases not to be tempted to try and speed up the healing process. Although just 20 minutes a day does not seem very much, the effects of an Equissage treatment continue in the body for several hours after the initial 20 minute cycle.

Once the horse is restored to health, then either a daily session can be maintained as part of your management programme or on alternate days to help reduce the risk of future ERS occurrences.

Point to Note:

Be sure that your feeding is in line with the work your horse is doing.