Ask the DJD Expert

What Should I Consider When Creating a Multimodal Treatment Plan?

By Sherry Johnson, DVM, MS, PhD, DACVSMR

In some ways, a horse is like a machine that operates with different systems running simultaneously. So, when approaching a degenerative joint disease (DJD) case, it’s important to take a step back and look at the horse as a global entity and think of all the different tissue types and other factors at play.

When developing a multimodal approach to manage DJD, choose treatments that complement one another to not only treat the disease at the cellular level but also rehabilitate the whole body. When we take this approach, we help protect the joint and get the athlete back and stronger for the long term.

TAILOR TREATMENT TO THE INDIVIDUAL ATHLETE
DJD is one of those things that can affect all types of athletes. But the same treatment plan won’t work for every patient because their bodies face totally different challenges. It’s similar to how human athletes train differently based on their sport—a horse that runs the Tevis endurance race needs completely different training and care than a quarter horse sprinting short distances or a barrel racer making tight turns.

Their bodies are under different types of stress, so their treatment and training have to match what their sport demands. When designing a DJD management plan, consider asking specific questions about the horse’s competition schedule, training regimen, and performance demands to help identify the particular stresses their joints experience.

BALANCE MEDICAL MANAGEMENT WITH PHYSICAL REHABILITATION
The most important aspect of a multimodal plan is having your approach dialed in and understanding the role and expectation of each treatment. Consider how each component—from medications to rehabilitation exercises—works together to address the complex nature of DJD. I like to incorporate Adequan i.m.® (polysulfated glycosaminoglycan) when I need to maintain constant systemic levels of PSGAG over time. I also prescribe Adequan i.m. alongside other treatments, whether they be medical or physical. Adequan i.m. is recommended for the intramuscular treatment of non-infectious degenerative and/or traumatic joint dysfunction and associated lameness of the carpal and hock joints in horses. WARNING: Not for use in humans. See additional safety information for Adequan i.m. below.

THE VALUE OF EXERCISE
In my opinion exercise is the most underrated therapeutic in veterinary medicine. We often focus a lot on medications while overlooking the pillars of physical therapy—flexibility, strength and cardiovascular fitness. Consistent exercise helps promote joint stability and keeps the rest of the body in shape. No elite human athlete is prescribed complete rest for an injury; they modify activity while maintaining fitness. Our equine athletes deserve the same thoughtful approach to rehabilitation.

By combining appropriate medical interventions like Adequan i.m. with targeted physical therapy, we can better support our equine patients throughout their careers. This is the essence of a multimodal approach—addressing joint disease from multiple angles to achieve the best possible future for the horse.

Dr. Sherry Johnson is a paid consultant of American Regent Animal Health.

Adequan® i.m. polysulfated glycosaminoglycan (PSGAG) solution 100 mg/mL

INDICATIONS
Adequan® i.m. is recommended for the intramuscular treatment of non-infectious degenerative and/or traumatic joint dysfunction and associated lameness of the carpal and hock joints in horses.

IMPORTANT SAFETY INFORMATION
There are no known contraindications to the use of intramuscular Polysulfated Glycosaminoglycan (PSGAG). Studies have not been conducted to establish safety in breeding horses. WARNING: Do not use in horses intended for human consumption. Not for use in humans. Keep this and all medications out of the reach of children. CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian. For additional safety information, please see full prescribing information at adequan.com.

Please see Full Prescribing Information at adequan.com.

All trademarks are the property of American Regent, Inc. © 2025, American Regent, Inc. PP-AI-US-1227