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Equine Tying Up & Exertional Rhabdomyolysis

Tying up isn't a supplement problem. Stop trying to solve it like one.

Most chronic tying up is genetic — PSSM, MFM, or RER. Selenium and Vitamin E aren't a cure (the research has refuted that). The right workup goes diagnostic-first: bloodwork, then genetic testing, then nutrition. Here's how to do it in the right order.

3 conditionsoften called "tying up"
Genetic testingis the gold standard
Mineral panelis one input alongside
01 — Definition

What is "tying up" in horses?

Tying up — clinically called exertional rhabdomyolysis (ER) — is a syndrome of muscle pain, stiffness, cramping, and tissue damage during or after exercise. The horse's hindquarters become rigid and painful. Muscle fibers actually break down, releasing myoglobin into the bloodstream and turning urine dark. It is a real veterinary emergency at the moment it's happening.

Sporadic vs. chronic

The single biggest mistake in tying-up management is treating chronic ER like sporadic ER. The horse who keeps tying up doesn't need different turnout or another supplement. That horse needs a genetic test and a diagnosis.

What it's been called in the barn

Old names you might still hear: Monday morning disease, azoturia, blackwater, set-fast, tied-up, shipping fever-related cramping. They're all describing the same general syndrome — exertional rhabdomyolysis — but with different underlying causes that modern genetics can now identify specifically.

02 — The Causes

PSSM, MFM, RER — three different diseases, one common label

Three distinct inherited conditions account for most chronic tying up. They look similar from the outside. They are not the same disease. Treatment that helps one can do nothing for another.

PSSM1
Quarter Horses, Paints, Drafts
Polysaccharide Storage Myopathy Type 1
Single gene mutation (GYS1) causing abnormal sugar/glycogen accumulation in muscle. Triggered by starch and sugar. Most common in stock breeds and draft horses.
Test: GYS1 genetic test (mane or tail hair sample). Multiple labs.
MFM / PSSM2
Warmbloods, Arabians
Myofibrillar Myopathy
Disorder of muscle fiber organization. Multiple suspected genetic variants under active research. Often presents as poor performance, exercise intolerance, and muscle soreness more than classic tying up.
Test: P2/P3/P4/Px genetic panel + muscle biopsy in some cases.
RER
Thoroughbreds, Standardbreds, Arabians
Recurrent Exertional Rhabdomyolysis
Disorder of intracellular calcium regulation. Triggered by excitement and stress as much as exercise. Often the "hot" filly who ties up at the gate.
Test: Clinical diagnosis based on breed, history, response to management. Genetic markers being researched.

The smart diagnostic order

First — during episode

Vet bloodwork

CK and AST muscle enzyme panel during or shortly after an episode confirms ER and quantifies severity. Critical baseline.

Second — once stable

Genetic testing

GYS1 for PSSM1, P-variant panel for PSSM2/MFM, breed-history assessment for RER. Tells you which disease you're managing.

Third — diet & work

Management protocol

Diet (low-NSC + fat for PSSM1), consistent daily exercise, controlled excitement (especially RER), electrolyte management.

Fourth — context

Mineral & toxin status

Hair mineral analysis to rule out selenium deficiency, electrolyte imbalance, heavy-metal contributors. One input among the workup, not a substitute.

Refuted Claim

"Selenium and Vitamin E will cure my horse's tying up."

The published research has refuted this claim. Most horses with chronic ER already have adequate or more-than-adequate selenium and vitamin E status, and further supplementation has not been shown to prevent or cure tying up. Adequate selenium status is necessary for normal muscle function — but you cannot supplement past adequate. Test before you supplement; don't assume.

The right relationship between hair mineral analysis and tying up: it tells you whether selenium status is in range, whether magnesium and electrolytes are balanced, and whether heavy metals are contributing background load. It does not diagnose PSSM, MFM, or RER. Genetic testing does that.

Get the mineral piece of the workup

$49.99 kit. ICP-MS analysis. Selenium status, Ca/Mg ratio, electrolyte panel, heavy metals.

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03 — What You Learn

What the test does — and doesn't — tell you

Hair mineral analysis is one input in a complete tying-up workup. It identifies the mineral and heavy-metal contributors. It does not diagnose the underlying muscle disease.

TierWhat It MeasuresWhy It Matters For Tying Up
Essential Minerals Selenium, Magnesium, Calcium, Sodium, Potassium, Phosphorus, Sulfur, Copper, Zinc, Iron, Manganese, Cobalt, Chromium, Boron, Molybdenum Selenium status (deficiency OR toxicity both relevant). Magnesium for muscle function. Sodium/potassium/calcium for electrolyte balance during work.
Mineral Ratios Sodium/Potassium, Calcium/Magnesium, Sodium/Magnesium, Calcium/Phosphorus, Calcium/Potassium, Zinc/Copper, Iron/Copper The Na/K and Ca/Mg ratios are the muscle-function ratios. Iron overload status reveals indirect oxidative stress contributors.
Toxic Heavy Metals Lead, Mercury, Arsenic, Cadmium, Aluminum, Antimony, Beryllium, Uranium Cadmium has documented impacts on equine musculoskeletal function. Chronic exposure to lead, mercury, arsenic can contribute oxidative stress to already-vulnerable muscle.

What the test does NOT do

Be honest with yourself about the limits — they matter:

Where it does help

Important framing: Hair mineral analysis is a wellness and nutrition assessment tool. It does not diagnose tying up, PSSM, MFM, or RER. For a horse who is tying up, work with your veterinarian on bloodwork during episodes, genetic testing, and management protocols. Use the mineral test as one input alongside that workup — never instead of it.
04 — How It Works

The process — start to mineral answers

Four steps. About a week of total elapsed time. No needles, no extra vet visit required for the hair sample.

1

Order your kit

Order the $49.99 hair & mineral analysis kit from Mane Metrics. Resealable bag, pre-labeled return envelope, plain instructions.

2 business days to arrive
2

Collect & ship

Snip about 1.5 inches of mane hair close to the crest. Total time at the barn: under 5 minutes. Drop the sealed envelope in any mailbox.

~5 minutes
3

Lab analysis

Partner laboratory runs ICP-MS analysis across 42+ elements — including selenium, magnesium, the electrolyte panel, and the heavy-metal panel.

5–7 days at the lab
4

Get your answers

Email-delivered report with color-coded findings, plus a follow-up phone consultation focused on the mineral picture and what to bring to your vet.

Email + voice debrief

Note for tying-up workups

List "tying up" or "exertional rhabdomyolysis" as your main concern at checkout. The lab interpretation focuses on selenium, magnesium, the electrolyte ratios, and the heavy-metal panel when they know that's the investigation. Bring breed, age, episode history, current diet, and any genetic test results to the follow-up consultation.

05 — Timeline

The full workup timeline — vet, genetics, mineral, in parallel

The mineral test is one of three things you should be doing at the same time. Run them in parallel — don't wait one out before starting the next.

WhenWhat's happeningWhat you do
Day 0Decide on a real workup, not more guessingOrder kit on manemetrics.io. Schedule vet bloodwork. Order genetic test panel.
Day 1–2Kit ships. Vet appointment scheduled.Watch your mailbox. Confirm vet appointment for CK/AST workup.
Day 2–3Collect mane sample, send genetic panelSingle sample collection can serve both — take one for hair analysis, separate sample for genetic lab per their instructions.
Day 7–14Vet bloodwork results backReview CK/AST trends with vet. Confirm ER vs. other muscle issue.
Day 9–12Mineral panel results deliveredRead the report. Schedule the voice debrief.
Day 14–28Genetic test results returnDiagnosis: PSSM1? PSSM2/MFM? RER? Negative? Plan management accordingly.
Month 2+Combined workup informs management planDiet (low-NSC + fat if PSSM), work program, electrolyte support, mineral correction if indicated.

The honest truth from the racing world: trainers who get tying up under control are the ones who do the diagnostic work. Trainers who keep losing days at the track to recurring episodes are usually the ones still running through their fifth or sixth supplement protocol without ever genetically testing the horse.

I'm ready to learn what is really happening to my horse

Order the kit now. We'll handle the rest. Questions? Call (972) 284-1878.

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06 — The Research

What the science says about tying up

The literature on PSSM and RER is one of the better-developed areas of equine muscle physiology. The supplement claims are weaker than the marketing suggests. Here are the references worth reading.

  1. Exertional Myopathies in Horses Merck Veterinary Manual. Comprehensive clinical reference covering PSSM1, PSSM2/MFM, and RER, including the published refutation of selenium/vitamin E as a universal cure for chronic ER.
  2. Kentucky Equine Research — Exertional Rhabdomyolysis (ER) — Practitioner-focused review of the inherited muscle conditions and their management. Covers the genetic basis for PSSM1 (GYS1), the calcium regulation theory for RER, and current diet/exercise protocols.
  3. Exertional Rhabdomyolysis — ScienceDirect Topics — Aggregated peer-reviewed reference covering pathophysiology, genetic basis, and clinical presentation across the ER spectrum.
  4. Equine Rhabdomyolysis — ScienceDirect Topics — Companion reference covering diagnostic approach including CK/AST muscle enzyme panels, genetic testing, and exclusion of differential diagnoses.
  5. Exertional Rhabdomyolysis (Tying-Up) in Horses — LSU AgCenter — University extension reference covering both sporadic and chronic forms, with practical guidance on diet management for PSSM and RER cases.
  6. Evaluation of hair analysis for trace mineral status and exposure to toxic heavy metals in horses Animals (Basel), 2022. Open-access study supporting hair as a useful biological indicator for both selenium status and heavy-metal exposure — both relevant inputs to the tying-up workup.
  7. Brummer-Holder M., et al. Interrelationships Between Age and Trace Element Concentration in Horse Mane Hair and Whole Blood Journal of Equine Veterinary Science, 2020. Foundational work supporting hair tissue as a stable substrate for mineral status assessment.
  8. Emerging insights into the impacts of heavy metals exposure on health, reproductive and productive performance of livestock Frontiers in Pharmacology, 2024. Documents cadmium's musculoskeletal impacts and other heavy metal effects on livestock muscle function.
Honest framing: The genetic basis for PSSM1 is well established. The genetic basis for PSSM2/MFM is under active research with multiple identified variants. RER is clinically diagnosed and increasingly understood as a calcium regulation disorder. The claim that selenium/vitamin E supplementation cures tying up has been refuted in published research. Hair mineral analysis is one input in the workup — useful for identifying actual deficiencies and heavy-metal contributors, never a substitute for genetic testing or veterinary care.
07 — FAQ

Frequently asked questions about tying up

The questions trainers and owners ask most often before they finally do the diagnostic work.

What is tying up in horses?

Tying up — clinically called exertional rhabdomyolysis (ER) — is a syndrome causing muscle pain, stiffness, cramping, and damaged muscle tissue during or after exercise. The horse may sweat, refuse to move, urinate dark coffee-colored urine (myoglobin), and have visibly hard, painful hindquarter muscles. Most chronic cases are caused by inherited muscle conditions, particularly polysaccharide storage myopathy (PSSM1, PSSM2/MFM) or recurrent exertional rhabdomyolysis (RER).

What is the difference between PSSM, MFM, and RER?

PSSM1 is a glycogen storage disorder caused by a single gene (GYS1) mutation, common in Quarter Horses, Paints, Appaloosas, and Draft breeds. PSSM2 / MFM (Myofibrillar Myopathy) is a disorder of muscle fiber organization, common in Warmbloods and Arabians, with multiple suspected genetic variants. RER (Recurrent Exertional Rhabdomyolysis) is a disorder of intracellular calcium regulation triggered by excitement, common in Thoroughbreds, Standardbreds, and Arabians. All three present clinically as "tying up" but the underlying causes — and the right management — are different.

Will selenium and vitamin E cure tying up?

No. The claim that vitamin E and selenium prevent or cure equine rhabdomyolysis has been refuted in published research. Most horses with chronic ER already have adequate or more-than-adequate selenium and vitamin E status, and further supplementation has not been shown to improve outcomes. Selenium is important for normal muscle function — but supplementing a horse who is already replete provides no benefit and can risk toxicity.

What is the right diagnostic order for tying up?

The right diagnostic order is: (1) vet bloodwork during or shortly after an episode to confirm muscle enzyme elevation (CK, AST); (2) genetic testing for PSSM1 (GYS1 mutation) and MFM/PSSM2 variants — multiple labs offer reliable panels; (3) RER assessment based on breed, history, and clinical presentation; (4) nutritional and environmental workup including diet analysis and hair mineral analysis. Skipping ahead to supplements without the diagnostic foundation is the most common mistake.

Can a hair mineral analysis diagnose tying up?

No. Hair mineral analysis cannot diagnose tying up, PSSM, MFM, or RER. Those diagnoses require genetic testing and vet bloodwork. What hair analysis can do is reveal selenium status (over OR under), magnesium and Ca/Mg ratio, electrolyte balance, and chronic heavy-metal exposure that may be contributing factors. The right framing is: hair analysis is one input alongside the genetic and clinical workup, never a substitute for it.

What is the right diet for a horse that ties up?

PSSM1 horses benefit from a low-NSC (non-structural carbohydrate) diet with minimal starch and sugar, plus high-quality fat as the primary calorie source, plus daily consistent exercise. RER horses benefit from controlled excitement, consistent routine, and similar low-NSC feeding. MFM horses may benefit from increased amino acid support. Specific protocols depend on the genetic diagnosis — which is why testing comes first.

Can heavy metal exposure cause tying up?

Heavy metals are not a primary cause of inherited tying up syndromes (PSSM, MFM, RER). However, cadmium has documented impacts on equine musculoskeletal function, and chronic low-level lead, mercury, or arsenic exposure can contribute to oxidative stress and overall muscle dysfunction. Ruling out heavy-metal exposure is a reasonable part of a complete workup, especially in horses on older properties or in industrial-proximity environments.

How quickly can a hair test reveal mineral status in a tying-up horse?

Approximately 9-12 calendar days from order to results: 2 days for kit shipping, 5 minutes to collect, 5-7 days at the lab. You receive an emailed report plus a follow-up phone consultation focused on the mineral picture and what to bring to your vet alongside genetic testing and bloodwork.

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