New research: Adding NSAIDs to lameness treatment boosts dairy cow fertility by 42% while improving recovery. Are your protocols outdated?
EXECUTIVE SUMMARY: Claw horn lameness costs dairy farmers millions in lost productivity and fertility, but new studies reveal a game-changer: combining NSAIDs like meloxicam with traditional trimming and blocking. While mechanical treatments address visible lameness, NSAIDs tackle hidden inflammation, leading to a 42% fertility boost—even if gait scores don’t improve. Early intervention with this “TBN protocol” (Trim, Block, NSAID) accelerates recovery in heifers and moderates chronic cases in older cows. Farmers skipping NSAIDs risk prolonged days open and $600/cow losses. The data is clear: modern lameness care requires anti-inflammatories to protect both mobility and reproduction.
KEY TAKEAWAYS:
- TBN Protocol Wins: Trim + Block + NSAID (meloxicam/ketoprofen) outperforms partial treatments, especially in early-stage cases.
- Fertility ≠ Gait: Meloxicam increased conception rates by 42% without visible gait improvements—systemic inflammation matters.
- Early Action Pays: Delayed treatment cuts recovery odds by 50%; weekly locomotion scoring is non-negotiable.
- ROI Justified: $20 NSAID doses prevent $300+/cow fertility losses and reduce culling risks in heifers.
- Tailor by Parity: NSAIDs show stronger results in first-lactation cows; multiparous herds still need mechanical fixes first.
The evidence is clear: treating claw horn lameness without NSAIDs is like running your parlor without pulsation. New research reveals that adding anti-inflammatory drugs to your lameness protocol doesn’t just improve recovery—it could dramatically boost your herd’s fertility by up to 42%. Here’s why the industry needs to rethink its approach to one of dairy’s most costly problems.
Lameness remains dairy’s most visible welfare challenge and one of its costliest production issues. While most producers recognize the importance of prompt hoof trimming and blocking for claw horn lesions, many are still missing a critical third component that research shows could be the difference between merely getting cows walking again and restoring their full productive and reproductive potential.
The conventional approach to claw horn lameness—therapeutic trimming and orthopedic blocking—addresses only part of the problem. These mechanical interventions fail to target the underlying inflammation that prolongs recovery and may silently sabotage your herd’s fertility long after the cow stops limping. Recent groundbreaking research reveals that adding NSAIDs (non-steroidal anti-inflammatory drugs) to your lameness protocol could be the missing link to maximizing both recovery and reproductive performance.
The Hidden Cost of Incomplete Treatment
When a cow develops a sole ulcer or white line disease, the visible lameness is just the tip of the iceberg. Beneath the surface lies a complex inflammatory process that mechanical treatments alone can’t address. This inflammation doesn’t just cause pain—it triggers systemic responses that can derail everything from milk production to conception rates.
“Most producers understand that lameness costs money, but they’re underestimating just how much,” says Dr. Helen Mason, lead researcher on a groundbreaking 2025 study examining the fertility impacts of lameness treatments. “A cow might look sound after blocking, but her body is still fighting inflammation silently sabotaging her reproductive performance.”
The numbers are staggering. Lame cows typically take 12-50 days longer to conceive than sound herd mates (Mason et al., 2025). For seasonal calving operations, this can mean the difference between a cow remaining in the herd or facing culling due to late conception or failure to conceive within the breeding window. Even in year-round calving herds, these extended days open translate directly to reduced lifetime production and profitability.
Are you saving money by skipping the NSAID when treating lameness, or just delaying the inevitable cost of extended days open and lower conception rates?
The Science Behind the TBN Protocol
The emerging gold standard for claw horn lameness treatment is what researchers call the “TBN protocol”—Trimming, Blocking, and NSAID administration. This three-pronged approach addresses both the mechanical and biological aspects of lameness:
- Therapeutic Trimming: Corrects hoof balance, removes damaged horn, and redistributes weight—like rebalancing an uneven tire
- Orthopedic Blocking: Elevates the affected claw to relieve pressure and allow healing—like putting a spare tire on your tractor while repairing a flat
- NSAID Administration: Reduces inflammation and pain both locally and systemically comparable to how you’d treat mastitis with both stripping out the quarter and administering anti-inflammatories
While the first two components have been standard practice for decades, the critical third element is still widely overlooked. Yet recent randomized controlled trials show that this comprehensive approach significantly outperforms partial treatments.
A landmark study by Thomas et al. (2015) found that cows receiving the full TBN protocol had a 56.1% cure rate at 35 days post-treatment, compared to just 24.4% for trimming alone. Another study focusing on first-lactation animals showed that cows treated with the complete protocol had 4.5 times higher odds of recovery than those receiving only trimming (Sadiq et al., 2022).
Let’s be brutally honest: if you’re still treating lameness without NSAIDs, you’re using outdated protocols that are costing you money and compromising cow welfare.
Key RCT Findings: The Evidence for TBN
| Study (Year) | Treatment Protocol | Recovery Rate (Soundness) | Fertility Improvement | Culling Risk Reduction | Notes |
| Thomas et al. (2015) | TBN (Trim+Block+NSAID) | 56.1% at 35 days | N/A | N/A | Highest cure rate vs. trim-only (24.4%) |
| Mason et al. (2025) | Trim+Block+Meloxicam | No significant difference | +42% conception hazard | N/A | Blocks masked gait improvements |
| Wilson et al. (2025) | Trim+Block (Multiparous) | No NSAID benefit | N/A | No reduction | Mechanical correction is critical for older cows |
| Sadiq et al. (2022) | TBN (Primiparous) | 75% recovery at 28 days | N/A | N/A | Reduced pain sensitivity |
The Fertility Connection: The Most Compelling Evidence Yet
The most eye-opening research comes from a 2025 multi-farm study in New Zealand’s pasture-based dairy systems. This randomized controlled trial examined what happened when meloxicam (a commonly used NSAID) was added to standard trimming and blocking for cows with hoof horn lesions.
The results were striking. While there was no significant difference in the time it took cows to return to normal locomotion, the reproductive benefits were dramatic:
- 42% higher hazard of conception for meloxicam-treated cows (Mason et al., 2025)
- 15% greater probability of conceiving within the first 6 weeks of breeding (Mason et al., 2025)
- 15% greater likelihood of being pregnant at final pregnancy diagnosis (Mason et al., 2025)
This represents a breakthrough in understanding lameness treatment. Even when cows appear to recover similarly based on locomotion scoring, those receiving NSAIDs experienced substantial improvements in fertility—a benefit that goes straight to the bottom line.
When did you last implement a management change that improved conception rates by 42%? This isn’t incremental improvement—it’s a game-changer.
Why Different NSAIDs Aren’t Created Equal
Not all anti-inflammatory drugs deliver the same benefits. The research shows essential differences between commonly used options:
| NSAID | Key Benefits | Practical Considerations | Best For |
| Meloxicam | Strong evidence for fertility improvement (42% higher conception hazard); longer-lasting effect from a single dose | Typically has a milk withdrawal period (e.g., 5 days) | Maximizing fertility benefits; situations where single administration is preferred |
| Ketoprofen | Good evidence for improved recovery rates; may reduce future lameness in heifers | Often zero milk withdrawal; typically requires 3-day administration | Lactating cows where milk withdrawal is problematic; acute cases where rapid pain relief is a priority |
| Flunixin | Less commonly studied for lameness | Concerns about retained placenta when used around calving | Generally, not first choice for lameness treatment |
Why Aren’t More Producers Using the Complete Protocol?
Despite compelling evidence, NSAID use for lameness remains surprisingly low on many farms. Several barriers prevent wider adoption:
- Cost concerns: NSAIDs represent an additional expense per treatment
- Milk withdrawal inconvenience: Some NSAIDs (particularly meloxicam) require milk discard
- Lack of dramatic visible improvement: The benefits may not be immediately apparent in gait
- Insufficient awareness: Many producers and even some veterinarians aren’t familiar with the latest research
These practical concerns are understandable but shortsighted when considering the substantial economic benefits, particularly regarding fertility. The cost of a single NSAID treatment pale compared to the value of improved conception rates and reduced days open.
Cost-Benefit Analysis: The Real ROI of Complete Treatment
| Item | Cost per Cow | Benefit per Cow | Net ROI | Source |
| Meloxicam (5-day milk discard) | $20 | +15% pregnancy rate ($300 value) | +$280 | Mason et al. (2025) |
| Ketoprofen (3-day course) | $15 | 75% recovery vs. 40% (trim-only) | +$150 (milk/fertility) | Sadiq et al. (2022) |
| Chronic Lameness (Untreated) | $0 | -360L milk, +36 days open | -$600 | AHDB (2025) |
“When you factor in the reproductive benefits alone, the return on investment for NSAID use in lameness treatment is substantial,” explains Dr. Mason. “We’re talking about a 15% improvement in pregnancy rates from a single injection—that’s a game-changer for seasonal calving operations and valuable for any dairy focused on reproductive efficiency.”
Let’s call it what it is: the dairy industry has been slow to adopt NSAIDs for lameness treatment because we’ve been fixated on visible gait improvement rather than the invisible but far more valuable fertility benefits.
Implementing the TBN Protocol: Practical Considerations
Ready to upgrade your lameness management? Here’s how to implement the complete TBN protocol effectively:
Early Detection Is Non-Negotiable
The research consistently shows that all treatment components are most effective when applied early. Implement a systematic approach to lameness detection:
- Conduct regular locomotion scoring (minimum weekly) by trained personnel
- Establish clear protocols for prompt restraint and examination of identified lame cows
- Train all staff to recognize subtle early signs of lameness
- Create a dedicated time slot for lameness treatment to avoid delays
If you wait until cows are severely lame before treating them, you’re already fighting a losing battle. Early intervention is the single most important factor in successful treatment.
Step-by-Step TBN Protocol Implementation
| Step | Action | Responsible Party | Timeline | Key Tools |
| 1 | Weekly locomotion scoring | Farm staff | Ongoing | 5-point scale, trackpad |
| 2 | Prompt restraint/exam | Veterinarian | ≤24 hrs | Hydraulic chute, hoof knife |
| 3 | Therapeutic trim | Hoof trimmer | Immediate | Dutch 5-step method |
| 4 | Block application | Veterinarian | Immediate | Woodblock, Bovi-Bond glue |
| 5 | NSAID administration | Farm staff | Day 0-3 | Meloxicam (0.5mg/kg) or Ketoprofen (3mg/kg) |
| 6 | Follow-up scoring | Independent observer | Day 7, 14, 28 | Blinded scoring |
NSAID Selection Strategy
Choose the appropriate NSAID based on your specific situation:
- For maximizing fertility benefits, particularly in seasonal systems, Consider meloxicam despite milk withdrawal requirements
- For zero milk withdrawal convenience: Ketoprofen offers proven benefits for soundness recovery
- For first-lactation animals: Consider more aggressive protocols, potentially including post-calving NSAID administration to prevent future lameness
Beyond the Injection: Comprehensive Lameness Management
The TBN protocol works best as part of a holistic approach:
- Maintain regular preventive hoof trimming schedules (typically twice yearly)
- Address environmental factors contributing to lameness (flooring, cow comfort, standing times)
- Monitor digital cushion condition through body condition scoring and transition management
- Consider the role of trace minerals and biotin in maintaining hoof integrity
Myth vs. Fact: NSAID Misconceptions
| Myth | Fact | Evidence |
| “NSAIDs are too expensive for routine use.” | The ROI is substantial when fertility benefits are included | $20 treatment can yield $300 in fertility value (Mason et al., 2025) |
| “If the cow is walking better, she’s fully recovered.” | Visible lameness improvement doesn’t mean systemic inflammation is resolved | 42% fertility improvement even without gait difference (Mason et al., 2025) |
| “All NSAIDs work the same way.” | Different NSAIDs have different COX selectivity, duration, and systemic effects | Meloxicam shows stronger fertility benefits than other NSAIDs studied |
| “NSAIDs only help with pain, not healing.” | Anti-inflammatories may modify disease progression and prevent chronic changes | Early NSAID treatment reduces future lameness in heifers (Wilson et al., 2022) |
The Bottom Line
The evidence is clear: treating claw horn lameness without addressing inflammation is like treating milk fever without calcium—you’re missing a fundamental component of effective therapy. The TBN protocol—combining therapeutic trimming, blocking, and NSAID administration—represents the current gold standard for treatment, particularly for acute cases caught early.
Most compelling is the dramatic fertility benefit demonstrated with meloxicam, which improved conception hazard by 42% even without accelerating visible recovery (Mason et al., 2025). This suggests that NSAIDs address systemic effects of lameness that mechanical treatments alone cannot reach.
For progressive dairy producers focused on maximizing animal welfare and profitability, implementing the complete TBN protocol is no longer optional—it’s essential. The question isn’t whether you can afford to add NSAIDs to your lameness protocol; it’s whether you can afford not to.
What This Means for Your Operation
- Review your current lameness protocols with your veterinarian to incorporate appropriate NSAIDs
- Implement systematic early detection to maximize treatment success
- Consider the fertility benefits when calculating return on investment for lameness treatment
- Tailor your approach based on cow age, with particular attention to first-lactation animals
- Track reproductive outcomes following lameness events to quantify improvements
It’s time to stop treating lameness like it’s just a hoof problem and start recognizing it as a whole-cow issue with profound reproductive consequences. Are you ready to join the progressive producers already reaping the benefits of the complete TBN protocol, or will you continue leaving money on the table with outdated treatment approaches?
The dairy industry has long recognized lameness as a major welfare and economic challenge. By embracing the complete TBN protocol, we can get cows walking comfortably again and ensure they’re performing to their full potential in every aspect of production. Your bottom line—and your cows—will thank you.
Learn more:
- Reducing Lameness and Injuries in Dairy Cattle: Prevalence, Risk Factors, Treatments, and Adoption Barriers – This article explores comprehensive approaches to lameness management, including rehabilitation strategies and physical therapy options that could complement the TBN protocol.
- Lameness in Dairy Cattle: Identifying Risk Factors and Overcoming Barriers to Best Practices – Covers preventative measures like footbaths and explores innovative treatments that could work alongside NSAID protocols for comprehensive lameness management.
- Lameness in Dairy Cattle: Uncovering Why Hoof Health Issues Persist Despite Interventions – Examines why lameness continues to be a problem despite various interventions, providing context for why new approaches like the TBN protocol are needed.
Join the Revolution!
Join the Revolution!Join over 30,000 successful dairy professionals who rely on Bullvine Daily for their competitive edge. Delivered directly to your inbox each week, our exclusive industry insights help you make smarter decisions while saving precious hours every week. Never miss critical updates on milk production trends, breakthrough technologies, and profit-boosting strategies that top producers are already implementing. Subscribe now to transform your dairy operation’s efficiency and profitability—your future success is just one click away.
