Managing a horse that has PSSM is geared at preventing episodes and tie-ups. Unfortunately, the horse can still become symptomatic and get an episode of PSSM. If you suspect your horse is tying up, please consider the following guidelines:

• Stop exercising the horse and stable it. Don't force it to move any more than absolutely necessary. 
• Call your vet
• Blanket the horse in cold temperatures and hose off the horse under warm conditions
• Check if sweating caused your horse to be dehydrated. Take a little bit of skin between your fingers and let go of it again. The skin should return to its oringal shape almost instantly when the horse is not dehydrated. Check your horse's saliva: it is supposed to be liquid and not sticky.
• Give your horse water and add electrolytes if necessary. Make sure your horse does not drink too much in one go when it's very sweaty. Once the horse has cooled down, it can drink as much as it wants. In the case of severe dehydration, your vet may decide to add fluids intravenously.
• Remove all grains/ hard feeds and only give the horse hay until symptoms subside
• Provide your horse with a small turnout once it gives the impression it want to move about. This usually happens between 12 and 24 hours after a ty-up. Movement will help remove sugars and toxins from the bloodstream

Muscle tissue has an uncanny ability to heal. Usually, it takes three to 4 weeks for muscle tissue to recover without any scarring after a ty-up. It is possible that muscle loss becomes evident after particularly severe episodes, which is the result of the body disposing of damaged protein. On average, muscle mass will restore to its previous level in about two to four months.

When managing a horse with PSSM, it has to be taken into account what type of PSSM the horse has (type 1 or type 2)