Box rest for tendon injuries

[bouncing_ball]

Friend of mine's horse has a hind leg tendon injury. Visible swelling for the last two weeks, and scans show a hole in the tendon. I think it is Deep Digital Flexor Tendon.

Horse has been turnout daily whilst waiting for scan.

Vet has said either 6 months box rest, or up to 18 months paddock rest, in a paddock that is tiny so cannot run around. Repeat scans to measure progress.

Not lame on leg, and the heat has gone.

Possibly shock wave / PRP etc.

Horse is 16 and already arthritic.

I am struggling with the idea of confinement for so long.

Equally I understand the risk of making injury worse / rupturing tendon.

Is box rest / turnout on two stable size paddocks still the gold standard rehab for tendon injuries of this nature?

With all the risks of exploding between stable and paddock at some point.

Is it really detrimental to quietly turn them away, even if healing takes longer.

I thought more and more vets were agains prolonged stable rest? Or is it still advised for some injuries?

 

[PinkvSantaboots]

I wouldn't box rest in that circumstance it's of no interest to the horse whatsoever, I would be inclined to have treatment if its covered under insurance then turn away.

One of mine will not turn out in a tiny pen he goes berserk his had long stints of box rest over the years, the last lot was for a fractured pedal bone last year then he had suspensory damage, vet wanted him box rested for the suspensory which was directly after the pedal bone, he lost so much top line and was so weak after that I didn't box rest for the ligament, he had shock wave on it for a month and I just continued to keep him out and it healed up no problem.

His 19 now and I won't box rest anymore his poor body suffers for it his also got hock arthritis it's just not worth it in my view.

 

[TheMule]

Tendons need initial immobility then very controlled movement to heal well. No, I wouldn’t do it with my own 16yr old horse and would be inclined to risk just turning away on a nice level pasture with quiet companions, or PTS if not possible

 

[bouncing_ball]

Tendons need initial immobility then very controlled movement to heal well. No, I wouldn’t do it with my own 16yr old horse and would be inclined to risk just turning away on a nice level pasture with quiet companions, or PTS if not possible

thanks, he's been turned out as normal for the two weeks up to scan. Not sure if that impacts the success of now box resting? I did wonder if using shock wave / PRP if they work better on a box rested horse.

PTS might seem extreme when he isnt lame or appearing in pain.

I'd lean towards quite pasture rest with other retired (or staying out all the time, no coming and going) companions for 6-12 months and then rescan. The vet was pretty adamant 6 months box rest, or longer period of tiny pen paddock rest.

My friend would like a second vet opinion from the scan. Are there ways to find more pragmatic vets, that are anti box rest, that might support field rest. I think this vet is very very anti horses being in the field. So might not be neutral.

 

[TheMule]

thanks, he's been turned out as normal for the two weeks up to scan. Not sure if that impacts the success of now box resting? I did wonder if using shock wave / PRP if they work better on a box rested horse.

PTS might seem extreme when he isnt lame or appearing in pain.

I'd lean towards quite pasture rest with other retired (or staying out all the time, no coming and going) companions for 6-12 months and then rescan. The vet was pretty adamant 6 months box rest, or longer period of tiny pen paddock rest.

My friend would like a second vet opinion from the scan. Are there ways to find more pragmatic vets, that are anti box rest, that might support field rest. I think this vet is very very anti horses being in the field. So might not be neutral.

The vet will be recommending based on best return to athletic performance. If you don’t confine/ do controlled exercise then healing will likely be irregular and with scar tissue, so whilst the horse may not be painful mooching around in the field, it would be if you wanted to ride it again.

 

[Lady Jane]

I wouldn't box rest a 16yr old arthritic horse. I would turn away in a quiet herd and what will be will be. At least the horse will be happy. If the priority is to bring back into ridden work I think box rest is the solution. There is a vet in Ireland (can't recall the name) who has developed a boot which stablises the leg and can be adjusted to allow more movement which has been used with sucess on tendon injuries. DDFT injuries have a poor prognosis from what I know

 

[MagicMelon]

My horse did same sounding thing - he ended up with a big hole in his DDFT, he had surgery. Vet then advised box rest for 6 months with controlled walk outs in hand. After literally 2 weeks the horse was leaping round the stable and was dangerous to take out, he was going to cause himself more damage so I turned him out 24/7 (which is what he was used to prior) in a small enough paddock he couldnt gallop about. His injury was so bad I was told at the beginning it was career ending so I figured if I could just get him field sound then Id retire him as I owed him that. Id say after a year he became sound. He ended up far sounder than they expected and I did actually ride him again for a while and tried low level dressage (I was too scared to risk jumping him again) but he was an eventer at heart and found it too dull so he's been retired happily ever since and you wouldnt even know he had the injury even now.

 

[Gallop_Away]

Husband's standardbred is 17yo and has mild arthritis in his fetlocks. Personally if he were to sustain an injury that would require months of prolonged box rest then we would either turn him out and what will be will be, as long as he is field sound we would happily retire him and let him live out the rest of his days in his paddock with his friends OR if it wouldn't be possible for the injury to heal with turnout then we would pts.

It comes down to what is best for the horse at the end of the day, and I know being confined to a stable for months on end would certainly not be in our boy's best interest.

 

[spacefaer]

My partner had a 17 yr old who put his foot down on unexpectedly soft ground in canter and he ruptured his DDFT.
There was an inch gap between the two ends He wasn't lame as such, but he didn't have much control of how he put his hoof down. (It was like when you've sat on your foot and it's gone to sleep)

We were told the only hope we had of him becoming probably field sound would have been 12 months in the stable. The injury needed very little movement to enable the structure to infill and strengthen.
Since he was a high mileage horse who was only sound because we never let him down, we made the decision to put him down.

 

[Season’s Bleatings]

Mine has box rested for DDFT injury (front leg) - he had surgery last June and the hand walking started fairly soon after, and he was a very good patient. Been doing some ridden work since January, and he’s currently with a pro for some hacking. No arena for the foreseeable.

I wouldn’t have done it with either of my previous horses - one wouldn’t have box rested well, the other wouldn’t have coped with the inhand rehab. I probably would have turned them away to see would happen and I’d be inclined to do similar in this situation.

The vet in Ireland is called Henk Offereins btw.

 

[Birker2020]

My horse aged 12 was only five days at a retirement home and we visited him and found him crippled, it took us 30 mins to walk him up from the field. Called emergency vet out and box rest. Scanned four days later and had what the vet described as significant injury to DDFT and SDFT and said it would be career ending. As he was retired it didn't matter.

I took him home that day with the aim of rehabbing him to be able to return to retirement. The vet said three weeks box rest with in hand walking. Then turnout in 5m x 5m paddock. We were very strict about that, 'small enough so they can't canter' were my vets words . I was cold hosing and ice vibing for the first five days twice daily, then ice vibing twice daily plus used my vet physios ultrasound for ten mins once a day. Stable bandages overnight. Then in hand walking gradually increasing from 30 seconds, to a minute, two minutes, etc.

After 3 weeks he went out initially for 2.5 hrs gradually increasing time. He had a blip where the vet thought he had laminitis but EMS and Cushings testswere negative. Paddock size was increased very gradually every day. I stopped bandaging.

He is now out in a paddock approx 45m x 25m, he has the odd hooley but his leg is cool and down and has been for sometime. I turnout overnight in overreach boots and premier equine air cool boots which I am starting to leave off every other day.

I doubt he would stand up to anything other than hacking if I tried but I won't as he's retired anyway due to unrelated issues.

Two months following injury I am not icevibing or using therapeutic ultrasound anymore.

Vet is amazed at his progress. If there's one thing I've learnt over the years is cold therapy is so VERY important and early intervention with ice boots, tubbing, cold hosing, etc is so, so beneficial for good treatment and prognosis of such injuries.

 

[ihatework]

An arthritic 16yo would in no way, shape or form be staying in a stable if it were mine.

I’d do the prp/stem and have living out 24/7 in a smallish paddock (but not teeny tiny) ideally with quiet companion for the short term - mid term

 

[Season’s Bleatings]

Yes just to add to mine, along with the surgery we had cold hosing, ice boots, PRP and laser - threw everything at it in the hope of a reasonable return to work, only time will tell if that’s worked though we don’t intend on returning to the same intensity, even if he is 100%. He was 9 at the time of his injury for further context!

 

[Cragrat]

My 10 y/o bashed his tendon - icevibed for 3 weeks waiting for scan, still turned out. Vet was gobsmacked to see the hole in his tendon, as there was no heat/swelling/soreness.
As he ahd already been turned out, the vet was happy we continued as we were (did keep him off the steepest hill for a few months) - carried on ice-vibing and then vibing with no ice. Re-scanned every now and then- he's now cantering/schooling/ small jumps - 18 months later. Scanned 2 months ago - excellent healing, barely noticeable unless you know where it was on the scan.

 

[Elf On A Shelf]

DDFT's are harder to fix than SDFT's. Many vets these days often say box rest for 4 weeks to allow the start of healing then to start walking out to help promote healing.

In your situation I would probably small paddock/pen rest for a few weeks so there is absolutely no chance or much space for a hooley before gradually increasing the area of turnout.

Time will be your best friend.

 

[expanding_horizon]

DDFT's are harder to fix than SDFT's. Many vets these days often say box rest for 4 weeks to allow the start of healing then to start walking out to help promote healing.

In your situation I would probably small paddock/pen rest for a few weeks so there is absolutely no chance or much space for a hooley before gradually increasing the area of turnout.

Time will be your best friend.

Thanks, interesting to hear the six months box rest that vet is holding up as gold standard for best recovery for DDFT hole isn’t what would typically happen with racehorses! Hand walking after 4 weeks makes a lot more sense.

 

[Elf On A Shelf]

Thanks, interesting to hear the six months box rest that vet is holding up as gold standard for best recovery for DDFT hole isn’t what would typically happen with racehorses! Hand walking after 4 weeks makes a lot more sense.

It used to be 3 months in a box. 3 months walking. 3 months turnout. 3 months to get fit to race again 12 months on from the initial injury. Whilst we still give them the year out the tendons do tend to come back stronger from having been walked earlier once the initial bedding in of tendon fibre/scar tissue mix starts to form.

 

[bouncing_ball]

It used to be 3 months in a box. 3 months walking. 3 months turnout. 3 months to get fit to race again 12 months on from the initial injury. Whilst we still give them the year out the tendons do tend to come back stronger from having been walked earlier once the initial bedding in of tendon fibre/scar tissue mix starts to form.

that is fascinating. I suspect riding horse vet advice is a bit further behind. Is the typical rehab same for SDFT or different?

 

[Tracking_up]

When mine was 16, 2 years ago, he was diagnosed with a chronic/aged DDFT strain. It had nearly healed, (but with lesions to the Collateral Navicular ligament).

Vet advised the treatment for just the DDFT would be to turn away for a year to fully heal the DDFT (no suggestion of box rest), but this wouldn't deal with lesions; or drop his work to steady, and bute to manage any pain for the lesions. He had already been diagnosed with coffin joint arthritis in the same foot, and a touch of hock arthritis in both hocks. He also wasn't a great candidate for doing nothing.

(we decided to go the bute (1 every other day)/work route and he's been good, and the vet was happy with his front foot a couple of weeks ago on a medicine review. No lameness on straight trot up and on a circle on the hard, just what you'd expect for a now 18 year old horse....)