Going against vet advice for medial collateral ligament injury

[PoppyAnderson]

So, footy on and off for a while, niggling suspicion that something just not quite right. X rays inconclusive, MRI scan shows an injury to the medial collateral ligament. Vets advice - 3 months box rest, followed by 3 months box rest with in hand walking. Shock wave therapy and remedial shoeing. What I want to do - turn away for 6 months in a small paddock, keep barefoot, review diet and add in mag supplements, maybe shock wave therapy and see how she goes. Am I barking? Vet is brill and doesn't dismiss precious princess owner but I've just never seen a good outcome with remedial shoeing and I just want to try it my own way first.

 

[Oberon]

You won't be the first or the last

Insurance usually dictates that we treat with something NOW. So the days of 'time out in the field' have been lost

FWIW - I think your plan sounds sensible. Look more at nine months though - time to grow a whole new hoof capsule at the balance he wants it to heal the internal damage.

Bailey W (the dun) had collateral ligament damage.

http://rockleyfarm.blogspot.co.uk/2010/07/wonderful-friday-clip.html

and now

http://rockleyfarm.blogspot.co.uk/2012/05/3-of-best.html

 

[PoppyAnderson]

Thank you so much. Hoped you might reply! Youve recently advised me about her. Horse can have as long as it takes. She's a pet as much as anything (was to be a show pony but ah well, maybe not to be), so it doesn't matter to me if she can't do a useful job in the future. Happy hacker is fine and she can pootle about. Yes, feel dictated to by insurance constraints but want to do what feels instinctively right. Have been thinking about Rockley for her but then I've got to be able to manage her regime back in the real world anyway.

 

[glenruby]

I don't see why you wouldn't box rest and control exercise unshod if you don't want to go with remedial shoeing. Ligaments and tendons require rest and controlled exercise to heal first and foremost. Turning out in the acute phase is contra-indicated.

 

[touchstone]

I turned out my mare who had a ddft injury after seeing the performance she created on box rest we decided it was better all round. I gave limited bute so she didn't feel too well oShe came totally sound and back in full work,although it took a long time, she was off for two years but sound after about 18 months.

 

[ferrador]

trim and balance and give it time , cannot see the point of shoes

 

[Oberon]

I don't see why you wouldn't box rest and control exercise unshod if you don't want to go with remedial shoeing. Ligaments and tendons require rest and controlled exercise to heal first and foremost. Turning out in the acute phase is contra-indicated.

If the horse can be turned out somewhere quiet and with a sensible companion, I think it's the lesser of two evils.

Box rest is very hard on horses (who are designed to move) both physically and psychologically.

I would prefer constant, gentle movement at liberty, rather than no movement and then sudden spurts of exercise. You also have less risk of those horrid in-hand explosions

 

[cellie]

Friend turned away her sj for year and hes now back aff sj again.She had mri and confirmed collateral ligament damage.My tb was same I did box rest and then turned away 9 months he is happy hacker now ,he went barefoot with new owner I did remedial shoeing so he had both .Good luck

 

[Holly Hocks]

My horse didn't have the same as you - she had PSLD in one hind limb. I had the same advice as you re remedial shoeing, box rest, in-hand walking etc. This was in October last year. She was also diagnosed with navicular, spavin and arthritis in one fetlock where a bone chip had been removed previously. The vets said that the outcome would be brood mare/field companion or PTS, even after all the box rest etc.
What really peed me off is that they put remedial shoes on her at the hospital without my consent, so I had to wait a few weeks before I brought her home before I could get them taken off again.
As the winter was so wet here, we only had limited turnout on my yard anyway, so I got the shoes taken off, gave her a couple of hours turnout each day to keep her sane, and she was fine. If the weather had been better and we had had more grass I would have kept her out all day, but I just didn't get chance. In March or early April I started long-reining her in hoof boots, got a good physio and am now back riding her again - not excessively - mainly in walk and only hacking - not schooling yet until winter, but it's more than the vets said that I would ever do with her.
If I were in the same position again, I would do the same - either turnout permanently if in summer, or limited turnout in winter. My horse wouldn't have done box rest and would have done herself more injury in her stable box walking. Good luck - turnout and barefoot is working well for me, hopefully it will do the same for you.

 

[PoppyAnderson]

Thanks Cellie. A bit of luck won't harm I don't suppose! She'll have a restricted outside space, so will be akin to box rest, only difference is it will be in a massive al fresco box! She's a very laid back pony who hardly ever breaks a sweat, so little chance of her galloping about wildly. The only bit I'm struggling with is that she's always been barefoot and always had great farriers trim her feet and yet we're still where we are. Had a very reassuring conversation with the vet today though, who's been totally supportive and not dictating in any way.

 

[sarahhowen]

I think collateral ligament, same with any injury there isn't a "one size fits all solution" indi my warmblood was diagnosed with lateral collateral ligament damage to the coffin joint via MRI in Jan and with him we were recommended 12 weeks box rest followed by 12 weeks restricted turnout. Straight away we were recommended inhand walking on the roads which we did religiously and touch wood we are now in 5 weeks into the turnout phase and hacking out at walk for 40 mins daily and touch wood sound......I do think if we had done just pure box rest he would of totally lost the plot, but sticking to a fixed routine he understood that mum came up twice daily and his anxiety levels were lower because of this, I think the key is controlled movement, my biggest worry with turning him out in a small paddock was he would fret and I was worried about a slip which for cl damage wouldof been the worst thing ever. Indi never had any Bute even though he also had a bruised pedal bone also, we supplemented his diet with copper, zinc, selenium, bit e and lysein, all this seemed to also have a positive effect of his hoof growth and the internal repair of the foot, good luck, you have a tough few months ahead of you, but speaking from experience, it is worth it........... Oooh forgot to add look into magnetic boots, they were the only thing that seemed to reduce the residual inflammation after the acute phase had passed!

 

[glenruby]

Oberon I am fully aware that being turned out is "nicer" for a horse. However with certain injuries there is just no replacement for box rest and controlled exercise. This applies to tendon injuries and fractures more so ( usually 3 myths minimum) while ligaments tendon to require shorter durations of strict rest. The prognosis from turning away too early is much poorer. Believe me, I am all for turning away - I think most people just don't give horses enough time to recover from injuries, however box rest is a very important part of the recovery process of tendon/ligament injuries. This is based on muchdocumented evidence rather than anecdotal.

 

[Pebble101]

My vet wanted my horse as quiet as possible with a DDFT tear. He was climing the walls after 24 hours in and whizzing round his stable like a demented thing. So with the vets agreement he was turned out in a small pen a couple of times a day (I moved it each day so he had fresh grass). He wasn't perfect ( the worst being when he rolled over right next to the electric fence, pulled it all down then galloped off up the hill in panic), but we got through 8 weeks OK and he is now turned out, just coming in for a couple of hours a day for grooming etc.

 

[natalia]

I had one who did this ripping a shoe off when he got caught in fencing. We box rested him for just over a month then turned out and let nature take its course barefoot. Horse seemed sound after about 6 months but I left out for a further three to make sure all was strong enough again. Came back in to full work with no problems. Damage like this is best healed by time and nothing else.

 

[star]

My vet wanted my horse as quiet as possible with a DDFT tear. He was climing the walls after 24 hours in and whizzing round his stable like a demented thing. So with the vets agreement he was turned out in a small pen a couple of times a day (I moved it each day so he had fresh grass). He wasn't perfect ( the worst being when he rolled over right next to the electric fence, pulled it all down then galloped off up the hill in panic), but we got through 8 weeks OK and he is now turned out, just coming in for a couple of hours a day for grooming etc.

mine is the opposite lol. he has a really slight DDFT tear and vet recommended turnout 24/7 in a small pen (small enough that he couldn't canter) - i tried that and he was right on edge and on the first day had spun round, managed to canter 2 strides then stood there holding him leg up. So I've gone against the vet in the opposite way and brought him in onto box rest where he is completely happy and chilled. Just dreading transitioning him to being out again. He is a loon in the field and especially wont like being cooped up in a tiny pen away from his friends. Plus it was electric fencing that he got caught up in that did the injury originally so bit worried about penning him in with the stuff!

 

[misst]

Having done the traditional route and not had a good outcome I think I would go with your option if I could. I do believe strongly that not every horse can be unshod in every circumstance and one of my old ones would have been almost impossible to manage unshod. However if I could, I would do what you suggest. The shoes will give a good short term result I expect but long term they often don't help. If I ever have another one with collateral ligament problems I will try unshod/small paddock etc first. Good luck.

ETS My vet suggested once that if you do box rest for a long time with a horse over the age of 9 or 10, you can expect that to flag up other problems. He was a believer in small paddock turnout where possible as standing in a very confined space and doing a lot of resting of one leg could cause problems with another leg. I have no idea if this is true but can say from personal and friends experience that this does sometimes seem to be the case.

 

[soloequestrian]

Just a comment on your point about having a good farrier and regular trims.... I've found over the last year that leaving one of mine to his own devices has meant his feet are a very odd shape but much more functional than they used to be with regular trimming (he is barefoot). Might be worth thinking about - Oberon makes the point about growing a hoof capsule to suit the leg above it, and the horse can't do this if it is being trimmed to a particular shape.

I'd always go turn-away rather than box-rest.

 

[Oberon]

Oberon I am fully aware that being turned out is "nicer" for a horse. However with certain injuries there is just no replacement for box rest and controlled exercise. This applies to tendon injuries and fractures more so ( usually 3 myths minimum) while ligaments tendon to require shorter durations of strict rest. The prognosis from turning away too early is much poorer. Believe me, I am all for turning away - I think most people just don't give horses enough time to recover from injuries, however box rest is a very important part of the recovery process of tendon/ligament injuries. This is based on muchdocumented evidence rather than anecdotal.

Are you certain of that?

Just because it is the most recommended treatment doesn't mean it's the best for each individual horse.

Box rest seems to denote that we are resting said injury. But a horse can't rest and elevate a damaged tendon/ligament like we can. They have no choice but to bear weight on it. So they aren't really resting it so much as reducing movement on it.
However movement creates circulation.
Surely gentle movement at liberty is better than standing in and reducing the blood supply and nourishment to the injury?

No one is suggesting turfing such a horse out into a huge expanse with 10 other horses.

I guess it's a matter of perspective.

The muchdocumented evidence often carries a poor prognosis or restricted working life afterwards.
I guess I am saying there is nothing wrong with thinking outside the box if that's what suits the horse and owner.

 

[Oberon]

Thanks Cellie. A bit of luck won't harm I don't suppose! She'll have a restricted outside space, so will be akin to box rest, only difference is it will be in a massive al fresco box! She's a very laid back pony who hardly ever breaks a sweat, so little chance of her galloping about wildly. The only bit I'm struggling with is that she's always been barefoot and always had great farriers trim her feet and yet we're still where we are. Had a very reassuring conversation with the vet today though, who's been totally supportive and not dictating in any way.

I would be interested to see pics of the hooves - particularly these types of shots as well as the standard side view and sole shots.....

 

[Oberon]

Sorry - I tried to resize several times but photobucket not playing

 

[Zuzzie]

My horse had collateral ligament damage, right fore, (confirmed by MRI) recommendation was 3 months box rest. However, he also had arthritis in his coffin joint. Result: came out of box rest worse than when he went in. He was literally hopping lame in walk which he never was before - it was only seen in trot. Although he coped really well with the box rest, as soon as he came out he was lethal. Had to sedate him just to turn him out in a small pen. With the benefit of hindsight I would not do this again.

 

[cptrayes]

Oberon I am fully aware that being turned out is "nicer" for a horse. However with certain injuries there is just no replacement for box rest and controlled exercise. This applies to tendon injuries and fractures more so ( usually 3 myths minimum) while ligaments tendon to require shorter durations of strict rest. The prognosis from turning away too early is much poorer. Believe me, I am all for turning away - I think most people just don't give horses enough time to recover from injuries, however box rest is a very important part of the recovery process of tendon/ligament injuries. This is based on muchdocumented evidence rather than anecdotal.

Humans are recommended to use damaged tendons and ligaments as much as they can without pain. Resting these injuries, in a human, does not produce the best result, so why should it in a horse?

I am told that vets in France are very much against box rest for these injuries and that this kind of treatment is a British thing. I suspect the apparent increase in box rest in recent years may also be a "least risk for the Vet being sued" thing.

I am also wondering if the research you mention applies to ligament and tendon strains inside the casing of the foot, which seem in my experience and in an increasing body of anecdotal evidence, to heal just fine in most cases with the horse unshod, kept turned out and then worked appropriately as soon as it is able.

I'd be very interested to see the studies comparing rates of recovery of turned away horses compared to box rested ones. Can you point us to them?

 

[flitz02]

I recentley had to go against my vets advice with my mare who has a suspensory ligament tear.My vet had wanted 3 months box plus walking in hand 3 times a day but with three young kids i just couldnt do it.I have to say after being turned out for 3 months i am now seeing an improvement something i wasnt sure i was going to see as she really was quite uncomfortable on it but as it was a case of kill or cure i had to give it a go.I am going to have the vet out again in september for a rescan & if the prognosis is still not great with regards her ridden career then i may have to make the desision to pts.It hasnt been an easy few months i& i have questioned myself a few times whether i have done the right thing.i do bring her in every other day for a 12 hour period to have a nice rest in her stable. The vet in the end agreed it may be the way forward but it would take longer possibly 12-18 months & to be honest i would rather her be out in the field than stuck in a box anyday....but thats just my personal preference after box resting a mare for 5 months & i still ended up losing her! Let Dr Green do his stuff i say!

 

[Pebble101]

Are you certain of that?

However movement creates circulation.
Surely gentle movement at liberty is better than standing in and reducing the blood supply and nourishment to the injury?

I was speaking to someone (I think she was a physiotherapist) the other day who was firmly of the opinion horses are much better mooching around - her opinion was the most important thing was to keep the lymph system working, which it doesn't do very well when the horse isn't moving.

 

[Slightlyconfused]

Sounds fine to me.....a friends horse went through box rest for a year then in hand walkies then riding for a ligament injury and then did it again....vet adviced the same but she said no im going to chuck him out so it can heal while he is moving.....a year later he is completely sound *touches wood* and coming back into work......

 

[PoppyAnderson]

Just a comment on your point about having a good farrier and regular trims.... I've found over the last year that leaving one of mine to his own devices has meant his feet are a very odd shape but much more functional than they used to be with regular trimming (he is barefoot). Might be worth thinking about - Oberon makes the point about growing a hoof capsule to suit the leg above it, and the horse can't do this if it is being trimmed to a particular shape.

I'd always go turn-away rather than box-rest.

Interestingly, she always seems to be more, how can I say, sure footed if I leave her longer between trims. I've experimented leaving her for as long as I dare and have got to about 10 weeks and she's seemed fine. I come from an era where everything was shod and you went 4-5 weeks between farrier visits, so it's anathema to me to go longer but I can only really agree with what you're saying.

 

[PoppyAnderson]

I would be interested to see pics of the hooves - particularly these types of shots as well as the standard side view and sole shots.....
G]

Pics of feet http://www.horseandhound.co.uk/forums/showthread.php?t=527022

 

[Lainey123]

Hi, my horse is Bailey W who Oberon mentioned, he went to Rockley farm in 2010 with lateral collateral damage. He was diagnosed via MRI at Liphook. I did what the vets wanted for 2 years, including box rest for 10 months in total, IRAP, Tildren, and joint injections and every shoe under the sun. In short nothing worked! he was 2/10th lame permantly. Finally when we had tried all the conventional options 2 years worth, he went to Rockley,and my hope was that he would be at least a happy hacker. Well, he went from strength to strength and after 4 months there and his last day he went hunting with the Exmoor Foxhounds. He then spent the rest of the year building his body back up to what it should be as he is a big 17hh warmblood x. He now jumps, dressages and hunts, and hacks most days and schools. He is better than he ever was in shoes and has been totally sound now for 2 years (frantically touches wood!) and is set to do his first ODE next month and hopefully if mother can keep up BE next year. So sometimes the alternative therapies can work, only regret was that Rockley wasn't the first port of call. Good luck. Remeber it is the way his foot lands that is important, even some barefoot horses land toe first, for collateral damaged it is really important that the heel lands first so that the ligament gets a chance to heel.x

 

[PoppyAnderson]

Hi Lainey. Thanks for taking the time to post. I'm a million miles away from Rockley but am toying with the idea. I'm absolutely not going down the remedial shoeing route. Pony moves to full time grass livery this weekend and is essentially just being turned away for a year or so, then we bring her back and see how we go. Have also got magnesium supplements and Equimins metabalance for her. What did we all do before Google?!

 

[PoppyAnderson]

My horse had collateral ligament damage, right fore, (confirmed by MRI) recommendation was 3 months box rest. However, he also had arthritis in his coffin joint. Result: came out of box rest worse than when he went in. He was literally hopping lame in walk which he never was before - it was only seen in trot. Although he coped really well with the box rest, as soon as he came out he was lethal. Had to sedate him just to turn him out in a small pen. With the benefit of hindsight I would not do this again.

I'm really sorry to hear this Zuzzie. It's exactly the kind of thing that I want to avoid. How is he now?