Rehab plan following PSD

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Valo

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Hi Everyone,

I've been lurking here for quite some time now enjoying reading everyone's reports and soaking up lots of info and inspiration from the debates and discussions. I've been a bit shy so far but have just started to try to join in and I wondered if a few of you very knowledgable people would mind giving me some advice.

Bit of background. I have a 9 year old 3/4TB 1/4 shire gelding who I've owned for about 18 months now. Last year was our first season together and we did a bit of everything including unaffiliated one days events at 90cm, hunter trials, unaffiliated dressage at novice etc etc. This was with the aim of getting to know eachother so that we could aim to do some BE 90's this season.

Everything was going swimmingly until he came in lame from the field early November. 4 weeks of box rest followed after which we went to the vet for a full lameness work-up. Nerve blocks and ultrasound scans revealed acute proximal suspensory desmitis (PSD) of hind legs (left worse than right). My vet thinks he possibly did a bit of a Western style stop from gallop in a wet muddy field whilst turning which caused the damage (whether that's actually the case I guess we'll never know!)

Treatment was 3 lots of shockwave therapy at 2 week intervals plus steroid injections. He has been on box rest the whole time but with twice daily 20 minute walks on the treadmill at our yard.

We went back to the vet last week to see if the shockwave had worked and it is looking good. He was sound in a straight line and also on the lunge and the vet seemed happy that the ultrasound scans showed a lot of improvement.

So the idea was to start very slowly bringing him back into work and this is where I'm looking for some advice. The original idea for week one was to still give him 20 minutes on the treadmill in walk and then get on and walk for another 15 minutes but with 3x 30 second trots interspersed between. The idea of the treadmill first was to try and get rid of some of the sillies but also try to make sure that if he did start jumping about then at least he'd be a bit warmed up first. Annoyingly the snow has put paid to that so we're stuck on the treadmill for the timebeing!

I wondered if anyone had any experience of bringing horses back into work following an injury like this and had any tips for me? Or even if anyone had a schedule they had used that I could look at?
How quickly or slowly should I be increasing the trot work?
With an injury such as this, is it best to stick to flat ground or is some hill work beneficial? If hill work is good, I could start to introduce some periods on an incline on the treadmill.
Should I be hosing or icing the legs after work, even if it's just walk and a bit of trot?
Anything else I should be thinking about?

Sorry for such a ridiculously long first post and thanks in advance for any advice. He's a such a gorgeous boy and I want to do everything I can to give us the best chance of getting out to play again :)
 
I was told to start with half an hours walking, build it up to an hour by 5 minutes a week and if ok doing an hour start trotting. 5 x week.

Can't hack out from my yard at the moment as liveries go via fields ( verges left on fields for hacking ) as the road outside the yard is dangerous. Particularly on a horse which is more or less at the same standard of education as a just backed baby.
 
I'm in the same boat - horse is just coming back into work after diagnosis in June last year, shockwave and H-wave, and 6 months turned away.

I'm surprised that you have been told to trot him so early on in the rehab process though. I've spoken to a lot of other PSD victims, and we've all been told to walk in staight lines for 6 weeks before even thinking about trot, and that's after, in a lot of cases, 6 months rest.

I'm unclear whether you mean he had a suspensory injury, or if it IS psd. PSD is a degenerative condition, often related to wear and tear - but if your horse came up lame after an incident, I'dve thought the vet would have diagnosed a suspensory strain/tear. Unless it has been brewing for a while, and the incident just flagged it up?
 
When I rehabbed my horse from acute hindlimb PSD he did a couple of mths walking in straight lines (ridden because he was mental in hand) then trotting in straight lines. No hill work at that stage and when I had to go in school due to lack of light we just went round the outside. He was back in full work in 6mths and it never troubled him again.
 
Auslander said:
I'm in the same boat - horse is just coming back into work after diagnosis in June last year, shockwave and H-wave, and 6 months turned away.

I'm surprised that you have been told to trot him so early on in the rehab process though. I've spoken to a lot of other PSD victims, and we've all been told to walk in staight lines for 6 weeks before even thinking about trot, and that's after, in a lot of cases, 6 months rest.

I'm unclear whether you mean he had a suspensory injury, or if it IS psd. PSD is a degenerative condition, often related to wear and tear - but if your horse came up lame after an incident, I'dve thought the vet would have diagnosed a suspensory strain/tear. Unless it has been brewing for a while, and the incident just flagged it up?
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Hi, Thanks for replying! Glad to hear your horse is coming back into work to. Nice to speak to someone in the same boat! :)

It's definitely PSD. My understanding is that PSD just means inflammation of the top part of the suspensory ligament and it can either be chronic i.e. due to wear and tear like you describe or acute i.e. down to a particular injury which is what my vet thinks is the case for my boy. My understanding is that usually the recovery from acute cases can be quicker and more straight forward than chronic but I'm not 100% sure on that.

I guess he's effectively done the 6 weeks walking during the treatment as he's been doing 40 minutes a day on the treadmill split into 2 sessions.
 
star said:
When I rehabbed my horse from acute hindlimb PSD he did a couple of mths walking in straight lines (ridden because he was mental in hand) then trotting in straight lines. No hill work at that stage and when I had to go in school due to lack of light we just went round the outside. He was back in full work in 6mths and it never troubled him again.
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Thanks Star. Makes me happier to hear a good news story of a full recovery :D
I will stick to no hills or gradient on the treadmill for now then.
 
Valo said:
Hi, Thanks for replying! Glad to hear your horse is coming back into work to. Nice to speak to someone in the same boat! :)

It's definitely PSD. My understanding is that PSD just means inflammation of the top part of the suspensory ligament and it can either be chronic i.e. due to wear and tear like you describe or acute i.e. down to a particular injury which is what my vet thinks is the case for my boy. My understanding is that usually the recovery from acute cases can be quicker and more straight forward than chronic but I'm not 100% sure on that.

I guess he's effectively done the 6 weeks walking during the treatment as he's been doing 40 minutes a day on the treadmill split into 2 sessions.
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You have a fair point - I'm a bit one -eyed about my own horse, who is definitely chronic, and seemingly intent on doing his recovery no good at the moment, by spending hours practicing passage and pirouettes in the field! I'm jealous of those with the acute version, which doesn't seem to have quite such a gloomy prognosis!
 
pinklilly said:
The vet said I could go in the indoor as it's massive but it's permanently booked with lessons, could probably do with a yard move really.
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I think I'm going to be spending lots of time going round the edge of our school on dark nights over the next few months - joy of joys!

Auslander said:
You have a fair point - I'm a bit one -eyed about my own horse, who is definitely chronic, and seemingly intent on doing his recovery no good at the moment, by spending hours practicing passage and pirouettes in the field! I'm jealous of those with the acute version, which doesn't seem to have quite such a gloomy prognosis!
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Mine is still on box rest at the moment. Dreading the day I have to turn him out for fear of another injury

Auslander said:
There's a great PSD group on Facebook btw - Search for PSD discussion group
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ooh thanks I'll go and have a look
 
Auslander said:
Sedalin is your friend! Mine is part Shire too, and they seem to have a ridiculously low tolerance for the stuff - so a tube lasts for ages!
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Yeah I've noticed that! That's quite weird isn't it. Will definitely be dosing him whenever he does eventually go out. The trouble is even before the snow all our fields were really wet after all the rain we'd had and I'm told soft ground and suspensory injuries do not mix. So they're going to have some drying out to do before he can go out.

Actually tempted to give him a little bit before I sit on him the first few times. Is that a really bad idea?
 
Valo said:
Yeah I've noticed that! That's quite weird isn't it. Will definitely be dosing him whenever he does eventually go out. The trouble is even before the snow all our fields were really wet after all the rain we'd had and I'm told soft ground and suspensory injuries do not mix. So they're going to have some drying out to do before he can go out.

Actually tempted to give him a little bit before I sit on him the first few times. Is that a really bad idea?
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I did rather wish I had after the first hack out! He is usually angelic, and had ben turned out, so there was no real reason for him to flick the 'inside out' switch!! Thank god for the "Holy Crap strap" I say!
 
My horse had an acute psd in a front leg and I did the walk and slowly building up trot work for a month on acp tablets every time! It was in the arena as I didn't dare hack out. I decided if I got bucked off at least he would be safe in the arena but not on the roads... One year later next month and *touches wood frantically!* he is fine although I am still being a bit cautious with the jumping. I think that is just me being paranoid now though! Hope yours makes a full recovery :-)
 
I have one about to come back into work a year after PSD diagnosis - I'm planning on a full 12 weeks of walking (ridden) before introducing trot. Joy!

'Holy crap strap' is genius :D
 
I am a member of the FB PSD group, my horse is now over a year post surgery. I followed the rehab to the T, we had no small turnout or horsewalker/treadmill. Turning out was not the worst bit for me, although he did have a funny turn and I though he had broken his leg one day, but by the time the vet got out (within the hour) he was fine. Straight lines walking is the best possible for this type of injury. I did the whole old fashion eventer style fittening and he has, touch wood, been fine since, we even got a mention in H and H for it all when he won first time out BD! I have been told that shockwave is not as effective in the hindlimbs but tends to be used when surgery is not deemed necessary/viable. Even now I tend to do a lot of walk with my boy, I avoid deep sand surfaces and rarely lunge.
 
I have one recovering from PSD op in hind legs but also from KS surgery. Because of the KS he needs to be lunged which is not ideal for the PSD. I walked inhand in straight lines for about 6 weeks but he was a complete mentalist and ended up on 2 legs most of the time waving at me. We then started lunging round the outside track of the school in walk and trot and expect to keep that up for the next 3 months. He has still not been turned out (because of mud) and has been in whilst we had all the snow. Had the op last week of August 2012 and not due to get on until March (depending on how he is). He isn't going to compete but hoping he is ok for light schooling/hacking and can be turned out normally.
 
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