Suspensory injury rehab advice please

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Twiglet

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Hi, doing a bit of a straw poll in terms of rehab programmes for suspensory injuries.

My gelding injured the external branch of his right hind suspensory in late Feb (4 months ago), it was quite a clean vertical 'cut' on the ligament as a result of a kick. He's been treated with PRP (plasma therapy), cartrophen, shockwave, Arc Equine and hydrotherapy (water treadmill). He was initially box rested for 8 weeks, with limited in hand walking (NOT fun!!), and then progressed to turn out in a small pen and walk work under saddle. The ligament has responded well, with the lesion showing as healed under ultrasound.

My vets have offered a bit of conflicting advice on the rehab programme - practice vet has been keen to do very small amounts of work in walk building up very slowly, whereas the partner (his boss) has been advising to do as much (walk) work as possible, in order to prevent scar tissue formation on the injury site. So far I've been ultra-conservative and applied a programme designed for PSD (a more serious and degenerative injury to the suspensories), which has been positive, but I'm concerned that such slow progress isn't conducive to keeping the scar tissue formation at bay and getting him back into work.

Does anyone have any experience of this type of injury (rather than PSD or degenerative tears....I'm looking more to an acute injury), and the rehab programme used? We're currently on week 15, and he is due home from the rehab yard/water treadmill next week. The vets are keen for me to start trot work at that point, as he'll be lighter and stronger. The PSD programme advocates trotting around week 19, so it won't be much earlier, but I'm really interested to hear what others have done.

I can find lots of information about PSD but much less so about acute injuries and the healing time for them.

As an aside, he's been totally sound the whole time, the only way the injury was diagnosed was by swelling in the area.
 
My mare has damaged both suspensories proximal like Altho not PSD it was the result of sliding stops in field after box rest for an abscess in sticky ground.

She also had PRP injections no shockwave (I am told this is better for the damage if close to bone attachments which hers isn't). I had 4weeks box rest (she also had inflammation of flexor tendon sheath from same incident so wanted to start walking out sooner than normal to stop adhesions!)
She is currently at rehab yard now, 10days in and is building up from 5mins twice daily to 10mins twice daily over next 3weeks to be rescanned and if ok increase walk work by 5mins/week upto 1hour twice daily.
Vet has said I can sit on her once at 30mins twice daily (she will come home then), once she is ok doing an hour walk twice a day we will add very min trot work in approx 10-15sec short bursts doing 1min initially. She is to be scanned monthly throughout this.
She is also sound (she was lame initially but once flexor tendon sheath medicated she has been fine!) aim for 20mins- half hour trot work in an hours walking out to then add canter. All this walk/trot is straight lines on hard ground (not sure yet re:canter work- I have access to a straight gallop so I can do canter on that but she will need to be able to go on soft surface before then. I believe the walk and trot work is key to strengthening- once this is ok and horse Sound then canter shouldn't cause too much issue. I'm getting the idea from my vet that doing as much walking on hard ground as possible once further down the line is ideal as it keeps the ligament moving correctly and helps it heal in right pattern also important to make sure your shoeing is good and they are not putting any wedge etc in but to have more of a break over at toe to reduce any overstretch on back of legs

Vet has told me that he normally works on a 9month window of healing- if we get to 9months and sound (by then she will be walk,trot,canter and can school) then she should have no further issue from this injury. I am not sure when mine can actually be turned out yet we are 8weeks post injury and 6weeks post PRP injections.
Hope that helps!! I'm panicking currently tho as she has some thickening around site of one tear but no heat etc so I'm worrying re:scar tissue but it is apparently not abnormal to take time and vet has said he can inject into it if needed to help reduce inflammation. She is also having arcequine and laser therapy (twice weekly)
Can I ask have you followed the arc equine rehab program or your vets? I have followed vets advice obviously and Ian was happy with that- she is to now have 5weeks on program 4 while she is at rehab place then revert to maintanence program. She has already had it on for 6weeks (her 4week post injection scans were brilliant- vet was really impressed)
 
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Thanks....this is really interesting. I wish my vet had given me such a prescribed programme, I've had to very much design it myself and ask for his sign off.

So your programme is to add trot only once at an hour's walking?

How are you doing the laser therapy? I'm really tempted to try it but I can't find out how/where to access it?

I haven't had an Arc Equine rehab programme in terms of exercise - just the 6 week treatment and the 4 weekly maintenance. Did Ian do you an exercise plan too?
 
My vet has been really good thankfully (he has even put the arc equine in my treatment plan so hopefully they will pay for it!!)
Yes she won't trot until she is doing 1hour twice a day walking- it is possibly in some opinions taking it too slow but I am in no rush and from everything Iv read/researched slow and steady gives the best chance of full recovery.
I am getting laser from my horses Physio, she is having it twice a week, will reduce to once a week after her next scan if all ok. Death for local ACPAT physios and see if they do it (a lot do- you need one who has a good Machine tho not just a red light laser pen!) I know
My Physio covers Staffordshire/Derbyshire if your that area pm me for her details!

No Ian hasn't given a program but in the manual they do a rehab program to run with the program- this is what they have set up to get the best results quickest but i spoke with my vet about that plan from the manual and Ian and both were happy to delay the exercise program and to run through it as per the vets plan but to keep her on the treatment arcequine sessions rather than maintenance for longer than normal
 
Mine had a Psd injury which was treated with shock wave then the box rest and restricted turnout with in hand walk work.

I don't remember the exact programme, but I do remember giving each stage of the rehab a week or two extra at every stage!
 
Dizzydancer said:
Stencil face did your horse make a good recovery?
Click to expand...

Yes, from the PSD injury, still dealing with a ddft injury in both front feet :D

I took his shoes off a couple of years after the successful rehab for his PSD, PSD was in 2011, I think I did one competition in 2013 (had tendonitis in a front leg in 2012!) took them off in 2013. His leg with the PSD has grown an interesting shaped hoof which has a flare on the inside, I think to cope with the slight wonkiness within his leg which gave him the PSD in the first place - natural adaptive asymmetry if you will :)
 
Oh dear!! Sounds like a nightmare! Good to know he did recover!
I am considering that taking shoes off maybe a good idea as I have heard a few people say there hooves grow differently to manage the changes, although I'll probably wait until she is recovered as she hasn't been barefoot and don't want to make her footy on top of it
 
We did PRP, 6 months box rest with in hand working from 10 minutes to 30 minutes, then started a lot of walk hacking, after a year pretty much back to normal hacking but she won't jump again, won't do exciting/hill hacking and the vet would rather she wasn't doing some prelim dressage (she is tho ;) ) atm.
 
Did you turn out after at 30mins walking ester?
That seems quite limited outcome really- or maybe your vet is just being overprotective!!
Glad your doing some dressage tho- I don't mind if we don't jump again but would like to get back to dressaging!
 
I'm trying to remember sorry, Mum's mare, She walked from day one of box rest so yes I think she would have turned out at that point, quietly (only horse so no playing at least).
I think the initial injury got left too long, she had swelling but no lameness unless assessed the day after doing some schooling- the vet was surprised at the damage given her presentation. I wasn't at home at the time as would have got her scanned earlier to check but anglo mare so inclined to filling at times anyway (hindsight and all that). and it had rough ends rather than a hole so I know the PRP had a bit of a question mark about it because of that.
The mare is quite happy not to jump ;) and Mum doesn't have any transport anymore anyway, so she hacks from home and borrows a neighbours arena once a week/goes to some dressage about 20 mins hack away and obviously not seen the scan but I guess although the rehab went to the letter it hasn't knitted that well.
 
Ah right- as you say the sooner they are picked up the better!
Sounds like she is doing ok tho considering not perfect healing!

My mare does love to jump but if we have to forgo that then as long as she gets variety in another way she will be fine!!
 
I think they are hard to spot- mine would have been left too if the vet hadn't happened to run the scanner up her leg when he had scanned her flexor tendon!
She had no suspensory swelling etc it was all flexor sheath swelling- vet was shocked at what he saw on scan!
 
No he had no swelling, just intermittent lameness. All of his injures have been invisible ones that require expensive investigation!
 
Hmm, mine was the same - no lameness but swelling and a small cut, was diagnosed for first two weeks as infected mud fever :( Vet told me to keep on with getting him fit for our first event and work him daily to get swelling down - so we did a session on the gallops with a bust suspensory (albeit couldn't hold him for toffee so he obviously didn't feel too bad).
I'm really hoping he'll come back to event - the vets certainly seem optimistic about it, and we've thrown the kitchen sink at it in terms of treatment, so I really hope that he is ok.
 
Oh gosh twiglet!! My vet is giving me optimistic outcome too- it's costing me a small fortune and I'm just hoping insurance will pay out- but even without them I would have done this as this horse is my world and I'd prefer to pay a fortune out and not have to be horse shopping!
My vet has said if we make it to 9months from injury with her working then she will be good to crack on and it shouldn't affect her anymore than any other! I have heard of lots who have gone back to eventing so fingers crossed for you!
 
Hi, Jay had a hole in his suspensory, it was after a field incident where it looked like he had got caught in a post and rail fence, then single handedly ploughed the field. Initially he looked a OK other than a few grazes, and seemed sound too, but then he was occasionally dropping the odd stride when schooling. A scan showed a hole in the ligament.

I was told to keep him out in his field, and to keep walk work, 20 minutes 3 X a week, as it was quite mild and he was not lame. He did have PRP and 3 X shockwave, plus an ArcEquine, and initial 3 monthly scan showed a lot of improvement.

He then had the complication of becoming a wobbler, we think because he sort of sagged in the middle with only being ridden in straight lines at walk for 20 minutes 3 times a week. I have had him for 5 years, and apart for the odd week off to draw breath he had never had any time off, and was always fit and healthy.

Steroids to subdue the acute symptoms and lungeing to re-strengthen his frame took care of the wobbling, but because he was put into lungeing before the suspensory was healed we accepted that it may not heal, and fair enough, his 6 month scan showed not such a great picture.

I accepted that Jay was now retired, and found another horse to ride, and potentially buy. Meanwhile Jay Man was lungeing and hacking, which is all I thought he would be doing forever, and actually kept improving.

He got so much better we had a last scan at nearly 12 months, and the ligament is healed. A bit bigger than the other one, but all the fibres are lined up.

He is now on rehab proper. We have done proper walking for 6 weeks, as in every day rain or shine, and worked from 20 minutes to an hour and a half. At first it was straight line only, but in the last few weeks of that we started schooling at walk too, not least because he was getting weaker behind again.

Now we are into the 6 week trot phase, again starting straight lines only, but now we are also schooling up to 20 minutes, 10 minutes of which will be at trot.

Next will be 6 weeks with canter included. Then... well we will wait and see.

So, I learned that the healing went on despite having to work him for another (more serious) issue, and the healing went on for longer than 9 months.
 
Wow that is difficult than but good to know he is improving even with all those issues!
Fingers crossed for when he comes into canter work!
Will definetely keep in mind about the longer healing process and I'm in no rush!
 
Dizzydancer said:
Oh gosh twiglet!! My vet is giving me optimistic outcome too- it's costing me a small fortune and I'm just hoping insurance will pay out- but even without them I would have done this as this horse is my world and I'd prefer to pay a fortune out and not have to be horse shopping!
My vet has said if we make it to 9months from injury with her working then she will be good to crack on and it shouldn't affect her anymore than any other! I have heard of lots who have gone back to eventing so fingers crossed for you!
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That's kind of the timescale I'm working on too - aiming to start jumping him again at the end of the year, which will be 10 months since the injury. My vets have been pretty optimistic from the outset, but I'm not sure how much of that is them trying to cover their backs in terms of the misdiagnosis! The plus side is that it was an acute injury and not anything degenerative, plus the scans seem to show a bowing in the ligament fibres rather than tearing or fraying, so we're hoping that the majority stayed intact and it was a question of waiting for them to return to normal shape. But who knows. The shockwave did seem to be beneficial in terms of kickstarting the healing at the times it appeared to be slowing.
When did yours do his injury?
 
Red-1 said:
Hi, Jay had a hole in his suspensory, it was after a field incident where it looked like he had got caught in a post and rail fence, then single handedly ploughed the field. Initially he looked a OK other than a few grazes, and seemed sound too, but then he was occasionally dropping the odd stride when schooling. A scan showed a hole in the ligament.

I was told to keep him out in his field, and to keep walk work, 20 minutes 3 X a week, as it was quite mild and he was not lame. He did have PRP and 3 X shockwave, plus an ArcEquine, and initial 3 monthly scan showed a lot of improvement.

He then had the complication of becoming a wobbler, we think because he sort of sagged in the middle with only being ridden in straight lines at walk for 20 minutes 3 times a week. I have had him for 5 years, and apart for the odd week off to draw breath he had never had any time off, and was always fit and healthy.

Steroids to subdue the acute symptoms and lungeing to re-strengthen his frame took care of the wobbling, but because he was put into lungeing before the suspensory was healed we accepted that it may not heal, and fair enough, his 6 month scan showed not such a great picture.

I accepted that Jay was now retired, and found another horse to ride, and potentially buy. Meanwhile Jay Man was lungeing and hacking, which is all I thought he would be doing forever, and actually kept improving.

He got so much better we had a last scan at nearly 12 months, and the ligament is healed. A bit bigger than the other one, but all the fibres are lined up.

He is now on rehab proper. We have done proper walking for 6 weeks, as in every day rain or shine, and worked from 20 minutes to an hour and a half. At first it was straight line only, but in the last few weeks of that we started schooling at walk too, not least because he was getting weaker behind again.

Now we are into the 6 week trot phase, again starting straight lines only, but now we are also schooling up to 20 minutes, 10 minutes of which will be at trot.

Next will be 6 weeks with canter included. Then... well we will wait and see.

So, I learned that the healing went on despite having to work him for another (more serious) issue, and the healing went on for longer than 9 months.
Click to expand...

This sounds more positive than you expected - will keep fingers crossed he continues to improve
 
Twiglet said:
That's kind of the timescale I'm working on too - aiming to start jumping him again at the end of the year, which will be 10 months since the injury. My vets have been pretty optimistic from the outset, but I'm not sure how much of that is them trying to cover their backs in terms of the misdiagnosis! The plus side is that it was an acute injury and not anything degenerative, plus the scans seem to show a bowing in the ligament fibres rather than tearing or fraying, so we're hoping that the majority stayed intact and it was a question of waiting for them to return to normal shape. But who knows. The shockwave did seem to be beneficial in terms of kickstarting the healing at the times it appeared to be slowing.
When did yours do his injury?
Click to expand...

Mine injured hers at start of May and had her PRP 2weeks later. She hasn't had shockwave and it's showing good healing on initial scan just hoping she will be still looking good in another 2 weeks at rescan. Will keep that in mind tho if we get any slowing in healing.
I think that is key that it's acute not chronic as to how optimistic they can be- it's same with mine!
Just been to see her today- they are walking her 10mins twice a day now on treadmill once in water and once dry and she seems to be managing it well Altho her wonky pelvis looks more obvious now I assume due to lack of muscle from rest!!
 
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