Suspensory injury rehab advice?

[Twiglet]

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.

 

[Birker2020]

No acute injury experience but three suspensory branch sprains on three different legs on my horse, two of which were lateral branches and one was the medial branch. At 6.5 months post injury he is able to be ridden in walk, trot, canter and jump small fences (started jumping 2 weeks ago) - 2ft 3 at present single fence.

On the first branch which was the lateral my horse had shockwave (no effect) and scans kept showing no progress. He then had PRP and after a few months was back in full work jumping as siggy below. Then he had a traumatic injury (getting leg stuck in wheelbarrow frame between wheel and frame round wheel) and nearly broke his leg. By the time I'd arrived at the yard he'd been given ice therapy by my physio who was a livery on the yard and had seen the injury. We got him back into full work following this but he showed a consistent head nod - please see You Tube, Applecart14 for videos explaining and showing post injury progress. The vet felt that this was due to scar tissue around the suspensory branch but not connected to the branch but free floating which showed on xray as a small dot (they thought at first it was mud so tried to brush it off - re xrayed and realized it was calcification) The vet thought the head nod was nothing to do with pain, indeed on a bute trial it was still present. He felt it was mechanical lameness as a result of restriction of the ligament and scar tissue.

Some three or four years on from this injury the horse head nod has nearly completely disappeared. https://www.youtube.com/watch?v=BV0YvouNeA0 - if he rushes onto his forehand it is more obvious.

He has always had a funny headcarriage anyway and does nod but is not consistent. A very qualified BSHI instructor gave me a group lesson last week and said "he is nodding his head - squeeze him forwards into the contact, he is backing off the contact which is why he is nodding". A simple sentence but one which resulted in the head nod disappearing!


Current injury - I iced it like crazy every day, sometimes twice or three times a day at the weekend. I also invested in Ice Vibe boots and he wore then religously everyday. He was also on anti inflammatory bute and again turned out. Think it was something like six weeks walking straight lines hacking unlimited time after six weeks, prior to that up to half an hour. Then it was trotting in straight lines for six weeks, gradually introducing large circles in trot and a very small amount of leg yielding in walk over a period of many weeks and then canter I think it was about mid/end April - again large circles before collection leg yielding and flying changes. Jumping started two weeks ago.

I am convinced the ice therapy and early intervention of Ice Vibe plus limited two hourly a day turnout in a sand paddock has helped.

 

[AnShanDan]

I don't have any direct experience of this type of acute ligament injury in a hind leg, but I'd have thought, logically that the more walking you can do the better. If you could be hacking out in walk for an hour a day 7 days a week before you start trotting I think this would be the most likely to give no recurrence.

A few weeks of that and you'd have a pretty fit horse, with little risk to the healing area, gently stretching the fibres into the correct alignment is the best way to get them to heal permanently.

Most of my knowledge of ligament injury is from humans, but the same principles apply. Humans are a bit easier to explain things to, like no overdoing it.

Lots of purposeful walking on a hard surface will condition the leg best, then slow trotting in a straight line etc. etc.

It is boring tho

 

[Birker2020]

My vet has also said lots of walking on different surfaces, i.e tarmac, grass, arena surface, to get the ligament used to different stresses and load bearings.