Experiences w/ Suspensory Rehab

[hybriseris]

At the end of March, my lease mare came up intermittently lame. Some rides would be normal, some rides she’d be off left front. We thought maybe abscess as she’s been prone but when nothing came out from a soak after two days we had the vet out. Did blocks and ultrasound and found a strain - no tearing, and vet was very optimistic. She had us do immediate turn-out in our medical paddock as this mare doesn’t do well out of work/no mental stimulation, and start with 5 minutes of hand walk and we planned from there. We worked our way up to 45 minutes of tack walking and mare was an excellent patient, even if mentally she was a housefire. (Now treating for ulcers, currently middle of 30 days of Gastrogard, will be tapering to half tube and then quarter tube.)

Did three rounds of shockwave and a recheck ultrasound the beginning of this month and my vet was very surprised to see how well it had already healed. Still there and the ligament is not as tight as the opposite leg, but overall responding well to rest and the shockwave. We were instructed to do same length rides but incorporate 2 minutes total of trot for two weeks and then increase 5 minutes a week from there and keep in touch with her to change as needed. Our vet stated it is common to notice a backslide somewhere in this time, and to back off if mare seemed sore.

Mare has been doing well until this week. I don’t think anyone else would notice if they didn’t spend six days a week around her like me, especially since at the trot she is not lame either to my eye or to feel when I’m riding. (I am however, overly cautious since she had good days before diagnosis/treatment.) I am noticing that she is resting her RH and pointing the LF that has the strain. She commonly rests that limb but only when truly relaxed in the crossties. Yesterday and today I noticed she won’t stay off it even if I stand her square for a minute, and rested it under saddle and when I stopped to speak with my BO, which is very unlike her. Otherwise no remarkable behavior.

I have never dealt with suspensory rehab before and I’m looking for others to detail their experience with setbacks or common things that happen during this time. OR if someone would suggest looking at other issues. I spoke with my vet who instructed us to start over and step down to walk until next week and then 2 minutes of trot again.

For context, mare had hocks injected for the first time less than a year ago, and SI injected the beginning of this year.

[SLW]

My 12.2 driving donkey tore a ligament in a front pastern last August. After the necessary confinement she went back into work this spring and the directions were the same as yours “cut back if she shows any negative change”.

All I know is these rehabs take time.

[Roni4444]

I had 8 months of rehab and fortunately no resets, but I would have gone right back to the walk if so. Cant hurry the process and she might just be overfaced with the progression. The vet and trainer both advised to “listen” to the horse and cut back and not push through until they feel better again

[Calvincrowe]

RF suspensory strain for my mare. We are in month 5 of rehab. We’ve progressed to 40 walk, 20 trot minutes, but we’ve slowed down a couple times, backing off as she exhibits some “ouchy” moments. Our lameness vet says this is normal and her leg looks great on ultrasound. We’ve noticed that boots or wraps can make that ouchiness worse so she’s bare legged right now.

That being said, it can’t hurt to talk to you vet and maybe shoot video for them to see what you’re experiencing.

[hybriseris]

Thanks for your experiences!

I should clarify, I am in NO way trying to hurry this process. I want her to heal as well as possible, in whatever time it takes.

I was maybe just lulled in to a false sense of how well it was going and am worried to see her uncomfortable again. To hear other’s experiences that it is indeed quite normal to have some setbacks oddly puts my mind at ease that it stinks, but with time there’s a light at the end of the tunnel.

[Renn_aissance]

I’ve done a bunch of front suspensory rehabs and I can’t think of a single one where the horse DIDN’T have some kind of a setback. Sometimes related to feeling too good on that leg in turnout, and sometimes the horse declines to explain. Another cause can be that the horse broke through scar tissue, whether by themselves or because of therapy, and is now tender either in that area or in the surrounding soft tissues that are used to being pulled one way and are now going another. (I had some scar tissue worked on fairly recently and can tell you I was LAME after- my muscles simply did not know how to work without being pulled every which way.)

Either way, you go take some steps back in your rehab plan and build them back up.

[BLR]

Check out the book “Back to Work”. It gave some great examples of real life rehabs from many injuries but suspensories are specifically included- my personal experience is it takes longer than you think to get to true 100% and much better to go slow and steady and I think you’ll find that in the book too. Less heartbreaking to have an extra checkup ultrasound if you feel something is not right during the process than push too hard if you can swing it financially- you know your horse better than anyone else. Sometimes I think the vets are too optimistic with the timed weekly schedules, I repeated certain rehab weeks many times until I felt my horse was ready to move on with overall good results in the end. Our rehab was about a year or more for a severe tear with two rounds of shockwave but at some point hard to say when rehab “ends” lol… I was picky on arena footing/mild lameness/cold hosing/turnout etc. from then on. I think you are doing the right thing with the medical paddock t/o that is one thing I wish I had done differently in retrospect.

I also found this study to be helpful reading material if you are curious where the recommended rehab schedules come from: (http://www.equinepartnersamerica.com/research/Gillis-RehabTendonsLigamentsAAEP.pdf)

Best of luck, take it one day at a time and don’t rush, before you know it you’ll be further along than you realized.

[piccolopony]

I also recently purchased the Back to Work book and I found it extremely comforting and helpful. I’ve had very little experience rehabbing horses (thankfully) so it was just nice to see more examples and stories.

I’m rehabbing a hind leg, collateral ligament injury of the hock so different but still soft tissue. I’m also dealing with a horse that wasn’t fit to begin with. It took me a long time ( 8+ weeks) to get to 10 minutes of trot but we’re now at 12 and she’s looking good. The injury occurred in November but because there was also a fracture we didn’t start trotting (we were walking every day and built up to an hour of walk) until early May.

[hybriseris]

Thank you for the suggestion, I just ordered Back to Work!

[EmilyM]

I think your slow build up is wise. Also wise to back off if you feel she is slightly sore. Can’t hurt to have the vet check that you haven’t gone backwards. This will make you feel better and give you a sense of what you are feeling and what it means. I’ve had one go backwards and have to start over after a long rehab because he got too wild when I started cantering.

The slow build up of only adding a couple minutes every few weeks is really the best way. If you go to the gym and you are not fit, you can’t up your workout every week and not be struggling. Same for horses. Some people don’t get that, but it sounds like you do. I think it’s very promising that shockwave alone was very effective as well.

Consider also icing the leg after you ride. I ice everything on my body that hurts, and it helps me. I do the same with the horses. And it doesn’t mask any pain the way bute or banamine would.

Good luck. You’ve got this!

[hybriseris]

@EmilyM

I think it’s very promising that shockwave alone was very effective as well.

Agreed. Because I don’t have much experience with this I had to take her word for it (and very much like this vet though she’s new to me as our previous, wonderful vet moved to California), but the advice was that the best thing for this injury is just time. She said she doesn’t have much luck with biologics for strains, and we elected for shockwave mostly because it was available to us and not for speed’s sake.

In all honesty, I’ve been trying to look at it as an opportunity to build this mare back up properly with the right muscle and conditioning. She tends to be stiff through her ribcage so walk has been a great way to get her reaching and bending. There’s plenty that can be done at walk so when we reach consistent trot and some day canter, she’ll be prepared and while it stinks, I’m looking at it as a chance to do right by her, and to work on my own riding. It’s a lot easier to practice a finer coordination of my aids when we’re not eating up the long side of the ring in her huge canter.

I’ve got plenty of very kind people who have offered me saddle time on their horses in the interim but if I’m being honest, I still enjoy my 30 - 45 minutes of walk with her more.

[Calvincrowe]

@hybriseris
I was so happy to get back on my mare when her ‘walking rehab’ began! I am grateful for the catch rides and lesson horses I’ve been gifted over the last nearly 6 months, but nothing beats sitting on her big, bay back and feeling her under me. Thankfully, my barn is awesome with rehab and trainer fully embraces the slow and steady, take your time program. I’ve also begun working on bending and suppeling at the walk. Good luck and trust your gut–we’ve gone backward a few times as Ms. Mare has told us the workout hurt a bit.

[IPEsq]

Always listen to the horse when you want to increase time or intensity. It might take 2-3 weeks or more per phase instead of 1 week, and that is ok. Soreness, fatigue, and even some behavioral things (getting a little gate sour or balking when their timer is running out) all mean that you’ve done enough for the day.

[PaddockWood]

I have a Carol Gillis story. She’s the goddess of tendons - pHD in tendons something like that. I did a remote consult with her on a hind suspensory. My local vet gave clearance to begin turnout and begin riding like before the injury. She said absolutely not. She prescribed something like a month of Ace for turnout and then a much much slower intro back to work.

And that was after I hauled to Rood and Riddle to get ultrasound by someone very skilled to confirm it had healed. And after 6 months of her twice daily rehab program.

That hind never gave us any problems but I always took it easy after that. Long walk warmups and then took it easy. Never overworked and quick to ice if I’d done more than usual. Many years of fun and magic carpet rides. Take.it.slow.

[ndirish07]

I rehabbed a hind suspensory. I followed my vets’ instructions to the letter and I chose to add nearly a month additional at each gait. We took a year rehabbing and added jumping about 6 months after he was technically cleared by the vet. He’s going on 2+ years and it’s never been an issue. I always hack out for at least 10 minutes before any work and I ice him after conditioning, XC schools or anything more rigorous than his regular work.

[hybriseris]

@PaddockWood

My local vet gave clearance to begin turnout and begin riding like before the injury.

Woah. I think turnout is debatable if you have something that doesn’t allow them to tear around, but I can’t imagine being told to ride like normal!

I’ve gone back down to walk for the last week, and I think will continue to do so for July. The pointing LF, resting RH has improved a bit since she only does it while bored on the crossties and not whenever she gets to rest like before, but it’s also so subtle I feel like maybe I’m imagining things. But I’d rather be cautious and slow than assume it’s fine and go back to trotting.

[TheJenners]

@SLW

My 12.2 driving donkey [snip]

I tried to PMed you but your profile is hidden and I can’t Would you PM me?

[Hightale]

Another who had a setback mid way - hind suspensory with up til that point pretty much textbook recovery and similar rehab.
My vet said that that might be as good as she was going to get, but we tweaked her hoof trim, went back a months worth of schedule and built up again.
Unfortunately for us my mare then had a horrific accident and injured the other hind leg so was out of work entirely for the next two months.
On go three once she left the vets (3 week stay! ) we started right back at square one and she was eventually signed off as fully sound with no further issues almost a year to the day after she’d first injured herself.

[SLW]

@TheJenners

@SLW

My 12.2 driving donkey [snip]

I tried to PMed you but your profile is hidden and I can’t Would you PM me?

Oh gosh, sure will. I didn’t know I was hidden.

[TheJenners]

Welp, I can officially join this club I guess. I cried about a gallon yesterday, including in front of the poor traveling vet who was standing in for my regular vet who has no idea who I am and just awkwardly patted my back. Poor woman. Anyway. In addition to the suspensory tear (I can’t remember what she said to describe it but I know it’s not, like, all the way thru) he also gave himself an avulsion fracture where it connects to something, maybe a sesamoid?

So anyway. Regular vet is back at the end of next week to discuss how we proceed, guessing shockwave and prostride? But I’m not even certain his diagnosis for coming all the way back sound either. He is such a fool