100% understand that. I’m always curious as to what others are seeing in their horses (this thread has been awesome for that), which is why I asked!
I just hit month 6 of our RH suspensory rehab. We did shockwave at the beginning and PRP, then laser 4x weekly. From the beginning we’ve been doing 1 30-min tack walk and 1 30-min hand walk each day, plus VitaFloor or Respond blanket depending on the day. No turnout.
The last recheck was on Dec 9 and the tear is down to a pinpoint. We were cleared to start trotting at 2 mins, increasing by 1 min every other day. We got to 6 mins before rain closed the arenas and we’ve been back to tack walking around the property for a couple of weeks now. Laser is down to 2x weekly, but we’re now doing the uninjured hind leg too, just in case he compensates.
Once the arenas reopen, we’ll start back at 4 mins trot. My vet says that when we reach 15 mins trot, she’ll check him again to see if we can canter and turn out.
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I’m 3 months post diagnostic for a left hind suspensory branch tear. I’ve done 5 shockwaves so far and turn out in a medical paddock. We are currently up to 6 minutes of trotting within the 30 minute window of walk. Next check up is in February.
My question is when will I be allowed to canter, hypothetically? And once that happens, will he go to full turnout or just paddock turnout? Finally if I do get him back to full flat work, would it be helpful to just give him a few months off in full turnout?
I want to give this horse the best possible chance to return to his full level which was prelim when he got hurt. I know the attending vet will provide me a roadmap but just curious if anyone else gave their horse time off after the injury was presumed healed.
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How big was the tear and how does it look now? For what it’s worth, in my case, with bilateral hindlimb PSD - imo a much less serious condition than a tear - my vet advised adding two minutes trotting every week. Once at 20 min trotting, we can think about canter, though she was a little vague when I asked what that would look like. I figure if nothing else, add 2 min canter every week 
. The trick is going to be when/how to add all the lateral work at the trot, and more collected work, but I guess I’ll just take it super slow once cleared. My horse has been on small paddock (maybe 1/2 acre?) with mild sedation (ie trazadone).
In my experience and from what I can see in the various facebook groups I’m in, if you want to give him the best chance of a full return to work, Vitamin T (time) is the best antidote. So, the slower the better. More time with a good marching walk is probably one of the best things you can do. I was up to 50 min hand walking (5 min added each week, after an initial 2 weeks stall rest post-surgery), before we started tack-walking/trotting, but that was largely due to giving an extra month off since the one suspensory was still inflamed after two months rest. Now we do about 45 min undersaddle, 14 min of that trotting (I’d do more walking but I’ve got other stuff to do with my day lol). I’ve seen some folks add 2 min trotting every two days for PSD, so I’m glad my vet (who does a lot of upper level/CDI sport horses) is going a slow, conservative route. I was really nervous at first that we were going to fast, since, like yours, mine was an upper level sport horse, before I realize she was the slow vet 
I know it’s not the exact same condition, but maybe hearing my rehab plan might help. I find that hear others’ is very helpful/reassuring. I think it’s harder with the upper level horses since the workload expected is so much higher. Another much older equine vet at our barn said that, in the end, more time, time, time is never a bad thing. She even said an old track vet friend of hers used to not worry too much about how the fibers looked - he just gave every soft tissue injury ~ a year off, then if the horse was sound, slowly brought them back to work, and didn’t worry too much about how “pretty” the fibers looked on ultrasound. Obviously I’m not advocating this strategy, but another perspective to keep in mind 
Good luck!
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Maybe once you’re at 15-20 minutes trot? That seems to be typical, more or less. At that point some vets will have you do a month of canter before starting normal flat work, including lateral work, even at the trot. Some vets say once you’re cantering that comprises normal flat work.
It does seem like sometimes the vets dole out the rehab one step at a time, but I always want an idea of how long the suffering will last, even if it’s an estimate.
For stabled horses it seems the vets out here want you to wait until the horse would be ready to jump (after the normal flatwork) before doing turnouts or lunging. But it seems that might be different if the horse was already out in a small paddock???
YMMV
This is actually what worked for the horse I sold. I think he ended up getting around six months off in total before coming back to work, but the ultrasound never looked great, even when the horse was sound. Now, he’s been back in work just under a year, doing great.
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Curious what others’ vets are saying about when to start adding in trot work. We just did our second ultrasound today, about 15 weeks post-injury. Have done 3 shockwaves. She is still in a medical paddock (about 12x30) and we are up to 50 minutes of handwalking daily. I’ve had clearance to do tack walking, but just did that for the first time yesterday (she was great).
My vet is happy with the progress, says it’s filling in, fibers look nice and tight, but not yet completely filled in. She says it’s okay to start adding in trot work, adding five minutes a week.
Not really second-guessing my vet, just trying to canvass the group.
This is what I’m following, and my rehab barn has had good success with!
We just started trotting under saddle, and he’s being a goof about it but who can blame him!
Edited to add: depending on how he does, I may ask the barn to extend the trotting until he’s doing 20 minutes at +5min every 2 weeks. If he’s feeling strong and happy we may go canter at the 10min trotting mark (as suggested), but that’s the only “edit” I’d make (extending the trot time).
Thanks for posting this. I read this paper super closely at the beginning of our rehab. I wish the AAEP would publish another guidance/best practice for these kinds of injuries since this one is from 1997, and I think a lot has changed since then!
@Pico_Banana, For what it’s worth, my sports vet wanted us to add 2 min trotting every week. Re-scan at ~ 10 min trotting, then re-evaluate at 20 min for potential to add canter. This was for PSD, not a tear, so YMMV, but she also didn’t recommend starting tack walking (and trotting) until all inflammation was gone (since inflam was the primary issue with the PSD). That took 3 months rest/handwalking (up to 50 min), 3 shockwaves, and 1 PRP. She was ok starting tack-walking and trotting at the same time (but I gave it a week of tack walking before introducing 2 min trot).
We started trot work when the tear was down to a pinpoint on ultrasound, which happened around the 5-month mark. We started at 2 mins, adding a minute every other day.
Once we’re up to 15 mins trotting, we’ll ultrasound again and see if we can add canter and turnout.
Well I’m here for a rant and maybe some advice so I don’t go off the rails 
We are 5 months into medical paddock rest and rehab for a front suspensory, and my horse is officially Officially Done. He’s thrown tantrums of the rear/spin/fling around variety in his stall since day 1, but now that we are walking under saddle and trying to add 5 min trotting he’s begun the tantrums under saddle. We can’t get to even 2 minutes of trot most days, and he’s escalating - even rearing and flying backwards hard enough to sit himself down under saddle. So he’s back to handwalking and we are going to try lunging him at the trot.
The thing is, these tantrums are short lived and pop up with little to no warning. He’s a bit spicy all the time, but mostly marching along and then just explodes for 5-10 seconds, before going back to marching along. It’s almost worse than a horse that is just a fire breathing dragon 100% of the time. He’s too dangerous to ride right now, and I’m waiting on a script from the vet for Robaxin. I’m also considering drugging him, but I’m not sure since he’s got the drugged horse style sudden explosions already - as well as tripping in the ring and falling down with his rider. I’m not a fan of riding a well drugged horse that’s a trip hazard on a good day.
I’ve ordered an herbal anti inflammatory, am working on getting Robaxin, and looking for a good magnesium calming supp. This horse is wound tight as a bowstring, especially in the hind end, has KS and conformationally weak stifles, and is trying very hard to be a good boy but is losing his mind.
I’m partially tempted to drug the heck out of him, work him on the ground, and expand his turnout. But I also don’t want to waste or undo all the hard work it’s taken to get this far. I’m burnt out, frustrated, feeling sorry for myself (and him), and don’t want anyone to get hurt. I just would like to ride him someday - I really like him when he’s not on stall rest.
Ugh, I am so sorry to hear that. I can totally commiserate. I just did our first walk under saddle on Saturday, and Sunday she was ridiculously swollen in both fronts – and her suspensory is in a hind leg. Makes me want to cry.
FWIW, I think I have figured out a good calming supplement routine that appears to be working for us. As a baseline, she gets SmartTranquility from SP, which is a valerian-based calming supplement. (It’s not like we are showing 
) I found it took about 3 days to kick in, and it seems to be a bit more “direct” than the magnesium ones, meaning it seems to be most effective shortly after taking it. I therefore give it to her in the AM to help her during the day, since she is almost always naturally calm at night.
On top of this, if it seems like she needs a little help for our rehab exercises (it’s windy outside, we’re doing something different, etc.), I give her one scoop of the SynChill pellets about an hour before work. This seems to really help her be less distracted and just more workmanlike. The SynChill pellets are of the tryptophan group of calming supplements, rather than magnesium based. You can also give more of the pellets if you need to. Note: I find the pellets more effective than the gel, plus I think they work out to be less expensive. And more convenient, too, as my mare eats them from my hand like a treat.
I discussed this combo with my vet and she’s okay with it.
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Thanks for the suggestions! I may try one of those - though magnesium is supposed to help with muscle soreness which is a big issue for him so I thought it might do double duty. We shall see. He’s very uncomfortable in his skin - though not girthy or backsore and generally fine to be groomed. Which he isn’t always.
My lease mare developed ulcers during the rehab. She is wound SUPER tight mentally, and the smaller paddock and lack of regular work seemed to just completely unravel her. Same thing as your guy - she tried to be good, but she had too much thinking and not enough moving. Once we started treating for ulcers she was much, much more manageable, so that might be something to consider on top of the magnesium and some light sedation.
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He’s being treated for ulcers. This stupidity he’s showing is WAY better than before the treatment. He was borderline unmanageable then 
. Which is why I’m thinking general pain + confinement. I’m trying to do one thing at a time to help him but I really want to throw everything at him sometimes!
I rehabbed a racebredd App QH for lower suspensory on a front leg and an OTTB for the RH upper suspensory. It took 2X about a year or two apart for the OTTB (the suspensory has to mend at the optimum length as it won’t be as flexible). No problems with the App QH. However, for the first rehab for the OTTB, I used a GP saddle she really liked. The second time, I used a dressage saddle I thought she liked. However, maybe she had but her back lost muscle tone and it was rocking forward, especially if I became nervous and curled up in the fetal/fatal positions. So during the first rehab, I would hand walk her until her brain showed up (bucking, rearing, playful, wear your helmet high jinks) then get on and ask anyone to talk to me while I did the short rides so I wouldn’t tighten up. No problems, a little playfulness. The second rehab was when the rearing under saddle began. I finally paid someone to lead her while I rode and we had to add a nose chain. It was terrifying and I landed on my tailbone once which I had broken as a kid and had to climb right back on that day and continue. Both the horse and I were joyful once lunging and turnout could begin.
Unfortunately, I didn’t connect the difference in saddles until after the rehab was over (bang my head against the wall). With your horse having kissing spines as well, the loss of top line from no work may cause a lot more pain. Check the gullet width on the saddle. Check the fit. Not all saddle fitters are up on the importance of the width between the panels fully clearing not just spine but the ligaments around the spine. If your saddle doesn’t work, see if your friends have one you can borrow that will give plenty of room for his back. Look to see if the saddle comes down behind the shoulder parallel to the horse not winging out or perched too high where it can pinch his shoulders. My guess is that it may be a little wide now and pinching the shoulders. Maybe a fluffy half pad?
See if the vet oks lunging in side reins prior to riding to build the top line since it’s so unsafe the traditional way. Yes, the horse can play and be reinjured but that is really just part of optimal healing, at least that is how it was explained to me.
Good luck.
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Thank you for this. And you know what - I doubt the saddle fits. It does pop up in the back when posting the trot. That might explain the dramatic escalation when adding trotting (he still has explosions walking, but less). I needed a reminder to check if anything I own fits at all.
He may be lunged at least until the dentist comes out and his robaxin shows up - so 10 days or so. It’ll be helpful to see if the uncharacteristic histrionics continue without a rider.
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If there is enough width between the panels and the saddle usually fits, a good saddle fitter may help with reflocking and shims, maybe a half pad as well.
My current horse is doing very well after kissing spine surgery. I asked for help with riding rehab this time. For you and your horse to deal with all of this at once sounds like quite a challenge. My heart really goes out to you.
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Thank you so much @hut-ho78 for your sympathy. It’s been one tough road and I feel like it’s going to stay that way for a while
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With my mare since she wasn’t started under saddle I went from hand walking to long lines for the trot rehab. I know the vets don’t want them on a circle typically but my vet was ok with it since it was our only good rehab option. I kept the circles big and concentrated on keeping her as straight as I could. She’s 14+ months out from her injury and now started under saddle and looking great. I would think that if riding was dangerous doing something similar could be an option with your vet’s approval of course.
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