Is there such a thing as rehabbing too slowly?

[greeneyedwb]

Let me preface this by saying I am NOT in any way trying to rush the rehab process and have no interest in risking derailing this horse’s recovery.

I have done several soft tissue/surgery rehabs in the past that have followed a fairly typical progression of stall rest, hand walking, progressive load under saddle, return to turnout, etc. I have a lot of experience there and am confident in those protocols/understand the expectations. All had satisfactory outcomes and horses were back to work in 8-12 months.

Current horse: paddock accident last fall resulting in severe SDFT injury LH along with some other damage, with a concurrent infection that may or may not have been related. Protocol has been:

30 days strict stall rest, Renovo injection, shockwave therapy, MRI, multiple rounds of antibiotics
4 months’ hand walking/long lining progressing to 30 mins 2x/day, ice after each walk, laser 3x/week
3 months’ tack walking progressing to 30 mins 2x/day, ice after each walk
3 months’ walking + adding trot 1 long side every 7 days, ice after each walk
Have been performing stability exercises since the 4 month mark.

Has had progress checks via ultrasound every 8 weeks.

Currently 11 months in and walking 30 mins + 12 long sides trot. Vet gave permission to add short ends so now at 6 laps of trotting (approx. 7 mins), adding 1 lap every 5 days. Vet wants to continue this for next 8-10 weeks and then reassess. The goal all summer was to add in canter sometime in October–no reason given for the changing the plan other than the injury was severe and it’s best to be conservative. Every ultrasound has shown improvement, most recent ultrasound was 4 days ago and vet professed to be extremely happy with the healing–said it may not look better than it does now.

I will admit to being mentally, emotionally and financially burned out from this rehab. What bugs me more is the guilt of asking this horse to keep her $hit together for so long–I’ve never experienced a rehab where the plan is THIS conservative and I find myself questioning how fair it is to the horse…at what point does it become unrealistic? The goal is a gradual return to turnout in January. I would prefer her be solidly wtc before turning out but vet does not feel that’s necessary.

This turned into more of a vent than anything else, but opinions are still welcome, thanks!

[PaddockWood]

I’d do a remote consult with Dr. Carol Gillis. The goddess of equine tendons (pHD in them).
My guy had a hind lesion many years ago and it was money so well spent to have her advice and recommendations.

https://www.equineultrasound.com/

[IPEsq]

I think it depends on the individual case. This sounds pretty severe. And by now, I’d think with most SDFT injuries, the ultrasound would be clear. If it isn’t, I can understand the recommendation to go super slow. Has there been any heat or swelling as you have progressed with exercise? That is also a sign you are not going too slowly…best case would be none of that showing up at all as you increase load/stress. I think it’s not unreasonable that this will take more than a year. In my experience, hind tendon injuries take longer than the front also.

[strangewings]

Possibly not relevant for your specific case, but a general answer nis yes it is possible to go too slowly.

Successful rehab requires that you build up supporting muscles to the injured structures to prevent reinjury. If you don’t do enough safe, controlled, deliberate PT, you can delay recovery.

[rulex]

@strangewings

Successful rehab requires that you build up supporting muscles to the injured structures to prevent reinjury.

Can’t comment on this specific case, but another risk of taking things too slow is loss of bone density from lack of movement.

[RedHorses]

I had a couple of extensor tendon injuries to rehab. One of them developed adhesions to the tendon sheath and the vet had me introduce trot to break them before they got too established. The horse was lame at trot with the adhesions, and sound once they were broken. Never had any issues afterwards.

[greeneyedwb]

Good feedback, thank you. I’m not surprised it’s taking more than a year, I just did not expect it to be going this slowly, and it can be difficult to protect her from everything she reacts to in a boarding barn environment. Her ultrasounds are essentially clear–vet says there will always be something there but it’s about as good as it’s gonna get. So yes that’s a good sign!

[greeneyedwb]

Thanks, her overall strength/fitness has been something we’ve worried about as well. She has definitely improved but the 11 months of stall rest have not done her muscling any favors. We are trying to get creative within the confines of her PT to try and increase her strength a bit.