Let's talk rehab plans

[Frivian]

Hello,

As I’ve posted previously, my horse suffered a severe injury to his LH last fall. The lateral suspensory branch was nearly severed, and he also was fighting a severe infection that ended up in the fetlock joint.

Fast forward to now: we’re far enough along in the rehab that we are trotting about 3 minutes under saddle, within 30 minutes of walk. At his last recheck, the ligament was healed on the ultrasound, and she said we didn’t need to have any more rechecks unless there was a concern. She sent us off with instructions to build up to 5 min trotting by next week, and then every 2 weeks add 1-2 minutes of trot. Once we’re up to 10 minutes, we are allowed to add canter. She also said we could increase our total walking time (he’s turned out 12 hours overnight now in a small paddock) as well as add easy trail rides (where I’m boarding now we have access to a lot of nice easy trails). No circles or deep footing but most of the work is in the arena.

My main question is, what has been everyone’s experience with following rehab plans like this? I’m just looking for information on what kinds of plans others have followed, and how successful they were. How much riding out vs. arena work did you do to build up strength, at what point did you start incorporating hills, when did you start adding in lateral work etc?

Any tips are appreciated!

[Sansena]

H/J background here so not much advice WRT hill work. But I can comment about overall rehabilitation of tendons.

It won’t be linear. You will probably have some stiffness/ ‘lameness’ at each increase of exertion. It’s to be expected. So don’t become discouraged. Be prepared to have lots of diagnostic u/s along the way to continue to monitor healing.

Typically, once the horse has been sound for 4+ weeks at normal flat work, he’s authorized to start jumping small courses. Raising the height back to horses’s pre-injury levels once overall fitness has reached the same level.

Depending upon the size of your arena, I wouldn’t canter any corners for the first 2 weeks. Just long straight aways… and trot to canter transitions are probably preferred over walk to canter. And frankly, I wouldn’t even count on cantering every day once you begin to re-introduce it.

I personally wouldn’t incorporate hills at anything more than a walk until you’re cantering in the ring, at least twice around. I also would be very careful about trotting on trails, given the uneven footing.

You’ll see I’m not giving you any timelines because, as I said before, it’s not a linear recovery. You have to increase work load depending upon how the horse is responding. The calendar means nothing. I’d much rather go by what the u/s is saying and how the horse is responding to the present work load.

Considering the initial injury, I think 9 - 12 months from first tack walk (without any significant set backs) would be the expected time line to return to previous level of work.

I’m not sure if that helps.

[atr]

I’ve always taken what the vet says and added at least 50% in time to each stage, myself.

[tipzythegreat]

I don’t think this is an unreasonable plan. My only concern is that I’d probably not add cantering for a little while. Keep at 10 minutes trotting for a couple weeks before you add canter.

My plan from my vet is as follow
1-4 weeks: Walk 10, trot 2, walk 2, trot 2, walk 10. Do this every other day
5-6 Weeks: Walk 10, trot 5, walk 2, trot 5, walk 10. This can be done daily, but horse needs a couple days off
7-10 weeks: Walk 10, trot 10, walk 2, trot 2, walk 10
10-12 weeks: same as above, but add in 5 minutes of canter

It is at the second increment of rehab that I felt problems both time with this protocol. My horse had suspensory fiber damage, no tearing at all. The first time he had a big lateral spook and went lame. Vet told me to give a week off and try again. He was NQR. I consulted a specialist that said he needed special suspensory shoes and 8 weeks more weeks of walking and no turn out.

Went through it again after the 8 weeks, and horse felt really good into the 6th week. It was at that point he started backing down.

I honestly think he’s body sore. From moving differently and being out of shape. I’m rolling out of the 9th month of rehab/layup for right now. I backed his work load down and got chiro and acupuncture going into the 7th week.

I’m doing 7, 8, 9 minutes of trotting through the week to try and bump him up more slowly. I’ve also given him some more days off, because I do think he is sore. It’s a lot to get back into work like that after being a couch potato for so long.

So, my advice is never to push. Take your time. You had a significant injury, and ligaments can be very slow healing.

No lateral work, minimal circling, and I agree with not cantering corners for a while.I think you’re safer starting to jump small things than you are to add lateral work.

I would walk up small hills for where I am now. As long as you’re not walking up an uneven mountain, small hill work should be OK.

Good luck!

[Jax]

I agree with everything Sansena and tipzythegreat said. I’ve done 5 rehabs for my (now-retired) boy, ranging from short and sweet to long (and a bit painful), and everything they’ve said applies.

Things I will emphasize without going into the specifics of your plan:

• Your horse will definitely feel a bit off/ouchy the first ride or two after adding time, so plan accordingly with any sort of maintenance and body work, as well as not freaking yourself out when he feels less than fabulous
• Don't jump into adding time just because the calendar says so. When you're ready to add from the initial 5 minutes I might do something like this: 6 minutes, 5 minutes, 6 minutes, day off, 6 minutes, 6 minutes, day off, 6 minutes, 7 minutes, 6 minutes, 7 minutes, day off, etc etc etc. (writing this out it looks insane, but hopefully makes sense)
• Yes you should avoid circles but...it's literally a reality of riding in a ring, so don't drive yourself absolutely insane worrying about trotting through corners (when I first rehabbed mine I fretted endlessly that he had to turn half a 10 metre circle for me to go from gate to mounting block - it was unnecessary fretting on my part considering he lived outside and was definitely walking tighter turns than that out there)
• I said I wasn't going into the specifics of your plan but: I have never had a rehab plan that allowed for me to canter before I was *at least* doing 20 minutes of trot, often 25. I've rehabbed under two vets, both very good but neither one the end all and be all of sport horse vets and I can't imagine them prescribing such low trotting requirements before cantering...I would really reconsider that part
• Walk walk walk walk walk walk (that's it, that's the entire thought)

[IPEsq]

I also wouldn’t canter so early on. Don’t forget too to listen to the horse. Is he still getting tired at the end of a ride? Then it’s not time to increase intensity or diration. Get him comfortable with each step. Fatigue causes reinjury. Also for sure keep an eye on the whole horse.

Ive rehabbed a hind suspensory before and we did not add hills until the horse was in pretty normal flatwork on flat ground.

[quietann]

All good advice here. I took my mare’s rehab after suspensory surgery very slowly. I was given a set program, and followed it - much to my vet’s surprise as he has found that more people rush rehab, so he tends to prescribe a very conservative program, expecting that people won’t follow it. There were a few points where things stalled out, and if that lasted, I got the vet out. E.g. after one stalling-out, we added rear shoes, and that did amazing things.

(The first time I got on her, after 9 months off, we had gotten up to hand walks of 45 minutes, but trucking me around at the walk for 10 minutes was almost too much for her.)

[joiedevie99]

That definitely sounds early to canter.

My vet’s standard plan for serious injury rehab is as follows:

Hand walk 2x/day for 5 minutes each. Add 5 minutes per week.

Start tack walking as early as possible, assuming the injury is stable and healing (this is usually month 2 to month 6 depending on injury).

Build up tack walking from 5 minutes per day, adding 5 minutes per week until you hit 45 minutes. Maintain 45 minutes of walk per day until the ultrasound is clean and the horse is sound.

Then start adding 2 minutes of trot per week. 1 minute each direction, broken up further with walk breaks if you need to. Only straight lines, walk all turns.

Around week 4, we usually start trotting giant ovals (no real corners). Around the same time, we start incorporating some very gradual outdoor terrain at the walk.

When you finish 8 weeks of trotting (16 minutes), recheck ultrasound to confirm no negative changes. If ok, keep adding 2 minutes of trot per week until week 10 (20 minutes). Week 11, start adding 2 minutes of canter per week. Around this time we might ride some very large circles too, still no real corners, no lateral work, etc.

Once you’ve been cantering for about 8 weeks, and the re-check is still good, you can start thinking about real flatwork with corners and circles, maybe some trot poles, or trotting a hill.

[RedHorses]

The number one piece of advice I have is you increase EITHER time OR effort, not both.

Specifically if you want to increase your trot time, then decrease the walk time. If you want to increase your ride time, add walk time. You are doing W27, T3 right now. To increase the trot to 5 minutes you might go W25, T5 or a more conservative W26, T4 first.

When I’m putting a horse back to work I will alternate between lengthening the ride and increasing the work intensity. For example I might walk 2 more minutes on Sunday, repeat the same routine on Monday and Wednesday, then convert two walk minutes to trot minutes on Thursday, and repeat that routine on Saturday. If I only managed three rides that week I would only increase the walk time, and do the walk time to trot time conversion on the next increase day. When I did only manage three rides in a week I typically didn’t do both increases in the following week.

Number two is to really learn your horse’s tells. Really focus on how he feels, how easily he moves, how willing to go forward, how much effort he’s expending. This will allow you to account for footing changes, slope changes, temperature changes, and so on. Walking in mud, even if not deep, is more work than walking the same track dry. Wet sand vs dry. Hot day vs cool day. Hacking out - up, down, obstacles, etc. As noted above, hand walk vs ridden. All will affect how hard your horse is working. If you tune in and learn the subtle signs of your horse getting tired then you will be able to stop before your set time for the day instead of inadvertently doing too much.

As it happens I am rehabing an injury right now, though it is cartilage rather than active tissue. I have an Equestic clip and I am referring to the analysis it is giving me very carefully. The symmetry analysis tells me which trot diagonal has a longer airtime, harder landing, and stronger push off. I’m primarily looking at how the landing and push off are trending after each ride. The clip also gives me the data on time spent in each gait, impulsion (in G forces) in each gait, and tempo (beats per minute) in each gait.

I can see that when I rode two days in a row and cantered the first day he was landing softer on the injured diagonal, and pushing more with the good diagonal. When I did two days of trot in a row (with no or well under a minute of canter) that trend didn’t happen. Yeah, I quit cantering for a bit and stuck to walk trot for a week or two before starting very brief bits of canter again.

The sort of measurements are far more subtle than a rider will notice - first day with canter is 3% heavier on the good diagonal, and the second day is 5% for example. I am really liking this level of detail. Without it I might have cantered for several more days before the uneven landing and push off became noticeable. Having the quick confirmation of my thinking the canter was the culprit (it could have been too much time for consecutive days) was very helpful too.

Our rehab has been out on the trails, fields and roads which meant my other app has been helpful as well in giving me time, speed, and distance (Caynax - non social media linked activity tracker) so I can see if he was slower or faster on the given day. A slower second day might suggest too much work the previous day.

Take it slow. Suspensory injuries are easily reinjured. It’s worth taking the time it takes. Good luck!

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[Frivian]

Thanks so much for all the tips so far. So it seems like everyone is saying similar things but the exact plans are varying in each response.

It does seem like the consensus is to wait on the cantering for a bit. I am certainly willing to wait as long as possible. Let me clarify a few things:

1. The last ultrasound (taken after we had been trotting for 6 weeks already) showed almost complete healing in the ligament. There was one rough area and some scar tissue. Mostly the fibers were aligned very well. The vet said that at this point she doesn’t see a need to keep ultrasounding regularly unless we are concerned.

2. Due to the nature of his injury, there is no intention to return him to his previous job (training level eventing). He will do whatever he’s comfortable/happy with. He’s 15 and owes me nothing - I just want him to have a job and be able to enjoy riding him in some fashion.

3. We have been very careful with his rehab and taken things pretty slow - 3 months stall rest with only 2 5 min handwalks a day, then giving him outside time in a pen for several months, slowly increasing his turnout time and eventually the size of his paddock. His handwalks were built up in the spring to summer months eventually to 2 20 min walks a day plus 6 hours turnout in a small field. I got on him for the first time at 8 months post-injury this past summer.

4. The only time I’ve literally felt him get tired at all was the first day I got on him. He actually gets fit very easily so honestly, he is not tired with what we’re doing. He has felt great almost the entire time - there have been a few moments of stiffness here and there but not much at all.

Here’s how our rides go (and I have trainer doing 3 rides a week on him as well):
During the week, he usually gets 4 rides. We will do a 15 min walk warmup, then do the trot sets. Right now he’s up to 4 laps (2 each direction) trotting in the arena which adds up to almost 3.5 minutes. We do a lap, then walk a lap, then trot the 2nd lap. Then change directions and repeat. Then finish up the 30 min walking. The trainer does all of this in the arena, and I do my rides starting in the arena, then move outside after the last trot and walk around the outdoor grass jump field.

Then on the weekend, I will come out one of the days and do a longer walk around the farm - when I say “trails” I mean like, basically following alongside a gravel road (on the grassy part) that borders the farm. It’s mostly flat, with some gentles slopes, and very good footing (it’s been extremely dry here so there’s literally no mud or soft spots at all). Last weekend I did 35 minutes of this hacking with a couple of short straight trot stretches thrown in. It’s good for his brain and it seems to be helping his fitness.

We will keep the amount of time that we’re trotting the same for 2 weeks, so about 8-10 rides. The first week that we introduce the “new” time, we basically just do 4 extra long sides and skip the short sides. Then the 2nd week, add in the short sides so it’s 2 full laps. So next week will look like this:

walk 15 min
trot 2 full laps one direction (1.5 min), with a short walk break in between laps
walk a lap
trot 2 more long sides that same direction, walking the short sides (adds about 45 sec more of trotting)
walk break (2-3 min)
change direction
trot 2 full laps the opposite direction, with a short walk break in between laps (1.5 min)
walk a lap
trot 2 more long sides that direction, walking the short sides (adds about 45 sec more of trotting)

walk the rest of the 30 min

so this will get us to 5 min of trotting. Then the following week will be the same length of time trotting, but we won’t walk the short sides (will trot the full laps) and may eliminate the short walk breaks in between the first 2 laps.

Does this make sense?

I am thinking we will wait until we’re at least at 15 min of trotting total to canter and will obviously only canter the long sides to start. We will handle adding canter time the same way we’ve done trot. We will also obviously step back immediately if something feels off and the vet is literally just a couple miles down the road.

I’ve also been making sure to handle any body soreness since he’s been off for so long- we have done some acupuncture, a course of Adequan for the joint, and his farrier is working directly with the vet to ensure his feet are perfect (he is wearing a bar shoe on that hind leg). We’ve come much farther than I ever thought we would, so I am pretty much willing to wait as long as I need to to ensure his soundness and happiness.

[OutsidersOpinion]

I’ve rehabbed several horses and also agree wait to canter- usually I canter at 20 minutes of trot work and start with 2 minutes of canter and work up to 5 minutes the first week, then continue adding 5 minutes each week gradually until I am up to 20 minutes of canter.

I continue to do 10 min walking, 20 minutes trotting, then canter, then 10 minutes walking.

At 10 minutes of cantering I add in lateral work at the walk

At 15 minutes of cantering I add in circles at the trot

At 20 minutes of cantering I add in lateral work at the walk and trot

After 2 weeks at 20 min walking, 20 min trotting, 20 min cantering I start cantering poles, adding in counter canter

A month after that I start jumping and work gradually up to my intentions

I disagree that horses will be not sound when adding in work- that has never happened with me before with a horse that was fully ready to return to work. All the horses I have rehabbed have been 100% sound the entire process and returned to work at the same or higher level than before. To me if they are not sound when rehabbing they were not ready for more than tack walking