Recovering from Collateral Ligament Injury

[omgtb]

[QUOTE=beowulf;8858991]
In reading I got so hopeful and excited for you until the end. So sorry OP.

For what it is worth, I have a gelding now that had a medial & lateral full collateral ligament rupture that he raced on… He wasn’t even expected to come back sound. I tried 4 months of stall rest (they wanted longer) and he tolerated it because he’s a good soul, but wasn’t happy.

I ended up putting him out 24/7 in full turnout after a month of a ‘medical paddock’ because he behaved much better if he was allowed to move around.

He has been in full work as an eventer since 2014.

I have heard great things about the cold laser as well.

Chin up! Jingling for a full recovery.[/QUOTE]

Haha! Thanks! Seems to always be the way it goes! Great to hear about your guy, though. Love to hear when turnout worked. Cold laser is a wonderful tool–I use it on just about everything. I’ve been using cold laser and massage on some Great Dane puppies who have developmental deformities and were unable to walk and they started walking again–one of them now runs, plays and does stairs, even.

The horse used to injure himself all the time, but never anything serious. Future jumping is out for him mostly because of the re-bowed tendon, not the collateral ligament. But they are likely connected, as his front end conformation isn’t super, so for longevity’s sake, it’s a flat future, should he come sound enough to have a job again. Thanks for the supportive thoughts!

[omgtb]

[QUOTE=Hawks Nest;8859019]
So I am actually dealing with a rather severe lateral collateral ligament strain (no visible tear on MRI) and I can say that it is better to go very very slowly than to try and rush things.

My guy initially went quite lame but showed huge improvement in a week, we figured mild strain to the upper soft tissues of the leg and carefully put him back into work. Residual lameness that he would work out of was attributed to a slight shoulder strain. He showed on this, went XC schooling, etc and was working incredibly well.

Then a month later he had a few days off (normally he never has more than a day off) and came back feeling odd (but not lame). Then after jumping he was incredibly lame at anything more than the walk. That was when we were able to actually diagnose it, and the MRI showed that most of the damage had been done around the time of the initial lameness. He got a PRP injection into the site and has been in a medical paddock since the end of july, a few weeks ago an ultrasound showed very little improvement (4 weeks after the PRP injection), but the hope is that in another few weeks he will be able to increase his turnout size with the plan of him being in a large pasture for the rest of the winter.

My vets think he will easily return to full work in the end, although I will likely restrain from eventing him for fear of reinjury on the uneven terrain (but he should be able to return to jumping). I’ve got a thread about it somewhere (haven’t updated in a while)[/QUOTE]

Funny you say that about the quick improvement/mild NQR stemming from shoulder. Apparently with collateral ligament you do get quick improvement early on, giving a sort of false sense of healing, and I was sure this was a shoulder injury at the beginning. Even started to worry about neck and withers, etc. Fortunately(?) for us, my guy went dead lame quite immediately with no hope for sitting on him (despite one vet’s advice to ride him until it was either better or worse). It’s interesting how functional they can be with this kind of injury. PRP has mixed results over the long term, so I haven’t really tried it, but I like the supporting studies done for laser in human medicine leading up to its use in veterinary medicine. I wouldn’t do it if I had to have someone come out every day, but it was worth it for me to invest in one as it has paid for itself many times over. Once I knew where to point it (thanks to the nerve block) the subsequent improvement was exponential–supporting both the diagnosis and the laser’s efficacy. Prior to that I had been using it higher up on the leg and not directly on the foot/hoof. We’ve had no issues with full turnout as that was actually where he got most of his improvement, but acted the fool when turned out alone in his small space. I can’t save him from himself, but it was nice to know that full turnout and time really did help him. Wishing the best for your guy and that we are both bringing our horses back into work in the spring! At this point, that’s about as soon as I think I would even try again. Where we are doesn’t have an indoor anyway, so the temptation to try sooner is voided by weather. If this was just a collateral ligament tear and not that on top of previous SDF injuries, jumping might have been in his future. He can still pop over a log or some such if he ever gets sound and fit. Goodness knows his aerial antics on his own time are inspiring.

[Write_amp_Ride]

omgtb, you said your horse’s injury was inside the hoof -I didn’t think the cold laser could penetrate that deeply. I’ve tried doing my own research on this and there’s a lot of info and even more marketing hype. What unit did you purchase? Thanks!

[omgtb]

@Write&Ride

omgtb, you said your horse’s injury was inside the hoof -I didn’t think the cold laser could penetrate that deeply. I’ve tried doing my own research on this and there’s a lot of info and even more marketing hype. What unit did you purchase? Thanks!

There are different wavelengths, but the standard 880nm and 660nm combo is sufficient for just about any soft tissue application. I focused the device at the base of the pastern, between the bulbs of the heel, but also move it around the outside of the hoof. I use a 13 diode unit from Emerson Worldwide–they build them to order and I have used it for years on various animals and humans with excellent results. Just used it to help my dog’s incisions heal up nicely.

As for the injury and its progress, I do have an update and a question I can’t seem to find a direct answer for:

Since my horse severely re-injured himself in September, I am treating that month as the start of our current rehab. As such, he was out of work completely in a small paddock all winter. He did his own airs above the ground now and then, but with no ill effect.

He did something else funky to his left hind in turnout, but that resolved uneventfully. Just prior to the LH injury I had walked him under saddle probably twice, for about 15 minutes each time, as he was jogging sound. Whatever he did to the LH was bothering him, so he got a week or two off again, and by the time the vet came out and saw him on March 6, he jogged in hand very nicely. Probably 99.9% sound. Got the go-ahead to start him up and put the pieces back together.

Well, you know how these things go…walked him under saddle starting with literally 10 minutes. Probably a useless amount of time, but I was gun shy. That was March 21. After a month of walking under saddle, sticking at around 30 minutes each time and him holding up, we decided to turn him out in the bigger field so he could be on grass. He trotted off lame. Very subtle. But lame.

At this point, my inclination is to think that improving his overall fitness with continued walking is the right move. I don’t want to sacrifice the rest of his body for this one part. Restricting him for 7 months and cold lasering every other day didn’t bring him back to 100% (99% on good days), and I figured we should start adding resistance. We stick to flat, firm surfaces and increase time incrementally, adding no difficulty, except the occasional trot step if he gets the wind up his butt. He is off at the trot on a straight line, so absolutely zero turns or lateral challenges. Lameness at trot is probably 0.5/5.

We are now in the second month of walking under saddle, and I’m keeping it around 40 minutes. I guess my goal is an hour, but my question is this:

Were you all walking your horse under saddle like this while they were still lame at the trot? Or did you wait for 100% soundness at the trot before introducing under saddle work? I feel like the answer is that most were probably still off at the trot when walking under saddle, right? Did you add the trot work even if they weren’t 100% at the trot?

I obviously don’t want to do any damage, but I feel like it’s more harmful to let him go without some structured rehab at this point, so at the very least, he can get walking fit. I will probably just try to support him and take it slow until this September and if he’s not 100% by then, take him to New Bolton and see what our options are…knowing that I probably would not subject him to surgery given his conformation, age, and intended future use. But I do want to spare him any lasting damage and discomfort.

[Jungle_Monkey]

I rehabbed DDFT at P2/navicular, medial collateral and distal sesamoid. My horse had a follow up MRI to confirm how things were doing healing wise and he was jogged in hand to check soundness before he started walking under saddle. He was hand walking for 20 minutes twice daily prior to under saddle walking.

[omgtb]

@Jungle Monkey

I rehabbed DDFT at P2/navicular, medial collateral and distal sesamoid. My horse had a follow up MRI to confirm how things were doing healing wise and he was jogged in hand to check soundness before he started walking under saddle. He was hand walking for 20 minutes twice daily prior to under saddle walking.

My horse lives out 24/7, so hand walking doesn’t really apply here, and he already went through all of the stall rest/hand walking things prior to moving to outdoor living…so you are saying you didn’t even walk under saddle until 100% sound at the jog?

I’m getting the sense that most aren’t waiting for 100% in hand soundness at jog to start under saddle rehab because resistance work is key to proper fiber alignment.

[Jungle_Monkey]

Yes, that is what I am saying. He may have jogged sound a month into rehab but we didn’t jog him until we got MRI confirmation that the healing was good.He was at a top rehab clinic along with consultations with my vet and the vet clinic that performed the MRI so we had a lot of input.

I did find that there was some differences of opinion on exactly how much hand walking he should have been doing.

Hand walking really does apply in any case. I asked one vet about hand grazing versus hand walking and she told me that the most important part with hand walking/walking under saddle is the constant movement of the ligament/tendon for a continuous period of time as opposed to poking around grazing, stopping to eat and then moving a bit more. I was also told to do 15 minutes of walking every ride before doing any trotting to warm up the tendons/ligaments.

They gave my horse had 35% chance of returning to working soundness and he did it. We got lucky. To each their own and every horse is different.

[TullyMars]

Jungle Monkey, mine took two and a half years, but he is sound and working about 30 min per day, and we are gradually increasing that amount. I never thought my boy would be sound after that one year recheck that was so negative!

[2horseowner]

My horse tore his left front collateral ligament in 3 places. That was 3 yrs ago, and I did a lot hand walking, shockwave, cold hosing, etc. Once he could walk under tack, I walked the roads. I am old school and believe asphalt is great for toughening up tendons and ligaments. My old instructor was big on this, as the Brits were doing it and still do. Horse is back in full work.

[Jungle_Monkey]

Tullymars,mine is 1 year 8 months from actual injury date and one year this past March when we started under saddle walking. We were very conservative with upping workload as well. Better safe than sorry I say. One of the vets wanted his trot work increased by 5 minutes per week after one month of walking under saddle. I knew this wasn’t the right approach for my horse so I went with the more conservative vet and added more time to that plan.

So happy to hear there are other horses are doing well.

[TullyMars]

JM, I am so conservative that it is sometimes painful, but this is it for him. Otherwise he is done. I just decided that I will NOT be in a rush to get him back. The prognosis for jumping according to the radiologist is so poor, that we have decided to make him a dressage horse. The radiologist is tut tutting my decision to even attempt to bring him back, but he now looks sounder than I have ever seen him. He is a lovely horse and I want to try.

[Jungle_Monkey]

It will only hurt your sanity, your heart, your patience and your pocket book to try. Proving everyone wrong is so satisfying.

Prognosis for any kind of soundness was very poor for my horse but he is lovely too and loves the interaction with riding…not necessarily the work though. I don’t think they can ever be sure either. Every horse is different and I really think sometimes it’s just dumb luck that some get better and some don’t. My mare fractured her hip and pelvis ( possible joint involvement they thought). The vets told me they had never seen it before and I would surely have to put her down. It took 3 years but she came back and is jumping around hunter courses and winning!

I am told we can try jumping with my gelding but I still haven’t decided if it is worth the possible risk and stress for me. I’ll be too worried about not getting the perfect distance and him taking off or landing funny. Might take all of the fun right out of it. We’ll see.

[omgtb]

So did you all start under saddle rehab before 100% soundness at the jog? Sometimes imaging shows total healing but the horse is still ‘off’ a bit, but rehab proceeds anyway, per imaging.

Based on the fact that he was a little dodgy at the trot at liberty, as witnessed in the field, I backed him down from 40 minutes of walking to 25, the only problem is, I don’t want to jog him to find out in a few weeks whether that has helped or not! I would just rather be insanely conservative and cautious. Agreed on the concrete/hard surfaces. We walk a paved and very level driveway to a meticulously managed flat field and avoid the sand of the ring like the plague.

The magnetic boots seem to help more than the laser at this point, which makes me think it’s not active injury causing the ‘offness’ but tightness and discomfort.

Jungle Monkey–not contradicting you, sorry if it sounded that way… I’m sure it would benefit him if I hand walked rather than rode…I meant that in our case, he did hand walking when he lived at a stalled facility, and by the time we moved and put him out 24/7, he was basically in a rest phase–not sound enough to ride, but having reached the end of what hand walking could do for him, we did do some hand walking there, but mostly just rested him, waited for soundness and started walking under saddle. Yesterday, he wanted to trot under saddle, trying to prove a point or something. This is a horse that will absolutely NOT volunteer any more effort than absolutely necessary, especially if he is uncomfortable in any way. If he hurts, he will suck back and sidewind and just generally draw into himself in protest. I get the sense that he feels good, but that the ligament is very stiff and despite our cold lasering and magnetic boots and such, that the fibers are more scar tissue that properly aligned (maybe from having opted to just rest him rather than start the rehab sooner…but cold laser does help create healing that is more like the original fibers than scar tissue, so it must have helped somewhat).

I’m told he opts for a controlled canter to go out to the field … !

I’ve heard people come back to jumping after this particular injury, but in our case, as he’s bowed both front SDFTs (one of them twice) and now this, his jumping career is most definitely over. But he is a lovely, lovely mover and a joy to ride. It would be fun to try dressage or something with him, but I’d settle for just having him sound at the trot. It may never happen, and I’ve accepted that possibility. Just hoping to get a solid answer on what others did for rehab, to make sure I’m not pushing him before he is ready (vet’s all clear was obviously given on a good day), but understanding that every horse is different and my gut feeling is that if I just continue to let him sit, getting completely out of shape will make things worse for him and we will miss a critical healing phase that needs active rehab and resistance. He is a large horse, and I’m a pretty light person, so while I am a burden, as every rider is, I am not an unfair burden, I don’t think. Mostly, I am just trying to listen to him and do what he wants to do, while also trying to judge what is best for him in the long run.

[Jungle_Monkey]

My horse was 100% sound at the trot before we started walking under saddle. That is how all three vets wanted to handle his case.

[silverdog]

My horse had injury to right front foot 1 year ago. Treated that with no riding and small paddock rest for 2 months without improvement - for a variety of reasons decided against MRI so unclear exactly what his injury was. Then he suffered avulsion fracture to same leg at base of knee, and did 2 more mths in the small paddock. Was looking almost sound so sent him off to lovely facility for turnout. He looked on and off lame for months and in December seemed to jog sound and the US showed no serious damage to his suspensory. He will be coming home in a few weeks (still trots sound and is very active in his pasture) and getting his teeth done and shod and then if he jogs sound at the clinic will go to rehab farm for 30 days of Aquatred. Then we shall just do a very slow under saddle rehab to get him going again. Praying this all works out. Good to hear other people going with the just turn them out and see what happens approach. No way I would lock my horse up for months on end.

[omgtb]

I did turn him out, but I also actively cold lasered which made the biggest difference in his initial recovery, as he was not getting any better until we pinpointed the source of the pain and I started lasering that specific spot. In the later stages, I will say the magnetic boots made more of a difference, or are helping equally.

After those nqr steps in the field, I had already backed him down at the under saddle walk, and then gave him a few days off after that day that he seemed funky. Jogged him on Wednesday, and he jogged 99.9% sound, but he did grunt on the first step, which he only does when he has tweaked or hurt something :uhoh:…but seemed no worse for wear after that. I walked him under saddle that day for the backed-down amount of time (and I am super strict about timing) and he was sound and comfortable yesterday. I lasered yesterday and he’ll have a few days off now, possibly including the weekend if it rains.

Beyond just turnout, I do think the walking has made a large and positive difference for him, even if we caught those weird steps in the field in the meantime. I think we will stick with walking for much longer than we planned and with much smaller increases in time. I also only walk him about four times a week, I don’t do every day. If he seems uncomfortable in any way, we step back or give time off. No point in rushing, but we seem to be heading in a direction of steady, if infuriatingly incremental, improvement.

Silverdog–do they think the avulsion fracture was related? DDFT can pull in the foot and shear the bone. Magnetic tendon boots and cold laser made my horse’s recent 75% SDFT imperceptible to vets after healing.

I do wish we had an easier water rehab option for him, but this seems to have worked out okay. Good luck!

[betsyk]

I haven’t read all 12 pages yet, but today the vet is pretty sure my gelding has an old lateral collateral ligament injury that has already led to bony changes near the fetlock visible on radiographs. I wasn’t there when she looked at him and haven’t seen anything in writing yet so I’m going from memory. It’s possible this is almost 2 years old, if it traces back to when he first started feeling off, but he has never been terribly lame - looked like he needed to have hocks injected (and did) but no worse than that. Any thoughts on the likelihood of this ever healing? He’s an awesome trail horse and my preference is to do baby endurance and competitive trail with him. I think I’d go crazy if he could only do dressage. The plan for now is turnout and no riding for at least 3 months, recheck in a month and see where we are. No MRI for us. Thoughts?

[omgtb]

@betsyk

I haven’t read all 12 pages yet, but today the vet is pretty sure my gelding has an old lateral collateral ligament injury that has already led to bony changes near the fetlock visible on radiographs. I wasn’t there when she looked at him and haven’t seen anything in writing yet so I’m going from memory. It’s possible this is almost 2 years old, if it traces back to when he first started feeling off, but he has never been terribly lame - looked like he needed to have hocks injected (and did) but no worse than that. Any thoughts on the likelihood of this ever healing? He’s an awesome trail horse and my preference is to do baby endurance and competitive trail with him. I think I’d go crazy if he could only do dressage. The plan for now is turnout and no riding for at least 3 months, recheck in a month and see where we are. No MRI for us. Thoughts?

About a year late to this, but, did you do any supportive therapies? If they’re sure of the location of the injury, shockwave and cold laser wouldn’t be bad ideas as they would help the issue heal more reliably and with better tissue integrity. Laser is good for chronic issues like bony changes, in any case, and could prevent worsening. Hope he’s doing well.

[betsyk]

A little more than a year later, he’s back on the trail, cautiously. The 3 months of stall rest were miserable and he failed handwalking. Tried to start back under saddle last fall and he clearly wasn’t ready, so negotiated with the vet and turned him back out and promised to do nothing with him til spring. My nice horse came back in 3 days of normal group turnout! I sat on him for 5 minutes on valentine’s day. It was probably April before we trotted. First little trail ride was around the same time. Now it’s the first of august and we’re walking and trotting on trails with a little slope.

Did not do any supportive therapy. Did one Osphos injection last fall when I negotiated to turn him back out. His hocks are really stiff right now but I can’t give him enough work to keep the hocks happy and I’m reluctant to inject. I’ve had a couple of big life changes and have given myself permission to ride lightly when I can and not stress over z really formal rehab program. I think he’s going to be ok. He feels sound but really unfit. Maybe no endurance for us, but maybe just low key trails. Thanks for asking!

[mellsmom]

Kepping them on level ground and good footing is the key to long term soundness. My horse would always struggle when the footing got slick or he had too much lateral movement.