Rehab and treatment for a superficial digital flexor tendon strain - please share your stories!

[somanyhorses]

Hi Everyone, my eventer has a superficial digital flexor tendon strain in his near fore. He had two big days of schooling in sometimes deep going on Friday/Saturday, and on Sunday morning presented totally sound but with some swelling (no heat) in the tendon region. The vet scanned him on Monday and has confirmed my suspicions, reporting: “definitely at the milder end of the scale - as there is not a single core lesion as such it might be hard to give it a percentage in terms of cross-section. I would describe it as a mild, generalised odoema of the SDFT in the proximal to mid-third of the tendon with a few short focal lesions.”

This is pretty upsetting for me as he is a super horse and going extremely well, big competition schedule planned (and now wiped!) and he is currently my only riding horse. Devastated though I am, I’m relieved that I got him checked out so quickly and I am now looking at a 3 - 6 month rehab rather than a 9 - 12 month rehab and possible career ending injury if I’d kept him in work. He is on box rest for a month, currently being iced 3 times a day, a little bit of bute for a few more days, and is living in his back on track quick wraps. Also getting MSM and Rosehips in his feed to aid with reducing swelling and promote healing. To me, it seems that the swelling has completely subsided which is great news, as I understand that reducing inflammation early is critical for successful healing.

Needless to say I have hit google and this forum’s search function pretty hard and have read everything I can find about rehabbing tendon injuries, and have personally been involved in a few other peoples’ horses’ tendon/ligament rehabs over the years. I’m just after any extra ideas, pointers, advice or stories from anyone who has been through a similar tendon strain. I understand that there is little you can do to speed up healing, instead it is all about quality of healing, and controlled exercise seems to be a big factor.

I haven’t really looked at shockwave, PRP, stemcell treatment etc as from what my vet indicated, my horse’s tendinitis is mild and these treatments are used for more significant tears and lesions. However, happy to hear any advice or stories where these treatments have been successful or recommended for mild tendon injuries. I am located quite remotely and assume my vet probably does not have access to these treatments, however I am prepared to travel and spend money if it’s worth it.

I’m also interested in the controlled exercise protocol. It seems like a lot of hand walking before walking under saddle. I am anticipating a few dramas with this - my horse is an extremely fit, high energy, exuberant type. I took him out of his stable for some hand grazing this morning and it was like flying a kite. He is the kind of horse that is better behaved under saddle than he is in hand, I feel like I have much better control and chances of keeping him to a walk when I’m on his back than I do by his side. I am very light - jockey type weight - and he is a 16.1 reasonably solid thoroughbred. I assume that most controlled exercise plans recommend getting to about 40 mins hand walking then stepping to walks under saddle of only 20 mins, is because the weight of the rider/tack adds extra strain to a tendon? I’m considering getting on him after the first 30 days of rest, and building up from 10 mins a day walking to 30 mins a day walking, is that silly?

When building up the walking under saddle, I assume straight lines on flat ground are preferable… this is another challenge for me as I live in a fairly undulating, rocky area with limited access to flat straight line riding outside of the arena! Is it problematic to do some of the walking under saddle in an arena, avoiding small circles especially at the beginning?

I’m thinking of adding some chamomile to his feed to hopefully calm him down a bit, does anyone have any other suggestions for taking the edge off fit hotheads in stables? I’m thinking I might have to sedate him when he eventually goes back in the paddock… it would be great to hear what’s worked for others.

My vet has recommended one month in the box then he can go back out into a paddock. We’re hoping to build some smaller “day yard” type paddocks within the month (our smallest paddocks are 1 acre and he loves zooming around and fence walking - not ideal!). He has recommended our next scan at 3 months post injury. However I was thinking of getting one at around 2 months, maybe earlier. I’m keen to hear how often others have scanned in these situations, both after the initial injury and throughout the rehab and return to full work?

Thanks in advance.

[AKB]

Be very careful while your horse is on stall rest. He may need reserpine or other meds to take the edge off so you can handle him without getting badly hurt. One of our guys had a tendon injury and suspensory lesions. A few days into the stall rest, he kicked out two stall walls. The vet, a tendon guru, suggested no more stall rest. Instead, paddock rest was followed by an aggressive rehab program. The horse rehabbed well and remained sound for many, many, years.

[equest]

I would suggest you talk to your vet about a sedative. Mine is quiet by nature (to the point where the vet who did his pre purchases said “this horse will need a stick and spur”). He was ok confined to his stall, but once we were hand walking even he needed some Ace to take the edge off on certain days, for hand walking and eventually limited turnout. Some people feed oral Ace, but we just did injections as needed. We are finally at the point where he gets normal turnout with polos. That has changed his attitude back to normal.

I’m in the fifth month of rehab with mine. It can be challenging but your patience will pay off.

[IPEsq]

You may want to consider PRP. At this initial stage, I found it is good at knocking out the initial inflammation. It can also be prepared immediately at the barn from the blood draw. Stem cells take weeks, are incredibly expensive, and require a lab close enough that your vet can pick them up in a cooler the morning of injection. Based on your description of the injury and your location, I’d say stem cells are totally not necessary for good healing.

If you can’t hand walk safely, don’t. Controlled movement is good. Leaping in the air is not. If sedatives help, use them. Otherwise, it is ok to wait until healing is farther along. Ideally, you want to walk, but not if you can’t keep it controlled. It can still heal fine without it. I would not get on until the ultrasound shows good healing. Ideally, you would want him walking at least 30mins a day on a regular basis before you get on.

For my horse with a tendon injury, I had to send him to a rehab facility to walk on a treadmill and have access to a very small turnout. He was just too nuts. Giving him the treadmill to concentrate on worked wonders for him. It gave him a J-O-B in a controlled environment. He started at just a few minutes. Increased time at a rate of only about 3-5 mins a week, walking 5 days a week on the treadmill and after a little while could walk the other 2 days in hand. He kept walking at 30 mins once he got up that high during the time I also got on to ride. I could start trotting under saddle pretty early at this stage. He’d been on the treadmill for 6 weeks before I first got on. I timed my riding so I could get on right after he came off the treadmill, which cut down on some of the under saddle walking time, as he was nicely warmed up. He was comfortably trotting 10 mins almost ready to move up to 15 mins before I moved him out of the rehab barn. That took another 5 weeks but I could only ride 1-2 times a week while he was at rehab. He walked 30 mins on the treadmill that entire time and got upgraded to a little bit bigger turnout.

The initial transition between crazy stall rested horse and legging up is the hard part.

Mine had a grade 1 lesion of the DDFT. Stall rest for 4.5 months. Under saddle at 6 months. No restrictions on flatwork and starting cavaletti at 8-9 months.

[Fergs]

My horse is coming back from a SDFT strain that popped up in August. She was never lame, just a tiny bit of filling that went away in the first week. Like your horse, there was no lesion or tear, just some minor fiber disruption My vet didn’t think that PRP would benefit this particular injury, so we just did ice, poultice, and NSAIDs for 2 weeks and stall rest. I wrapped her every night for the first 8 weeks. I was able to build a little patio off my horse’s stall so she went “out” during the day, but it was very limited. I had to put her on a daily calming supplement and then Ace when I rode, because she was a complete psycho without turnout. I hand walked for about 6 weeks with the chain over her nose and drugs on board before I got in the saddle.

My arena needed sand badly (it was really hard) so I just waited to do that and walked and trotted (when the time came) in there and on the road, where the footing is good. We were so lucky to have a mild winter with almost no precipitation, so I didn’t have to worry much about the footing.

Anyway, her injury is now completely healed and we are ramping up for the season! It wasn’t too bad – I’m grateful that we caught it before it got worse.

[somanyhorses]

Thank you for the support, advice and shared stories everyone! We are now at Day 5 and pleasingly, my horse seems to be settling in to the stabling routine rather than getting worse. He has been good to handle and quite chilled out when he comes out to hand graze, though it is early days! I didn’t mention that he did live in Hong Kong for 2 years when he was in race training, so whilst he has been living out 24/7 with me, he has previously been stabled 24/7. I am fortunate insofar as my stables are quite “outdoorsy”, they are more like small yards with roofs, I only have 2 that are side by side, so 3 of the walls are not shared and are solid mesh from chest height to roof, so they see out and get plenty of fresh air and sunlight. They are just near my driveway, tack room, feed room, and where we tack up, so the stabled horses have plenty to look at, lots of visitors, a great view, and it’s about as “unboring” as stall rest could be. My boy seems to be getting along well with his neighbour, long may that continue!

From reading everyone’s stories (I cross posted on the Eventing forum and had some great input there too) I will get another ultrasound at 30 days and then as regularly as I can get my vet to do so, thereafter, and at key milestones along the way. My vet is an equine vet and does more work with racehorses than performance horses, so has been involved in a lot of tendon situations, however he is probably not the best placed to give me advice on the return to work plan for an eventer, it is good that there is so much great info here and all over the internet specific for eventers. I’ll take all the time we need, no rush.

Unfortunately the way things are configured at my place, we won’t be able to build him a yard off his stable, which would be ideal, but we will be able to locate one nearby and my partner is already designing a portable yard structure that we can slowly extend as he gets further into his recovery, and then eventually relocate down to his paddock so that he can be in a yard within a paddock and then when we do “release” him it’s not as exciting as it could otherwise be! Great advice above about doing hand walks in paddocks, for some bizarre reason I had not even thought of that, but now have realised that hand walking him in what will eventually be his turn out paddock is a great idea and one that will make the paddock less of a hoon place and more of a work place.

I came across a great current thread on the Hunter/Jumper forum about sedatives for this sort of scenario, lots of good ideas to store there. I’m open to drugs if necessary - my safety and his recovery/safety is key! He’s on his chamomile now and I have him on ulcer preventatives (he’s always on those).

Fergs, your horse’s injury sounds very similar in terms of severity to mine. Good luck for the season ahead! IPEsq, congrats on surviving such a long rehab! Good luck with the rest of the rehab for yours equest, and great to hear you had a successful rehab AKB.