Starting (modified) suspensory rehab - too little? Too much?

[fivestrideline]

I’m about to start rehabbing and I’m not sure what to do - vet advice is different from “published standard treatment” and also I have conflicting issues with the horse himself. I’d love some advice!

My Walking Vet Bill gelding has a diagnosed ‘thickening’ of his front left suspensory, blocks show 70% improvement with foot block, 100% improved with high suspensory block. We suspect he did it April 1 2022, but didn’t get a diagnosis until early June. He’s been on flat, medium sized solo paddock rest the entire time (~100 days since suspected incident, 30 days since diagnosis), while working with a new farrier to fix his feet. He also has some other issues that stall rest/tiny paddock rest would exacerbate - a bit of arthritis, very weak stifles + KS. Currently, he trots off pretty sound in front, but very weak behind.

Vet did not suggest any change to turnout despite some silliness (I asked), but suggested 30 days immediately following diagnosis of hand or tack walking for 30 minutes with Surpass on the leg afterwards. I have not done this, partially due to weather and partially due to being cautious. He’s just been chilling, getting ice and surpass whenever I go out there to groom and practice trailer loading.

I’m planning to start rehabbing officially, just to see what he can do. I’m just not sure if going straight to 30 minutes of tack walking would be too much considering he’s on 12-14 hours turnout? Nothing I can do handwalking can compare to what he does out there puttering around, but the suggested Gillis protocol is (stall rest plus) 15 min handwalking 2x daily for 30 days, then 40 min handwalking 1x daily for 30 days, THEN 30 min tack walking for 30 days.

I’m not a vet, obviously, so I’m just trying to be an informed owner as well as give him the best shot at recovery. He wasn’t doing anything before the injury but I’d love to be able to ride him again.

Should I be insisting on small paddock turnout despite the havoc it wreaks on his back/stifles/etc? Should I follow my vet advice to the letter and handwalk or hop on him for 30 minutes a day? Split the difference and do the 15/40/30 over 3 months while leaving him on turnout? I feel like I’m drowning in “options”!

[Calvincrowe]

We are at month 6 of rehabbing a RF suspensory strain. Did shockwave and PRP. Stall rest, no turnout but handwalking daily. We chose tack walking as horse is much better with that. It was 30 minutes daily for the first 3 months. As her check ups were always positive, we moved to an hour of walking (my god- the worst “trail ride/pony ring” ever May I add, so boring!).

I’d follow vet orders. If vet knows he’s been on turnout all this time then the walking is the next step to get the leg moving. Any other treatment done?

[joiedevie99]

Current thinking is that there is some benefit to slightly stressing the tissues as they heal, to align all the fibers. The hand walking - a decent march, not dragging a fat pony in from the field - accomplishes that. I’d do it.

[fivestrideline]

@Calvincrowe no other treatment done due to finances and the plethora of other issues he has. Shockwave was discussed but more as an option “if you want to “ from the vet. They seem to think it’s the best treatment but he’s got a lot going on so they didn’t push it. Which I appreciate.

I’ll definitely be taking it day by day but I didn’t want to push too hard or waste a ton of time either. Handwalking is so boring for me (he doesn’t care either way… it’s walking) so it’s tempting to get on him. I just don’t want to push it too hard.

[Calvincrowe]

TBH, I think you need to do the handwalking. The ligament needs to move to heal, and move in a precise, steady, repetitive manner— it’s physical therapy essentially, like in a human. Boring, yes, but necessary if you want this to heal correctly and not lead to future issues in the same spot. That’s the advice my vet gave based on the fact my horse’s injury is in the same place as a poorly rehabbed (by turning horse out instead of treating and rehabbing) previous ligament injury.

[fivestrideline]

This is a good point. Vet gave the option (instructions say “no change to turnout. Handwalk or tack walk 30 minutes daily”) but I wasn’t sure if that was provisional for him being unmanageable in hand or that it didn’t matter. I’ve tried to talk to them but am playing phone tag.

I think I’ll plan on handwalking 30 minutes 1x daily for 30 days and see how that goes.

[joiedevie99]

@fivestrideline

I think I’ll plan on handwalking 30 minutes 1x daily for 30 days and see how that goes.

That’s a good plan. I’ve gotten the ok to start with tack walking on a horse that was in full work until the day before. Once the horse has been off/rested for some period of time, I wouldn’t want to start straight away with tack walking unless .

[fivestrideline]

Well, I did two days of 15 min walking (all I had time for), and I think he may have tweaked something. He’s started “toe pointing” while grazing with his bad leg, where he keeps that one out in front and kinda shuffles along as he eats. It’s weight bearing, and he’s not dead lame on it, but just… NQR.

He did canter up to me in his paddock yesterday, and is flinging hind shoes/sliding them off his back feet. Which makes me think he’s out there being an idiot. Barn owners haven’t said anything, but ‘being an idiot’ is normal for him in turnout at this place.

I’m not sure what to do. Call the vet for a recheck ultrasound? Second opinion? Both? I’m so afraid I’m doing him a disservice to his future soundness by him being in the bigger paddock, but the vet seems unconcerned.

[SBrentnall]

My horse was just diagnosed with a small suspensory lesion last week. Vet-advised rehab protocol:

• NO turnout or uncontrolled exercise.
• No work in deep footing - flat surface or level fire roads only
• 30 mins tack walk or walker 2x daily
• Shockwave
• PRP
• Laser

[Calvincrowe]

That’s exactly what was recommended for my mare’s injury as well. Seems to be the standard protocol.

[ndirish07]

My horse had a more significant hind suspensory injury about 2-3 years ago. So keep that in mind…but my horse was not allowed turnout until he was back cantering. He had a tiny medical paddock several months in, but he didn’t get access to even the full (small) dry lot until he was cantering 2 minutes each direction. My vets’ approach was as soon as they’re on their own they will be cantering-- they need to be able to do it in a controlled manner with you beforehand and stay sound before releasing them back into gen pop turnout. (I had the full range of prison analogies for his rehab…). I don’t think you’ll ever regret going slower with a soft tissue rehab. If you don’t think it’s right and want to do a smaller paddock then you can do that. The slow, gradual increase in work is what strengthens the ligament-- not tearing around the field.

[IPEsq]

@ndirish07

My horse had a more significant hind suspensory injury about 2-3 years ago. So keep that in mind…but my horse was not allowed turnout until he was back cantering. He had a tiny medical paddock several months in, but he didn’t get access to even the full (small) dry lot until he was cantering 2 minutes each direction. My vets’ approach was as soon as they’re on their own they will be cantering-- they need to be able to do it in a controlled manner with you beforehand and stay sound before releasing them back into gen pop turnout. (I had the full range of prison analogies for his rehab…). I don’t think you’ll ever regret going slower with a soft tissue rehab. If you don’t think it’s right and want to do a smaller paddock then you can do that. The slow, gradual increase in work is what strengthens the ligament-- not tearing around the field.

This approach is pretty typical for all sorts of soft tissue injuries and long layups. It’s what I generally try to do.

Sure, some horses can live out 24/7 and heal a soft tissue injury ok. But some horses make poor choices.

[erinmeri]

@ndirish07

I don’t think you’ll ever regret going slower with a soft tissue rehab.

This. My trainer’s philosophy is to (paraphrasing here) take what the vet said and slow it down a bit. Worked for my mare on her two soft tissue injuries and seems to be for another one being rehabbed now.

For mine, she got hand walked (drugged) for a time with gradually increasing minutes, then IIRC hand and tack walked drugged again gradually increasing time, turned out drugged (can’t recall when that started, but I think it was early and maybe even before tack walking because my vet said stall rest was counter productive - but I could be wrong), then added trot, gradually increasing work until we were trotting about 30 minutes a day (in addition to walking) before she cantered a step on purpose. Once we started cantering, we gradually increased, but the regimenting went away and it was much quicker than earlier stages if that makes sense.

Overall, taking the slow route is brutal, but I enjoy it. The worst is when you’re at the max trot minute stages because riding takes forever, and you’re doing mostly straight lines and it is boring, and there are a lot of walk breaks. And if the minutes don’t “add up” perfectly, there is a lot of mental math. I consider my Apple Watch to be indispensable when rehabbing horses, as it helps to set timers. Just pray you have good connectivity.

Similar slow and build experience for the more recent horse I have been helping with, though the early stages were a bit different (I think it took longer for that horse to get turned out). My horse had to stay on ace for a long while to keep her sane in turn out, in hand, and under saddle. Other horse is quieter, so it was off ace pretty early after it started trotting in earnest, and if my memory serves, that horse started turnout later but again, had a different soft tissue injury. Both were in very small dry lots.

I have rehabbed check and SDFT and hind suspensory, and fully believe slow is the way to go, but also that they need to move. One thing I wish I had in my arsenal recently that I had when I was a kid with my first check ligament mare is swimming. That was cool. That said, when I was a teen we didn’t have shockwave, stem cells, PRP, etc.

Anyways, my experience is go slow, build (slowly), and be patient.

ETA: A few additions:

1. I spent a LOT of time in the early stages (especially before resuming turnout) hand grazing.

2. I think rehabbing my mare made her and I closer.

3. I didn’t have it at the time, but I now own the Back To Work book. I don’t LOVE it, as I felt the case studies were repetitive and didn’t encompass a broad enough range of injury, amongst other thoughts… but I think it is a good overall primer. It’s a good place to start!

ETA 2; in early hand and tack walking stages, consider listening to podcasts or audiobooks if it is safe. Trust me, it gets real torturously boring, real fast.

[fivestrideline]

Thanks for all the encouragement to go slower y’all.

I personally want to give this horse the best shot and am willing to do whatever that takes - it’s just my vet and I aren’t quite on the same page. I may talk to them (again), as I quite like them, I just think they don’t have high expectations for his return to soundness (he wasn’t doing anything before, no fault of his own) and as such aren’t really worried about letting him be a poor decision maker in turnout.

[Renn_aissance]

My vet is not a fan of totally discontinuing exercise unless the injury is at significant risk without immobilization. Her feeling is both that soft tissue lesions heal best (minimal scar tissue) under gentle load, and that the rest of the horse’s body is better equipped to support the leg in its rehab if it stays fit. She prefers tack walking to hand walking because she wants the horse practicing a working walk with correct posture and swing from behind. I’ve rehabbed 5 front suspensories on different horses with the horse in full turnout (12-18 hours a day in a large, gently rolling field) and 3-6 months of tack walking, depending on the nature of the injury, before progressing to trot under saddle. All of the horses but one were either naturally reasonable in turnout; the one who couldn’t make a good choice to save his life was paired with a buddy who discouraged his shenanigans. (If the horses weren’t like this, I think she’d have suggested reserpine or something like that.) Each horse has come back well and, knock on wood, maintained well for many years.

All that to say that there are a lot of roads to Rome, but I’ve personally had success with what your vet is recommending. Since your horse appears to be making some questionable choices, it’s worth a discussion about whether to proceed with those recommendations with some chemical help, or change the plan. Do know, though, that these kinds of occasional setback are normal in a soft tissue rehab.

[IPEsq]

Is the horse out with others? I would not sedate a horse in turnout unless he can be alone. Preferably, I would confine him to a very small turnout, alone, and consider something like Trazodone, not reserpine. Speed and height in movement are not your friend for healing a suspensory, so while movement is generally good to encourage the tissue to heal more elastic than if totally confined, it’s not good if he’s ripping around and jumping around. The more outside time is limited, the more you may have to do the controlled exercise (2 or 3 times a day walks for example). If he’s pulling hind shoes being a dummy, I think this turnout situation is not helping.

It sounds like the injury is mild as far as the ultrasound, but it’s going on a long time. I would rather take some risk of quality healing with less movement and get the thing actually healed versus staying at this same phase forever because he’s doing too much in turnout.

[Calvincrowe]

My vet is like Renn’s-- tack walk as much as possible for the first 3 months. My mare is a terrible turnout horse, she spends the first 10 minutes running, bucking, sliding followed by a repeat when it’s time to bring horses in. So she was in a medical paddock after month 5, once she started trotting long sides. She went out sedated the first few times-- because she still likes to act like an ass even in a small space. (Though, never in her stall-- she’s a doll for stall rest).

We’ve had some ups and downs with her soundness while increasing work-- a couple days she’d be sore during or after. So we slow down, return to the previous week’s plan, monitor, send video to our vet for advice. We have just now gotten to 2 minutes of canter. I have no agenda other than return to full soundness and previous level of competition. Mr. Vet says that’s absolutely doable, so we are slow…slow…slow… (and god, yes, it is SO BORING to tack walk for 60 minutes, 5 days a week…the single worst ‘trail ride’ in history. Thank god my horse enjoys my singing, even if no one else in the barn does!)

[Xanthoria]

For timing intervals with music (and no connectivity needed), this app is great

‎Interval Timer - HIIT Workouts

[erinmeri]

@Xanthoria

For timing intervals with music (and no connectivity needed), this app is great

Thank you SO MUCH, I love this! Never occurred to me to look for such a thing for this purpose.

I downloaded the app and created a new “routine” for our current timing. I can’t wait to try it out! I especially love the custom voice to text option. No guessing what to do next. Now I just need to look up BPM for walk, trot, and canter and create a new playlist. Thank you!!

[Xanthoria]

@erinmeri glad to help! That app saved me through a couple long rehabs. My horse even got to know the app’s “ding” for change of gait and would do the needful himself