My 12 year old TB has a small tear on the hind lateral suspensory branch. He also has mild peri ligamentous as well. 6 weeks of tack walking and reevaluate at that time. I’m gutted. I’m getting prognosis from good to guarded. Anyone bring them back to previous levels? He is a modified/prelim horse. If so what is time frame? I’m thinking at least 8 months?
Practitioners skill with the ultrasound varies. Horses individual ability to heal varies. Hind suspensories generally heal less satisfactorily than front. Things happen during recovery - climb the walls, get loose and run. Shake that all up with the wonderful new biological treatments available and good to guarded is about as accurate a prediction as can be made. Hoping your horse makes a good recovery!
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Just coming off roughly eight months rehabbing a strained front suspensory. Hind suspensories typically have a more “up in the air” prognosis which is probably why you don’t have a clear answer. I would assume with a tear you’re looking at more like a year of rehab, but if you’re able to control conditions as much as possible, you’ll set your horse up for the best possible healing!
I found shockwave to be very beneficial. The rehab was painfully boring but, I understand my mare better than I ever.
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Thanks for the thoughts. I’m trying to get my head wrapped around the recovery process but it seems like it is forever. Luckily he is fine with the rest, so far. Currently doing shockwave and trying to find out about PRP or other modalities that might help him come back to his previous workload. I’m reading it’s all about giving them time to heal. I was told that a surgery called Tenex might be a possibility? But the more I read about the surgery, it is for horses that have complete tears and used as a last resort for pasture soundness. I guess I’ll find out more once I hit the first check in a few weeks.
Absolutely. As my vet said, the best medicine for this injury is time. Don’t rush it as tempting as it can sometimes be.
Looking at the rehab from your current vantage point, I remember it being daunting. But it flies. What helped me was to understand the point of what I was doing. That tear will heal, but it will heal with scar tissue which is not as durable or flexible as the original ligament. By being dedicated to a program of controlled exercise, you’re helping that scar tissue form with as much flexibility as possible which makes for a better prognosis. Of course with horses, nothing is guaranteed. But it helped me to remember those painfully boring walk rides are doing something very important.
You’ll get very creative with halt/walk transitions, backing, etc as well LOL. Like I said, I know my mare better now than I ever did before.
I found it helpful to look at future ultrasounds, vet visits, etc as “checkpoints”. So instead of thinking you’re done in a year, the next point is your next recheck where you see your progress.
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I would recommend PRP and shockwave. I had one front suspensory, full tear that that took off part of the canon bone off, heal completely. My mare was hot/difficult/used to tons of turnout and went to a rehab center that used a eurocizer instead of hand walking, which isn’t ideal as she certainly did some bucks in there and it’s on a circle. Then started gradually walk/trot/canter under saddle. But she came back to full work and up to 2nd level dressage (sorry I don’t actually event so not the same as going prelim). I would recommend roughly using something like this schedule: http://www.ckequinehospital.com/files/Rehabilitation_Schedule_for_Tendon_or_Ligament_Injuries.pdf I would assume 6-9 months before full work, but the slower you go at the beginning with walking and trotting I think will pay off. Especially if you have a nice quiet horse! Feel free to PM if you have other questions.
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Hind suspensory, very small tear. Did PRP and shockwave. Horse was off for ten months from competition, First two months was stall rest with hand walking twenty minutes twice a day. Very slow rehab. Horse was competing at prelim, went on to be a successful 4* horse. Can not emphasize enough to take your time.
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My horse tore a lateral hind suspensory branch about 70%, in addition to having a joint infection on that fetlock. Was going training at the time, schooling prelim with a pro. 9 months off of riding (including 4-5 total stall rest, then gradually adding a small bit of outside time in a stall sized paddock). I did PRP but nothing else. After starting back with tack walking, I took every step the vet recommended in the rehab plan and drew it out longer. Taking your time is key. My horse ended up coming back completely sound, but we don’t event at that level anymore because I didn’t feel it was worth the risk. We have done a lot of lower level stuff including some beginner novice for fun and have recently found our home in the jumper ring. As he is much older now I keep the jumps below 3’, but it’s nothing to do with the suspensory.
I have also rehabbed him from a splint removal surgery, and was foolishly less careful that time, which caused him to get sesamoiditis in a front leg, leading to another 2 months completely off and another rehab. It taught me a hard lesson that I’m thankful I didn’t learn during the suspensory rehab - TAKE YOUR TIME.
Some of my key takeaways from all my experiences:
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Have no expectations. If you have goals, you’re more likely to push through something instead of being patient. Long term soundness and healing should be the only goal.
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Pay extra attention to the footing where you’re rehabbing. Deep footing is not your friend. When my horse started tack walking, the only place we had to ride was a relatively level gravel driveway (instead of a soft arena). I spent his first 6 weeks under saddle walking the length of this driveway according to the times set by the vet. I really believe the harder surface helped the suspensory strengthen better in those early days.
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Drugs are your friend …a drugged, quiet horse is better than a reinjured horse, especially on the first days of turnout etc. Similarly, make the environment as quiet as you can. His first 5 months on stall rest were spent at a wonderful rehab facility where he was as content as a horse could be stuck in a stall.
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Listen to your gut. If something doesn’t feel right, it probably isn’t. It took several vets for me to get his sesamoiditis diagnosed. One of the vets (a well known one) told me he was okay to be on full turnout and be ridden…I knew that wasn’t correct so I took him in to a clinic for a better look after that.
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Front suspensory combined with trauma to the knee. Poor prognosis.
First two weeks were complete stall. He could walk to the grooming stall and that was it.
We then started five minutes of hand walking. Next week six. Up to eight. Ten. Etc.
The biggest things… Tranqulizer. Walking under saddle as the weight helps build longer tissue. No circles. Avoid deep footing.
We did shockwaves which I believe very beneficial. The leg was cold after treatment was done.
He did not get turned out until we were up to to a 40 minute ride with cantering.
All rides included tranq as did turnout. We gradually decreased it as his turnout increased.
This was very conservative but he made a full recovery from a poor prognosis. He was a jumper.
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Update. 6 week ultrasound check shows tremendous healing. He was a 3 on flexion 6 weeks ago but now a 1. No surgery is required but vet did recommend 2 more rounds of shockwave. I was always under impression 3 was the gold standard? This would give him a total of 6. Cleared to start trotting. Still no big turnout. We went from a guarded prognosis to good with the lowest threshold of 3 foot or under but feels horse can go back to prelim level. My thought was to rehab him and then give him a few months just on turnout. When realistically could I do that? When he starts cantering?
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My horse had a small tear early in owning him. I gave him a full year. He was just coming off the track so I don’t have anything to compare it to. Six years later, he’s sound as a dollar (touch wood) schooling training but will easily go more. Fingers crossed you have a similar success!
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I’ve always been told they shouldn’t go to a large field turnout until they’re cleared for cantering under saddle in their rehab.
An old fashion time table but it generally is still true today:
Bone injury - B O N E = 4 months
Ligament injury - L I G A M E N T = 8 months
Tendon injury - T E N D O N = 6 months
That doesn’t mean 8 months of stall rest and it doesn’t mean everything is healed at 4 months. It is a time table to help understand that these injuries take time to heal.
The good news is there are fabulous treatments to support the time table that weren’t available 20 years ago. I hope your horse has a full recovery.
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Instead of just turnout after the rehab I would suggest making the rehab longer. Esp since the first parts are the most difficult. Once he is cantering and back to regular turnout, try hacking more or steady but less intense work. You want to keep the ligament flexible and avoid scar tissue that restricts movement because that might lead to reinjury. I posted above about my successful rehab. I had less success with a torn suspensory that treated with PRP, shockwave, rehab, then turnout for 9 months. In that scenario swelling started back after about 3 months in work, almost 1.5 yrs after the initial injury. Of course just my experiences.
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With my mare we did PRP, Shockwave, but I also added Laser treatment. (I’m a huge proponent of laser for superficial and deep tissue injury.) This past time we did two laser treatments a week for 6 weeks, I’m close enough so vet would come out, then I would take her to clinic the other (my remote )day. It was $75/treatment, which in total was more but was easier to stomach paying per session.
Just an update, 3 month recheck and horse is grade 1 lame. Ultrasound shows continued healing. We are now increasing trot with poles and adding canter at the end of the next six weeks. Still no turnout and it’s getting old. Horse is on trazadone but still explosive from time to time.
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This is progress in the right direction!
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At 5 months and the check is great! No overt lameness and s a shows the area completely filled and the attachment at the bone is good. We have another 6 weeks of rehab that includes walk, trot, canter and lateral work.
I’m most nervous on what happens next. The vet indicated he could go back to work and more of the issue, group turnout. My guy is not much of a runner but loves to play and has lots of airs above the ground.
How did you transition from small medical paddock to turnout? I’m assuming drugs will be a big part of it.
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Acepromazine is your friend! It is safe to give IV, IM, or by mouth. If you give it by mouth, the injectable form squirted under the tongue (remove the needle!) has been shown to be more effective than the pills. IM or by mouth the ace will need 30-45 minutes to become effective. Sedivet and dormosedan are also options but for daily use ace is the safest and easiest. Talk to a vet who rides about it. Good luck and be safe!
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Sad update. My horse fell in his paddock and reinjured the suspensory. A bit worse than the original injury. I’m devastated. I’m not going through the rehab again so I’m moving him to a small paddock then full 24/7 turnout. Gonna give Dr Green a try. Other than buying lots of wine, what else should I do for the transition?
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