Suspensory rehab- OTTB, need advice

Hello - my 7 year old OTTB mare was diagnosed with mild/moderate proximal suspensory desmitis of left front in August. We have completed 3 rounds of shockwave and 90 days of stall rest, just started tack walking. Vet still says no turnout and doesn’t give me a plan to return to turnout. I disagree, we have access to a small rehab paddock where we board and I want her out now a couple of hours a day.

My mare has reared on me during handwalking a handful of times and is very spooky under saddle. I’m in the midwest and the cold/wind has not helped to say the least as she was more manageable during the summer/fall. She is currently sound and suspensory is much improved last ultrasound.

I’ve had this mare for a little less than a year and while she is a bit anxious she has never been dangerous. Honestly I don’t know know how I’ll survive the whole winter at this rate. Any advice for those who have been through rehab/stall rest with a young Thoroughbred? I will add she’s on 2.5mg of reserpine daily and it doesn’t seem to have any effect.

Here’s the study and rehab protocol I’m using on my mild front suspensory horse.

He’s in a stall with attached run, 12x24, except for his workouts. He will not go into regular turnout until after we’ve completed the rehab (8-12 months out) and we see a healed ligament, at which point we will slowly increase his space to keep shenanigans to a minimum.

A properly sized rehab paddock that isn’t going to let her work up steam and reinjure that leg isn’t going to make her much more calm than she currently is. It can help her mentally but you’ll still be flying a horse kite. Doubling up short acting drugs like ace or dorm with the long term one (ask your vet first) can make a huge difference too.

If despite everything you’re still having problems keeping her calm and mostly earthbound, have you looked into rehab barns? A specialist barn has the experience, staff, and facility to handle intractable rehabs and they do it all the time. It’s very nice to know your horse is in good hands and not have to go out 2x a day for a year. Totally worth the expense and also peace of mind knowing I’m not asking my regular barn staff to walk a firecracker out to a paddock daily.

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As a general rule, no turn out until the horse is in full flat work. Walk/trot/canter. Small turnout areas can be worse in some cases, as the horse can really get to making some tight turns if they get wound up. Not good for soft tissue rehab.

The horse would also need to be supervised the entire time she’s out. What happens if she starts to loose it in turnout? Would the person responsible for bringing her in be able to catch her and bring her in safely?

If it were me, I would be looking at alternative management ideas in order to get the horse and rider safely through this part of rehab, vs altering the rehab protocol.

I may:
Speak to the vet about increasing reserpine. I’d have to look up the dose, but I think that’s fairly low to middle of the road and there is room to increase.

Speak to the vet about xylazine for hand walking and/or tack walking

Change her blanketing. People often over look it, I think, but I’ve changed the exuberance of more than one horse rehabbing by just blanketing up one level than I would normally. Like a medium instead of a sheet or heavy instead of a medium. The horse doesn’t need to/shouldn’t sweat. But if they feel like it’s 60 or 70 vs. 40, that can change them enough. This might include a quarter sheet for walking under tack even if I wouldn’t normally.

More hand grazing/getting out of the stall. The more they do it, the better their brains are, in general.

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fivestrideline - I’ve read this is an excellent rehab plan a lot of vets follow. I was hopeful since her injury was mild and not a tear we wouldn’t be rehabbing this long. There is a rehab facility that is run by a vet but it starts at $1600 and only includes daily hand walking, no meds. I may have to consider it as an option as we get farther along into winter.

You’re right, I’ve thought about the supervised turnout problem. She wouldn’t be supervised. I think I made it this far because it’s been warm for this time of year and I was able to supervise her in the small paddock for about an hour a few times a week and she would quietly eat hay. I also hand grazed every day. Today it was only in the 20s and wind was howling and I didn’t have a blanket on her since it’s decent in barn but that’s a good point. I will blanket her tomorrow. I will also increase the reserpine. 2.5mg is the very minimum so I will try 5mg which vet said was ok. I do have Ace tabs for hand walking but I only give her about 20mg. I’ve been going once a day but maybe twice a day to get her out will help get us through winter. Thanks for the ideas.

Mine is solidly a mild strain/disruption in fibers (so not exactly a tear), but the rehab time and protocol is the same. Mainly because a mild strain can turn into a severe tear so easily and my horse is an idiot in turnout when the weather turns.

I was lucky to find a small private rehab program for half the number you were quoted (no drugs but all the handwalking and riding and feed/care), so maybe there’s another option if you choose to go that way.

Regardless, I’d do what the vet who has actual hands on your horse suggests, but I wouldn’t rush the protocol or go to any turnout until the horse is wtc and ready to start jumping/lateral work/racing type work. Increase the reserpine and up the ace or try dormosedan, add some boredom busters to the stall, on vet approval try some calming supps that would test. Maybe do some clicker training in the stall or something to help tire out her brain, if you have the time.

Drugs.

More drugs.

Do not come this far to come this far. What I mean by that is, just because she seems okay to be turned out in small increments does not mean that she physically is. If you decide to chance it and she ends up re-injuring herself, the related rehab will start you back at square one and you may have even more problems. Additionally, being out of work this long will lead to weakness in other areas that may also be prone to breaking down if you push too much too fast or let her get loose.

My horse has been rehabbing a DDFT tear since July. We just started back under saddle recently. I probably won’t entertain turnout until well into next year. He has a salt block, a jolly ball, a HorsLic, and whatever else he needs to keep him entertained. He also has copious amounts of drugs if he’s getting too fresh and I’m not afraid to put a chain on him if I think he might feel like flying that day. I’ve had this horse for ten years, I adore him, and my fear is if we let him go too soon and don’t take it seriously - he’ll re-injure the area and be done for good. A suspensory injury is career ending for a lot of horses. The fact that you’re able to rehab it is very lucky; stick to the plan or send her somewhere that can so that you have a nice, sound horse for years to come, even if it sucks in the meantime.

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Phew, my suspensory horse would’ve committed suicide under this protocol. He was under guidance from one of the top soundness centers in the country and went outside from day 1, with ace as needed.

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No help but word of hope: our best 3 Day horse came to us with a healed bow, and continued in the upper levels Intermediate and CIC2 for the next 14 years finally retired to pasture for another 10 years. During his 3 day career which included 150 horse trials, many dressage shows, and o/f shows, the horse bowed three more time: he had a tendon issue in all four legs and still was sound. He retired sound at 21–ultimately his demise was due to arthritis and cribbing. He lost most of his teeth and was a challenge to keep weight on. So my point is that horses do recover from tendon injuries.

OP could you talk to your vet about using trazadone in place of or in addition to the reserpine? Vets in my area have moved away from reserpine as a long term sedative for rehab and have switched to using trazadone with great results.

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My last horse was like this, and Fluphenazine saved us. He had shots every 5-6 weeks, and it make him sane enough to handle during a long rehab.