Tips on rehabbing Chronic Active Proximal Suspensory Ligament Desmitis

[Suregotashot]

Hello! I am looking for some tips on rehabbing my horse, as this is my first go around with this kind of injury. He is a 14yo OTTB who I have had for 7 years with no previous injury to the hind end or suspensory ligaments. He does have mild navicular changes which have always been easily managed.

We took him to the clinic earlier this week because he was still lame after we injected his hocks a week before. Before that, he had a week off. After Evaluation, he has a very sore back, a 2/5 lameness up front (vet thinks this is secondary due to putting increased weight on the front end) and a 3/5 lameness on the left hind. After ultrasounding, (I am quoting the vets case write-up) “a mixed echogenicity pattern to the proximal suspensory without evidence of fiber disruption and consistent with chronic active suspensory desmitis and/or reactive osteitis” was found with similar findings found on the right hind as well.

He is having 3 rounds of shockwave 2 weeks apart, stall rest (or CALM individual turnout) and reevaluation in a month. Eggbars are being put on his hind legs.

I am wondering if anyone knows anything about also using good old ice or cold hosing, standing wraps, etc. I also was looking into equitape and I have BOT Hock wraps and standing wraps that I can use. I ordered the supplement SmartTendon because it had such great reviews.

Also, what are some good ‘back into work’ rehab programs? Trying to learn as much as I can.

Thanks in advance!

[Foxygrl516]

Hi,
My guy has the same thing. My vets here recommended surgery to nerve the suspensories but I wasn’t a big fan of that idea (just felt like they weren’t thinking outside of the box at all and I don’t want to nerve a talented 9yo).
So I called Dr Newton at Rood and Riddle in KY as he has been refining his research on this problem for years. He told me (over the phone without having seen my horse) everything about my guy and how he goes and how he is muscled. He went on to explain that nerve pain in my horse’s poll, back, and sciatic area are the reasons for the stress on the suspensories. So I loaded up and hauled 8 hours to KY where he confirmed everything he had told me on the phone. He injected my horse’s nerves with 3 different medications, one of which basically numbed those nerves for 6-8 weeks, and he taught me his rehab regimen for the issue. Basically the horse gets lunged every day in a contraption that encourages him to stretch down at the poll and lift his back. The idea is that with the pain gone, he has to relearn how to move and how to lift his back so that after a couple of rounds of injections he will be strong enough to not have pain. The best part: THE SUSPENSORIES RESOLVE THEMSELVES bc the stress is taken off of them when the horse travels properly through his back.
We also started him on Body Builder supplement and added triple crown 30% protein to his normal feed (legends performance with cocosoya oil and soaked alfalfa cubes).
We are 6 weeks into it and he is sound and getting stronger.

Dr Newton has a horse if his own w the same problem. He started this protocol w the horse last November and w methodical rehab the horse was running training in April and prelim in the summer. He has lots of cases of success stories that are incredibly encouraging. Hope you will consider seeking such treatment for yours! He has made a believer out of me!!!

[TWH_Girl]

I used PRP for medial patellar ligament desmitis. It seems to have helped as horse has started back to light work and rehab. The other thing I wouldn’t hesitate to try is laser therapy. I’ve heard more positive about that than shockwave. FWIW as well, I added HylaSport CTS for him as well as it supports connective tissue.

[mvp]

[QUOTE=Foxygrl516;8976526]

So I called Dr Newton at Rood and Riddle in KY as he has been refining his research on this problem for years. He told me (over the phone without having seen my horse) everything about my guy and how he goes and how he is muscled. He went on to explain that nerve pain in my horse’s poll, back, and sciatic area are the reasons for the stress on the suspensories. So I loaded up and hauled 8 hours to KY where he confirmed everything he had told me on the phone. He injected my horse’s nerves with 3 different medications, one of which basically numbed those nerves for 6-8 weeks, and he taught me his rehab regimen for the issue. Basically the horse gets lunged every day in a contraption that encourages him to stretch down at the poll and lift his back. The idea is that with the pain gone, he has to relearn how to move and how to lift his back so that after a couple of rounds of injections he will be strong enough to not have pain. The best part: THE SUSPENSORIES RESOLVE THEMSELVES bc the stress is taken off of them when the horse travels properly through his back. [/QUOTE]

Wow. That’s really interesting and useful. Thanks so much for posting about your experience in such detail. It’s nice to have an idea for taking care of this injury.

[silverdog]

foxygrl - how did Dr Newton diagnose the nerve pain? I’m curious because I have a lease horse with persistent low back pain. Back xrays are normal. Gets acupuncture regularly and the vet is stymied as to the underlying cause. He is not lame but seems weak behind. Very capable jumper but dressage seems nearly impossible and he is reluctant to use his back correctly. his back mobility is good though if I scratch his belly.

[Samantha37]

I have a now 13 year old OTTB who 6 years ago was diagnosed with proximal suspensory desmitis in both hind legs - HUGE holes in both suspensories. The vets told me that the surgery (fasciotomy with PRP and neurectomy) is the best option. I consulted another vet friend of mine before doing the surgery and she concurred that is the current gold standard for hind limb suspensory injuries.

He was great for 6 years until this past October when he aggravated the scar tissue around the left hind previous injury and became lame. My vet said this is about the time the nerves grow back so it makes sense that he was lame due to angry scar tissue. The ultrasounds are actually fairly normal for a horse his age/size/work history and the scar tissue is minimal but apparently enough to aggravate (by being stupid in the field!)

I use Horseware IceVibe boots and Back on Track quick wraps (vibe boots after work, BOT boots when he is stalled for prolonged periods of time).

In the 6 years post op before he aggravated the scar tissue, we did Novice level eventing, the 3’ jumpers, and were schooling 3rd level dressage (showing 2nd). He is in the middle of rehab right now and the vet feels confident he will get back to working 3rd level.

I would do the surgery (neurectomy included) again in a heartbeat.

MTA: I also work in equine insurance claims and the surgery is recommended a LOT all across the world.

[merrygoround]

Here is a lot of reading on the subject.

http://www.chronofhorse.com/forum/showthread.php?271451-Proximal-Suspensory-Surgery-Advice-Updates-at-end&highlight=Proximal+suspensory+surgery

[Foxygrl516]

[QUOTE=silverdog;8978118]
foxygrl - how did Dr Newton diagnose the nerve pain? I’m curious because I have a lease horse with persistent low back pain. Back xrays are normal. Gets acupuncture regularly and the vet is stymied as to the underlying cause. He is not lame but seems weak behind. Very capable jumper but dressage seems nearly impossible and he is reluctant to use his back correctly. his back mobility is good though if I scratch his belly.[/QUOTE]

Sorry, I only check in every week or so. Your lease horse sounds very VERY much like my horse. Mine had the competitive year dreams are made of, but no matter how ‘fit’ he was, he was always weak behind and anything outside of trotting forward and straight in dressage was impossible for him. I spent a fortune vetting him only to be told over and over again that he was “sound” but weak behind or ‘loose’ behind. We were on everything from hock and stifle injections, weekly estrone injections, adequan, previcox, etc. We put the lameness locators on him that detect miniscule differences in gate and even the computer said he was sound. He was getting weekly massages (and I was being told he had no back pain), regular chiro and acupuncture.

When I saw Dr Newton, my horse wasn’t capable of cantering on a lunge line. Not at all. It was sad. Dr Newton showed me how most massage therapists and even vets check for poll and back soreness (my horse didn’t respond at all to any of that). And then he showed me the difference in checking for muscle pain and nerve pain and he barely had to put any pressure on a certain point on his poll and the horse all but flipped over. Same on his back (it’s not just on either side of their spine on the topline, it is about 6-8 in further down more where ribs attach that the nerves run) and sciatic.

Dr Newton travels all over the country treating horses (he is treating mine in N GA this Friday and he is in Ocala right now) so if you can get him near your horse, DO IT

[Foxygrl516]

Just a note: My horse has NO TEARS in his suspensories. There is a huge difference between torn suspensories and chronic desmitis. If your horse has a tear, find a good surgeon and do what your vet suggests. For chronic inflammation I encourage you to look outside of the box

[TrotTrotPumpkn]

I would think lunging (circle) is bad due to the loading of the ligaments? I’ve always been told for suspensory rehab first you do time off and then straight line work on firm soil to start. Lots of walk work, then eventually trot and so on.

Just wondering about that in light of the post about lunging in a frame-system (I assume something like a Pessoa)?

I have an older mare at my place that I got last summer to get in shape and see what was going on with her alleged attitude (to help her get placed as an adoptee) and long-story-short she has thickened hind suspensories (old injuries–no new tears). So I am very interested in this thread!

[Samantha37]

Definitely NO lunging. Straight lines are your friends when rehabbing a suspensory!

[merrygoround]

^ The last two posts are absolutely correct.

[Foxygrl516]

It’s important to realize that every suspensory issue is not the same. If there is any kind of tear or compromised fibers then you absolutely shouldn’t work in circles. My horse had symmetrical bilateral thickening due to nerve pain in his back causing him to stress them.
We had a recheck yesterday with Dr Newton and after one round of nerve injections and 7 weeks of lunging in the rig, he had almost no nerve pain. He also flexed completely sound on all 4 legs (that’s a first) and his ultrasounds of his suspensories were both completely normal. I’m thrilled!!! We are going to start incorporating poles one pole at a time in his rehab and in the next month or two he will start doing his rehab under saddle. But he is well on his way to being sounder and stronger than ever and his suspensories, which were thought to be the primary issue originally, are no longer an issue at all and they are completely perfect.

If horses teach us anything, it is to keep an open mind and learn that not all horses or injuries are the same.