PDA

View Full Version : Once a suspensory, Always a suspensory?



eventr4life
Mar. 30, 2011, 11:07 PM
Hi All!
I was wondering - If a horse tears it's suspensory ligament in the front, will the horse most likely tear it again, or have problems?

I've talked to multiple of trainers/vets and they all say something different...

I am bringing back my horse right now from this such injury, she is 7 yrs. old and has a bright long future ahead...

The injury is a high insertion lesion of the right front leg. It occurred last November and we are still trotting for only about 40min. but able to do lateral work, etc. I'm taking it reallyyy slow with her and after every ride i poultice and wrap (better safe then sorry)!

Thoughts?

Simbalism
Mar. 30, 2011, 11:56 PM
I think there is always the potential for reinjury. I think that no matter how many treatments and how much rehab you do there is an underlying residual weakness to the area injured.

Go Fish
Mar. 31, 2011, 12:13 AM
Trotting for 40 minutes after only 4 or 5 months seems a bit aggressive to me. How was the injury treated originally?

deltawave
Mar. 31, 2011, 08:31 AM
Gwen tore a suspensory when she was 11(?) and came back to compete sound and solid for another 9 years at Training/Prelim after time off/rehab. :)

technopony
Mar. 31, 2011, 08:44 AM
It really depends on the injury. My mare had a very small lesion high on the suspensory - it was extremely minor, and after two months of rest she started back into light work. She was back in full work after 3-4 months. That was 5 years ago, and since then she has been eventing N/T and hunting first flight with no soundness issues (on that leg anyway!). Of course, this was the very best case scenario for a suspensory, and most are going to be laid up at least 6 months IME.

judybigredpony
Mar. 31, 2011, 08:45 AM
Higher is better than low.
I found depending on the degree and location its something resolvable.
Did the horse tear it racing, jumping or pasture accudent??
Plus conformation and way of going and foot balance play.

Is your horse aimed for higher levels, there more factors that goes into the answer.
What does the currrent ultrasound show? Have you had an MRI or Nuclear scan as well?

VicariousRider
Mar. 31, 2011, 08:47 AM
OP: You will find lots of stories that cut both ways. There are lots of horses like Delta's (or Woodburn who IIRC did a tendon about 3-4 years ago in England and came back to run at the WEG, etc.). There are also some horses whose tendon never heals right and they re-injure themselves. I would say that being conservative in bringing your mare back you will increase your chances of permanent, full recovery. Talk to your vet about what that looks like and share that you want to be conservative.

Keep in mind that horses are fragile generally. While you are focused on the tendon that had already been injured, anything else can happen, too. I don't mean to be depressing, but there is risk in everything with horses. Do the best you can but remember that anything can happen anyway (whether there is an old injury or not!).

subk
Mar. 31, 2011, 08:50 AM
I think there have been studies that show the body's repair work, once healed and rehabed, is actually stronger than the original tissue. The problem is that so many injuries have a relationship to conformation and that does not change.

echodecker
Mar. 31, 2011, 08:57 AM
This is solely based on my personal experience...

I second the above post that 40 minutes of trotting post-injury seems super fast! 40 minutes is where I would hope to be 10-12 months post injury.

My mare did a VERY MILD LF suspensory, it was a core lesion, really a strain (torn fibers, but no hole) and we did 4 months of stall rest with handwalking, then one month of saddle walking, then slowly started building up trotting. So at the point you are at, we were just beginning to trot. starting with 1 minute a day and building by adding one minute per week until we were up to 3 10-minute sets with 2 minutes walking in between. The total rides at that point were 60 minutes with half walking/half trotting before we added canter.

We also did shockwave times 3 and all of the handwalking and reahab work was on straight, level, flat stonedust. She is also on Recovery EQ.

It has been 4 years since then and that suspensory is just fine. She did a Denny camp and horse trial 20 months after the original injury.

I guess what I'm saying is, soft tissue injuries need time and slow work to heal correctly. If you rush the rehab, you will reinjure the site, or at best, get it to heal weaker than it should, with a higher potential of reinjury in the future.

It also depends on what your horses previous level of fitness was. If she was a solid prelim or higher horse before hand, then she already has a better base of fitness than a horse who had only done BN (in my case). I don't think that means you can skimp on the rehab, but your horses fitness will be easier to bring back so you might be able to get back in the game earlier once the slow rehab work is complete. Unlike us, where we had to do the flat level, NO CIRCLE rehab for 5 months and then restart arena work.

Check out the book Back to Work by Lucinda Dyer. It has good stories and several rehab schedules.

Hilary
Mar. 31, 2011, 09:00 AM
I can only give my own experience when my Prelim horse came in for breakfast with his RF the size of a telephone pole. It was an injury to the lower inside branch.

He recovered fully and quickly (4 months) and went on to another couple of prelim seasons and some foxhunting. It never bothered him again. He was not on stall rest very much, but spent the summer turned out in wraps. I swear he knew he needed to be a good boy because he never once ran around.

Early treatment is crucial too - eliminating the inflammation so the ligament can heal. Ice, bute, dmso, wraps, although that information doesn't help you much right now.

Let her tell you how she feels too. I did all his first recovery work on pavement at the walk, then the trot in straight lines. Then I worked him in straight lines on firm grass. Then I added turns. I didn't ride him in my soft sand ring until I he could w/t/c in circles on firm grass footing.

Have you learned to palpate the ligament?

wishnwell
Mar. 31, 2011, 09:05 AM
My daughter and her horse are dealing with a front suspensory now. Bottom line, time is your friend. Our horse injured himself in the pasture last August. After 3+ months of rest, we began hand walking till he got to 30 min. Then she began riding him under saddle but walking only, starting with 5 min. intervals and increasing by 2 min every other ride till they got to 45 min....They JUST got to that point a week ago and only starting with 5 min. of trot work after 15-20 min. of warm up walking, and again adding a couple min. every few days as long as he's handling it, which ( knock on wood ) he seems to be doing. She's also not trotting for a full 5 min at a time...she does one min. of trot, one of walk, one of trot, etc as long as the transitions look good and they do.
My biggest regret is that we didn't do an ultrasound initially....I kick myself all the time for it but I have the Vet coming out next week and we'll see if they think it's worth doing now to see what the damage may have been and where we go from here. I agree that if you had a tear in Nov, I think it's way too soon to be trotting. Be conservative, very conservative if you can. Good luck, I'm sorry about this, it's a tough thing to deal with but just don't be in a hurry.

VAevent
Mar. 31, 2011, 09:19 AM
You have a PM

purplnurpl
Mar. 31, 2011, 09:27 AM
Trotting for 40 minutes after only 4 or 5 months seems a bit aggressive to me. How was the injury treated originally?

same thought from me.
I would still be walking 3 times a day.

I have found that the injuries become chronic when the rehab is rushed.

Also, I double the time line given by the vets.
As much as I respect vets, they are better for diagnosis, they are not usually rehab specialists.

also, I find icing to be very important after works. Often icing is left out of the rehab.

purplnurpl
Mar. 31, 2011, 09:29 AM
I think there have been studies that show the body's repair work, once healed and rehabed, is actually stronger than the original tissue. The problem is that so many injuries have a relationship to conformation and that does not change.

stronger but with less ability to stretch, no?

Hence the reason you would rather have a high suspensory is what I have heard.

onthebit
Mar. 31, 2011, 09:31 AM
I think this is very much a question that has to be answered with "it depends." As in why the injury happened, how it is rehabbed, etc. I have a retirement farm. Many people think that means I live on a farm full of old horses. Plenty are old, many are young, as in under 10.

Several of the young ones are here due to reoccuring soft tissue injuries. The rehab is always done perfectly with stall rest, shockwave, some do IRAP/PRP depending on the specific scenario, very slow and controlled exercise coming back to work, etc. but the injury comes back. So they repeat the rehab. Usually after the 2nd rehab and then another reoccurence is when I get the call.

These beautiful horses get off the trailer and the first thing I always look at is their feet. Keep in mind I have horses here from all over the U.S. and Canada so I am not looking at a sample pool from a certain geographic area. Almost without exception their feet are always awful and they have these crazy shoeing jobs and I hear all about their farrier is "the best" and blah blah when I ask about the feet.

All I'm gonna say is when I look at the unbalanced trims, the awful breakovers, the sheared heels, contracted heels, toes a mile long, etc. it is no wonder there are ongoing issues with soft tissue problems. No one will ever listen to me on the front end though. Then we pull the shoes, get the horse a GOOD trim (as in we ditch the bar shoes, the wedge pads, the trailers behind, blah blah) and give it time. And often in 18 months to 2 years the horse that was pronounced by the big time vet and farrier as "done" is sound again and we look like miracle workers.

My latest arrival came with a shoeing job straight from Rood & Riddle. I about fell over when I saw what was on his feet. 2 shoes and 3 pads per hoof on each front hoof. I'll never hurt for business and I think it is a shame.

subk
Mar. 31, 2011, 09:41 AM
stronger but with less ability to stretch, no?
That makes sense to me.

I suspect that a good rehab is as much about recovering elasitcity as it is about rebuilding fiber strength. But hey, I'm just a layperson--I'd love to hear what Reed has to say. Can anybody channel him?

GotSpots
Mar. 31, 2011, 09:42 AM
Put me in the "it depends" camp. How bad, where the injury is, how it was rehabbed etc. I have owned two advanced horses who had mild lesions on a front suspensory who both came back to run Advanced (one who has done more than 30 events, including a CCI* long format, post injury). I've also seen horses who really get wiped out by a suspensory and never quite come back from it - as noted, often there's a conformational issue that tends to cause a repeated injury/tension there.

There's also a diagnostic aspect to this: I think we now have the tools to see lesions where we didn't previously. Thus, sometimes I think a "suspensory" can be over-diagnosed: we aggressively treat and rehab something we see on an ultrasound that might never turn into anything down the road. There are lots of horses out there who, if you actually put an ultrasound on their legs, would look a little funny, and there are horses who have had a lesion that never really fills in perfectly, but they come back and do just fine. That's not to say that there's not horses with legitimate bows and suspensory issues - there are many of them, but just noting that there are times I think we need to be careful that we may be likely to find what we're looking for, particularly with an older campaigner.

Bobthehorse
Mar. 31, 2011, 10:20 AM
It depends. Sometimes even if the prognosis is good, the damage is minimal, and you give tons of time and a slow steady rehab, it can go again. Maybe it depends on how they did it, if its an inherent weakness or if it was a fluke due to a culmination of things like fatigue, footing, etc.

Hilary
Mar. 31, 2011, 10:29 AM
Technology can be your friend - or not.

Much to many of my friends' dismay my vet did not ultrasound my horse. I asked him about it and he said "what do you want to know that you do not know now? He has an injury to his suspensory ligament "here" which we can feel by palpating it. No, we don't know exactly how big the lesion is, but do we really care if it's 5mm or 6? No, we know generally because we can feel it. We will treat it the same way, and he'll tell us for how long. We don't know how long it will take him to heal whether or not we have a picture of it. He'll come sound when he's sound".

If I had a nice picture of the hole or tear I'd have thought about it all the time! I learned to palpate his legs and really, when he was sound, he also palpated normal. It was a great learning experience for me to feel his leg healing. Maybe I just got lucky, but my vet had felt 1000s of legs by the time my horse needed him and he was right. I hope with the advent of the new technologies we do not lose the art of actually touching the horse.

eventr4life
Mar. 31, 2011, 10:53 AM
Trotting for 40 minutes after only 4 or 5 months seems a bit aggressive to me. How was the injury treated originally?

Woops! I accidently hit the 4 instead of 3 - i have been trotting for 30 min. sorry guys! (i need to remember to proof read)

Here is a complete timeline:
(This may not be completely accurate to the things at the end on what exactly i did and when, i need to get the medical history - i cant remember exact dates - one reason i should update my pony club record book ;)

Note: Slightly lame in the beginning, only on circle to the left(RF was on outside)

Nov 1: Went straight to lameness specialist about an hour away when local vet couldn't determine what was causing the lameness. He found it was the suspensory within 15 minutes. She had barely to no swelling. We ultra sounded and found again, that it was an insertion lesion of the right front he told me it was pretty mild and should only take a couple months till i can at least get on and walk/trot. Told me i needed to wrap her everyday with poultice or sweating it - also give me antibiotics for slight swelling.

She is perfectly sound at this point just FYI

Mid Nov-Go back for update, i think? She is sound, so i had walk her on the road for about 10min. every day.

Mid Dec-Stall Rest for about a month and then she was able to go out onto a small (about 1/10 of an acre, very small) paddock while i wrapped her legs. She has went into a stall during the night, so there was time for rest during then.

Still sound.

-(We gave two treatments of shock wave therapy treatments spread during this amount of time.)

-he told me i could start walking under saddle in December/January i think...(that does seem quick now that i think about it)... this was only for 10/15 min. for only 3x a week NO circles, or hills
(**please note i am a bit foggy at this point in time it was rather long ago)

***LEFT HIND LEG: Brought her in one day found a splint looking thing close to the hock...(great) went to the vet, took x-ray it was where she just bumped her leg or something and inflamed a tiny non-important ligament in the upper part of the LH. - was then off for a week to get sound - put again back onto antibiotics until that hind went sound.

Late Jan-I'm pretty sure we did another ultrasound and it was healed enough to do 15min. for only 3x a week of straight trotting in the arena NO circles, or hills. Please note that the trotting includes walking/trotting intervals.

Continues for a month-Late Feb till now- ultrasound 75% healed, he had expected it to be healed more then this. He gave me the okay to start trotting for 30min. about every day including lots of walking. I'm doing lateral work to help her stiffness would this affect the suspensory?

->I've had trouble with noticing she doesn't do as well when going to the left-putting more weight on that hind, so i told him and he gave me Legends to inject her muscularly in the neck 3 times and now its 100% (that was only a few weeks ago)

Please Note: During this time if i felt her lame or acting weird at all i would not ride her, and concerning the "splint" i didn't ride until it was perfectly sound after the injections.
Also, please remember it was a mild high insertion lesion. Not a core lesion which is much much worse. (just fyi)

After every ride i poultice and wrap. She has been getting regular deep tissue massage to help her hind end - from compensation.
We are going back soon to get another ultrasound i will post an update as to what that looks like.

[B]Main questions:
1. Do you see a problem with this?
2. What should i be doing differently?
3. Should i be icing after every ride?
4. Should i be "roading" more often?
5. Should i not be riding in soft footing like the arena?
6. What type of rehab plan should i do? [/B

Conformation: Her Right Front leg is a slight clubbed foot, not sure how this affects it....

So sorry for the long message :eek::eek:

subk
Mar. 31, 2011, 11:24 AM
As someone else mentioned, you need this book:

http://www.amazon.com/s/ref=nb_sb_ss_i_0_58?url=search-alias%3Dstripbooks&field-keywords=back+to+work+how+to+rehabilitate+or+recon dition+your+horse&sprefix=back+to+work+how+to+rehabilitate+or+recond ition+your+horse

Lucinda has great stories and examples of injuries and schedules of rehab. If you get nothing else from it, you'll find some comfort in hearing about the real life expereinces of others and that helps on the days you feel like you're out in the wilderness alone. :)

purplnurpl
Mar. 31, 2011, 11:49 AM
[b]Main questions:
1. Do you see a problem with this?
2. What should i be doing differently?
3. Should i be icing after every ride?
4. Should i be "roading" more often?
5. Should i not be riding in soft footing like the arena?
6. What type of rehab plan should i do? [/B

Conformation: Her Right Front leg is a slight clubbed foot, not sure how this affects it....

So sorry for the long message :eek::eek:

don't apologize! we thrive on this stuff. :cool:


So, what happens is that the fibers in the ligaments run together in one direction. When there is a tear the repair work looks more like a very thick spider web.
Hence the repaired area loses elasticity.

walking is sooooo important during repair time.
I think what happens is when folks are instructed to keep the horse up for X amount of months the new tissue is laid down solid. Then when the horse is taken out for the first bits of work you have soreness and swelling because this new area of tissue is being stretched for the first time.

and this is often when the leg is re injured.

(I'm a biomechanist and was certified also to be a physical trainer. I worked in a movement lab for CP kids and talked with their Ortho docs weekly. And I was an athlete with many many soft tissue injuries during the 1st half of my life. I'm not Reed, just me, but this is what I learned and what makes sense to me.)

I spent my days as a competitive swimmer icing allll the time.

I'd throw some ice cells on that sucker every time you take him for a walk.

I'd kick the leg yield. Lateral movements create extra torque that is not needed just yet.

If you are dealing with just a mild origin issue from 6 months ago then your program isn't terrible.
But the fact that the spot is only 75% filled in is curious.

For me, I would have stuck to the hard ground and only hit the arena for a "once around" each ride at this point. But you're already past that point.

You are now at the 6 month mark and now is the time I would have started adding straight trots with that once around in the sand at the walk.

and I'm in the minority, I'm all for just always riding. Even from the start (if the horse is not head bobbing falling over lame). Personally I don't see a huge difference in a horse walking with a rider, or being walked in hand. Staying on them keeps their backs strong.

Have you ever had to rehab injuries on yourself?
I had a fall from a horse last April. The major injury was bone bruising and muscle injury. Once the muscle started to work properly again I realized that I also had a mild ankle sprain.
That ankle didn't feel normal again until about Nov/Dec. It was functional but I knew it was not right. So that was a very mild sprain that I was always able to walk on. It took 8 months to be 100% functional. EIGHT. holy cows.

Sounds like your horse is sound now so that's super! good work. ;)

I don't think I would say, "I see a problem" because this is such a subjective topic.

VicariousRider
Mar. 31, 2011, 12:23 PM
If you have a trainer or horse person who you really respect and trust, I would consult with them. Despite the frustration, these episodes can be great learning opportunities. If you aren't sure that your vet is giving you the guidance you are looking for, set up a time for a phone chat about it or see if someone can recommend another vet for a second opinion. There is so much variability in these types of situations. All horses (like humans) heal at different rates and differently in general. Sounds like you are on the right track, though!

Hilary
Mar. 31, 2011, 12:28 PM
I'm surprised you were supposed to poultice/sweat it - COLD therapy is usually prescribed for initial injuries. Antibiotics for swelling? That also doesn't make sense. Antibiotics are for infections - which can in turn cause swelling, but swelling from an injury needs ICE, not antibiotics and definitely not a sweat wrap. But that's in the past. SO going forward:

I'd stick to riding on firm surfaces - especially if she is off when turning. Until she's sound when turning, ride in straight lines or VERY easy arcs.

eventr4life
Mar. 31, 2011, 10:25 PM
Sorry - i guess you could still call me a "greenie" but he gave us Naquadex - does that sound right, but i know it was an anti-inflammatory, so not an antibiotic? sorry, wow i feel stupid haha!

Yeah - that is strange that he didn't tell me to cold hose or ice :/

Update: Went to the barn today, slightly more swollen and hot...great - massage therapist said she is compensating really bad, so the poor girl was telling me today to slowwww down...I'm going to give her 5 days off to re-cooperate and then walk under saddle unless its still hot or swollen :/

Thank you SO much for the advice! It's really helpful! Again, sorry for my confusingness/stupidness!

Hilary
Apr. 1, 2011, 08:25 AM
hey, we all had to learn, most of us by going through it.

You might, instead of complete rest, take her for a hand walk -even just 10 minutes. She'll enjoy the company and activity, and the light movement may help alleviate the swelling by increasing circulation. It is a fine line between enough and too much. Oh, and if there is swelling, ice/cold hosing is still your friend.

purplnurpl
Apr. 1, 2011, 08:52 AM
Sorry - i guess you could still call me a "greenie" but he gave us Naquadex - does that sound right, but i know it was an anti-inflammatory, so not an antibiotic? sorry, wow i feel stupid haha!

Yeah - that is strange that he didn't tell me to cold hose or ice :/

Update: Went to the barn today, slightly more swollen and hot...great - massage therapist said she is compensating really bad, so the poor girl was telling me today to slowwww down...I'm going to give her 5 days off to re-cooperate and then walk under saddle unless its still hot or swollen :/

Thank you SO much for the advice! It's really helpful! Again, sorry for my confusingness/stupidness!

while she's swollen, hit her with DMSO wraps. It's so important to get the swelling down.
And now that she's showing this issue it sounds like it's time to start over from the beginning.
For me, if she is off, I would do like you said and keep her quiet for a week.
DMSO 1/2 the day, then ice that sucker twice a day if you can.
Until the swelling has resolved maybe take her out to graze but not so much hand walking.
And keep that wrapping icing routine for the next 3 months.

ugggg! stinks. sorry to hear that her leg is hot again.
Also, has your vet considered a steriod injection or PRP in the lesion?

Yup, we all learn through trial and error.
I've fixed a few torn ligs over the past 10 years.

bornfreenowexpensive
Apr. 1, 2011, 09:29 AM
You also learn it is very different for every horse. I have a horse with a VERY MILD one. As in no swelling, no tears, no leisons...no heat. Just very slightly off (in otherwords, we wouldn't get rung out of a dressage ring) on a circle (looks great in a straight line) and a very mild difference on ultrasound (10%).

We did stall rest and shockwave and tried to do slow rehab. But horse doesn't really cooperate with slow rehab. Even drugged, he leaps around and is a bit dangerous for the person re-habbing him--and probably reinjures himself. So we made the decision to pull his hind shoes, and kick him out (building up to 24/7). I wont even look at him for 3 months (well...I'll still LOOK at him and groom him...but no messing around with him). He will probably end up turned out for 6 months and then if all looks good I will slowly leg him back up (if not, he will get more time off).


Most horses I know have each re-habbed differently. You have to do what works for each individual horse and you have to be willing to give it time. So I'm looking at losing about a year---and my horse's injury is about as MILD as you can get.

purplnurpl
Apr. 1, 2011, 12:36 PM
and kick him out (building up to 24/7). I wont even look at him for 3 months (well...I'll still LOOK at him and groom him...but no messing around with him). He will probably end up turned out for 6 months and then if all looks good I will slowly leg him back up (if not, he will get more time off).

.

I did this with my last rehab too.
After rehab I played around on him a bit but I didn't put him back into full work until he put in 24/7 for 6 months.

VicariousRider
Apr. 1, 2011, 12:42 PM
Ugh. Such a bummer! I, too, would back off and get that swelling taken care of. Better to be conservative, IMO. This is an example of how you have to listen to what the horse is trying to tell you.

I know it can be time consuming, but I second the suggestions about hand grazing, walking, grooming, etc. The objective is to keep them entertained while resting sufficiently and, again, this will vary from horse to horse. BFNE's horse clearly needs more action and stays calmer turned out. Other horses just need adequate stimulation in the form of attention. I am sure you know your mare well enough to have a sense of what will keep her happy.

Keep us posted.

eventr4life
Apr. 1, 2011, 07:53 PM
Anyone else have a hard vet to get a hold of? urghhh!!!

Today went out and less swollen after her Bowen yesterday, but still slight heat...
I just groomed, cold hosed, and hand grazed her for about 2hrs while studying!

Tomorrow i'll actually ice it & wrap.

I've been using DMSO as in "sweating" it from the beginning - maybe i did something right lol.

But right now i just decided maybe it was best to look for a horse to lease for my mental health so that i can still compete,etc. and keep her slowly recovering back 100% because she has such a bright future ahead!

mg
Apr. 1, 2011, 08:05 PM
But right now i just decided maybe it was best to look for a horse to lease for my mental health so that i can still compete,etc. and keep her slowly recovering back 100% because she has such a bright future ahead!

My horse was diagnosed a week and a half ago with a proximal suspensory injury and I am applying to foster a CANTER horse. They cover vet and farrier bills and your costs are tax-deductible. I, too, need something to keep me mentally healthy while my guy is out and to prevent me from trying to push it with him!

Best of luck with your mare's recovery. Injuries are the pits :(

cbv
Apr. 2, 2011, 11:14 AM
I had a gelding with a suspensory tear many years ago. He did 6 weeks small paddock (not much bigger than stall) followed by six weeks pasture rest with ultrasounds between each transition.

After the pasture rest the ultrasound looked good. My vet at the time, who raises race horses and fox hunters, based his rehab program on one recommended by another local vet that is a fitness specialist (worked with everyone from folks swimming the english channel to iditarod racers to eventers). He (my vet) wasn't a big proponent of long walking periods (remember horse had been on pasture for six weeks so not coming straight off stall rest). He started me trotting right away for five or ten minutes a day for a week and adding five minutes each week til we got to 45 minutes. Then another month of trotting at 45 minutes a day (could have two days off a week). The could add some canter and start some jumping month 4. Sounds like a similar schedule to the op's. Last I heard that horse was still sound many years later.

Since then I have had a horse with major tendon injury with almost a year of stall rest. He was started back much more slowly with 5 minutes walking a day, five minutes added each week, up to thirty minutes, then start with the trotting adding five minutes each week. Had to be trotting 30 minutes before he was allowed to be turned out. Different vet/different schedule. This second horse is now 23 and still sound on that leg and that tendon was swiss cheese on ultrasound.

I got to say I much preferred the first program -- safer for the rider at least --but I generally trust my vets and follow their recommendations.