Can you talk to me about rehabbing after soft tissue injury?
My mare injured her left foreleg six weeks ago. It was diagnosed via ultrasound as a sprain, and included tears in a variety of structures (not sure all which ones), but including carpal canal and check ligament. She's been on stall rest with hand-grazing only for three-four weeks, and then I got the OK to start hand-walking, and then riding at the walk with some trot. The trot to the right is reasonably OK. At the trot to the left she is not sound. I continue to do about 10-15 minutes walking, and 30 seconds of trotting (mostly just what I call diagnostic trotting) a day. She isn't getting worse, but is also not getting better. Vet thought when ultrasounded in the second time and saw the improvement that she'd be more sound than she is. He's involved, of course, but I would really benefit from some words of encourgement that this, too, shall eventually pass. How long did it take you? How did you balance keeping the horse moving but not moving too much. (I'm using reerpine and ace to keep her from killing me undersaddle from time to time.)
I'd double the rest time, double the hand-walking time, double the ridden walking time, before starting to trot. There is no real recipe, but nobody ever complained of giving more time of rest and walking. So, for me, given what you've said, I'd go back to a few more weeks of rest, a couple of weeks of hand walking, and then 2-4 weeks of walking under saddle before even doing any diagnostic test trot u/s.
Is there a small place she can be turned out, for quiet movement, where she will STAY quiet?
______________________________ The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET
If the horse is still unsound, I might consider additional diagnostics. Either the strain is worse or has worsened or else there might be something else going on.
Barring that I would do another 2-3 weeks of stall rest with wrapping/Surpass (did you use Surpass initially). Then restart the slow progress of work. I would not continue encouring anything more than limited motion on a soft tissue injury that has clearly not healed.
Is ultrasounding a possibility to help prevent the adhesion? A gelding with suspensory strain had that done at my barn and it seemed to have a very, very good outcome.
Really, if it were me-- I'd be going for more diagnostics-- potentially even an MRI. Until you're 100% sure WHAT is wrong it's REALLY hard to get it fixed.
I think I'd want to know exactly what structures were involved and how bad the damage was first of all.
And I'd stop with the trotting and walk, walk, walk, in hand until your brains fall out. Then try a diagnostic trot in hand. Once you've got that OK, and can trot in hand comfortably for a decent distance (I have used "until my lungs are about to explode" as a guide... but you maybe in better shape and not live on a mountainside at 7000 feet,) you can consider getting back on and walking under saddle, and building up to a trot from there. Straight lines only.
It takes quite a bit longer than you think it's going to, but if you rush it, you end up starting all over again.
And if you are trotting in hand, you might want to use a bridle or a chain shank.
I would say it took us from March to November last year to be sound enough to wtc under saddle.
Thanks for the insight. I've pulled back on my program and gave her two days off and just walked under saddle yesterday with just enough straight-line trotting to see how she was. She is still sound to the right and MUCH improved on the left. So I'm going to continue with much more walking in hand and undersaddle and much less trot.
I had used Surpass on the original injury. Now using that, Traumeel and Sore No More in a bit of a rotation. also recently got the Back on Track wrap boots and putting that on the leg while we graze. And also put her on SmartPak's tendon/ligament supplement.
Vet has been happy with what he's seeing on ultrasound in terms of healing, so I'm not pushing for further interventions quite yet. MRIs and shockwave therapy ain't cheap and insurance doesn't cover major medical on her anymore . . .
No, it's not cheap. I don't blame you. But I spent a couple months chasing what we thought was ONE injury that turned out to be something entirely different. And the treatment was much different. Once I finally did the MRI, I know what I had and that made a big difference in terms of treatment.
Being cautious never hurt anyone. I'd continue on with the longer-than expected period of rest and see if that helps. I also would just go with the Surpass rather than the Sore No More, etc. I think you're going to get the best theraputic response from the Surpass, and if you use that judiciously it's not SO expensive. Good bang for your buck on that so, if it was me, I'd use that exclusively in terms of topical swelling reduction/pain management.
IIRC you can rent the shockwave machine and do it yourself. Someone at my old barn did that and I don't think it was THAT expensive. Person at the current barn is an MD so just went ahead and bought the machinery ($$$) but I believe you can rent it.
Time. Rest. Walking. And then more time. My horse took over a year until he was able to be turned out (suspensory), and then he seemed to get better much more quickly. I did have to sedate him for turnout initially however.
Sometimes things just don't heal as quickly as they should because they are in an area with low blood flow or something. Have you considered another form of therapeutic treatment? Platlet Rich Plasma seems to work very well (even on less than fresh injuries.) There is also stem cell treatment and ultrasound. All of these may help a slow to heal soft tissue injury.
"Against stupidity the gods themselves contend in vain" ~Friedrich Schiller
I'm on month 6 of stall rest for a horse with a torn check ligament. We've been doing walking under saddle since December and have worked up to trotting. He was just cleared for cantering last Friday with a good ultrasound. Still working on straight lines and minimal circles, unless needed for behavioral reasons
Dr. Riddle says 2 more months stall rest and then he can go out in a small area.
For comparison, I have a 17 year old gelding with a severe tear of the straight sesamoidean ligament. It's been two years, 1.5 of which he's been on stall rest. His surgeons finally decided he need to "sh!t or get off the pot" in terms of stall rest; we could never get him quite sound after 9 months of progressive rehab, so we started to turn him out in a small paddock (goal was a pasture ornament). His 24 year old paddock mate got loose late Sunday night, the injured one went bonkers, and now we're back to square 1 with a re-torn ligament (perhaps completely; I take him back tomorrow to find out).
Granted you're not dealing with a severe tear like I am, but the ligaments & tendons in the suspensory apparatus are much more important. Mine spent weeks in just a stall, months on increasing handwalking (5 min for two weeks, 10 min for two weeks, 15 min for two weeks, etc etc). Then months walking U/S (5 min for two weeks, 10 min for two weeks, etc etc) and so on. And even with all of our care, there's still no guarantee, seeing as we're back to the beginning.
Vet is out tomorrow. I will jog and ride horse for him and we'll probably re-ultrasound, too. After that, we'll decide if additional diagnostics or therapeutics are necessary and if the rehab can/should be changed. Wish me luck!!
Vet was very happy with horse both at jog and me in the saddle. Said she was a Grade one on the affected foot to the left only and that was "being picky." So I'm going to veerrrryyy gradually increase the trotting for now. The hot weather here in Maryland is helping enormously. I can ride her now without Ace and without feeling like I'm staring death in the face! :-)
Uhm, I would not be trotting this horse for a while. Ligament tears do not heal this quickly and unfortunately, lameness grades do not really mean much by themselves Many soft tissue injuries are only displayed in a NQR off-ness, not lameness.
For comparison, my gelding with severe lesions on DDFT diagnozed via MRI, was never more than 1 on lameness grade, and it took us 2 years to get where we are right now (just been given an OK to start a normal training program.)
So, please, take a very conservative approach with your horse.
Very reputable vet who knows horse and seen ultrasounds says trotting is OK, so I'm going with that. At this point, it's 10-15 minutes of walking and probably a total of one to two minutes of straight line trotting five times a week . . . I will slowly increase trotting over time, as long as she continues to make forward progress. It would be nice if we could do our walking around the farm, but she's a bit too reactive mentally for that, so we're stuck in the indoor even in nice weather.