Warmth and swelling while rehabbing suspensory injury? Normal?
One of my ponies began looking NQR and developed heat and major swelling around his LH fetlock. Had vet out in August to ultrasound. Diagnosed a minor tear to the lower suspensory branch. It showed as fiber disruption on the ultrasound. (I believe this would be called a grade 2 lesion?) Vet advised not to do stem cell or PRP since no core lesion was present. Horsey was on stall rest for the first month, then handwalked 20-30 minutes per day. Began turning out a couple hours at a time in October, up to full day turnout by the beginning of November. (and has been since) Recurring ultrasounds showed excellent healing (even faster than the vet expected) Externally, he did develop a couple windpuffs and some thickening around the tendon area, once initial heat + swelling was gone.
The vet was out to re-ultrasound at the beginning of this month (December). She said the ultrasound was completely clean, wasn't able to see any scar tissue, or even evidence of previous injury on ultrasound. The vet cleared him to start back under saddle, and bring him back into full work over the next 2 months. (She advised starting him at 20min of tack walking, adding trotting after a couple weeks, and starting him at 1-2min of canter by the end of first month) I decided to go for a bit slower rehab schedule, and started building up his walking time on the ground, and under saddle about 2 weeks ago. I also began building up his trotting time while ground-driving. He seems completely sound, and I have not noticed any difference soundness wise since I've started working him.
Anyways, about a week or so ago (I'm bad at remembering), I noticed some warmth and thickening around the tendon area. Not hot, but definitely a temperature disparity between his two legs. Leg was slightly puffy, but nowhere near what is was when he originally injured himself. (Note that his bad leg almost always has some degree of thickening/windpuffs if not kept wrapped since his injury)
I freaked out thinking he might have re-injured himself, and called the vet right away. When I spoke to the vet, she said that the warmth + swelling is probably from adhesions or scar tissue breaking up. As long as he doesn't develop actual heat in the leg, and it goes away after a couple days, its probably fine. She said to keep working him, and continue with my rehab schedule.
Warmth + swelling go away, and I'm left thinking "whew, all clear" ..... Nope.
Horsey is good for a day, then warmth + swelling comes back again, and goes away 1-2 days later. The cycle seems to repeat itself. Soundness has been exactly the same. Horsey seems perfectly forward, and is starting to get back his floaty trot. He seems to usually develop warmth in his leg after work, but sometimes it will go away the next day with work.
Amount of work doesn't seemed to matter. A few days ago, I did a mini-lesson. (pony is a baby-greenie, and I suck at long-lining, and needed a refresher course) I cheated and worked him more than he has been. (longer period of walking, and *gulp* trotted some large circles.) Completely fine afterwards, leg is cool and tight. Then yesterday I handwalked him for 15 minutes, trotted a couple long sides each direction, and his leg is warm again already!!!
I'm just wondering, is this normal? Is it possible that he has re injured himself? I keep reading that any changes in the leg while rehabbing is bad news. It makes sense that there would be warmth and swelling if its scar tissue or adhesions breaking up, but I'm concerned over how frequently this is happening!
Last edited by Haffy Hop; Jan. 1, 2011 at 12:02 AM.
I've been through this a few times myself, and I'm sorry you have to deal with a suspensory injury, HaffyHop.
In short answer: Yes, it is quite common to have these sorts of minor setbacks during the looooonnnnggg rehab necessary to properly heal a suspensory injury. I wouldn't call it "normal," but it's common.
That said, based on my experience, you are moving pretty quickly with your pony. Yes, you are following the vet's instructions. However, I've found that going even slower than the best lameness vets in the country advise is a surer and smoother path.
For instance, after your 30 days of strict stall rest and 30 days of rest with handwalking, assuming a clean u/s and no signs of heat or swelling, I would do a full 30 days of gradually increasing walk work only. For the next 30 days, I would add short trots on straight lines; start with 1 minute (broken up into 10-15 second stretches) per workout and sloooowwwly increase that. So now, you see, you are 4 months out from the original injury, still no circle work (longeing is right out!) and no canter under saddle.
Anytime any warmth or filling shows up, apply cold, limit movement (don't eliminate, just limit it to a smaller paddock with flat ground; avoid buck-n-fart scenarios and boggy/deep footing), and when the leg is cool and quiet again, take a couple of steps back in the work and slowly rebuild. No "cheating," no sudden increases in work! You are inching up by minutes every few rides, no more!
My most successful rehabs were close to a full year post-injury before full work (w-t-c, jumping, showing, long trail rides, etc.) was achieved. This is definitely the type of injury where you will get their faster by going slower!
i agree with coloredhorse. seems you're moving pretty fast. and i guess it wouldn't matter except that now you have this heat swelling to contend with which may mean that the amount of work is causing some inflammation in the injury area.
having dealt with 2 serious hind suspensory injuries and then subsequent irritation to the area of injury in one of them, i've learned to be v. cautious and slow. i'd also suggest that you take it easy with circles. the torquing action puts a lot of strain on those suspensory branches.
I think the year scenario is about right according to my own experience. My very good lameness vet initially said 3 months. Now, at 3 months he was in pretty good shape, felt sound and solid. I overdid it with him, and ended up more or less back at square one. After that we went very, very slowly. Three months off completely with controlled T/O. 3 months of walking on hard surfaces in straight lines. Then adding in short trot session--still on hard surfaces. I think it was 7 months before we went back in the arena at all, and then another couple of months before we were doing canter circles. And lunging is largely a thing of the past. He's doing great now.
I have two friends who deal with recurrent suspensory injuries. Neither of them will step back and give the horse time to heal completely. At 3 months, every time, they are both saying, OK feels good back in full work, and boom, a couple of months later, the same problem arises. Both horses need to get some serious time off and then be on a walking program on hard surfaces for months, but it isn't going to happen.
Again, coloredhorse gives great advice. As one of my vets (and others) said about another vet: take that program and double it. Any heat or sensitivity, means you need to take a step back and reevaluate your program. I've also seen people try to up the suspensory program too quickly. They end up bringing their horse back into work 2-3 times and then giving up. In the same amount of time, they might have had a sound horse. Be patient.
Just another poster here who agrees with the others in advising to slow it down. It took our horse a full year and a half before he is now packing beginners around at w/t/c and some little tiny jumps. He had a major setback 4 months into his rehab (shockwave, stall rest, handwalking and then walking u/s) from his initial tear. After that, we just turned him out and left him alone for about a year. It was hard because he would look so great out galloping and ripping around, but vet advised just leaving him alone.
Agreed that it takes close to a year to fully and properly rehab a suspensory injury. Been there, done that. It's a painstaking process, but very rewarding if you take the time to get it done right the first time. I also rehabbed my horse all the way up to full flatwork under saddle before he got turned out at all. Views differ regarding this approach, but I have been very happy with the results of my horse's rehab. Suspensory branch injuries are generally trickier/more serious than high/mid-body suspensory injuries, so that is something else to consider.
Now...on to your actual question. At times during my horse's (very slow, meticulous) under saddle rehab, I did note some very mild warmth or puffiness in the affected leg. And, really, even to this day, it is slightly different from the other leg. No one else would notice, really, I'm positive. I just notice because I've had him since he was 3 and a half and I know his legs like a topograpical map. I freaked out the first time I noticed warmth/puffiness and the vet said it was not necessarily abnormal and to continue with what we were doing unless it got worse or he became lame. However, we were very conservatively paced, and he was getting ultrasounded almost every month, so there was not a ton of risk that I was going to cause a ton of damage between vet visits if I just kept on with our slow rehab work.
You're not too far into this injury yet. As you move along with the rehab you will develop a better sense of what is normal and what is cause for concern with your particular horse. I know that's not particularly helpful, but I do think it is the truth. It's just one of those things that you sort of learn as you go.
Good luck to you. I wouldn't wish a suspensory injury on my worst enemy. The year or so rehabbing my horse was a very stressful time, so I definitely feel for you.