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Once a suspensory, Always a suspensory?

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  • Once a suspensory, Always a suspensory?

    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)!

    Why walk when you can ride?

  • #2
    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.


    • #3
      Trotting for 40 minutes after only 4 or 5 months seems a bit aggressive to me. How was the injury treated originally?


      • #4
        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.
        Click here before you buy.


        • #5
          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.


          • #6
            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?


            • #7
              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!).
              "We can judge the heart of a man by his treatment of animals" Immanuel Kant


              • #8
                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.


                • #9
                  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.
                  Thoroughbred Placement Resources, Inc


                  • #10
                    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?


                    • #11
                      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.
                      "If you've got a horse, you've got a problem"


                      • #12

                        You have a PM


                        • #13
                          Originally posted by Go Fish View Post
                          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.
                          Horses are amazing athletes and make no mistake -- they are the stars of the show!


                          • #14
                            Originally posted by subk View Post
                            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.
                            Horses are amazing athletes and make no mistake -- they are the stars of the show!


                            • #15
                              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.
                              Blogging about daily life on the retirement farm: http://paradigmfarms.blogspot.com/
                              Paradigm Farms on Facebook


                              • #16
                                Originally posted by purplnurpl View Post
                                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?


                                • #17
                                  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.


                                  • #18
                                    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.


                                    • #19
                                      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.


                                      • Original Poster

                                        Full on Details & need help with some things....

                                        Originally posted by Go Fish View Post
                                        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
                                        Why walk when you can ride?