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10 Weeks to Condition post-suspensory lesion - how would you do it?

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  • 10 Weeks to Condition post-suspensory lesion - how would you do it?

    I don't want to start a trainwreck. The situation is what it is. I have voiced my opinion - but the vet has another idea - and owner goes with vet 100% of the time. The only thing I can do here is to help guide the situation as best as possible.

    13mm (Owner said cm - but he had to mean mm) lesion on the front left suspensory diagnosed via ultrasound. Horse received 24/7 turnout for two months and two, possibly three, shockwave treatments, per vet's advice. Suggested IRAP but not performed because insurance would not cover. Vet says horse will be ready for **one lower level event (think Elementary - Maybe up to 24 inches**) in ten weeks. I have danced around, fussed etc that this is quite different than what I've heard/read for suspensory injuries -both in treatment, turnout, and return to riding - but to no avail - I'd *love* to be wrong here.

    Student and parents, bless their hearts, are very pro-canter, quick turns etc for conditioning. I believe part of the injury was caused by the student doing "gallops" in the front 1.5 acre hilly pasture. I'd like to give her a week-by-week plan of how to get from week zero to ten, with the understanding she may have 50-75% adherence.

    Vet did not have any suggestions for conditioning/return to riding schedule. Owner/student *want* a schedule.

    I know what I'd suggest - but given the unique situation, I'd like others opinions.

    Horse is a 16 year old TB (Think THICK - looks warmblood) campaigner who has been there done that. Horse/Rider pair do not need to school jumps just for the sake of exposure - although the rider may feel differently : ) In addition, horse is a roarer.

    Last edited by In_; Mar. 2, 2013, 12:18 PM. Reason: Clarity and basic spelling

  • #2
    If they're not going to take your advice anyway, it's sort of a moot point. They need to ask the vet. I wouldn't be any part of it. Why can't you just tell them you don't feel like the time frame is reasonable and if their vet thinks this can be done in 2.5 months they should ask HIM (or her) for precise directions on rehab. If the vet can't provide it, that may clue them in that the advice seems iffy.
    Click here before you buy.


    • #3
      Well, if it is doing Elementary, I would do 8 weeks of very slow building up of walk/ trot, in straight lines and generous turns only, and then have a w/t/c practice the dressage test once a week and jump once a week in the last two weeks.

      So maybe week one would be 15-20 minutes of walk, and week two would be building up to 15 minutes of walk and 5 minutes of trot (two, two and one minute intervals or something) and so on until the horse is doing 30-40 minutes with maybe half of it being trotting.

      But I'd be inclined just to send them down the road now before things get worse. Was it re-ultrasounded after the shockwave/ turnout?


      • Original Poster

        Post-shockwave/turnout ultrasound demonstrated a clean suspensory. Which is a big positive in this situation.

        Why bother? Because given the logistics of the situation (pre-teen rider, outdoor only, historically wet spring, time constraints, local-lack-of knowledge, poor local-eventing scene, mostly pleasure rider, boards at home) expecting 100% compliance is naive. So even if they listen 50% of the time - it is something. Horse's welfare will not be perfect - but may be slightly improved.


        • #5
          OK, my horse did this. Now, he was competing at prelim when he got hurt, so really fit, but he healed perfectly in what some considered to be a ridiculously short period of time. All horses are different.

          Since he's been turned out (as was my horse) I would do this. (this is all riding, btw)

          Week 1: Walking on hard surface (Pavement) in straight lines starting with 10 minutes per day, now obviously he has to turn around at some point, but he's not working on a circle. Work up to 20 minutes/day. I did not increase every day, but it's hard to do exactly 10 minute, then exactly 12 - sometimes you do 13 because you're not back to the barn at 12.....

          Once he reaches 20 minutes (probably about 10 days, i'm not going to do all the math for you!), add 5 minutes of walking in a straight line on grass footing - not soft sand, but something softer than the pavement. Still no turns.

          Alternate hard & soft, with the goal to be walking on the softer footing for 20minutes.

          Add trotting before you start adding turns/circles. I used the same distance that took us 20min to walk but did it at the trot, takes less time but you can add some walking to maintain the time ridden. Riding for 30m. total is fine now.

          Next is trotting on the softer surface (still straight lines).

          After that is adding large (30-40m) circles on the softer footing - you can walk on the pavement, but I wouldn't circle at the trot on the pavement.

          I did not allow my horse into deep sand or mud until the following spring - I was very very careful about his footing.

          And of course you keep checking the leg to make sure nothing is flaring up.


          • #6
            I feel like I'm coming from another planet. So you guys were allowed 24/7 turn out immediately following an injured suspensory?


            • #7
              This is interesting to me, too. My horse is starting a 2nd thirty-day confinement due to a suspensory injury. His first 30 days, he was in a 15 x 30 foot pen. Now he will be allowed in a 30 x 60 foot pen. He has been given this much space (rather than a 10 x 12 stall size pen) because he is very compliant and calm. Even when taken out for grazing, he remains very composed and mannerly.

              Our veterinarian is confident that the 2nd thirty days' confinement will do the trick and then we can start re-conditioning him.

              I would love to be able to turn him out in our small paddock. He will NOT run around and act silly; that is just not him. However, our veterinarian wants him in small, flat enclosures and our small paddock has a slope to it.

              I didn't know that turnout was an option for a suspensory injury.

              I am also interested in the return to work conditioning schedules that have been posted. We trail ride, so I have already worried about the eventual return to the trails and the wildly variable footing. We have lots of hills and steep areas, so I am sure it will be a long time before we can do our real trail riding again.

              Not meaning to hijack this thread at all; I am just interested in others' experience in bringing a horse back after a suspensory injury.


              • #8
                My horse stayed on 24/7 turnout, partly because of logistics, but realistically she hated being up and on stall rest would have walked circles. The upside was she was generally much better behaved once she started back under saddle, so there was a decreased risk of under saddle injury due to silliness. Plus movement helps the fibers align themselves correctly, so that was a benefit.

                Ideally, I think a small turnout area would be best. How sloped is your paddock? Does it have anywhere that is relatively flat where you can put the hay to try to keep him in that area?

                I think somewhere a horse can walk around normally during the day would be better than standing in a stall for close to 24 hours and then acting like a loon when he comes out for hand- or tack-walks.

                As for the OP, I think 10 weeks is really pushing it, considering you want the horse to be jumping at that time. Cantering a little, maybe (with a really strict schedule), but not jumping. You'd think if the vet was the one encouraging this, she'd at least provide a back to work schedule.


                • #9
                  You can ask the owner to look online for back to work schedules. There are some out there. Puts the ball in her court and I don't think any will fit into the 10wk time schedule so might give her a hint.


                  • #10
                    Originally posted by SEPowell View Post
                    I feel like I'm coming from another planet. So you guys were allowed 24/7 turn out immediately following an injured suspensory?
                    Me too. I've had 2 horses injury their suspensory.... both in RF both down low.... both came out of the turnout with the injuries.

                    Both stabled on the same barn nestled into side of a huge mountain... So all the handwalking all the riding you had to come down off the mountain slope to get to flatter land on the driveway. And the turnouts remind me of that big hill in the Sound of Music..... so all of the turnouts are sloped in multiple directions per turnout...... so not just one steep slope but multiple.

                    For both I was told by the vet to stall rest. First 30 days in stall you can hand walk for 15 min straight and hand graze all you want. Next 30 days might be the same; or might be walk under tack for 15 min. and increasing amt of time you walk. Work in 30 day increments. Then add trot go up to 5 min in first month, and eventually to 20 min before adding canter. When you are cantering under tack the horse can go back to fullscale turnout. And before that when you were trotting the horse was allowed to be in a roundpen for 2-4 hrs a day.

                    First horse was suspensory branch tear, both medial and lateral.... his original prognosis to return to work was good and it was estimated that he'd only be in the stall for 3 months. Well he was in the stall for 8 months. So at 8 months we were finally cantering and he went back to his usual turnout routine. We were given the ok to jump at 11 months and I decided to wait and he retore the branch in his turnout at 12 months. SO he's retired for good. And he can go for walking hacks around the farm now. he did trot and canter a little last summer (3 years post injury)

                    The second horse is currently on his 3rd week of stall rest. His injury is lateral collateral ligament with the suspensory... and a few other things. its going to be a while/

                    Edited to add that 2nd horse was in t/o for 2 months while we thought that we were dealing with an abcess (in stall shoe off 5 days then shoe on and in t/o) So he took a full 2 months to diagnose. SO from lame to MRI diagnosis and full stall rest was 2 months
                    Last edited by NRB; Mar. 3, 2013, 07:28 PM.


                    • #11
                      My horse only had a strain, but was on strict stall rest until he was back cantering under saddle.

                      However, to answer your question (and given that the horse is on turnout already), I'd recommend:

                      Week 1: 15 mins walking on firm footing
                      Week 2: 20 mins walking on firm footing
                      Week 3: 25 mins walking on firm footing
                      Week 4: 30 mins walking, 4 mins trotting (straight lines only, lots of walking in between)
                      Week 5: 30 mins walking, 8 mins trotting (straight lines only, lots of walking in between)
                      Week 6: 30 mins walking, 12 mins trotting, start adding some giant circles
                      Week 7: 30 mins walking, 16 mins trotting, add corners
                      Week 8: 30 mins walking, 16 mins trotting, 4 mins cantering
                      Week 9: practice dressage test, just a few cross-rails
                      Week 10: practice dressage test, jump a few cross rails in the field

                      It's elementary- I don't see a need for conditioning, nor would I suggest sending her out to work on bad footing. If he's a packer, he's better off just going out on the carefully managed x-c footing at the event.


                      • #12
                        Originally posted by Highflyer View Post
                        Well, if it is doing Elementary, I would do 8 weeks of very slow building up of walk/ trot, in straight lines and generous turns only, and then have a w/t/c practice the dressage test once a week and jump once a week in the last two weeks.

                        So maybe week one would be 15-20 minutes of walk, and week two would be building up to 15 minutes of walk and 5 minutes of trot (two, two and one minute intervals or something) and so on until the horse is doing 30-40 minutes with maybe half of it being trotting.
                        This looks generally right to me. Add those other suggested work outs with minutes of this and than building up to the canter.

                        The only bit I'd add has to do with management: Rider should do *something* post ride to take any edema out of there. After all, you guys are making microscopic tears in the ligament and those need to heal between rides. Fluid in the way doesn't help.


                        Cold hose afterwards.

                        Use an ice pack or frozen veggies held on with a polo wrap while you are grooming and putting the horse away.

                        Some people might paint on a bit of DMSO, or DMSO and Pre-def (a mild steriod and not often!).

                        Wrap the leg after a couple of rides when you up the work load.

                        Ideally (and probably well beyond your clients), someone should palpate the horse's ligaments from time to time. With the foot raised and the ligaments lose, you should get a baseline for how reactive the horse is. Do all of the ligament; do both legs. If you are really good, you can feel the texture of the ligament and it's sheath, feeling for puffiness or lack of definition. Do this a couple of times a week to keep tabs on any damage you are doing.

                        IME, a horse will show pain upon palpation before he is officially broken. It is normal for suspensories to be a tad sore with increased work, but if you keep track with palpation and noticing what you see in how the horse moves, you can do a pretty good job of knowing what's going on.

                        Frequent palpation: The poor man's ultrasound.
                        The armchair saddler
                        Politically Pro-Cat


                        • #13
                          Given the details, vet's input and description of the teen rider...I'd be prepared to pray a lot!!! Poor horse. THIS is not the approach I would have followed. It doesn't sound like a good story for the horse.
                          Breeders of Painted Thoroughbreds and Uniquely Painted Irish Sport Horses in Northeast Oklahoma


                          • #14
                            24/7 turnout for a suspensory???? 10 weeks until a show???
                            That's just crazy to me. CRAZY.

                            Mine had a smaller lesion than that and was on stall rest for 2 months, kept in standing wraps with 2x daily 10min hand walk. Then he was in small paddock for 2 months. We did walking under saddle during these 2 months, finally introducing trot at the 4 month mark. Only once he was walk/trotting for 15 minutes under saddle did he return to full turnout...5 months into his rehab.

                            We didn't canter under saddle until 7months post injury (young unbalanced TB).
                            He learned to jump a x-rail at 10 months post injury.

                            These aren't injuries to mess with. Careful rehab is the ONLY thing that will help prevent re-injury. I don't care how much $$ you want to spend on PRP, Shockwave...it is the CAREFUL REHAB that works.
                            Founder & President, Dapplebay, Inc.
                            Creative Director, Equestrian Culture Magazine
                            Take us to print!


                            • #15
                              Comments are beginning to sound more familiar. The mare I have with a suspensory has been in for 8 months, just moved beyond 45 minutes of handwalking to riding at a walk for 45 min with three minutes of trotting. I think we started with 10 minutes of hand walking... And we have a long way to go


                              • #16
                                My horse had a suspensory that did not have a visible lesion detectable from an ultrasound. He started on the confined rest/controlled exercise program that was supposed to bring him back into regular work in 6 months. after 4 months I decided to bag the program. He was NOT doing well mentally or physically. I brought him home to his regular barn where he had a 2 acre pasture with run-in. He was on pasture rest for 2 months, after which I started bringing him back into work. It was only after the pasture rest that he was sound. In stall rest he would weave and circle and be generally agitated. He got very bound up and did not seem to be healing. He seems to be doing great so far, but I started with a week of hand walking (20 minutes), then walking under saddle (20 minutes, adding 5 minutes a day up to 60 minutes), and now i'm doing a 10 min walk warm-up, 3x90 sec trot sets with 5 minutes in between and then a 10-15 min warm-down. Every 5 days I will add 30 sec of trot and subtract 30 sec of the walk in between until he is at 3, 4.5 min trot sets with 2 minutes in between. Canter will start and progress the same way. With this program, the elementary event would be borderline at 10 weeks. Reinjurying the suspensory the second time around is much more serious from what I've heard?! Good luck ...


                                • #17
                                  No, my horse was not just turned out immediately upon diagnosis - he had been on turnout by the time I was OK'd to ride him.

                                  He was stalled, iced, wrapped, iced, buted, iced, DMSO'd, iced (you get the idea) for 2 weeks. Then he was allowed handwalking (plus all that icing/wrapping etc). When the swelling did not come back when he was off the bute we stopped the bute & DMSO. But kept up the icing and wrapping.

                                  He also did not ever run in turnout. He was smart. He was a menace in the stall and it was better to be out, than spinning. Turnout a few hours a day, up to all night (Stalled during day) and he was never withouth his wraps - I didn't know you could do that, but you can.

                                  And yes, after the rides there was always icing or cold hosing and I got really good at palpating the leg. Since he never had a setback, we just kept proceeding at the slow pace.


                                  • #18
                                    Originally posted by SEPowell View Post
                                    I feel like I'm coming from another planet. So you guys were allowed 24/7 turn out immediately following an injured suspensory?
                                    More and more they are using controlled turn out. Turn out in a very small area, rather than stall rest and hand walking. Much as when years ago with a human back injury they went on bed rest. Now they continue to be up and about , carefully. The healing curve is much better.

                                    This works better for horses who tend to be fractious even with medication when hand walked.
                                    Some riders change their horse, they change their saddle, they change their teacher; they never change themselves.

                                    Remember the horse does all the work, we just sit there and look pretty.


                                    • #19
                                      Originally posted by merrygoround View Post
                                      More and more they are using controlled turn out. Turn out in a very small area, rather than stall rest and hand walking. Much as when years ago with a human back injury they went on bed rest. Now they continue to be up and about , carefully. The healing curve is much better.

                                      This works better for horses who tend to be fractious even with medication when hand walked.
                                      Aftr her injury stablized my vet and I agreed to try very limited turnout with the mare I'm currently rehabbing but she was so rambunctious that I had to stop. So now I use an area in the barn that is 13x24. As long as there is a roof over her head she won't levitate and hurt herself. If I put her in an equally small area outside she's too wild. The same was true for another mare who hurt herself last spring. I'm very envious of those of you with horses who won't exacerbate their injuries while being in limited turnout!


                                      • #20
                                        I keep them moving from the beginning as well. Usually starting in stall with attached pen.

                                        Our current rehab is 5 month post diagnosis (40%) tear in DDFT at the navicular which is a pretty devastating injury. I started turning him out 3 months into his rehab. But turn out is flat, and he's alone.

                                        I never ever keep them sedentary.

                                        Also, just a side note, I'm thinking maybe the OPs client's horse had a 3 mm tear or a 1.3 mm tear. 13mm is 1.3cm. That's still too big.
                                        Horses are amazing athletes and make no mistake -- they are the stars of the show!