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Suspensory Rehab Game Plan - Suggestions?

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  • Suspensory Rehab Game Plan - Suggestions?

    So long story short, I have an OTTB that had a minor suspensory swelling at the end of August. I did 30 days under saddle walk, then gradually built the work back up to 20 min trot and about 5 min canter by the beginning of this year. A week or two ago he was lame, vet said very minor flare-up and gave him 3 days of high-powered anti-inflammatory and then he was sound again with no heat or swelling. Throughout the entire process the leg has maintained some swelling, but it has fluctuated from none to definitely swollen, but not too bad. Ice and poultice controlled it and he was sound. Now the vet says I can go back to trotting, but only straight lines.

    Well, I'm concerned and really don't want to jump into things and get him hurt again. It's tempting to get him back in work, especially when he feels so good and sound but my gut says I need to slow down.

    So I have come up with a tentative game plan for a slow rehab process and would love input from COTH. The first priority is helping his brain deal with the rehab process - which right now it is not doing so well with. I am going to get him some stall toys and turn him out in a small pen, as I have learned the hard way that this is better for both of us than trying to keep him in his stall all the time. I also plan to put him on Reserpine and stock up on the ace (although by now he has built up a tolerance for it and it doesn't work like it used to).

    I think during the rehab I'm going to set a requirement for myself that I will not add anything new to his program (such as trotting, trotting longer, trotting corners, cantering, etc.) until his leg has stayed completely cold and tight for at least one week. I expect some minor heat and swelling as a result of just using the ligament and asking more of it as it gets stronger, but if it doesn't stay tight then I will back-up until it can.

    So here's an outline for what I was thinking of as a plan:

    -u/s walk until leg is tight
    -trot on hard surface, straight lines, starting with 3 mins until leg stays tight
    -add 1 min every other day
    -when 10 min of trot with tight leg, begin straight line trot in the ring
    -after leg is tight add 1 min every other day until 15 min, and then start trotting corners
    -after 15 min of trot w/ corners and leg staying tight, add 2 min every other day and gradually add circles
    -at 30 min w/ tight leg begin canter
    -add 1 lap of canter each direction every 5 days
    -begin jumping when normal w/t/c rides with tight leg

    So I guess what I want is opinions on this plan - comments or suggestions on any aspect of anything I have said would be much appreciated!

  • #2
    did the vet ever u/s him? do you know what was the cause of the initial swelling?

    in my experience slow is the key with suspensory rehab. lots of walking, straight lines, and good footing. i left my old barn partially b/c the footing in the indoor was too deep for my mare rehabbing from hind suspensory injury.

    that leg may never feel "tight" again so you may have to use some other marker to decide when to trot him. that flare up few weeks ago is concerning. was it caused by too much too fast?

    i really don't think that there is a canned rehab you can apply across the board. you just have to kind of see how it goes but again, in my experience - SLOW.
    TQ(Trail Queen) \"Learn How to Ride or Move Over!!\" Clique


    • #3
      I've never dealt with rehabbing a suspensory but I did do a collateral ligament. When starting the trotting my vet had me start with 3 mins for a week and then add 3 mins every week. When we got to 15 mins of trotting then we added the canter. Once she was cantering then we turned her out tranq'd and in a really small paddock. I understand though if you can't keep him but make sure you tranq him appropriately for turnout. We used demosedan for the first 3 days with Ace and she still broke through that after about 45 mins.
      Good luck with your boy and it sounds like you have a good plan with taking things slow.


      • Original Poster

        I know the leg can feel tight because some days it does and it was nice and tight after this past week that he had off. He was ultrasounded back when he originally got hurt and again when hr had the setback. Both times revealed swelling in the suspensory, but no tear/lesion.


        • #5
          Also did a collateral ligament. Details are in the lameness blog linked in my signature.

          But I would say your plan looks reasonable. We did a full month of gradually escalating normal flat work after getting to 20 minutes of canter before we jumped.
          The Evil Chem Prof


          • #6
            My mare has inflammation in the high suspensory of her hind leg. She has had 15 weeks of stall rest. The vet gave us this plan:

            1 week- slow walk
            1 week- working walk
            1 week- collected trot (working up to 15-20 minutes)
            1 week- working trot ""
            1 week- collected canter ""
            1 week- working canter ""

            The first 4 weeks are for every day, then the last two about 5 days a week.


            • #7
              Yikes! I'm not a vet, but I wouldn't be doing collected trot on a horse who has been in a stall for 3 1/2 months 2 weeks after starting her under saddle.
              And I sure wouldn't take one week to work up to 20 minutes of trotting.

              I would be very, very careful with that rehab plan. I've rehabbed a suspensory, a collateral ligament, AND a DDFT. Each time we walked for several weeks, then added trot in over several weeks, then added canter. Very, very incremental.
              NO collection until horse was well into "normal" flat work (that is, W-T-C, including circles, for 40 minutes or so without having to time it). Only then would you add in anything more strenuous, be it jumping, collection, or serious lateral work.
              The big man -- my lost prince

              The little brother, now my main man


              • #8
                Without an ultrasound, I would not try and come up with a rehab program until I knew for sure what was going on.

                If you had an u/s done, what were the results?


                • #9
                  I wouldn't do anything without an ultrasound diagnostic. This way you can tell how bad it is. Sometimes suspensory injurys are quite silent. My horse was completely sound but then had a swollen tendon sheath. Turns out he had a nice strain (or stretching of the fibers). This equaled 3 months in the stall with handwalking for 30-60 minutes a day AFTER the first 2 weeks. I wanted to make sure nothing was recurring in the future so I followed instructions to the T. Now he's back to work for 2 months now and that leg is as tight as a drum!!!
                  Turn out is also important once he's allowed back out. Flat, safe, good footing is important for at least the first couple of months. You don't want him to slip and then put you back at square one.
                  Good luck...start with that ultrasound!


                  • #10
                    Originally posted by thechestnutmare View Post
                    My mare has inflammation in the high suspensory of her hind leg. She has had 15 weeks of stall rest. The vet gave us this plan:

                    1 week- slow walk
                    1 week- working walk
                    1 week- collected trot (working up to 15-20 minutes)
                    1 week- working trot ""
                    1 week- collected canter ""
                    1 week- working canter ""

                    The first 4 weeks are for every day, then the last two about 5 days a week.
                    I suspect, hope, that by"collected" your veterinarian simply means "slow",or "easy", as "collected" in dressage parlance has absolutely nothing to do with either slow or easy
                    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.


                    • Original Poster

                      As I said above, he has been ultrasounded twice - once when he originally came up lame and again when he had the flare up 2 weeks ago. Both times showed swelling in the suspensory but no tear or fiber disruption. The second time the swelling was much more minimal.


                      • #12
                        It's fairly typical to ultrasound at the end of each level of work, say before you begin trot work, before you begin canter work, etc. So, you can add that to your protocol.
                        The Evil Chem Prof