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Rehab methods for a suspensory

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  • Rehab methods for a suspensory

    Am in the middleish part of rehabbing my mares injured front suspensory and (as you do!) have beome pretty fixated about the methods used by others and the varying degrees of sucess. The things that are confusing me slightly are footing and length of rehab rides. Im in the UK so realise that everyones facilities etc being different do impact on how they do things.
    She injured the main body and lateral branh in mid August. Lots of swelling and heat but not horribly lame. No actual hole on the u/s but lots of swelling and disrupted (though not torn) fibres. Did around 6 weeks of box(stall) rest - with 3xdaily(at least) cold hosing, anti inflammatories and 3 x shock wave. Then another 6 weeks of in hand walking 2 x daily, up to a total of an hour per day (split between two sessions) - stuff of nightmares....aaaaarrrrgh...even with acp.Then u/s walking which is where the differences seem to be kicking in.
    Have been told to stay out of the sand school - do as much as poss on tarmac. Living in a very hilly area hasnt helped here but vet thinks its ok to walk up and down hills. Now starting to trot - up to 5 mins per ride atm- once again on the tarmac (everywhere else is a bog anyway now!!) Am riding her for at least 1hr 15mins on average per day(sometimes longer) 6 days p/w - far longer ride times than most that Ive read about - but vet is happy and each u/s has shown great improvement.
    So questions - has anyone else been riding for way over an hour per day 4 months post injury? Trotting on tarmac? (admittedly nice controlled trot and very level footing)
    She is also turned out in a small area for a couple of hours per day - but doesnt wander around much - mostly stands in the shed out of the rain and eats haylage!!!
    She is an arab endurance horse and racehorse. No idea what level Ive got a hance of bringing her back to but fingers xxxxxed and trying to do everything right.
    Observations on a (largish) postcard please:- feel free to knock my programme, Im very happy to take other views on board.

  • #2
    If you've got the time and most of the ride is at a walk, I can't see a problem. People in this country sometimes get the vapors about trotting on tarmac (I think the formulation is different and it tends to be more slippery than we are used to in the UK, particularly in hotter climes), but I'm from the UK too and I find it useful in controlled circumstances--particularly when I was rehabbing my horse from his front suspensory injury a couple of years ago.

    In fact, I still try to get him out and work on hard surfaces--tarmac roads in suburbia around the barn in the winter, hard packed dirt in the summer, including trot work, at least once a week just to keep up him hardened up. I say "try" because I'm on the injured list at the moment and my trainer is riding him, and she doesn't have the time to take him out...


    • #3
      I'm copying a post of mine on another thread regarding suspensory rehab. Hope this helps... The slower the better with suspensory rehab!

      Originally posted by LDavis104 View Post
      For rehab, here was my written plan on how to bring my horse back (4 at the time, front high suspensory tear). I stuck to it no matter how tempting it was to do more. I measured by laps around the ring instead of how many minutes (but you can do it either way). It's been 2.5 years since the diagnosis and he is doing great. I did not have any therapies done except stall rest and slow rehab process (but he showed good healing through the follow up ultrasounds so my vet did not think the other therapies were needed).

      Months 1-3 (Fed, Mar, Apr)
      Stall rest w/ 30 mins handwalking

      Month 3-4 (May)
      Walking, faster walking under saddle - 30 mins

      The following includes walking under saddle as well
      Month 4-5 (June)
      Week 5, 1 trot lap
      Week 6, 2 trot lap
      Week 7, 3 trot lap
      Week 8, 4 trot lap, broken in 2

      Month 5-6 (July)
      Week 9, 5 trot lap, broken in 2
      Week 10, 6 trot lap, broken in 2
      Week 11, 7 trot lap, broken in 2
      Week 12, 8 trot lap, broken in 2

      Month 6-7 (August)
      Week 13, 7 trot lap
      Week 14, 8 trot lap
      Week 15, 9 trot lap
      Week 16, 10 trot lap

      Month 7-8 (September)
      Week 17, Unlimited trot
      Week 18, Unlimited trot + 1 lap canter
      Week 19, 2 laps canter
      Week 20, 3 laps canter

      Month 8-9 (October)
      Week 21, 4 laps canter
      Week 22, 5 laps canter, broken in 2
      Week 23, 6 laps canter, broken in 2
      Week 24, 6 laps canter

      Month 9-10 (November)
      Week 25, 7 laps canter
      Week 26, 8 laps canter
      Week 27, 9 laps canter
      Week 28, 10 laps canter

      Month 10-11 (December)
      Week 29-33 Unlimited flatwork

      Month 11-12 (January)
      End rehab phase! Begin jumping (start with 1 jump, slowly increas)
      "And I saw heaven opened, and behold a white horse..." ~Revelation 19:11


      • #4
        During the initial u/s part of Star's suspensory rehab we were walking up to 45 minutes a day. Vet said a mix of sand ring and outside area (packed dirt)/asphalt road or one or the other was fine, but to stay the heck out of one arena at the facility that was pretty deep in places.

        Once we started to trot, it was 5 minutes at first with long sides of arena only and we built up from there, five minutes at a time (see linked blog in my signature line).

        Another horse at the barn with a tendon injury (same vet) the instructions were to walk on hard ground/pavement, both for the hand-walking and saddle walking and, IIRC, the initial trotting.

        There is a great book called Back to Work, but not sure if it's available in the UK.

        IMHO, the vital thing is to work with your vet, have a specific plan but listen to what your horse is trying to tell you about his level of fitness and soundness and be ready to digress from said plan, and time your trot and canter sets. Five minutes of canter doesn't seem like much until you are actually doing it and are at about three minutes that seems like it's been six.

        Good luck.
        The Evil Chem Prof


        • #5

          Hmmm! How big is each lap. 20mx40m? 70feet by 200feet? Football field?
          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

            thanks for the replies everyone - yes I have got the "Back to Work" book. Im also giving her MSM powder and she had Ruta Grav for the first couple of months (cant hurt)> I use magnetic boots too for a couple of hours per day. I did query the differences in our programme from what Ive read, particularly re the length of rides but vet was very happy with what Im doing and its also helping the horse to feel shes having a fairly normal life (instead of walking up and down the same bit of road loads of times for exactly 40 mins which was causing major tantrums). she appears (fingers xxxxxed big time!!!) perfectly sound with no reaction to palpitation of the injured area (do it obsessively at least 3 x times per day!!!)and makes it very clear that she would LOVE to more -but that just aint happening just yet, we are sticking to our VERY gradual increases in trot atm!!! Hard packed level tracks etc would be great (sigh!!!) I dont have any choice but to do lots of uphill and downhill walking but am choosing flat stretches for the trots and timing religously.
            Lots of knowledge and varied experiences on this forum Going to do a bit more reading up now


            • #7
              Originally posted by merrygoround View Post
              Hmmm! How big is each lap. 20mx40m? 70feet by 200feet? Football field?
              It was in a 70x140 ft indoor ring
              "And I saw heaven opened, and behold a white horse..." ~Revelation 19:11


              • #8

                Good enough. Distance makes a difference.

                Now, how do you keep count?
                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.


                • #9
                  Originally posted by merrygoround View Post

                  Now, how do you keep count?
                  I just counted every time I passed the door, usually outloud
                  "And I saw heaven opened, and behold a white horse..." ~Revelation 19:11


                  • Original Poster

                    I use the second timer on my GPS to count the cumulative total of the trots. She already knows to go into trot when I take a hand off the reins to hit the start button


                    • #11
                      I've got one of those. Grumbles and complains when I add a lap too!

                      Taking it day by day!


                      • Original Poster

                        well today after the just over 4 weeks since starting trot telephone progress report with the vet Ive been told its ok to start some trot work in the sand school (am hammering through shoes like theres no tomorrow with all this taarmac trotting so that might help a bit) Now to persuade horse that she WILL trot nicely round said school!!!!! My school is around 20 x 40 so out of interest I will time one lapAlso been told that I can up the amount of trotting more than I have been doing - have been super super regimated and cautious and only just allowing her to do 9 mins. Phone vet again in around 4 weeks - or when Im consistently over 20 mins trotting per day (if it freezes here everything will be put on hold) Then rescan and see if we can begin cantering. Rapidly running out of routes to go on and darent go to beach yet as theres NO WAY we will acheive any controlled trotting there.... NO NO NO!!!!!...shame as its a great place to work but its also where we do our galloping........somehow dont think the Orange Princess and I would see eye to eye theere atm


                        • #13
                          so the issue with soft tissue is not getting it to heal, but keeping it from re injuring.

                          Most poeple come in to troubles because their horse has been somewhat sedentary and then when they take said horse out to start work the stretching of the suspensory during regular walking causes inflammation or a retear.

                          You seem to be past that point. horray!!

                          I would add an ice boot to your program.
                          Each time your horse works, come in to the barn and put an ice boot on him directly and leave it there while you untack and such.
                          I use ice cells and sick them in a shipping boot or wrap them on with a standing bandage.

                          I've rehabbed two. Both back to work.
                          The last was a difficult injury. I hand walked him 3 x a day for 30+ minutes (or as long as I could) for 1.5 years. And I iced that sucker every time.
                          It got to where I would come home from work, grab a beer, hop on up and walk on the tarmac. lol.
                          I did all of my work back and forth on our packed gravel drive for a year.
                          Then started him over the rest of our property while sitting in the golf cart. (thank goodness for golf cart trained horses!!)

                          He made a full recovery and even went on to pass a PPE with flying colors.
                          Horses are amazing athletes and make no mistake -- they are the stars of the show!


                          • Original Poster

                            pp your rehab sounds like a nightmare extension of my hand walking weeks (was literally shaking like a leaf every time - "will she freak out" "will she get away from me" "will she reinjure" etc - everytime we got through it without major incident I needed a triple brandy - didnt get one though) then the initial u/s walking was almost as bad - every time we turned round to go home the fireworks started. Yours just lasted a lot longer by the sound of it
                            ice boot is a good idea but tbh Ive never had much success with ice type boots - never seem very effective. But maybe Ill have a shop around and see if I can find anything better than the fairly useless ones Ive got. Cold hosing seems, to me, to be faaarrr more effective (although time consuming and mud creating as the water runs into the turnout area) I did religously cold hose after every walk for weeks but have to admit Im not doing it so much now. Anyway - thanks - wake up call - will see if theres anything better onto the market in the last couple of years!


                            • Original Poster

                              aaaarrrghhh first real setback- am hoping its minorwe were up to 20 mins trotting - all hunkey dorey and then on post exercise check the leg was hot and tender on (non weightbearing) pressure above the fetlock. Horse still sound. Advised to go back to walking which we did but had a good old leaping and bouncing "incident" yesterday. Off to vets today for u/s and she trotted up very slightly lame - more after fetlock flexion. Suspensory scanned fine, fetlock x rayed fine. Scanned tendon sheath around the area where there was intermittent heat and oedema (quite squishy) and there are some very small adhesions. It looks as if they formed during the acute part of the injury to the suspensory branch due to the swelling and inflammation and are now starting to break down. Im assuming this is positive? Vet thinks this is the cause of the lameness. Any thoughts or experiences out there? Any ideas as to how to encourage further breakdown? Am now going to do a week of restricted turnout and cold hosing to (hopefully) get rid of the heat and filling (which is also intermittent!!) Vet doesnt seem overly concerned - but on googling this Im getting VERY concerned