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Deep Digital injury and rehab

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  • Deep Digital injury and rehab

    I know this has been a somewhat common topic but after I searched I found nothing quite the same. My 4 year old gelding injured his ddft high on the left front. At first we thought it was a heel injury. He would head bob at the trot but still track up fine. The head bob was slow but very pronounced. On the lounge to the right he would head bob a little but not as bad as under saddle. We soaked the foot thinking it may be an abscess but had the vet out a couple days later. The ultrasound showed some disorganization but the vet classified it as a strain. We put him on stall rest doing 2 treatments of shock wave and 6 weeks stall rest. During stall rest we had to do a lot of hand walking because he was becoming too wound up in the stall. Often he would be seen rearing up and spinning etc. Next we started walking under saddle and low doses of Dormosedan gel, this was increased to trotting slow strait line. 8 weeks after injury was had another ultrasound which showed scar tissue and the vet cleared him to gradually get back to work.

    I know this is a minor injury as far as DDFT injuries go but I am wondering if anyone else has rehabed a horse similar to this. I have been following vets orders but still worry about a reinjury everytime I ride.

    Right now we are doing light walk and trot work, some shoulder in at the walk adn transitions. He is ridden often 5 days a week for short periods of time (15 - 20) mins this is mostly because it is too wet to turn him out. He is doing really well, not sore, head bobbing etc. I want to step up his workouts a little without stressing him. Prior to the injury he was schooling second level and we had just started putting changes on him. It has been about 10 weeks since the original injury.

  • #2
    I am currently rehabbing same injury, but it's the left hind DDFT and SDFT that were bowed. I too thought it was abscess (I was in denial, the swelling in her leg couldn't have been from an abscess) and actually left my mare on regular turnout (12+ hours a day) for the first 11 days after injury. Vets (both in the same practice) came out and quickly diagnosed her with bowed tendons. I put her on stall rest immediately, with twice daily hand walks. By the 12th day of this regimine, my wonderfully sane mare started to lose her mind over the course of 3 days (spinning, pacing, biting the stall, bucking, trying to rip away from me while walking). The day I walked into the barn and found her trying to stand on her hind legs was the day I turned her back out. She's been on normal turn out (12+ hours a day) ever since.

    Tomorrow will mark 12 weeks since original injury. I was cleared to ride her (walk only, 10 minutes at a time at first, then build up) almost 6 weeks ago - yes 6 weeks after original injury! (I credit all that turn out and her sanity for the quick recovery.) I have since only ridden her a handful of times - I too am terrified of reinjury. For me, it's enough that she's alive and painfree, I don't HAVE to ride her to enjoy her. Her quality of life is what's most important, and if I were to cause reinjury, I would be devastated. So...while different leg...I'm right there in the same boat with you, OP, in terms of fear.

    For what it's worth - I had no experience with tendon and ligament damage before this. I did tons and tons of research and just about everything I found stated that this injury on a front limb is much easier to heal and recover from! Good luck! I'll keep everything crossed for you and your boy as I keep everything crossed for me and my mare.
    “Riding a horse is not a gentle hobby, to be picked up and laid down like a game of Solitaire. It is a grand passion.” ~Emerson


    • #3
      I would follow the advise of your vet very carefully. A careful and controlled rehab in very important If at any time your horse was to go lame again you may want to consider an MRI. Hopefully your horse continues to recover well.


      • #4
        You don't mention your timeline. When did the injury occur and how long were you not riding him for?

        Tendons take a LONG time to recover. Tendon are always under a measure of tension because they always want to shorten. They have moderate blood flow - far less than that of muscles (which is why muscles heal quickly), but more than what ligaments get (which is why ligaments are a real devil to get healed).

        That being said, tendons can recover nicely when you have rehab, but it must be the RIGHT KIND of rehab.

        After the initial acute treatment (which I think you've already progressed through and you're now into rehab, correct?), start the rehab process excruciatingly slowly.

        I'm not sure how severe the DDFT injury was, but I am assuming it was very severe and the rehab lays out accordingly. If your horse was less severe, then follow the same modality, but the timeline will be shorter.

        Start with hand walking on a hard surface. Build up to walking with your horse for at least 30 minutes sustained a day. Any given day his tolerance could be up or down, so check periodically in your walk for any sign of heat. First sign of heat get yourself back to the cold-hose station - note the time in minutes from start of walk to excessive heat/swelling, because that's his limit for the next week. When he gets to the point where he has no heat with 30 minutes of hand walking, and he's comfortable and happy even in turnout, then and only then is he ready for saddle rehab time.

        Working under saddle presents a different stress to the horse because no matter how good a rider you are, your weight is constantly shifting, requiring the horse to be shifting his own balance. This puts stress on every part of his body from skeleton, to muscles, to joints, to tendons to ligaments to feet. Everything is impacted.

        Also, start riding your walking rehab on a hard surface. Soft squishy surfaces are harder to cope with during activity! Start walking. 5 minutes, stop and check for heat. None? Okay, do 5 more. Get off and cold hose and your done for the day. Gradually build up to 30 minutes walking with a rider on a hard surface. Then switch to a soft surface like your riding ring and start with a decreased time, always checking for strain and heat. When he can do 20 minutes walking, try adding 3-5 minute trot followed by a 5 minute walk break. Check for heat, I mean, heat hotter than the good legs. Then, next week add a second 5-minute trot session broken up with a 5-minute walk session. Check for heat. If good, increase another 5-minute trot with a 5-minute walk. And the like. Depending on the severity of the injury, you can build into longer riding time, but never more than 5 minutes sustained trotting at a time without a 5 minute break. Periodically check for heat. Stop at the very first sign of this leg being hotter than the healthy ones. If he can 30 minutes with intervals of 5 min trot to walk to trot, to walk, to trot, etc., then start increasing the trot time to 10 minutes, 5 walk, 10 trot, 5 walk, check for heat. If he's good that week, then increase time to 45 minutes.

        I would not be doing leg yields, half-passe, or circles smaller than 30 meters. These add additional stress. Wait until he can happily canter for at least 5 sustained minutes followed by trotting for 10 minutes. If he can do that and stay happy, THEN you're ready for lateral work. And always checking for heat. It might become an obsession for the first 6-8 months, but excessive heat is your only guide as to how well the tendon is coping with rehab, because your horse might actually be too giving to tell you honestly, hey this hurts. Until he starts to limp because he can't take it any more, and then you've done damage!

        Your goal is to strengthen the tendon, but it can only strengthen if it has adequate repair time. So, 5 days a week is good. You could do 3 days of riding in a row with a day off with hand walking, then 2 days of riding, and a day of total rest. If your horse starts to show stiffness after his day off, then you mnight be overdoing it and so step it down to 2 days riding, 1 day hand walking, 1 day riding, 1 day hand walking and a day of nothing but pasture turn out.

        Progress tends to be up and down. A very severe injury - I wouldn't be cantering before 6 months. A less severe injury, maybe in 2-3 months? Be sensitive to what your horse tells you. He's the only one that knows how it feels. However, even with a minor tendon injury, I would never consider jumping of even cross poles until he's at least 6 months out from injury. The landing percussion and weight-bearing on the limbs are enormous and actually end up being more than his total body weight. So, don't do it until you know beyond a shadow of a doubt that the tendon is good, strong and well healed, because if it ruptures (sounds like a gunshot), your horse is done.

        Keep in mind, a horse is very stoic and they tend to try to do what we ask even when it hurts. If he starts limping, you have done way, way, way, way too much and you've actually injured him again and you have to start all over from scratch again.
        Last edited by rodawn; Mar. 15, 2013, 07:06 PM.
        Practice! Patience! Persistence!


        • Original Poster

          Thank you Rodawn, your post was very helpful. The injury was minor as far as DDFT injuries go. The vet classified it as a strain, not a tear. We did two treatments of shock wave, just because I would rather do too much than not enough. We did an ultrasound after 2 months and there was a bit of scar tissue and everything was looking really good so I was given the ok to slowly get back to work. Everything I read is about very severe injuries, so I have been so nervous about getting back to work. We are trotting about 15 mins. The outdoor arena is very wet or icy so I work in the indoor, strait lines mostly, 200 meter circles at the ends. He has seemed very happy and has stayed sound. Today I thought he felt not quite right for a couple strides, mom, who was watching said that he didn't look off at all and I did not feel it again, but I just always feel nervous about a reinjury. I stopped riding early. He is off tomorrow. I use Back on track books for warming up his tendon, always 10 mins of walking before any trotting, 15 mins of trotting work, then 5 to 10 mins cooldown. I palpate the tendon, put ice boots on for 20mins, then follow up with liniment (sore no more). I have planned on starting to canter this weeked but am holding off. It will be three months in 2 weeks. Please note that during the original injury he never got gimpy or lame, he would head bob at the trot while still tracking up. Anyway thank you for all of your advice.


          • #6
            I am reading all of this with interest. My mare is recovering from what was diagnosed as a severe coffin bone bruise. The bone scan shown "crazy hot" in the outer half of said bone on RH. Been over 2 mos. rest and turn out and then hand walking and a little free trotting and occasional canter. The canter had disappeared when this all began, then the trot started getting spotty, then just reared when asked to go forward.

            Now I have her on l. Line in outdoor every day wtc both directions. Canter looks great, for a change. Horse is green and coming 5 next month. Growing like crazy too.

            I have been sitting on her bareback at the walk. A few weeks ago when I first tried this she reared and i swung off or stayed on for a few tries. Now she walks great and is doing little trots, but then the ears go back and I stop trotting. I hope to work up to a little more trotting, then putting the tack back on. She was never one to go forward because she is so intermittently rump-hi (going to be 17 hh at least and gangly at the moment). I hope I am doing this right. I had the Tildren, MRI, Scan a few months ago so I know that it isn't soft tissue or fracture injury. But she sure was sore! Not head bobbling so much, just refused to canter. Canter is back, but not under tack. I have her barefoot behind at the moment. Afraid to bang shoes back on. She did it kicking her stall, so I keep a kicking chain on the RH when she's in. She is a great patient for a baby. Just not much fun under tack at the moment. Enjoying our walks, however. I feel as if she is never going to be back to "normal", which was never completely normal to begin with because of her growth spurts/sucking back attitude. Please keep posting on rehab!


            • #7
              When rehabbing from tendon and ligament strains or tears work in 3 day increments. Don't change anything until he successfully handles the current workload for 3 days. If you miss a day go back to where you were. I would not be thinking of cantering if you are only at trotting straight lines.
              Also hand walk as much as possible... 2 or 3 times per day.