Horse Problems DatabaseFront End – Suspensory Rehab

Getting a lot of questions about rehab for suspensory injuries! Here’s my top 3 suggestions:

A horseat a full gallop.

#1 Don’t start rehab until your horse is ready to start rehab

How do you know? Several signs of healing:

  • No heat
  • No swelling
  • No limping
  • Standing without placing leg forward.
  • ultrasound improvements
  • No pain upon touch or squeezing suspensory


Most IMPORTANT: The three Fulcrums of the stay apparatus (shoulder, accessory carpal bone, and sesamoids) move properly and have no tendency to re-”stick”. That is, if any of the three Fulcrums keep “sticking”, then there is an underlying primary cause that must be addressed.

If that underlying primary cause is not addressed, then the suspensory is in danger of renewed injury.

Don’t know what I mean by the three Fulcrums? There’s a free video on this page:

#2 Modify the rehab schedule to fit your horse

It’s great to follow a rehab schedule. Either the schedule your veterinarian recommended, or the one in the Save Your Suspensory course.

However, keep in mind that things change. You know how some days you feel gung-ho to go to the gym, but other days you feel blah? Well, horses have good days and bad days too. Instead of following a rigid schedule, allow for reasonable flexibility.

So every day before and after rehab, you should:

  • Feel the leg for heat
  • Look carefully for swelling (consider taking pictures)
  • Test the suspensory for sensitivity by squeezing it.

I recommend really knowing your horse’s normal reaction to suspensory palpation. Suspensory palpation is covered in detail in the Save Your Suspensory course. Basically, it’s just squeezing, or pushing on, your horse’s suspensory to see the reaction.

Then, if you notice any itsy-bitsy (ie. tiny) changes in heat or swelling or sensitivity, you can make a change. Skip rehab the next day, for example, or cut the time in half. You are the one who knows your horse best.

Keep in mind that rehab schedules are designed for the average horse. Your horse is not average. Your horse is an individual with specific needs. It would be far more beneficial for your horse to have you checking his or her leg every day, and making a plan based on the leg. Instead of rigidly following the rehab schedule without considering your horse’s response to that schedule.

I know it can feel scary to make an adjustment. But I’m talking about small changes, not letting your horse run wild in the pasture because he or she looks fine.

Here’s some examples:

Let’s say your horse’s leg feels a bit warmer, and maybe seems a bit puffy one day after 10 minutes of walking. You’re supposed to do ten minutes of walking again. Instead, just change it to 5 minutes. It won’t hurt to slow down.

If you feel adding more exercise would benefit your horse, of course it’s best to take it slowly. Let’s say your horse’s leg feels great. You’re supposed to do ten minutes of walking each day all week. You could do 12 minutes instead. Two additional minutes won’t hurt, especially if you’re checking the leg before and after rehab every single day.

This is really the best way to do rehabilitation. Each horse is an individual. Use a rehab schedule as a guide. Check your horse every day and make small changes to help your horse.

#3 Make a plan to avoid scar tissue

Even if your horse’s three Fulcrums of the stay apparatus are perfect all the time, horses with suspensory injury can still get scar tissue.

How does the horse get scar tissue?

Any inflammation (heat/swelling) can increase fibrinogen, which can turn into adhesions, which can turn into scar tissue. This doesn’t always happen, but it can. In addition, the fibers of the suspensory can have scar tissue incorporated into it.

Why don’t we want scar tissue?

Some people feel that scar tissue is stronger than regular tissue. While that is debatable, the issue is scar tissue is not as flexible. In addition, adhesions are “sticky”. So both scar tissue and adhesions may cause lack of function of the suspensory, even in a “perfectly healed” one. Lack of proper function may cause the suspensory to tear again.

How can we avoid it?

The body puts in scar tissue because it needs it to be there. But we can do our best to help make sure the body doesn’t need it. Here’s a few ways:

Ice (ie. cold therapy) when the suspensory injury is active (hot or swollen). Twenty minutes at a time of topical icing or cold-hosing the leg.

Arnica used topically. Two to three times per day on the leg. Arnica decreases inflammation fantastically, and does not block pain receptors like bute or banamine. You can add arnica to a poultice if you like.

Adjunct therapies such as Tucker BioKinetic Technique (TBT), acupuncture, red light therapy, and I’m sure there are others I am not familiar with. You want a therapy that helps deal with scar tissue, as well as the reasons the body deposits it. Avoid therapies that increase blood flow to the area, such as magnetic therapy, heat, microcurrent, cold laser, and the like. These are good therapies, but not helpful for scar tissue issues.

If you can avoid scar tissue and adhesions, and keep the three Fulcrums of the stay apparatus in perfect working order, then your horse can get back to their original baseline work. Obviously that’s a generic statement that depends on the individual horse, but it can be done. Don’t give up! Even if you have older scar tissue, that can still be released to a great extent.

In summary

The road after a suspensory injury can be long and lonely and tough. But your horse can get back to normal, and maybe even better than normal. Keep in mind these three tips as you rehab:

#1 Don’t start rehab until your horse is ready to start rehab
#2 Modify the rehab schedule to fit your horse
#3 Make a plan to avoid scar tissue

Other Resources:

  • Join our free Save Your Suspensory Facebook group here:
  • Free Save Your Suspensory Video:
  • Want to align and heal horses?

    Want to Align and Heal Horses? You Can!