Save Your Horse’s Suspensory!

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Suspensory pulls are the second most common horse health issue. Second only to colic. Study by the Center for Equine Health, 1999

**A “Pull” in this article refers to all tears, strains, sprains, etc. resulting in lameness.

The tall bay horse waited for me in the cross-ties as I hustled down the aisle way to meet Katya, her owner.  

“I’ve been so looking forward to our appointment,” Katya said. “But I don’t know if you can help me now.  Bailey has pulled her right suspensory.”

“Oh I’m so sorry to hear that,” I sympathized.  “Do you have any idea how it happened?”

Katya shook her head as she replied, “No, none at all.  I’ve had her for eight years and no lameness ever.  Now this.  The vet says she’ll be out of jumping for a year, if she ever can jump again.”


No one sees them coming…

Suspensory pulls are so devastating, not only because the horse has to be rested and rehabilitated for so long, but because no one sees them coming.

Many times horse owners have told me, “My horse was fine when he was put in the stall at night, and the next morning his leg had blown up.”  Suspensory pulled.

“No previous limping at all.  She just came in from the pasture dead lame.”  Suspensory pulled.

Overall, very few horse owners say “my horse tripped over a jump and came up immediately lame” resulting in a suspensory injury.  That would make sense.

Suspensory pulls are not only devastating, but rather mysterious.
And what about the reoccurring suspensory pulls?


Reoccurring Suspensory Pulls

A recent poll found that more than 50% of horses that pull one suspensory, will do it again. As a veterinarian, I have always found reoccurring suspensory pulls to be suspicious.

Why do I say that?  Because I have known many horse owners who conscientiously and tediously rehab their horse with a suspensory pull for a year.

Then, a few months later, the worst news:   very often the horse will re-injure that same suspensory, even with a decreased level of work.

Was the suspensory even healed? Are the ligaments of the entire horse simply weak?  Did they rush the rehab?  Let me tell you what I think.

After over 20 years of Chiropractic experience, including developing my own Tucker BioKinetic Technique, I have seen hundreds of horses with suspensory injuries.  
Every single one of them had at least 3 out of 4 of the following problems with their suspensory-injured leg:

  • Contracted heels
  • Non-functioning Sesamoids bones (at least one of two)
  • Non-functioning Accessory Carpal bone (back of the knee)
  • Severely restricted shoulder movement

To my knowledge, I have never seen a horse with a suspensory pull (active or previous) that did not have three or all four of the above problems.

Now there has not been an official scientific study on this, because regular veterinarians do not know how to assess items 1-3.  But, I’m going to tell you how to check them!
But first…


Why is this true?

Before I can tell you how to check these 4 items, it is best to explain why what I’m saying makes sense. Let’s talk for a minute about what happens when the horse steps on a front leg.

There is a transfer of the concussive forces that travels up from the foot to the body. “What concussive forces?” you may wonder.

The concussive force is the weight of the horse as it hits the ground. That “pounding” power has to go someplace. The horse isn’t leaving massive holes in the ground from his 1000 lbs. Instead, that force goes back up the leg. It travels up the foot, over the sesamoids, and climbs to the knee. ALL of this goes through the suspensory ligament.

Next that force travels up the rest of the leg from knee to shoulder, and from there spreads out to the body via connected muscles.

If all the “transfer points” aren’t functioning correctly, the concussive force doesn’t transfer correctly either. Instead, some of it slams into….you guessed it…the suspensory ligament.


But wait!  There’s more

If the transfer points are “jammed” (i.e. not correctly functioning), then the suspensory ligament can’t rest and heal either. This means that all those weeks and months of resting and rehab are wasted.

It’s like trying to heal a broken bone when it is not aligned right in the first place. That bone will be much weaker, and likely break again when it appears healed.


The Transfer Points

The transfer points I am referring to are the four items listed previously. They are:

1) Contracted heels
2) Non-functioning Sesamoid bones (at least one of the two)
3) Non-functioning Accessory Carpal bone (back of the knee)
4) Severely restricted shoulder movement


How to Check the Transfer Points

1)  Contracted Heels

Let’s start at the foot. If the heels are contracted, they cannot expand upon contact with the ground. This limitation puts strain on the biomechanics of the suspensory ligament.

Contracted heels mean that the heel bulbs are squished together. Normal heels have space in between each heel bulb. In this case, a picture is worth a thousand words.

Images courtesy of Hoofmaiden, www.blue-heron-farm.com

Image on the left:  Thin frog with crack between heals indicating severe heel contraction.

Image on the right:  Wide frog with no crack at all between heels — strong, supportive back of foot.

How to check Contracted Heels

To check your horse, simply pick up the hoof and look at it like the above images show.  If you have only a “crack” between the heels, then they are contracted.  If you have at least a thumbs-width (1inch or 2cm) between the heels, then in most cases you should be fine.
I say “most cases” because the larger the overall foot, the larger the space should be between the heel bulbs.  In addition, the desired space depends on the breed and natural shape of the foot.  But overall, just make sure you have at least an inch.

How to fix Contracted Heels

There is a lot of helpful hoof information out there, so I am not going to go into a lot of “how-to” detail here.  Primarily because most people will just need to have a conversation with their farrier or trimmer.  If you are interested in trimming the feet yourself, I recommend Pete Ramey’s informative website:  www.hoofrehab.com

The general idea is to trim the foot to allow the heels to widen.  Ideally, this would mean removing the shoes, at least for a period of time.

If removing the shoes is impossible, you can have your farrier use a larger size shoe with a minimum amount of nails near the heels.  This larger shoe should extend beyond the heels in length and width. Your farrier should have a good idea how to fix contracted heels, as long as he or she wasn’t the one who got your horse contracted in the first place.

As an example, these images are from a horse with contracted heels over a one-year period of time.  Note that this horse was barefoot.  Trying to expand contracted heels while remaining shod takes even longer.


2)  The Sesamoids

At the back of the fetlock lie two sesamoids. Little squat, triangular pear-shaped bones, one each on the right and left. The suspensory ligament has right and left branches that go over these bones.

As the foot hits the ground, the fetlock drops down. The Sesamoids move up slightly to accommodate the extra tension on the suspensory ligament.

IF the Sesamoids cannot complete their movement, however small, it increases strain on the suspensory ligament. Depending on where/how the Sesamoids are “stuck”, that increased strain can be happening all the time.

How to check your horse’s Sesamoids

To check your horse’s Sesamoids, first find them. They are located on the back of the fetlock. See diagram below.

This is the view from behind the foot, looking forward to the toe. Keep this image in mind as you hold up your horse’s foot. I find it easiest to face towards the horse’s head as I hold up the foot. See photo below.

Feel around the back of the fetlock until you have located a Sesamoid bone. Now push it gently with your thumbs. It should move about ⅛ to ¼ inch (2mm to 4mm) in all directions. As you gently move the Sesamoid, it should give easily and softly.

If you push it with your thumb and it feels like you are pushing on a hard, immoveable rock, it is definitely out of alignment. Even if it is “stuck” only in one direction, it is still causing problems.

Be sure to check both right and left Sesamoid bones on each front leg.

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How to fix “stuck” Sesamoid bones

Ideally, calling a competent bodyworker would be best.  A certified equine chiropractor,  physio, massage therapist, Masterson method, acupuncturist, fascial worker of any kind, laser therapy, etc.  Any therapy that increases mobility will be helpful here.  
If you are without a professional, you can try to help the Sesamoids yourself.

To fix them yourself, I have a download for you, available here:  Save My Suspensory!

This free download includes this entire article (with pictures and diagrams), AND includes all the “how to” portions.  If I put the “how-to” in this article, it would get ridiculously long.  :)


3)  The Accessory Carpal Bone

At the back of the knee (carpus) is the Accessory Carpal Bone (ACB). It did not sit in the center, but rather over to the outside. The suspensory ligament ties into the cannon bone just below the ACB.

Similar to the Sesamoids, the ACB needs to be able to move to accommodate the tension changes in the suspensory apparatus.

If the Accessory Carpal Bone cannot do its movement, strain is increased on the suspensory ligament. Depending on where/how the ACB is “stuck”, that increased strain can be happening all the time.

How to check your horse’s Accessory Carpal Bone

To check your horse’s Accessory Carpal Bones, first find them. See diagram below.

This is the knee (carpus) viewed from the outside of the leg. The round bone on the right is the Accessory Carpal Bone.

Keep this image in mind as you hold up your horse’s foot. I find it easiest to face towards the horse’s head as I hold up the foot. See photo below.

Left front leg. Holding up the leg to feel the Accessory Carpal Bone.
Feel around the back of the knee until you have located the ACB. Now push it gently with your thumb and forefinger. It should move about ⅛ to ¼ inch (2mm to 4mm) in all directions. As you gently move the ACB, it should give easily and softly.

If you push it and it feels like you are pushing on a hard, immoveable rock, it is definitely out of alignment. Even if it is “stuck” only in one direction, it is still causing problems.

Be sure to check the accessory carpal bone on each front leg.

How to fix “stuck” Accessory Carpal bones

Ideally, calling a competent bodyworker would be best.  A certified equine chiropractor,  physio, massage therapist, Masterson method, acupuncturist, fascial worker of any kind, laser therapy, etc.  Any therapy that increases mobility will be helpful here.  
If you are without a professional, you can try to help the Accessory Carpal bone yourself.

To fix them yourself, I have a download for you, available here:  Save My Suspensory!

This free download includes this entire article (with pictures and diagrams), AND includes all the “how to” portions.


4) The Shoulder

As you may know, the shoulder having the correct range-of-motion is needed for leg movement. However, the shoulder (and associated muscles) is also primarily responsible for transferring the concussive force from the ground to the body.

Without the shoulder moving properly, that concussive force cannot transfer. That force remains “stuck” in the leg and impacts the suspensory ligament negatively.

There are actually three parts to the Shoulder Checkup. However, for our purposes we will only do the main one.

Hold your horse’s leg up, making sure it is relaxed.

Study the diagram below. You will be placing your hand on the top of the scapula (shoulder blade), NOT directly on the shoulder joint. If you place your hand directly on the shoulder joint, it impedes the motion and then you won’t know if there is a shoulder problem or not!

The shoulder joint is circled in blue. Your hand needs to be within that blue circle, on the left side of the scapula (upper bone).

From that position, you simply push straight back towards the tail.

The shoulder should move back two inches (4-5cm) at a minimum. If the shoulder will not move back, then it is stuck/out of alignment.

This is the Shoulder Checkup position. I am holding the leg up with my right hand, and pushing straight back with my left hand.

How to fix a “stuck” Shoulder

Ideally, calling a competent bodyworker would be best. A certified equine chiropractor, physio, massage therapist, Masterson method, acupuncturist, fascial worker of any kind, laser therapy, etc. Any therapy that increases mobility will be helpful here.

If you are without a professional, you can try to help the shoulder yourself.

To fix them yourself, I have a download for you, available here:  Save My Suspensory!

This free download includes this entire article (with pictures and diagrams), AND includes all the “how to” portions.  


This will Save Your Suspensory!

In summary, there are four parts of the horse that must be correct for the suspensory ligament to be protected from injury and to heal.

Those four parts are: the foot (having normal heel expansion), the Sesamoid bones, the Accessory Carpal Bone and the shoulder.

If those four are correct, then there is plenty of “slack in the system.” Your horse’s suspensory ligaments can avoid injuries if these four are correct. Even if your horse steps in a hole, there is still enough “give” to keep the suspensory safe.

Best of luck with your horse!

Renee Tucker, DVM

PS. The Checkups of the Accessory Carpal Bone, Sesamoids, and Shoulder are all explained in much greater detail in the book “Where Does My Horse Hurt”.

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Join us to start discovering the Equine Body Checkups. Dr. Tucker teaches the main Checkups. Share your videos on the private Facebook group to get feedback from Dr. Tucker!

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We are looking for submissions for Dr. Tucker's "Featured Cases." If you have a puzzling case you want solved, we would love to post it to help others. Pictures needed, videos welcome. Email to drreneetucker@gmail.com. Thank you.

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36 Comments on “Save Your Horse’s Suspensory!”

    1. Hello Patrick,

      No unfortunately there is not a direct correlation between “culprit” and specific area of injury. But if you had ANY suspensory injury, then 3 (at least) out of the 4 transfer points were most likely impaired.

  1. Very interesting article thank you, does this also apply for hind limb ? My horse was diagnosed with bi lateral hind PSD, what factors are involved with this type of suspensory injury ? Many thanks

    1. Hi Jemma,

      I’m sorry to hear about your horse. I hope she is doing well now. For the hind limb suspensory, it’s the same idea. Different mechanism, obviously, but same idea. I will get into the details in a different post. Thank you!

    1. Hi Julie,
      Hind suspensory injuries are similar in nature, but with different mechanisms. I will have to give advice for hind in a different article. Thank you!

  2. There is another possible reason for suspensory problems as well as these more common mechanical ones, horses born with the genetic disorder DSLD/ESPA. With bilateral problems this systemic incurable cause of connective tissue breakdown should also be considered.

    1. Hi Laurel,
      Yes, that is correct. There are certainly horse’s with extenuating circumstances. DSLD, old fractures, arthritis anywhere in the joints, problems with the other leg causing more weight-bearing on the suspensory injured one, and of course….actually catching a leg in a deep hole in a soft pasture.

      This article is directed at “plain-old” vanilla suspensory injuries. I’m glad you posted, though, so people can know there’s always the unusual stuff out there. :)

  3. Hi, could I have the paper on hind leg suspenseful ligament injury, I have a horse with an old hind suspension injury. Thank you for your article.

    1. Hi Lyn,

      I’m sorry I don’t have that written yet. If you are a member of the free “50 Horse Secret” emails, you will get a notification when it is up. Thank you!

    1. Thank you Shawna. I am glad you enjoyed the article. I’m sorry it is so many pages. I’ve had requests in the past to be sure and make the font size large, so it’s easier to read. I’ll try and get rid of some of the white space. :)

  4. Thank you so much for this Renee. I live in paranoid fear of suspensory issues but now feel I have some insights to help protect my mare’s.

    How fantastic to have someone of your training and calibre share such valuable info for FREE with us horse fanatics. Brilliant!

    You and Sue Palmer should hook up for clinics in the U.K!
    Much gratitude, Rachel

  5. Thank you Renee for making this easy to understand. My mare has a suspected suspensory pull off hind. In the morning I will try to apply similar principles and see what happens. Have ordered your book can’t wait to read it. Cheers Verna

  6. Great article, well written. I noticed you left out the spinal column as a source of alignment problems contributing to injury. The spinal column seems to be the biggest transfer point of the forces of energy. That would be a much more complex issue than contracted heels, stuck sesamoid and carpal bones. Would love your input on this too.

    1. Thanks Patty! The spinal column transfers energy primarily from the force of the hind legs, through the back and forward. The concussive force of the leg of the foot hitting the ground transfer up the leg and dissipate over the shoulder muscles. So each leg is effectively “separate” when it comes to suspensory injuries. Thanks for your thoughts! :)

  7. I have a question that doesn’t seem to be answered in this article. What exactly is it that the sesamoids and accessory carpal bone get stuck on? Further explanation would be greatly appreciated.

    1. Hi Robyn,
      Thanks for your question. When I use the word “stuck”, I am referring to the bones not able to go through their full range of motion. What is causing them to be “stuck” could be many different things. For example, if you’ve ever been to a chiropractor for your neck, let’s say your neck is “stuck” and won’t bend to the right. After the chiropractor (or masseuse or acupuncture, etc), works on your neck, then it becomes “unstuck” and is able to bend happily. Does that help?

  8. Thank you for your excellent article. Well articulated so even a novice wanting to learn can easily follow. I’ve been an equine massage therapist for twenty-six years and always learning from other professionals like yourself.
    Thank you for helping the horses and their owners!!

  9. Been meaning to read this for a few days and now I have it has become even more pertinent as my horse is lame, LF, and am hoping it is not suspensory pull however am aware that the horse slipped and fell, quite heavily, on the left side a few days ago (Saturday) in the paddock. Thank you so much for this article.

    I had already some suspicion that there was a very slight, intermittent problem with left front movement and unwillingness to stretch left front leg on first attempt but on latter attempts would stretch satisfactorily (the horse is slightly ‘tied-in’ left elbow). My question now, if possible to answer this here, is that over the last 2-3 weeks I had noticed that on picking up left front to pick out hoof there would be a moment when I felt the horse drop the shoulder and therefore the leg making me feel that at any moment I would be ‘carrying’ the horse. Never actually got to that point but could this be a sign of shoulder misalignment from some previous incident?

    I am going to do your 4 checks this afternoon :-)

    1. Hello Alison,

      Thanks for your comment. Let me try to give you some suggestions that may help. First, any horse that is “tied-in” at the elbow most likely has a shoulder problem. Next, in answer to your question, that “drop” of the shoulder can be a sign of a C7 issue (cervical vertebra #7). I talk about that on the youtube videos. Did you see those?

      Also, just fyi, how to check C7 is included in the Level One BioKinetic class: https://renee-tucker.mykajabi.com/p/tucker-biokinetic-level-one-masterclass

      Thanks and good luck with your horse!
      Renee

    1. Hi Lisa,

      I don’t know anyone personally, unfortunately. You might try the American Veterinary Chiropractic Association. They do have people internationally. Best of luck with your horse! :)

      Renee

  10. Contracted heels also go hand in hand with a toe first landing, and this completely compromise the biomechanical movement of the horse.
    As a trimmer, I see this as the “root of all evils” in a compromised foot, if only owners would video their horses to identify this early, they will be saved many complications later on.

    1. Hello Marjorie,
      Thank you for your comment. You are totally right. In addition, I find that when a horse’s shoulder has a compromised range of motion, they can also land toe first. And sometimes this can cause contracted heels, too!

      It’s a vicious circle, and problems can start at any point on the circle. As long as horse caretakers (you, bodyworkers, owners) know what is RIGHT and to look for that, then we can keep these majestic animals safe.

      Thanks again,
      Renee

  11. Hello from Glasgow, Scotland

    Came across your YouTube posts and found them intriguing and also a lot of sense.

    I have an 11 year old mare who was diagnosed February 2016 with bilateral PSD [hind], had 3 sessions of shock wave treatment, 4 months box rest and a slow return to work / rehab programme. Treatment deemed successful and signed off in December. However, her canter became disunited again in March this year and although scans showed that there was no change to the suspensory ligaments, clinically though and after nerve blocking vet confirmed suspensory again. She has also had physio in the last week as she wasn’t getting any better even on daily danolon… her pelvis had rotated most likely as a result of over compensating, follow up session booked, I am also thinking that it is impacting on her hamstring as after the physio she is lame and if I touch at the dorsal there is clearly twitching in the thigh area behind the stifle.

    Just don’t seem to be getting out of the vicious circle until I came across your YouTube posts on the front limbs.

    I know a few on the blog have asked about hind limbs and how to check so I would be really interested to find out more on how to check the transfer points related to hind limb PSD.

    Also interested in the masterclass and assuming that it would be ok not being in the USA?

    Every hopeful

    Ann

    1. Hi Ann,

      Yes I agree it sounds like the vicious circle. I am still working on the hind limb suspensory issue video, etc. It is more complicated than the front, so it is taking longer.

      I would love to have you in the MasterClass. We have people from Uk, Netherlands, Sweden, Canada, US, Ireland, and even Taiwan. I think you would be our first Scotland person! :)

      Meanwhile, best of luck with your mare.
      Blessings,
      Renee

  12. Hi Renee
    Thank you for responding and I would only imagine that the hind may be more complex, it certainly has me confused but I’ll watch out for any updates on the site.
    Will definitely look to join the masterclass in the future and fly the flag for Scotland…may be the only person in the world not on facebook so will maybe have to cross that bridge.

    Ann

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