Should I or Shouldn't I? Explaining Tendon Injury Rehab
This article is written to give you an insight into the rehab process for a severe tendon injury. Do I or Don't I? is one of the hardest questions to answer in the event that your horse suffers this unfortunate injury.
In the latter part of 2019, leading Victorian Harness trainer Dean Braun sent his un-raced 6yo gelding Mister Velasquez (Chester) to Sydney for one last shot at making it to the races. Chester had suffered previous tendon issues and Braun had hoped a different training environment and the facilities at Cobbitty Equine (Craig Cross & Luke McCarthy) might be Chester's best chance of making it. Despite the amazing care and tailored training regime, unfortunately he broke down again following a trial.
When we learned of this, we approached Dean and offered to rehab the horse. Why you might ask? Dean is widely regarded as one of the best judges in the sport and he had very high opinion of this horse. So sometimes the best way to prove yourself is to put your money where your mouth is and step into the challenge. So here we are.
We are pleased to report that 7 months later Chester's rehab has progressed beyond expectation and his prospects of being a racehorse are very much alive and well.
So, how did we get to this point?
The First Scan (October 2, 2019)
The initial scan indicated a severe superficial digital flexor (SDF) injury that begins in the proximal one-third of the cannon and extends downs the pastern. There was complete disruption on the lateral half of the SDF tendon. The medial part of the SDF tendon also appeared adhered to the annular ligament. In other words this is an ugly one and needs serious treatment. A return to racing with this type of damage is unlikely.
Initial Rehab Phase
We started Chester out with intensive laser therapy on a daily basis for 3 weeks. During this time Chester was confined to box rest. The laser plays a vital role in minimising scar tissue as the tendon heals. Scar tissue weakens a tendon and increases the chance of re-injury. We consider the first month to be the most important part of the process.
After 3 weeks we introduced some controlled exercise of walking on the treadmill. At the same time we reduced laser treatments to 4 times weekly. Introducing exercise in the water walker requires judgement and for Chester this happened at the 6 week point. Going too early can harm the process as walking in the water can force the horse to 'over stretch' the injured tendon.
The Progress Scan (December 6, 2019)
With Chester's injury being so severe we didn't bother with scans every 4 weeks. Instead we stuck to a clear rehab plan and waited until 9 weeks for his first progress scan. The scan indicated we had made good progress on reducing the lesion size but there was still a poor fibre pattern and the compression created between the annular ligament and SDF tendon was still a concern. There was some chronic inflammation that needed to be addressed as well.
So what next?
At this point we determined the introduction of shockwave treatment (weekly) alongside the laser (3x weekly) would be beneficial in removing the inflammation and helping to strengthen tendon fibres. We continued with a controlled exercise regime of walking on the treadmill and some light water walker exercise.
At the 16 week point the improvement is quite visible with the inflammation in the tendon almost gone and the shape of the tendon starting to look significantly better.
The 20 week Scan (March 3, 2020)
This scan provided the validation that we were looking for. The lesion size had shrunk considerably with only a small amount of scar tissue remaining. The tendon fibres are visibly stronger and there is minimal inflammation.
It's now time to commence trotting on the treadmill and start to introduce some concussive impact. This is a progressive process starting at 5mins of trotting, 3x weekly and building up to 30mins over a period of weeks. This is combined with a 30 minute water walker workout every other day.
Time for a well earned break
Yesterday (April 25, 2020) we sent Chester to Jazcom for a well earned spell. He will spend 4 weeks in a small paddock getting a mental break from the repetitive rehab rhythm and get some grass in his his belly.
After 7 months of precise and controlled rehab his tendon has progressed to a stage where we feel upon returning from his spell he can commence a slow build, pre-training program. This will take 16 weeks with planned increases in intensity being monitored closely throughout.
The future for Chester, in our opinion, looks bright and we hope that in 2021 Mister Velasquez is a name you hear making his was through the racing grades in Sydney or Melbourne. That would be nothing short of awesome.
We hope that this story gives you an insight into the rehab process for a severe tendon injury. It's important to point out that we acknowledge there are numerous ways to rehab injuries like these and that some injuries are simply too severe. It can be an expensive process, so we encourage all owners to research and understand the potential costs upfront as there are no guarantees on outcomes. However, with careful planning the right success can be achieved.
We recognise that injury rehab is an expensive exercise. The type of program referenced in this article will cost you approximately $3000-$3500 per month and can be up to a 12 month program. We hope this article provides you with a reference point to make your own decision on the cost/benefit/risk analysis. We tailor the rehab program of every horse in our care and we take every effort to minimise the cost for connections.