Diary of a tendon injury: 52-week strict rehab and the ‘magic boot’

H&H’s website editor shares her experience of successfully rehabbing a significant tendon injury

  • A white check mark
    This article has been edited and approved by Karen Coumbe MRCVS, H&H’s veterinary advisor since 1991.
  • When my thoroughbred eventer’s minor tendon tweak turned into a potentially career-ending injury, I was devastated. But thanks to the excellent advice and care of Ricky Farr MRCVS of Farr & Pursey Equine, combined with use of the Equestride support boot and sticking to a strict exercise programme, my horse not only returned to work, but he was able to compete and jump on a surface once again.

    Here’s our story…

    20 September 2016: A couple of days after a successful BE100 run, Dennis feels slightly off in trot, on the near fore, while hacking on the road. There is no obvious heat or swelling and as he has suffered from bruised soles before, I give him a few days off.

    26 September: he feels unlevel again so I call the vet. There is nothing notable to see or feel, but hoof testers confirm bruising to the sole and a week off work is prescribed.

    30 September: after pulling some impressive acrobatics while turned out, Dennis is found looking sorry for himself, not grazing or moving, and he has an obvious soft tissue injury in the near fore below the knee. He is prescribed Danilon, plus five days’ box rest with ice and cold hosing multiple times a day to reduce the swelling.

    5 October: the swelling has gone down enough to scan the injury, which is located towards the top of the superficial digital flexor tendon. An ultrasound shows a disruption in the tendon fibres, but no core lesions and my vet is fairly upbeat. Danilon, box rest, cold hosing and bandaging continue.

    24 October: a significant setback. An incident on the yard leads to the leg blowing up considerably. We return to more aggressive levels of cold therapy and prepare for further scans to assess the damage.

    Embryonic stem cells tendon injuries

    Injury to the upper part of the superficial digital flexor tendon.

    2 November: scans show the tendon is splitting and forming a mushroom shape as the fibres peel away from each other (see video top). The prognosis is now far less positive. Dennis is insured for vet fees, but the injured leg is excluded, limiting treatment options. We begin the topical application of a gel with anti-inflammatory properties, and an analgesic to reduce the swelling. Box rest and bandaging continues.

    11 November: a scan shows core lesions have formed within the tendon. We discuss treatment options, costs and the long-term prognosis. Ricky feels the tendon will benefit from some “scaffolding” to kick-start the healing process. At this stage it looks unlikely that we will return to jumping in any form, but if we can enjoy dressage and hacking I feel that would make the treatment worthwhile. Stem-cell therapy is financially out of reach, so we go ahead with an injection of platelet-rich plasma (PRP) therapy into the lesions. This treatment can be carried out at home, avoiding the risk of further injury in transit and any hospitalisation costs.

    21 November: Dennis is sedated and blood taken from a vein in his neck. The blood is run through the PRP filter kit and then the PRP solution is injected into the lesions in the tendon. The leg is heavily bandaged and left for a few days to let the treatment take effect. This heavy bandage is then replaced with standard support bandages to keep the leg warm, supported and clean. Dennis is on box rest for one week. We order an Equestride support boot, designed by Andrew Daly, to reduce the chance of reinjury during the rehab period.

    28 November: Dennis starts walking out in-hand, for 10 minutes daily, wearing stable bandages. We walk on a large circle around the yard, which has a non-slip surface, regularly changing direction.

    5 December: walking increases to 15 minutes. We decide that sedation is necessary to avoid reinjury of the tendon (and keep his handlers safe) while waiting for the Equestride boot to arrive.

    12 December: walking increases to 20 minutes. I’m praying the Equestride boot arrives soon as even with sedation, walking in-hand is like flying a horse-shaped kite.

    19 December: an Equestride boot arrives to coincide with Dennis’ next scan. Ricky is pleased with the scan, fits the boot and walking under saddle begins. We start using the boot on setting two, which allows some loading of the injured tendon while providing support to prevent putting the damaged structures under too much stress.

    26 December: walking increases to 25 minutes wearing the Equestride boot. Stable bandages are no longer required in the stable. Sedation is required for ridden work, which is mainly in straight lines on a firm surface.

    9 January 2017: walking for 30 minutes now, mostly in the school under saddle. Otherwise, walking is done in-hand on the yard split across two sessions a day.

    6 February: walking for 40 minutes a day and we begin hacking, still wearing the Equestride boot on level two. I’m very grateful for it as Dennis produces some significant aerial manoeuvres on the road.

    27 February: the ultrasound scan shows good progress. A further four weeks of 40 minutes’ walking a day, incorporating five minutes of trot work, follows.

    27 March: 35 minutes’ walking with 10 minutes’ trotting for four weeks. My vet advises reducing the Equestride boot to setting one, which increases the load on the injured structures. I introduce in-hand grazing for short periods. Dennis is very pleased to eat grass again!

    8 April: he is turned out loose for the first time in six months in a paddock only slightly bigger than his stable. I’m delighted that his stomach wins out and he’s more interested in grazing than leaping about. He is still wearing the Equestride boot for turnout and exercise.

    24 April: 30 minutes’ walking and 15 minutes’ trotting for four weeks, gradually increasing turnout time.

    11 May: another scan and it’s good news — Ricky is happy with progress.

    22 May: We are up to 25 minutes’ walking and 20 minutes’ trotting daily under saddle, with the turnout paddock increased to 10 times stable size.

    5 June: we introduce short canters in the school, a couple of weeks earlier than advised by the Royal Veterinary College’s rehab programme, which is designed for injured National Hunt horses, because the Equestride boot is due to be returned soon and I want to have it on for our first few canters.

    19 June: the Equestride boot has been returned. We reduce the walk but increase trot periods, plus include five minutes’ canter, for two weeks.

    3 July: 15 minutes’ walk, 20 minutes’ trot and 10 minutes’ cantering for the next four weeks.

    27 July: The tendon still shows residual signs of damage both on the scan and externally, but Dennis is coping well with his workload; the leg is cold and hard and he is showing no signs of discomfort while working or on palpation.

    August: Dennis makes his British Dressage (BD) debut and qualifies for the BD thoroughbred championships at prelim level.

    18 November: We head off to Vale View for the BD thoroughbred championships and return home with first place in the warm-up class and third in the prelim championship. Brought home our first BD plaque, which I’m very proud of.

    25 February 2018: Head to Addington for the BD winter regionals at prelim level. Our test rather split the judges but we collected another BD plaque to go alongside his TB one.

    22 March: I’m keen to advance Dennis’ training on the flat so we can have a go at some higher level dressage in time. We had our first attempt at flying changes but he got quite hot/tense, so we left the idea there for him to mull over at his leisure.

    6 May: took Dennis to the gallops to accompany a young horse, and had a couple of steady canters. Iced afterwards.

    19 May: decided to bite the bullet and popped Dennis over some small fences for the first time since his injury. He was a very happy boy. Iced afterwards. Continued to jump only on a good surface and always icing afterwards.

    24 June: First competitive jumping outing since his injury. Headed to Quainton Stud for the 80cm combined training. Happy days. Iced and cold hosed the legs after. No heat or swelling the following morning.

    14-15 July: I had booked my young horse in to attend a two-day eventing camp at Boomerang, but as he couldn’t go I decided to take Dennis and just do as much as I felt was wise at the time. We were in the 80cm group, kept the jumping to a minimum and only on a surface, and iced after every session. Dennis loved being away and was a very happy chappy throughout. Was good fun and I was glad I went.

    21 August: Take a very deep breath and head at Attington for our first time jumping solid fences since his injury. I’m still terrified he’s going to break, but it’s as if he’s never been away. I’m far more rusty than he is and afterwards I don’t know which of us is happier. Will admit to a few happy tears in the lorry afterwards. Iced before travelling home and cold hosed when we got back.

    30 September: First competitive elementary dressage test and scored 69.67%

    13 October: Won the 80cm combined training championships at Quainton Stud. First time we’ve ever won a sash! More ice.

    9 December: Arena Eventing at Keysoe. Finished fourth in the BE80 class. More ice.

    15 December: On my request, Ricky rescanned the leg two years on from the PRP. There has been further significant improvement in the tendon fibres since the previous scan some 18 months earlier. At the time, Ricky felt we might have had all the healing that was going to happen, but the remaining shadows have pretty much disappeared and the fibre pattern is also looking improved. There is a still a little bit of ragged edge where the mushroom shape was, but the shape of the injury site is much closer to what you’d expect to see. On external view the tendon is looking much tighter and the thickening has significantly lessened.

    January/February/March 2019: Further visits to Attington and Aston-Le-Walls confidently jumping a range of fences up to BE100 level heights and questions. More ice (are you sensing a theme here?)

    Summer 2019: I moved yards at the end of March to a place with a wider range of hacking, including more opportunities to canter and pop some small solid fences on grass. I started by introducing short steady cantering on good grass going out hacking, and have popped a few small logs. While I have been sorely tempted to go cross-country schooling and do some unaffiliated eventing (and don’t rule out doing so in the future on good ground) I haven’t done so yet. I ice his injured leg religiously after jumping or cantering on grass. At the moment his leg remains cold and hard at all times, so I feel the current work regime is suiting him physically and he seems happy so long may it last.

    A quick note on shoeing: throughout his rehab and since his return to work, Dennis has not received any remedial shoeing, although my farrier always ensures his feet are as well balanced as possible and shoes him to provide plenty of support to his heels. We did not shoe him with wedges or graduated shoes during his recovery.

    You may also be interested in…