21/04/2026
The most common injury i treat!
I had a really interesting conversation with a client recently that properly made me stop and think.
Theyâd watched a video from quite a big social media account where suspensory desmitis was being described as a neurological issue đ¤ŻâŚ and a neurectomy was basically presented as the only option.
Now â just to clear that up straight away â it isnât neurological. Itâs a musculoskeletal soft tissue injury, and whilst surgery can be an option in some cases, it is absolutely not the only route, and it doesnât fix the underlying problem.
It just reminded me how important it is that we show people the whole picture, not just bits of it.
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Honestly, I see suspensory injuries all the time. Some weeks it feels like every other horse I see has some degree of involvement â whether thatâs proximal, through the body, or into the branches.
And itâs very rarely down to just one thing.
In most cases, itâs a bit of a perfect storm of factors building up over time. Things like:
⢠repetitive, unvaried work
⢠foot balance and farriery
⢠conformation (youâll often see things like straighter hocks or a more upright hoofâpastern axis)
⢠general weakness or lack of stability
⢠horses that are a bit more hypermobile and rely more on their soft tissues for support
⢠sudden changes in workload or surface
⢠and quite often, something else going on higher up â sacroiliac, hocks, stifles â that ends up overloading the suspensory
I also think we need to talk a bit more about young horses here as well. Itâs not that young horses shouldnât be worked â they absolutely should â but when the work is too much, too repetitive, or too high impact (jumping being a big one), you can end up overloading tissues that just havenât adapted yet.
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If you think about what the suspensory actually does, itâs a huge part of how the limb functions.
Itâs there to support the fetlock, control extension, and help store and release energy as the horse moves. When itâs not doing its job properly, something else has to pick up the slack.
In the hind limb especially, that often means more strain going through the hocks, stifles, and even up into the SI and lumbar region. So itâs never really just a suspensory issue.
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In terms of treatment, there are a few different routes vets might take.
Steroids are sometimes used to settle inflammation and pain, and they can help in the short term, but they donât fix the underlying issue. And from a tissue perspective, they can actually inhibit collagen production and affect how well that structure heals if theyâre not used carefully.
Shockwave is another one people often ask about. Itâs used to stimulate a healing response and modulate pain. Some horses do really well with it â others, not so much. If Iâm being honest, I probably see about a 50/50 split in real life.
PRP is a bit more of a biological approach â using the horseâs own growth factors to try and improve the quality of healing within the ligament.
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Then thereâs neurectomy.
And this is the bit where I think thereâs quite a lot of misunderstanding.
Yes, it can reduce pain. But it does that by cutting the nerve supply â it doesnât repair the ligament, and it doesnât restore normal function.
So youâre still left with a structure that may not be doing its job properly, and a body thatâs still compensating⌠just without the same pain feedback.
From a biomechanical point of view, thatâs something I personally find quite difficult, because the underlying issue hasnât gone anywhere.
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Youâll also often hear the âjust turn them away for 12 monthsâ approach.
And yes â the ligament will heal.
But the question is how well it heals.
Without controlled, progressive loading, you can end up with quite disorganised scar tissue that isnât as strong or functional as it could be. And thatâs where re-injury risk can creep in.
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From a physio point of view, this is where we can really make a difference.
For me, thatâs usually a combination of:
⢠the right therapy (I do use Indiba a lot in these cases)
⢠a properly structured rehab plan
⢠looking at the whole horse, not just the ligament
⢠and gradually building strength, stability and correct movement patterns back up
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Suspensory injuries arenât quick fixes.
They need time, the right input, and a bit of patience â but when theyâre managed properly, you can absolutely improve outcomes.
As always, work closely with your vet, but just know there are options, and itâs rarely as black and white as it might sometimes be made out to be.
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If youâre dealing with anything like this or just want a second opinion on how your horse is moving, feel free to drop me a message đ
