Suspensory Ligament Injuries in Horses

Your horse isn't quite right under saddle, but they're not limping either. Nothing looks swollen. The vet can't find anything on the radiograph.

This frustrating, hard-to-pin-down pattern is the calling card of a suspensory ligament injury in horses, one of the most common, and most commonly missed, causes of performance loss in sport and racing horses.

This guide breaks down what the suspensory ligament actually does, why these injuries are so difficult to catch early, how vets diagnose and treat them, and what a realistic recovery timeline looks like.

What Is a Suspensory Ligament Injury in Horses?

A suspensory ligament injury in horses is damage to the ligament that runs behind the cannon bone and supports the fetlock joint, preventing it from overextending during movement.

Injuries range from mild strain to full ligament tears, and they're especially common in racing, jumping, and dressage horses due to the repetitive strain these sports place on the leg.

What Does the Suspensory Ligament Do?

The suspensory ligament’s main job is to stop the fetlock joint from overextending every time the horse's weight comes down on that leg.

It also stores and releases kinetic energy with each stride, acting almost like a spring that helps power the leg forward.

It sits just below the knee and runs down the back of the cannon bone. Rather than a single straight band, it splits partway down into two branches that wrap around the sesamoid bones at the fetlock, giving it a shape like an upside-down Y.

This is part of why horses can move as efficiently as they do. The leg isn't just muscle doing all the work; it's a finely tuned system of ligaments and tendons absorbing and returning energy with every step.

When the suspensory ligament is damaged, that balance breaks down, and the horse can become lame, sometimes dramatically, sometimes so subtly it takes a trained eye to catch it.

What Causes Suspensory Ligament Injuries in Horses?

Ligament injuries usually come from one of two patterns: a single traumatic event, like a hard hyperextension of the fetlock, or repetitive strain that builds up gradually over months of training.

Several factors raise the risk of either

Sport intensity: Racing and jumping put the most force through the main body of the ligament. Dressage and cutting, with their repetitive, controlled movements, are more likely to injure the branches.
Footing: Deep, slippery, or unevenly angled footing puts uneven stress on the leg. Sudden changes in footing type are a common trigger for acute injury.
Shoeing: Poor or unbalanced shoeing changes how weight travels through the leg with every step.
Age: Younger horses are more prone to acute injury from a single traumatic event. Older horses often develop the injury gradually, as the ligament weakens with age.
Conformation: Horses with straight hocks or a dropped fetlock are more prone to hyperextension and injury than horses with more typical conformation.

What Are the Types of Suspensory Ligament Injuries?

Where the injury occurs changes both the symptoms and the treatment approach.

Injury Location	Common In	Notes
Proximal suspensory desmitis (PSD)	Any discipline; affects fore and hind limbs differently	Symptoms and prognosis differ significantly between forelimb and hindlimb PSD
Body of the ligament	Racehorses, jumping horses	Most often from acute trauma or hyperextension
Branches	Dressage, cutting, and other repetitive-movement sports	Requires careful treatment to avoid compartment syndrome, since the branches sit closer to bone

Why Are Suspensory Ligament Injuries in Horses Hard to Diagnose?

Suspensory ligament injuries have a well-earned reputation for being sneaky. Several factors make them easy to miss, even for experienced horse people:

Little to no visible swelling, even with a real injury present
Symptoms often come and go, rather than showing up consistently.
Horses rarely show an obvious limp, since both the front, or hind limbs are frequently affected together.
Standard soundness tests and radiographs frequently look normal, even when the ligament is genuinely damaged

This combination is exactly why so many of these injuries go undiagnosed for weeks or months; the horse just seems "a little off," without any of the classic red flags owners are trained to look for.

What Are the Symptoms of Ligament Injury in Horses?

Instead of an obvious limp, watch for these subtler changes:

A shortened stride, or a stride that just looks slightly "off"
General weakness or reluctance in the affected leg
Symptoms that ease with rest and return once the horse goes back to work
Soreness along the back or in the sacroiliac region
Tenderness the vet can feel on palpation, especially when a branch is involved
Pain that shows up in the opposite foot: a confusing pattern that can throw off diagnosis
Short-term improvement after joint injections, which can mislead vets toward a joint-related diagnosis instead

How Do Vets Diagnose Suspensory Ligament Injuries?

Because the symptoms are subtle, diagnosis usually takes more than a single exam. Your vet will likely:

Watch the horse walk and trot in a straight line, then walk, trot, and canter in circles.
Observe movement on different types of footing, since symptoms can vary by surface.
Watch the horse move under saddle, since lameness sometimes only becomes visible with a rider's weight.
Use targeted local anesthesia (nerve blocks) on specific parts of the ligament. If the lameness improves once that area is numbed, it helps confirm exactly where the damage is.
Order an ultrasound to check for ligament enlargement or structural abnormalities.
Order an MRI for a more detailed look, especially when ultrasound results are inconclusive.

How Long Does a Horse Need to Rest for a Suspensory Ligament Injury?

Suspensory ligament injury recovery depends on severity. Mild to moderate injuries typically need about 3 months of rest.

More severe injuries can require up to a year, sometimes combined with additional treatments or surgery. Rushing this timeline is the single most common reason for reinjury.

Severity	Typical Rest Period	Notes
Mild to moderate	~3 months	Most horses recover well with rest alone
More involved cases	~9 months	May need additional treatments alongside rest
Severe or reinjury	Up to 1 year	May require surgery; higher risk of lasting issues

⚠️ Turnout in a paddock with no training isn’t enough. True rest means a box stall or small paddock, with only hand-walking as exercise. It's tempting to bring a horse back once they seem sound, but symptoms often resolve well before the ligament has actually healed. Returning to work too early is the most common cause of reinjury, and reinjuries tend to be worse than the original.

How to Care for a Horse With a Suspensory Ligament Injury

In the first 10 to 14 days, ice or cold packs combined with compression on the injured area help manage the initial inflammation.

Medical treatments are also an option. Your vet may suggest:

Corticosteroid injections: Sometimes used locally to control inflammation, which is particularly important when the ligament is surrounded by bone, since swelling in that space can lead to compartment syndrome.
Regenerative therapies: Platelet-rich plasma, stem cells, or bone marrow injections are sometimes used to support healing and reduce the scar tissue that can permanently affect performance.
Extracorporeal shockwave therapy: Often used for hindlimb PSD, which tends to respond poorly to rest alone.

Once your vet confirms the ligament has healed enough on imaging, work resumes gradually.

A common guideline is increasing activity by about 10% per week, similar to return-to-activity protocols in human sports medicine.

Your vet may adjust this based on how your horse responds. Regular rechecks during this phase catch problems before they become reinjuries.

❓ When rest and conservative treatment aren't enough, a few surgical options exist. Desmoplasty and fasciotomy encourage the ligament to heal by making controlled incisions in it. Neurectomy involves cutting nerves to reduce pain without further altering the ligament itself. These are reserved for horses who don't improve with standard treatment and are at risk of chronic lameness.

How to Prevent Suspensory Ligament Injuries in Horses

Because these injuries are so difficult to diagnose and slow to heal, prevention is worth real investment:

Keep shoeing balanced and appropriate for your horse's conformation.
Work your horse on safe, consistent footing whenever possible.
Properly condition and warm up before asking for demanding work
Avoid overtraining, especially in young horses and uphill movers.
Cross-train rather than repeating the same movements constantly
Build core muscle strength to support the whole leg
Limit training on unfamiliar or lower-quality surfaces
Avoid overworking a tired horse.
Watch closely for signs of back pain, which can be an early indicator.
Have your saddle fit checked regularly.

If you notice anything that looks like early symptoms, getting your vet involved right away gives your horse the best possible odds; these injuries are far easier to treat before they become chronic.

Can CBD Oil Help Horses with Suspensory Ligament Injuries?

Some horse owners use CBD oil to support comfort during the long rest periods these injuries require.

CBD is not a treatment for the injury itself and won't heal the ligament, but there's a peer-reviewed research behind its use for equine joint pain and comfort more broadly.

A 2024 study published in Frontiers in Veterinary Science gave horses with osteoarthritis oral CBD alongside their existing pain medication (phenylbutazone) and found improvements in pain scores and quality of life measures compared to horses on the medication alone.

It's an example of CBD being studied as an add-on to veterinary care, not a replacement for it, which is exactly how it's best used during suspensory ligament rehab as well.

CBD may be worth discussing with your vet for a horse recovering from a suspensory ligament injury, particularly around:

General comfort and support during a long, restrictive rest period
Stress related to stall confinement, especially for horses used to regular turnout and work
Appetite support if the horse is stressed or less active than usual
Complementing prescribed anti-inflammatory or pain medication, always with your vet's knowledge

⚠️ If your horse competes, check the rules before using CBD. Many competition and racing governing bodies classify CBD as a controlled or banned substance, regardless of THC content. Using it without checking first could result in a positive drug test and disqualification. Always confirm the current rules with your horse's specific discipline or racing authority before adding CBD to their routine.

Are You Supporting Your Horse Through Recovery?

Innovet offers CBD specifically formulated for horses, including oil tinctures for oral use and balms for topical, localized supports.

Explore our CBD oil for horses, CBD pellets for horses, or our full range of horse products.

Not sure which product is the right fit? Our team is available at (310) 817-5731 if you have questions about which option fits your horse’s situation.

Frequently Asked Questions

Can a horse fully recover from a suspensory ligament injury?

Many do, especially with mild to moderate injuries caught early. A proper rest period, often around three months, is enough for many horses to return to full soundness.

More severe or chronic injuries have a less certain outlook and may always carry some risk of reinjury, but full recovery is a realistic goal for most horses when the injury is managed correctly from the start.

How do I know if my horse has a suspensory ligament injury versus a different kind of lameness?

You generally can't tell on your own; that's exactly why these injuries are so often missed. A vet exam involving movement observation, nerve blocks, and imaging (ultrasound or MRI) is needed to distinguish it from joint issues, tendon injuries, or other causes of lameness.

If your horse seems subtly "off" without an obvious cause, it's worth a vet visit rather than waiting to see if it resolves.

Can I ride my horse if I suspect a suspensory ligament injury?

No; stop work and call your vet. Continuing to ride or train a horse with a suspected suspensory injury risks turning a manageable injury into a much more serious one.

Waiting for a formal diagnosis before resting the horse is one of the most common mistakes owners make.

Do suspensory ligament injuries always require surgery?

No. Most suspensory ligament injuries are managed successfully with rest and conservative treatment alone.

Surgery is reserved for horses who don't respond adequately to rest and other treatments, or for specific injury patterns (particularly some hindlimb PSD cases) known to respond poorly to rest by itself.

Is a suspensory ligament injury the same as a bowed tendon?

No, though they're often confused since both cause lameness in the lower leg and involve soft tissue. A bowed tendon involves the flexor tendons, which sit differently in the leg than the suspensory ligament.

They require similar general approaches (rest, imaging, gradual return to work) but are anatomically distinct injuries with their own diagnostic nuances.

Which horses are most at risk for suspensory ligament injuries?

Racehorses and jumping horses face the highest risk to the main body of the ligament due to the intense, high-impact forces involved. Dressage and cutting horses are more prone to branch injuries from repetitive, controlled movements.

Older horses and those with straight hocks or a dropped fetlock are also at increased risk, regardless of discipline.

Important Notice: This article is for educational purposes only and does not constitute veterinary medical advice. Suspensory ligament injuries require professional diagnosis and a vet-directed treatment and rehabilitation plan. CBD products for animals are not approved by the FDA to diagnose, treat, cure, or prevent any disease. If your horse competes, confirm current medication rules with the relevant governing body before using CBD. Always consult your veterinarian before starting any new treatment or supplement.