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  Discussion on Right Hindleg Lameness
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New Member:
scrupi1

Posted on Sunday, Jun 3, 2007 - 6:27 pm:

Hi Dr. O,

I have a 4 year old warmblood cross that has come up lame after a jumping session. We were doing a small line of gymnastics (18" to 2'6": a set of 2 in and outs to a 2 stride that had been preceded by warm up on the flat, over crossrails and a line of jumps 6 stides apart with appropriate walking rest breaks) and I did not notice any lameness that day but the next day that I rode he was definitly stiff tracking to the right and would slow down on turns when normally he is quite forward. It did not really feel like he was limping or favoring the right side significantly but it did feel like he was stiff and short behind) I gave him two days off and went out yesterday to see how he was doing. I put him on a large lunge circle to the left first and he looked a little short behind at the trot but nothing noticable. I changed directions to the right and could tell instantly that at the trot his right hind had a significant shortening of the swing phase. I of course stopped lunging and a trainer at the barn advised me to call the massage therapist and the chiropractor. I have a combined training show in three weeks (maiden only, jumping 18" to 2' cross country and stadium plus a walk trot dressage test) and she seemed to think that with rest and massage and chiropractic he would be ready for the show. I am not so sure. The reason she advised chiropractic was when he is standing square and you view him from behind his right hip seems lower than the left and the muscle mass is flatter vs being rounded as it is on the left side. I have only owned this horse for 8 months and we have always had issues with the right hind not tracking up as well as the left (so I am aware and have been working on the weakness issue) but never to this extent. I don't know much about his past but he does have a horse shoe shaped scar in the muscle belly of his right semitendinosus and he does not have as much muscle mass in his stifles as I would like although they have improved with the training we have been doing. He is not on any bute and is still being turned out as he is not that rowdy out in the pasture. The trainer seemed to think this was not a vet kind of issue but he has never been this lame before with no obvious incident/injury. My gut feeling is that I should call the vet vs. pursue the chiropractor. Any thoughts?
Member:
amara

Posted on Sunday, Jun 3, 2007 - 6:53 pm:

hi susanne,
while i am a huge believer in massage and chiro, i think anytime you have a young horse come up lame like your horse has it should be vet first... with his help (and the help of dr.o's article on diagnoing lameness) you can get a much more accurate description of what is going on.. by not having checking for more "traditional" lameness first you are running the risk of it being a soft tissue injury that may be easily healed if treated correctly early on, but can be a nightmare if left untreated... while there are many good massage/chiro's out there who are vets first and would look at the whole horse before deciding on problem/treatment, this is frequently not the case, and he may end up treating a problem that is secondary to the primary (lower leg) problem, which is left unchecked...

good luck...

p.s. as a 4 yr old warmblood cross is he really ready for xcountry?
New Member:
scrupi1

Posted on Sunday, Jun 3, 2007 - 7:32 pm:

Melissa,

Thank you for your advice. I agree with you about the vet vs. chiro/massage. Whenever I have waited on calling the vet it has turned out not so good. He will actually be 5 in June and the xcountry course is only a schooling horse trial with most the of the fences being 18" vs. the 2' max. I have been very careful with not pushing him hard and we have previously only been to 2 dressage schooling shows, one an intro level test and the other a beginner novice test. This would be our first horse trial. My thought is that as a young horse who is on the spooky side it is better to get him accustomed to the show world in a low stress situation, we planned on trotting only through the cross country course. Is this not appropriate for his age as a coming 5 year old?
I have had a lameness exam performed on him in the recent past (about 4 months aga) after a kick to the right lower leg and followed the vet's advice to a t regarding bringing him back into work.
It has been difficult to find consistent advice as to when horses are ready for what level. My trainers seem to think that we should have been going to small schooling shows months ago and I have been dragging my feet wanting to feel like he was mentally and physically ready. What is a good indicator that a horse is ready and prepared
Member:
amara

Posted on Sunday, Jun 3, 2007 - 9:04 pm:

glad you are going to get a vet out...he may well tell you to get a chiro, but at least you shouldnt be missing anything else!...

as far as mentally and physically ready, i agree there are many many different schools of thought...
most horses arent physically fully mature until age around 6, when all the growth plates are closed...
your horse is technically a 5 yr. old, not a 4 yr old, if he turns 5 in june...you probably didnt start him over fences till he was a 4 yr old?...
while i personally would wait till a horse was a little older to start jumping, as the maturity gained in years is only an asset, a lot of people start jumping horses at age 4 and many seem to do just fine, as long as they are brought along slowly...if you are planning on trotting the courses then i think you are going slowly... from your original post i thought he was 4 this year which would mean he would probably have started jumping in his 3 yr old yr...

as far as mentally, only you can be the judge of that... there is still a lot of mental changes going on in a young horse, even one that seems quiet...you see the most of these changes until 5-7.. at that point a horse develops some maturity and is starting to settle into the horse he will be (barring complications, of course).. that's why i like to wait, it seems to be easier for them to pick the whole thing up... they also get more flat time, which makes them stronger and more able to maneuver their body...i rememeber when i started this arab mare i used to own.. i got her at age 9, halter broke only, got her broke to ride in the next few months.. put her over a few fences the next year but she really fell apart physically, tho mentally she was ok... didnt try jumping her again for another 2 yrs or so.. then one day just pointed her at a fence and she just very calmly started trotting and cantering over anything i put in front of her...like she'd been doing it all her life.. the added years physically and mentally made all the difference..
i dont really believe in levels... when a horse is doing something easily, i slowly start stepping a few things up a notch... eventually we're at another "level"... but i let the horse tell me when he's ready.. if he can do everything while staying calm and relaxed and maintaining an even pace without you having to do anything, he's ready to move up.. otherwise, maybe not.. it never hurts to go slower, but it definately hurts to go to fast...
doesnt really matter what your trainer says.. you pay the bills and you own and ride the horse...

good luck.. i'm sure everything will be fine
Moderator:
DrO

Posted on Monday, Jun 4, 2007 - 7:48 am:

I think Melissa covers it rather well and would love to hear what the veterinarian says. It may be, "get out the chiropractic".

I am a bit more cynical on this point and think this option is often taken when the physical exam is inconclusive and yet the owner wants something done and does not like the idea or bute and rest, which is very effective therapy for most causes of lameness. After all, a little time and rest alone and the horse is likely to get well through regular healing. There is very little (no?) evidence equine chiropractic is more beneficial than massage. But it sure does seem to make folks feel better.

I would like to comment specifically on the diagnosis of unlevel hips: a common cause of treatment with chiropractic. Lameness will certainly result in a horse not bearing weight evenly and often a DrOp on the lame side while standing. But it can be very hard to get some normal horses to stand perfectly square and even a slight change in stance, imperceptible to the eye can cause hips to be uneven. Which is the almost always the reason for this appearance. Also, if the light does not fall evenly across the pelvis, it can give the appearance of unevenness across the hips. I don't know how many times I was called to look at a horse in a barn aisle because one side was higher than the other that when we got him out in the sun, with the sun directly behind us and standing directly behind the horse, that this uneveness was fixed.

It is important to understand when this finding represents muscle atrophy on one side (not uncommon) or subluxation of the joints of the pelvis attaching it to the sacrum (less common): there is nothing a chiropractic can adjust to make them level. Though there are many post mortem studies of back pathology, I have not seen any studies that find rotation of the vertebrae around the center of the long axis as a cause of uneven hips.

When you see or hear of unevenness corrected it is a show and not a medical procedure and I believe the chiros are kidding themselves here. The trick is getting the horse to stand square following a procedure or if there is a physical reason for the unevenness, stand unsquare with more weight on the low side. Of course if there is lameness and the adjustment corrects the lameness this would be an explanation, I just have never seen a lame horse that was tested dependably lame right before adjustment that then went off sound.
DrO
Member:
scrupi1

Posted on Saturday, Jun 9, 2007 - 4:04 pm:

Well, it took some time but the vet came out today and did a preliminary lameness exam, trotting on the lunge, trotting on firm ground and sand and performing a flexion test at the hock. The flexion test was not positive. She than did some hoof testing and found that he was very sore/responsive over one of the clips on his right hind (one of the outside clips). She said that there was also a bruise around the clip. She removed the shoe and recommended soaking with epson salts and poulticing to see if an abcess may develop. She showed me how to test the hoof for soreness and told me to have the farrier come out in 7-10 days to replace the shoe, as long as there is no actively draining abcess and no tenderness. She was going to suggest an x-ray of the hock prior to finding the soreness in the hoof as well as an injection of Adequan? She also said that when a horse has a sore foot it can cause the swing phase to change which was my question as I thought that if the hoof hurt the stance phase would be affected.
She did say that he did not have any swelling in any of the joints of the back legs and considering his age she hopes that he is not having any issues with degenerative changes as of yet. She did not seem to think that it was mucscular in nature and did not recommend a chiropractor. We did not really even touch on the subject of the unlevelness of the pelvis. She said that she is not sure that the hoof is the cause of the lameness but that we need to address the pain there before we continue with examining other areas. So I guess I will see how this turns out. Is it common to have changes in the swing phase of gait with soreness in the hoof? She did mention that he seemed to be compensating with increased use of his stifle vs. flexing at the hock when at the walk even though the flexion test was negative. Can anyone further explain the correlation between what was found and his lameness? When I had him on the lunge he was very short strided behind and not tracking up with either hind leg but when we were trotting in hand and he was more excited his movement was fine. I was worried that his adrenaline was masking the symptoms as he seems to be most lame when on a circle to the right. The vet did suggest that she may need to see me riding him if the foot does not seem to be the true source of the problem.
Moderator:
DrO

Posted on Tuesday, Jun 12, 2007 - 6:41 am:

Hello Susan,
Swing and stance phases are tied together and any change in one "must" cause a change in the other: if you shorten the stance you must also shorten the swing. Weight bearing lameness can definitely cause a shortened stride as the horse attempts to decrease the amount of time spent on the limb.

Flexion of the hock and stifle are also connected by way of the stay apparatus so unless the peroneus tertius is ruptured (we have an article on this) they both must flex and extend together a change in one would cause a similar change in the other.
DrO
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