Let's talk stifles

[saultgirl]

I am possibly dealing with a slight stifle problem with my 5 year old. Lameness has been 1-2 off and on for the last week. My trainer thinks it's his stifle and that he most likely slipped outside (it's been icy). We are giving him some time off and applying "Tuttles" liniment daily.

So, I'm on a mission to learn everything I can about stifles.

I know lunging/circles is really hard on them so we won't be doing any of that. I also understand that while re-habbing walking over groundpoles can help strengthen stifles, as well as hill work. - This is the extent of what I know about stifles.

Experiences? References? Thanks

[buck22]

yes, thats basically it, trot poles, hills, long energetic walks, straight lines, no tight circles, no round pens, no longing. Lots and lots and lots of low key exercise. Ime, you can't ride enough frankly.

I'll share my story, I learned stall rest was the worst possible thing I did for my gelding with a torn meniscus/arthritic stifle.

It was very hard on me and the barnstaff to send him off into turnout and watch him gimp around, especially if the footing wasn't ideal (which it rarely was), and he seemed 'sounder' after a few days stall rest.

But, it took a couple years for me to learn the nasty cycle of it all... how stall rest was just fueling the fire long term. Yes he'd be rested up on stall rest, and the pain would subside, and he'd appear sound and ready and eager to go back to work and play, but then a few days or a week or two back out in turnout and light work he'd be back to gimping. It took a leap of faith on my part to continue riding him (long loose rein walks) and keep him turned out despite him gimping. What an awful feeling to ride a limping horse, and often times I'd hop off and hand walk... but we needed to break the cycle of rest then pain rest then pain. After a while of keeping him moving we found an even keel, he wasn't sound, but sound enough to go out in turnout daily, and go on long walks daily.

When I finally retired him to living out 24/7 in a flat sandy location, he made a remarkable comeback all on his own and we were able to go back to riding lightly competitively for another 2 years.

Its actually another injury that has him permanently retired now, at age 30 I would still be riding this horse lightly. As it is, I pony him for exercise.

I discovered that an *active* outdoor 24/7 lifestyle (aka paddock paradise, not loafing in a pen all day), with plenty of light exercise, keeping his weight as low as possible, and keeping his feet trimmed short with a strong roll on the hinds, and lots of omegas like flax and cocosoya for anti-inflammatory (he's allergic to MSM or I'd be using that too), all went miles. I'm entering my 10th year with him since going off.

Let the farrier know too, my stifle guy needs plenty of breaks during trimming, always did, if he's forced to hold his leg up or awkwardly, he'll be off for 2-3 days after.

Good luck, ime stifles are really tricky and sneaky, but manageable.


eta: ah yes re JB below, didn't realize you hadn't spoken to a vet. I'd been working with several vets for a few years.

[JB]

Vet.

There's a difference between working with weak stifles, and rehabbing an injured stifle. In the end, they are they same, but the beginning treatment is different. You need to know what you're dealing with.

[saultgirl]

To clarify, I'm asking to hear other people's stories about stifle problems, maybe how they presented, what the initial diagnosis/misdiagnosis was, what treatment options were available, what treatments were recommended, what was successful/not successful.

Also if anyone has references to good websites with further information on stifles (I have found a few with great diagrams, etc.) so that I can learn more about the form and function of the joint, etc.


I will be following up with my trainer either today or tomorrow; she will take another look at him and then we will talk about what we should do next. I'm just trying to get a little more educated about this type of problem so that I can have a better discussion with my trainer and vet. I find it easier to remember things if I have an understanding of the issue as a whole.

Maybe it's just me, but I find if I have a lengthy discussion with my vet, trainer, or farrier about an issue that I have very limited knowledge about, I can get a little "overloaded" and have trouble remembering things after, or don't know enough to ask the right questions during the discussion.

Thanks.

[JB]

Well, it's hard, because the question as it stands now is "how do you diagnose and treat weak stifles and how do you diagnose and treat an injured stifle" which is fairly wide open.

You say he's been 1-2 lame for a bit now, and the trainer *thinks* it's a stifle. Why does she think stifle and not a suspensory issue? I'm just trying to get a better idea of how the horse is presenting as lame. Lame on the straight? Lame on a circle only? Only in one direction? Toe dragging or just short-strided?

Injuries generally require rest at first. Stall rest if severe enough, or normal turnout if not. Then you go to long slow distance work, building up over time. Cantering and circles are avoided in the beginning. Always always working correctly, working up to more and more transitions, incorporating backing (especially since you don't have hills) and poles, eventually elevating the poles a small bit. It's really just good correct work, as if you were starting a youngster on a "formal" dressage program - correctly working over the top, engaging behind, reaching, lifting the back, etc.

[saultgirl]

Well, it's hard, because the question as it stands now is "how do you diagnose and treat weak stifles and how do you diagnose and treat an injured stifle" which is fairly wide open.

I didn't mean for this to be the question; I would rather just hear about personal experiences with specific horses, or be referred to a better resource (i.e. if someone just read a great article on stifle problems in EQUUS, or something like that). Didn't really want to type out everything that's gone on in the last week (since onset of problem), it's just so much.

[Donkey]

Stifle issues are scary. If you haven't I would get the stifle ultra sounded so you know exactly what you are dealing with in regards to soft tissue injury because depending on what it is the treatment, recovery and prognosis will be different. Plus it is no use torturing yourself with worse case scenarios and then treating your horse as if they are one if they are not. Also take an honest look at your horses conformation to see if your horse is predisposed for stifle problems - this should help guide your actions.

My horse strained her stifle in turnout last summer. She was three legged lame the first day and then back to using that leg comfortably within three days. She was slightly lame for a month. She had 1.5 months off before I put her back into work. I had the stifle ultra sounded and she has a small tear in her patellar ligament. She is fine today and I expect no problems from it. Her conformation does not lean towards stifle issues though.

I just want to add that I like to use the horseadvice website as a reference because it usually mirrors what my vet will/has told me.

[saultgirl]

Donkey, was the ultrasound something you were able to have done on-site or did you need to ship to a clinic to do it?

[Paddys Mom]

Donkey, was the ultrasound something you were able to have done on-site or did you need to ship to a clinic to do it?

If it were my horse, I would take him to a good clinic for a workup. Bring video tape of him. In the long run, this should save you time, money, aggravation, and could prevent an acute problem becoming a chronic problem.

[saultgirl]

If it were my horse, I would take him to a good clinic for a workup. Bring video tape of him. In the long run, this should save you time, money, aggravation, and could prevent an acute problem becoming a chronic problem.

Easier said than done -- it's an 8.5 hour drive (probably more like 10 with snow/ice-covered roads) to the nearest clinic (about 460 miles), and I would need to hire a commercial shipper. That is definitely not my first option.

[Donkey]

Donkey, was the ultrasound something you were able to have done on-site or did you need to ship to a clinic to do it?

I had it done at a clinic (the clinic was 7 hours away - I understand logistical challenges) and my horse was standing with little sedation. If a vet has a portable ultra sound they may be able to do it on site - but I have no clue if a portable ultra sound machine would be able to do the job :confused:

[Mallard]

My little guy was also every so slightly NQR 'somewhere' in his LH for a couple of days. Not really lame...just NQR.
He does have small spurs in both hocks and it's been nearly a year since they were injected.
So naturally my trainer & I both 'assumed' it was his hock bothering him.

I called the vet.
And it's his stifle. Strained. Was pretty tender when the vet palpated.
Probably slipped on the ice.
No riding for at least a week...he lives outside 24/7 so he is resting out tehre. He'd go nutso in a stall and vet agrees that 'outdoor rest' is just fine.
DMSO 2x daily.

And I will have the vet back out next week to check him before I get back on and do anything more than a casual walk around the arena.

So...my advice...
Don't assume you/your coach know what the problem is.
Call your vet!

[Swale01]

I feel your pain.

My OTTB has minor stifle issues if he isn’t kept fit and in regular work (nothing of critical mass, he basically can be stiff and sticky at first until thoroughly warmed up.) But this past summer we had an incident where he slid to a stop a couple of times in front of a fence he decided he was terrified of (a big roll top, the likes of which he hadn’t seen before) and afterwards he was on-again-off-again, very much as you’re describing your horse. He was perfectly sound at the walk, and even sound at the trot if hand-jogged…and most days, sound when I was posting on the opposing diagonal. Some days, my friends on the ground thought he looked pretty good in either direction but I could still feel it slightly. I was also in the same shoes you’re in, being advised to work the horse through it, even though I struggled to do so on the days I could feel he was slightly off. (Same advice as buck22, no lunging, no circles.)

I tried a series of estrogen shots (given IM every few days) but didn’t feel like it did much. After doing some internet research, I came to the conclusion that the estrogen shots may be better at building up a chronically weak stifle, as opposed to one that has been irritated by a specific event. Although my gelding can be prone to weak stifles, the problem he had over the summer was definitely specific to one stifle and caused by what we not-so-affectionately refer to around our barn as ‘Roll Top Day’.

I ended up taking him to a clinic to have a sonogram done. Once we confirmed that there wasn’t any serious soft tissue/ligament injury, we did stifle injections - the goal of which were to make him comfortable enough to build the stifle back up through his regular exercise. That was 8 months ago, and he has been great ever since.

I have kept him in regular work, trying to ride at least 4X a week. I agree with buck22 about the 'vicious cycle'. Anytime the horse feels 'off' your instinct is to give them some substantial rest time, but it can backfire on a stifle, depending on the nature of the problem. My BO is bringing back her mare from a mild suspensory injury, and after having spent months and months on stall rest, her mare was off as a result of her weak stifles as well. Her vet had her keep riding through it (as soon as the vet confirmed that it wasn't the suspensory again!) and sure enough, she eventually worked out of it as she became more fit again.

For my gelding, I warm him up over elevated cavelettis (probably six inches or so off the ground.) I’ll set up 5 or 6 of them in a row and trot him through them repeatedly as part of his warm up routine. I think these have made a huge difference, forcing him to really use his stifle in his warm ups. I also learned (from my farrier) a stretching exercise to stretch his stifles before we start (pick up the leg, and once he has relaxed it, push back and down softly until he has extended the leg behind and has straightened through the fetlock.) My gelding loves this stretch now and is quick to relax his leg and do it himself when I begin to ask. I also have a heat rub cream (it’s really just a muscle-warmer in cream form, like the equine version of Ben-Gay) that I will sometimes use on cold days when I’m pulling him right out of a stall to ride.

[appychik]

Stifles are horrible. I've had Gus for 10 years this March and have been dealing with stifle issues for about 9 years.

Like JB said, do get a vet out there. You definitely want to be sure you're doing the correct treatment.

In the long run, 24/7 turnout in half-way decent footing has worked wonders for Gus. He still has stifle issues and has major arthritis now, but he's sounder then he's been in years.

Like others have said... you really don't want to mess around with stifles. So, if at all possible, get the vet out. And good luck with your horse.

[Audrey79]

I have become the stifle expert unfortunately. Mirroring what others have said--get a vet out ASAP and if you have insurance on the horse I recommend you bring it to an expert who is used to looking at stifle US and diagnosing the problem. I wasted 6 months treating a RH stifle lameness that eventually required surgery. I will tell you that it was 200% worth it and my horse is now sounder then ever. The problem is that they cannot tell exactly what is going on until they go in arthroscopically and I was lucky that there was no joint damage or tears, only a softening of the cartiledge.

Not trying to scare you but you really want to be working with an expert on this one becuase if isn't managed properly your going to be dealing with it off and on forever!

My horse is barefoot and moves fabulously--this has been key for keeping his hind end stable and reducing torque. Also he needs to get as much turnout as possible and be ridden correctly with his hind end underneath him on good footing. I also spend a lot of money on supplements (Cosequin ASU and Adequan).

Good luck!

[horselesswonder]

For what it's worth, my horse has a meniscal injury to his stifle. His injury was not visible on digital X-ray. He was ultimately diagnosed at the farm with a portable ultrasound machine. However, I am fortunate in that there is a local veterinarian who does nothing but ultrasound work and was therefore confident in evaluating my horse's stifle. My regular vet, who is very competent, did not want to try to ultrasound the stifle, as doing so is apparently quite difficult.

My horse will never be 100 percent sound and surgery was not an option for him, but he is serviceably sound and happy to have a job as a hunter. I maintain him on stifle injections, weekly Acetyl-D glucosamine injections, and supplements, including devil's claw. He loves to jump, go on trail rides and work in the ring.

I also agree with what buck22 posted about the cycle of lameness and turnout. I just keep my guy going - lighter work if he is gimpy, and normal work when he is feeling good. If he's lame from over-exuberant pasture play (he is a complete goofball out there), I give him a couple of days off from ridden work, but let him continue with turnout.