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Now what? Hind end NQR, rehab not working, how to proceed?

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  • Now what? Hind end NQR, rehab not working, how to proceed?

    I've got a really lovely TB mare that came off the track in 2010. I got her last March. She'd been in and out of work since leaving the track but never ridden very consistently. She was not sound when she came to me. I attributed it to an abscess, foot soreness and subsequent body soreness.

    However it quickly became clear her hind end is NQR, sometimes in a big way. I suspect she has done something catastrophic to it at some point and we are dealing with an old injury that she "tweaks" when playing or working.

    With stall rest and 2 grams of bute a day, she looks ok-ish. Then we start working her again, weaning off the bute, and it all goes downhill.

    There have been times where she is sound enough for light work with a lightweight rider-- W/T/C with no expectation of hind end engagement, no lateral work, straight lines. Other times she is so lame she can barely trot.

    I've had two vets and a great farrier involved. Vets can't really pinpoint it, I've had several lameness evals with no real answer. It's pretty clear it is something higher up in her hind end, complicated by an old injury to the LH that swells occasionally. I've not done chiro-- they are hard to come by around here and my primary vet is not keen anyway... plus she looks so sore I at times I'm kind of scared to have her adjusted not knowing exactly what is going on in there.

    She has one of the nicest temperaments I've ever come across... kind, honest, just so easy and sweet. It is breaking my heart that I can't get her serviceably sound.

    I have no idea what to do at this point. Pursue more diagnostics and try to get a definitive answer? I'm tempted to turn her out and essentially retire her, but even turn out makes her really sore a lot of the time. Stall her most of the time and find a lightweight rider to keep her going lightly and hope she builds some muscle and the controlled exercise helps? (I am not huge, but at 5'9 and 165 I'm not small, either.)

    I'm kind of at a loss and I guess a little sad that my relatively young mare is broken. Not to mention feeling like an idiot in some ways for taking her on, but I was sure I could get her reasonably sound, and I guess I am a bleeding heart.

    I joke that she just wants to be my daughter's leadline pony, but at this rate, that is about all I can expect her to be!
    Last edited by FlashGordon; Dec. 7, 2012, 12:39 AM. Reason: grammar
    We couldn't all be cowboys, so some of us are clowns.

  • #2
    I know you said you thought she had stifle issues--did you ever ultrasound that joint?

    Is there a vet hospital you can haul her to, with a vet who is a diagnostic specialist? I have a brilliant diagnostician here, and she just sees stuff other vets do not. Hell, I wonder if you could VIDEO another vet performing a lameness exam and send it to someone really talented, if you do not have that sort of person locally? I'd be happy to give you the name/number for my vet, if you would just like to chat with her. She might have some ideas for you.

    If she gets sore with turnout, can you handwalk her daily to build muscle? Perhaps work up to an hour a day, marching, forward walk, encourage her to stretch down? It would be advised for a variety of stuff, anyway. I love handwalking for fitting up a horse.

    Or, if we're really just throwing darts at the board, you could try gabapentin for a month and see if you got any response. It is particularly effective at nerve-y type pain.

    With your description of NQR, comes and goes, sometimes terrible...I almost wonder if she has an old injury to her pelvis, with a nerve that periodically gets pinched, or is actually neuro due to changes in the neck? Both difficult to diagnose without a bone scan, though. I suppose another possibility would be a chip that floats in and out of the joint? Easier to diagnose, although potentially a lot of dollars on radiographs, looking around.

    I love your beautiful mare and I'm sorry you've not been able to pin down what is bothering her and get her through it I think you two could do great things together!


    • #3
      Your story is giving me flashbacks of what I went through with my stifle gelding. I will try to make a very long story short in the hopes you will find something useful.

      My horse went through a lameness that took 3 years and 4 vets to diagnose. This was 15 years ago, technology was different - and so were mindsets, chiro considered voodoo, etc - and I was a broke kid just getting out of college.

      It was a NQR in the hind end. Some days he would be w/t/c/g sound, some days he could barely walk. It seemed more or less random and everyone was scratching their heads (while I cried rivers of tears).

      The cycle went like this: horse 3 legged, stick him in stall, bute him, call vet. Vet comes out. Finds *something*, we treat, bute, stall rest. Horse comes out breathing fire and sound as hell. We think we have it licked. Back on full turnout. Back to light work. 2-6 weeks later, horse is 3 legged again. Put him back in the stall, bute him and call the vet.... start all over again.

      This was the story of my life for 3 years. A monthly rollercoaster of he's fine/he's 3 legged. Until I finally said *no more! I just can't take it* and decided to figure it out on my own.

      The biggest mystery was how random the lameness was.

      I know that nothing is nature is truly random so I figured I'd start by finding the pattern.

      I kept a daily log, and after several months learned that cold wet weather played a huge role. At first I thought it was the cold wetness, but it turned out to be the lack of turnout, and then turnout on muddy footing after. I also learned that the longer he was stall rested, the sounder he would look coming back out AND THEN the lamer he would be after 2-8 days turnout.

      I came to see him every day after work for 3 years. To take the edge off his boredom I would take him for walks if he were only mildly gimpy, or just teach him tricks, do TTouch and stretches if he were 3 legged

      When my horse was stall bound he would become all over body sore. His back and shoulders especially too, but really his whole body ached. Calling a massage therapist was on the order of calling a witch doctor back then, so I learned TTouch and it helped him out a lot. In hindsight it is amazing how that one joint affected his entire body.

      I noticed that when I kept him active, AND he was getting regular turnout, he slowly became sounder. It was when he was stall rested that the cycle of sound/3-legged started again.

      I tried every joint sup on the market. Every drug for pain. The most successful combo back when he was stalled was anywhere from 1-4g bute daily plus legend bi-monthly. In the years he was stalled at night, he could not go a day without bute.

      In the end, I found a clever vet, showed her my clues, she determined it was stifle and we injected him. At the same time I decided that stall rest was playing a huge role in this, so I kept him working lightly no matter how gimpy he was. Everyday we went for a long walk. If he was looking good, I got on bareback, if he was hobbling, we handwalked. The more consistently he was exercised, the less of a rollercoaster we had.

      It took a lot of gumption on my part to work a lame horse daily. I drew a lot of criticism at first, as its our knee-jerk reaction to think a lame horse should be in a stall, not made to walk around. But with consistent, light work daily, he would become sounder - eventually riding sound and on minimal bute - as time went on.

      Problem always was foul weather though, as there was no turnout in poor weather. The one hour I could spend with him each night wasn't enough if he didn't get his turnout that day. If he had a day or two or three where he didn't go out, he would become 3 legged, body sore, and we had to start from scratch.

      Finally, my vet and BM came to me to talk about his quality of life. He was still so full of vitality, his brain was so keen and his eyes so sparkling, I just couldn't euth him. I decided to give him one last chance and move him to a 24/7 turnout situation on easy footing, just pull the shoes and turn him out - which required I move too as it didn't exist where I lived.

      Living out on 20 acres, he rebounded back to full riding sound on only occasional bute within 6 months. We rode and competed lightly for another year and a half before another injury permanently retired him. 8 years later I still have him pasture sound, NSAID free.

      My stifle horse needed light consistent work to break the cycle of pain. When stalled, he responded best to bute and legend and stifle injections. Anal attention to his feet helped too. Having my farrier aggressively roll his hind toes really went a long way, and I never went more than 5 weeks between trims/shoes. DMSO painted on his stifle really helped too, but it caused a burning sensation that drove him nuts, so I didn't have the heart to keep it up.

      These days, I trim his feet every 2-3 weeks to keep him optimal. BOT products help, especially his blanket when the weather is cold enough, it drapes over the stifle enough to help. He still does get sore days, if the footing is terrible for some reason, or he is feeling too good and over does it. Previcox helps, but it bothers his tummy (all the bute wrecked him), so its only for emergencies. Whole flax and MSM have been the best "joint sups" I've found - my wallet says *thank you*. And pentosan overall has been a big help to him.

      I massage him myself, and at age 32 I'm afraid to get a chiro for him, as I think of him as an old car... fix one thing and everything else will break... so I let that dog lie sleeping.

      Sorry for the length, we've had a long long journey and its hard to condense. I hope something sparks an idea or thought for you. Good luck.
      Being terrible at something is the first step to being truly great at it. Struggle is the evidence of progress.


      • Original Poster

        Thanks Simkie, those are exactly the kind of ideas I was looking for. I've dealt more with foot related lameness, and thus this seems out of my depth.

        I thought for sure it was stifle for awhile, but vet didn't think so. Last lameness exam she did, we agreed to shoe her behind and see if that helped at all, before we got crazy with any more diagnostics. It did seem to help, but looking back, I think it was more the stall rest and bute she was on at the time than the shoeing job.

        I agree that it seems pelvic.... I have no idea how you go about diagnosing something like that. I am about 3 hours from Cornell, there are also two smaller clinics nearby that may be able to run some diagnostics for me. I do worry we could go and spend a lot of money shooting arrows in the dark to come home without a real answer.

        She is a really lovely mare, which makes this doubly sad. I would be utterly happy to get her sound enough to hack lightly a few times a week.

        ETA: I did grab some vid of her the other night, however it was so dark in the indoor it didn't turn out. Gonna try again this weekend......
        Last edited by FlashGordon; Dec. 7, 2012, 09:06 AM. Reason: info
        We couldn't all be cowboys, so some of us are clowns.


        • Original Poster

          Buck22, thanks so much for typing it out and it is also immensely helpful. Sounds a lot like what I am going through with her. This has worsened since the weather has changed, whether it is the bad footing in turnout or the cold/damp aggravating something that is arthritic, not sure.

          Anyway I appreciate the response, and it gives me a lot to think about...
          We couldn't all be cowboys, so some of us are clowns.


          • #6
            Unfortunately, a lot is going to depend on how much money you can sink into getting a diagnosis. When a horse is NQR up high, figuring out what the problem is can be costly.

            I would either think about taking her to a diagnostic clinic or vet school and trying to get to the bottom of it, or consider turning her out (or stall rest) for a while (maybe the winter?) and seeing if it works itself out.

            Have you taken a really good look at saddle fit? How about a masseuse? A really experienced masseuse might be able to help pinpoint where the pain is coming from.


            • #7
              What happens if you give her healthy doses of Robaxin for 3 or so days?
              Bute just helps diagnose inflammation and skeletal, Robaxin will go after muscles.

              Contact Kit Heidt with Animal Krackers. He travels the country doing body work on horses, and he is phenomenal.
              chaque pas est fait ensemble


              • Original Poster

                Thanks guys for the recommendations.

                Petstore, good question about the robaxin.... might be worth a shot.
                We couldn't all be cowboys, so some of us are clowns.


                • #9
                  Absolutely nothing beats a slow careful diagnostic survey. This usually starts with hoof testers. proceeds to flexions then to blocks. After blocks sometimes its radiographs, or ultrasounds can pinpoint the problem.

                  Otherwise you are shooting in the dark, sometimes doing more harm than good by delaying. For a lot of it a knowledgeable lameness practitioner can do the job, only occasionally you need the big machines of a veterinary center or school.
                  Some riders change their horse, they change their saddle, they change their teacher; they never change themselves.

                  Remember the horse does all the work, we just sit there and look pretty.


                  • Original Poster

                    Last time the vet was out, she was reluctant to block her as she had filling in the left hind. No heat at that time though. It has always stocked up off and on, sometimes with heat, sometimes without. She actually always looks more lame on the right side, go figure, except maybe she's compensating.

                    We've done the hoof testers and flexions several times. Changed her shoeing regime but that didn't help much.

                    Anyway vet is coming back again on Monday.... Sigh.
                    We couldn't all be cowboys, so some of us are clowns.


                    • #11
                      Perhaps this has been addressed and I just didn't see it, but do you know why she was retired from racing? I'm wondering if she was already sore or injured then. My geldings random intermittent hind end lameness is due to wiping out on the training track in a morning workout.
                      "I think animal testing is a terrible idea, they get all nervous and give silly answers."
                      -fry & laurie


                      • Original Poster

                        Originally posted by spaceagevalkyrie View Post
                        Perhaps this has been addressed and I just didn't see it, but do you know why she was retired from racing? I'm wondering if she was already sore or injured then. My geldings random intermittent hind end lameness is due to wiping out on the training track in a morning workout.
                        Funny you say that.... a good friend said the same. She may have had a starting gate injury or the like. Seems she's had *some* kind of trauma, given the state of her pelvis and her LH.

                        She came from Finger Lakes and I actually remember her listing photo.... she was stood kinda funny, with her hind end sort of tucked under and her back almost roached.

                        I do have the contact info for the trainer that had her at the track, maybe I will give her a call and see if she has any insight.

                        She was never really in *regular* work until I got her, beyond the period where my friend had her in which she was of and on lame. The kid was tiny though and she just rode her W/T/C on the buckle and the horse seemed to stay sound enough for that, at that point.

                        Ugh, bummed today. I am retiring from horses!!
                        We couldn't all be cowboys, so some of us are clowns.


                        • #13
                          I've posted here many times over the years about my two upper level horses. My mare who came to me a physical train wreck and ended up showing far outside of her scope level at 1.40m. And my gelding who made my mare look great in comparison.

                          My mare was always technically sound. But it took about a year of regular chiro, acupuncture, and finally shockwave therapy to her SI area to get her comfortable and able to hold the adjustments.

                          My gelding (who was off of the track and a terrible racehorse presumably because he was such a physical train wreck). He was not "lame" per se, but moved extremely unevenly behind. I'm sure just about any vet around here other than the one I use would have called him very lame behind. He had a dropped hip as a result of his pelvis that was sheared to the left and tilted forward. With him it took 2 years of regular chiro and acupuncture, plus my vet/chiro's mentor (who's seen as a "pelvis specialist"....she doesn't call herself that, she just gets called in by my vet any time she has a tricky pelvis issue) doing a lot of pelvis work, plus a very serious conditioning program.

                          Neither of my horses would have come around so well without the chiro and acupuncture (and massage and whatever my vet's mentor does....I call it "voodoo" work ). Ultimately we also did shockwave on my gelding's SI area, though it didn't make as big of a difference as the bodywork, which he was actually holding fairly well, unlike my mare. Oh, and to convolute what fixed him a bit more, we also did a LOT of shoeing adjustments and changes culminating in different angle wedge pads on his front feet that helped balance some of his unevenness.

                          Anyhow, my point is that my personal approach to SI issues relies heavily on GOOD chiro/acu more than anything else. Unfortunately, I don't think there are very many GOOD (not just "good," has to be all caps GOOD or GREAT) bodyworkers out there. But if you can find one I think that can make the biggest difference if the issue is, in fact, that the horse is "out of whack."
                          Flying F Sport Horses
                          Horses in the NW


                          • #14
                            A bone scan may be a consideration although an expensive one.

                            Best luck!


                            • #15
                              I have a OTTB who came up NQR in the hind, thought it was in the foot and/or hip.. and after six months off, I took him to a chiropractor..which I was reluctant at first. But he diagnosed him with tight hamstrings. he was 100% sound after one session and he gets worked on every 6 months now.


                              • #16
                                If there are the dollars for it, FG, haul her to Cornell and have her worked up there. Even just a full lameness exam with flexions might be VERY illuminating--those guys are sharp! If the simple exam doesn't nail down Miss Mare's problem, then they can at least point you in the right direction on what to expect for further study.

                                Since you're not real happy with your current at home vets, I'd stop dicking around with them, if you can. They might be good at some stuff, but it doesn't sound like complex lameness is really in their wheel house?

                                If you do go the Cornell route, I'd be tempted to video the whole exam. Then you could potentially send off the file to others for review.


                                • Original Poster

                                  Well the chiro stories are definitely encouraging.
                                  We couldn't all be cowboys, so some of us are clowns.


                                  • Original Poster

                                    Originally posted by Simkie View Post

                                    If you do go the Cornell route, I'd be tempted to video the whole exam. Then you could potentially send off the file to others for review.
                                    Great idea Simkie....
                                    We couldn't all be cowboys, so some of us are clowns.


                                    • #19
                                      Have you already done diagnostic blocks (all the way up the leg including the hock and stifle joints)? This should help pinpoint where the problem is. You need a good, experienced vet in order to do this properly.

                                      If she is still lame after blocks all the way up the leg, then you may need to consider a bone scan. Sometimes, a good vet can perform a rectal ultrasound to look for bony changes in the pelvis (these may be able to be palpated also).


                                      • #20
                                        The lame-er on turnout is a (bad) clue, because if it were a more benign stifle thing turnout would likely make it better. Turnout exacerbates pelvis injuries, for,the most part.

                                        I, too, would be reluctant to chiro a dead lame horse, although you may at this point have little to lose. A truly good chiro may be able to direct you, tho. The value may lie in why they are unwilling to adjust her.

                                        Have you checked her trochanters? Damage there can be misleading. What does she do on a basic neuro test? Can she walk up and down a hill... Can she back up one? What does she do if you pull on her tail?

                                        I am assuming when presented with her being VERY lame, your vet cannot find somewhere to start? Meaning she is a 4+ lame? Is she lame at the walk?

                                        I sincerely doubt your weight is an issue.

                                        Poor Fancy
                                        "Kindness is free" ~ Eurofoal
                                        The CoTH CYA - please consult w/your veterinarian under any and all circumstances.