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Back/hind lameness looking for ideas.

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  • Back/hind lameness looking for ideas.

    I'm looking for ideas on a recent hind end lameness and just want to make sure I'm covering all the bases. The history is somewhat long but I'll try to stick to the point.

    My horse is an ~ 11 yr. old grade (probably QH mix) gelding. I've had him just over 3 years. He's always been a horse I've had to push to work.

    In September of last year he had surgery for a bone chip in the right front fetlock. He was on strict stall rest for a month followed by light turn-out and hand walking for a month then full turn-out. I started him back into light work around the middle of January and started to step up the level of work around the middle of February.

    At first everything was going well, he was more forward then he has ever been and seemed happy to work. About 2 weeks ago I started to notice that he was starting to suck back again. I had had his hind shoes pulled while he wasn't working so had those put back on. He was going great again for a couple of days then last weekend he just started to refuse his right lead canter completely. He seemed fine at the walk but I noticed him pinning his ears even at the trot.

    I put him in the round pen and asked for a canter to the right (unmounted). He would pick up the lead then swap behind. I could also see a strange "hop" behind where the 2 hinds leave the ground almost simultaneously. Left lead looked reasonably good. His trot actually was quite nice in both directions.

    The horse's back seems sore. We noticed some muscle fasiculation after the vet did a little bit of chiropractic work ("well that's weird" is not something you like to hear your vet say). He also flexed positive in both hind legs. No signs of lameness in the front.

    He's continued on his regular turn-out (out during the day, in at night). A couple of friends have seen him playing in the field the last couple of days which is definitely an improvement over last week when you could tell he just didn't want to play.

    So here's where we stand:

    Rads of hock and stifle look good, consistent with age and work, unremarkable.

    Hematocrit and WBC both a little low compared to baseline. Not screaming a problem but off enough to consider that it might mean something. AST slightly elevated. The rest of the blood work is normal.

    Lyme-negative.

    ACTH/insulin and EPM pending.

    I haven't attempted to ride him since last weekend and I won't until I get the results from the EPM test.

    I've had a few thoughts since I last spoke to the vet. I'm sure I'll be hearing from him soon and I'm just looking for other possibilities that we maybe haven't considered yet.

    Any ideas or experiences to share?
    "Some people are born on third base and go through life thinking they hit a triple” – Barry Switzer

  • #2
    It is late for me, waiting for my son to come home from a birthday party. Three years is not that long. My story: had my OTTB come home from trainers about 45 minutes away last May. He had some mild hind end issues and she had him for a year. Once back home had the dressage trainer and an ammy ride him. Both said the saddle fit him. He was off after 3 weeks in the hind end. Had a great vet come out (she only does lameness) diagnosed him with extremely sore back after 5 minutes.

    After a month lay up with pain meds have had another trainer who used old trainer's saddle and then purchased her own saddle with a professional saddle fitter ride him. He is totally sound and lovely.
    Hocks and stifle are OK for you but the back may be the issue. I just started to ride him and I intend to purchase a new saddle with a saddle fitter to help. I also have him on smarkpaks anti-inflamitory supplement. Back soreness is a big issue.

    Good luck with your horse.

    Comment


    • #3
      I want to say the "hoppy" thing is an indicator you should take a look at the SI, and see if that's sore. He could have really tweaked something compensating for the front, and/or tweaked something after being on stall rest....
      "On the back of a horse I felt whole, complete, connected to that vital place in the center of me...and the chaos within me found balance."

      Comment


      • #4
        Good that you have had the lymes and epm pulled. Look at SI also. Have they looked at where they took the bone chip out again since this has happened? It is possible that if he overcompensated for a while because of the front end being sore that he has now made his backend sore overall. I'd look back at the front and make sure all is well and that he isn't uncomfortable still up there. Have you tried a bute test on him to see how he responds?
        Horses aren't our whole life, but makes our life whole

        Comment

        • Original Poster

          #5
          Originally posted by rabicon View Post
          Good that you have had the lymes and epm pulled. Look at SI also. Have they looked at where they took the bone chip out again since this has happened? It is possible that if he overcompensated for a while because of the front end being sore that he has now made his backend sore overall. I'd look back at the front and make sure all is well and that he isn't uncomfortable still up there. Have you tried a bute test on him to see how he responds?
          We're pretty sure it's not in the front. As a matter of fact I think that is what the vet thought he was going to find when he came out. The surgical site is cool and tight. He's moving fine on the front. Follow-up rads at 5 weeks post-op looked great.

          He came back into work fine. I'm not saying this isn't related to the surgery, I just think I'm dealing with a different issue. I'm taking all suggestions to heart though.

          Bute doesn't seem to make any difference, or if it does it's insignificant.
          "Some people are born on third base and go through life thinking they hit a triple” – Barry Switzer

          Comment


          • #6
            Screams SI to me.

            Comment


            • #7
              Same here. Two-footing (hopping) behind is a classic symptom of SI issues. Swapping off behind would also point me towards SI.

              Comment


              • #8
                Yep. I'd look at the SI then. Sounds like you've covered all your basis and are on the right path for sure.
                Horses aren't our whole life, but makes our life whole

                Comment

                • Original Poster

                  #9
                  Heard from the vet today. EPM is negative. Thanks for the ideas, I talked to him about the possibility it's in the SI joint. It's certainly something to consider.

                  My other ideas were sore stifles, EPSM, or ulcers. He's always had loose stifles in spite of the fact that he appears to have plenty of muscling. My thinking is that a month of strict stall rest and another of hand walking/light turn out certainly didn't help that. I could have just pushed too hard too fast.

                  For the time being I'm going to spend the next couple of months doing light hacking on straight lines and up and down slopes. We'll start with walk, and a bit of light trot and progress from there if he stays sound. Do us both good to get out.

                  Wish us luck.
                  "Some people are born on third base and go through life thinking they hit a triple” – Barry Switzer

                  Comment


                  • #10
                    In the bloodwork, was his selenium and Vit E levels checked? low selenium affects the large muscles, i.e., hind end.

                    Comment

                    • Original Poster

                      #11
                      Originally posted by gabz View Post
                      In the bloodwork, was his selenium and Vit E levels checked? low selenium affects the large muscles, i.e., hind end.
                      We didn't check for selenium but the soil around here is known to be low and since he gets less than 2 lbs/day of feed (~0.5 mg selenium total) the vet suggested that I start a selenium vitamin E supplement making sure I don't go over 3 mg selenium/day total.
                      "Some people are born on third base and go through life thinking they hit a triple” – Barry Switzer

                      Comment


                      • #12
                        We owned a horse who did that hoppy thing you described. We bought him when he was coming 5 and it (the "hoppy" thing) started happening as we were starting to bring him along (low level dressage), as we would ask him to balance back a bit and start working from the hind end. Turned out to be OCD lesions on both stifles. He ended up having surgery.

                        Good luck to you and I hope you can get to the bottom of things!

                        Comment


                        • #13
                          Did the vet/chiro resolve the muscle fasciculation? I had one with the same symptoms that improved with SI injection but recovered with consistent, targeted manipulation and release of the long back muscles. If he's sore in his SI, he will avoid flexion/extension over his back, causing or contributing to muscle soreness along the long back muscle (longissimus dorsi). This will also cause the 'hopping', potentially a result of compensation on the left hind limb from the right fetlock injury?

                          Comment


                          • #14
                            Weren't blocks done before the radiographs? If not why not?

                            The normal progression of a lameness assessment starts with hoof testers, proceeds to flexions, and then to blocks, which start at the foot and work their way up. After pinpointing the problem area, radiographs and/or ultrasounds are done

                            I grant you blocks take time but skipping them is skipping a valuable diagnostic tool. It is much faster to take a barrelful of radiographs and shrug.

                            You may well have a soft tissue problem which radiographs won't show.
                            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.

                            Comment


                            • #15
                              One more thing to think about - the hopping movement you describe is absolutely classic presentation for discomfort/injury in the neck, also. Cervical arthritis or injury can result in inflammation and bony deformation which can then cause impingement of nerves responsible for various aspects of hind end control. Given your explanation of difficult to pinpoint lameness and lack of clear expression of pain in the hind end, I'd take a serious look at his neck.
                              What does he do if you push straight down on the point of his rump? If you gently manipulate his hind legs backward and forward while standing?
                              Work on sloping terrain would be counter indicated for cervical nerve impingement, so maybe stick to flat ground until his neck is ruled out as the culprit?
                              "Absent a correct diagnosis, medicine is poison, surgery is trauma and alternative therapy is witchcraft" A. Kent Allen
                              http://www.etsy.com/shop/tailsofglory

                              Comment


                              • #16
                                Originally posted by mswillie View Post

                                My other ideas were sore stifles, EPSM, or ulcers. He's always had loose stifles in spite of the fact that he appears to have plenty of muscling. My thinking is that a month of strict stall rest and another of hand walking/light turn out certainly didn't help that. I could have just pushed too hard too fast.

                                For the time being I'm going to spend the next couple of months doing light hacking on straight lines and up and down slopes. We'll start with walk, and a bit of light trot and progress from there if he stays sound. Do us both good to get out.

                                Wish us luck.
                                It definitely sounds like stifles to me and your plan sounds like a good one. One thing you might add is massage especially over the back/Psoas muscles. He is likely very sore there from compensating. Good luck

                                Comment

                                • Original Poster

                                  #17
                                  Originally posted by merrygoround View Post
                                  Weren't blocks done before the radiographs? If not why not?

                                  The normal progression of a lameness assessment starts with hoof testers, proceeds to flexions, and then to blocks, which start at the foot and work their way up. After pinpointing the problem area, radiographs and/or ultrasounds are done

                                  I grant you blocks take time but skipping them is skipping a valuable diagnostic tool. It is much faster to take a barrelful of radiographs and shrug.

                                  You may well have a soft tissue problem which radiographs won't show.
                                  The vet didn't block because after he did the exam and flexions he determined that it's high and bilateral and that we wouldn't gain much from blocking at the time. He specifically said as much. The hock and stifle rads were mainly to rule out a problem there, that might be contributing to a sore back. This vet is not at all adverse to blocking, in fact that was how he narrowed down the front end lameness and discovered the chip. If he thinks any diagnostic tool is useful he has no problems taking the time (or my money) to do it.

                                  All the other testing, except CBC which is just routine, came from the odd muscle fasiculations and his concern that the sore back may have had a disease origin.

                                  Once the lab work came back clean for EPM I started a stifle strengthening program. So for the last 10 days or so I've been out of the arena just doing walk/trot hacks up and down the rolling terrain I'm lucky enough to have available. Today we were out with a buddy (long legged TB as opposed to my short legged QH) and when his friend got too far out in front he picked up a nice smooth canter for a couple hundred feet. He felt nice and strong and I actually had to pull him up since I don't want him working too hard yet. So far he's been sound and seems happy to go out. He does tire easily though so we're taking it very slow and I'm sticking to straight lines and rolling hills for now.

                                  So, so far I've spent well over $1000 to find out my horse doesn't have EPM, Lyme, Cushings/insulin resistance, arthritic hocks or stifles, or PSSM type 1.

                                  He is slightly anemic and he lost a lot of muscle while he was recuperating from the chip surgery so I started him on a ration balancer.

                                  I collected a fecal today and it will go in the mail tomorrow just to make sure he isn't carrying a worm load that may be contributing to the low HCT. He's on a worming schedule but it never hurts to check.

                                  I'll see how it goes over the next month or so.

                                  And thanks to everyone for your suggestions.
                                  "Some people are born on third base and go through life thinking they hit a triple” – Barry Switzer

                                  Comment

                                  • Original Poster

                                    #18
                                    Originally posted by JackieBlue View Post
                                    One more thing to think about - the hopping movement you describe is absolutely classic presentation for discomfort/injury in the neck, also...
                                    What does he do if you push straight down on the point of his rump? If you gently manipulate his hind legs backward and forward while standing?
                                    Work on sloping terrain would be counter indicated for cervical nerve impingement, so maybe stick to flat ground until his neck is ruled out as the culprit?
                                    I've never tried it. The vet may have but he didn't mention it. I'll try those things and see what he does.
                                    "Some people are born on third base and go through life thinking they hit a triple” – Barry Switzer

                                    Comment


                                    • #19
                                      I've had a similar problem with my mare (now resolved). Right hind suspensory injury, stall rest, rehab.. 9 months after the initial injury we were given the OK to canter. After a couple weeks of that she started to not want to go forward. Got to the point where she wouldn't even trot, she's just throw her head up in the air, trot, and buck.
                                      Long story short and after many many different ideas from various vets, it ended up being soft tissue damage to the right stifle. An x-ray won't show this. We injected her stifle and had a week of free lunging (ended up lunging because she was crazy on her own) because her movement had been restricted for so long and she needed to move and loosen up. Mare is going really well now but we're back to rehabbing and taking it really slowly.

                                      Comment


                                      • #20
                                        I'd try some carrot stretches, too, to get an idea of the full range of motion of his neck.
                                        "Absent a correct diagnosis, medicine is poison, surgery is trauma and alternative therapy is witchcraft" A. Kent Allen
                                        http://www.etsy.com/shop/tailsofglory

                                        Comment

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