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Lameness and Rehabilitation

Lameness and Rehabilitation

  1. My horse appears to have a front knee injury and is lame on the front. I believe he twisted it playing in the field a few weeks ago. It seems much worse and sounds like it a clicking noise in the joint. My horses are not shod and I have also noticed much more sensitivity riding . His heels are trimmed too low, from another farrier, and it also appears my horses have too much wear on the inside of the hoof compared to the outside. I have mentioned this several times to my farrier as we also have rocky soil. I have gaited horses but most of the farriers in my area work primarily on Quarter horses. What should I do about his knee and what could have caused its sensitivity? I have wrapped him, thinking it was a bruised sole, and have kept him separated from the other horses. Should his movement be restricted? (View Answer)

    It sounds like you may have a couple of different issues going on. You mentioned that you thought he had twisted his knee in the field a couple of weeks ago and a clicking noise. You also mentioned the issues with his feet.


    The fact that you have a worsening lameness over the past couple of weeks is a concern to me and I would highly recommend restricting his movement until you can have a veterinarian out. I would recommend an examination including hoof testers, flexions and possibly localized nerve blocks to differentiate whether there truly is an injury to the knee or whether the lameness is coming from the foot or possibly neither. Depending on what they find, you may need radiographs and/or an ultrasound to determine whether there is a bone injury or a soft tissue injury. Radiography gives us a better view of the bones while ultrasonography gives us a better view of the soft tissues including tendons and ligaments.


    It may be that he just needs a good balanced trim and possibly shoes to help with his foot balance and provide some protection.  Radiographs of his feet may be beneficial for your veterinarian and your farrier to determine the best course of action for his feet. However, I would have your veterinarian perform a thorough examination to rule out a more serious injury. Lisa Borzynski, DVM, Wisconsin Equine Clinic and Hospital

  2. I have a 7-year-old Warm Blood horse that had a right dorsosacroilic tear diagnosed 12 months ago. He is back in work but after only six months off. I am slowly building him up but would like some exercises to target the area. Do you have any suggestions? (View Answer)

    I'm sorry to hear about your horse's injury! I'm assuming that this was diagnosed with an ultrasound and that you have had a follow up ultrasound to determine that the injury is healed and you are able to proceed with work.


    I approach back pain/injury from many different aspects. 

    1) Establish or maintain a base level of fitness

    2) Core strengthening and supplying exercises from the ground 

    3) Professional saddle fitting or saddle recheck before resuming under saddle work

    4) Rider fitness and balance

    5) Core strengthening under saddle

    6) Physical therapy modalities

    7) Topline supplementation 


    I'm not sure where you are in your fitness program, but if he has not had any type of work or hand walking I would start with hand walking for 20 minutes per day and increase by five minutes per week for the first month. 


    During this time, you can begin core strengthening exercises on the ground. If you are not to familiar with carrot stretches, belly lifts, pelvic tilts and suppling exercises, I would recommend having an experienced massage or physiotherapist out to demonstrate proper techniques.


    After a month, I would start lunge work with 10 minutes of walking for the warm-up then five minutes of trot and 10 minutes of walking to cool down. Add five minutes of trot work each week over the next month.


    Slowly add exercises to strengthen the back and core before getting back to work under saddle. It is critical to rebuild the muscle and topline that has been lost over the extended time off. Long and low stretching while asking the horse to come forward on the lunge line will help to lift and round his back. 


    I am a big fan of the Equicore pad can be used during lunge work and under saddle work. A Pessoa type lunging system is also useful, but some disadvantages are that it can be a bit tricky to adjust properly, horses are still able to "cheat" and hollow their back, and it cannot be used while riding. 

    With devices such as these, it is important to start on the lightest contact while still maintaining the position of the equipment and gradually increase the tension and engagement. I would also slowly increase the amount of time using these. I typically start with 10 minutes three times a week the first week on the lightest contact and then gradually increase the amount of time and tension each week. Be careful with horses that are sensitive about their hind end. That is another advantage of the pad. You can just attach the bellyband initially. These devices help to prevent the horse from hollowing his back during work, but it is not a foolproof system, so pay attention to your horse's engagement and the lift of the back.

    It is critical to have your saddle evaluated before you start back with under saddle work. Even if you have had it checked in the past, it's important to have an experienced saddle fitter reevaluate your saddle every six months especially after time off. The change in musculature will alter the saddle fit and it's very important that your horse is comfortable and uses his back correctly.


    If you have not been riding other horses while your horse has been out of work, I would recommend getting back into a riding/training program on other horses to be sure that you are fit and riding in a balanced position. Incorrect riding can hinder his recovery and performance.


    When you do begin under saddle work, I like to incorporate a lot of long and low walking and trotting and encourage the horse to step from behind, lift the back and feel the swing. As you increase the collection, be sure to incorporate suppling exercises and lateral work. Poles on the ground can be incorporated for strengthening.


    If at any point he is showing signs of pain such as reluctance to go forward, tightening or spasms in the back, pinning the ears, or bucking, then back down to the previous level of work. If pain persists, have your veterinarian out to reevaluate.


    There are many different physical therapy modalities that can be beneficial for back pain. I believe they all have some value. Their use will depend on availability, cost and your personal preference. I believe that veterinary spinal manipulation therapy (VSMT or chiropractic) by a licensed veterinarian is the most beneficial. A good massage or physiotherapist is also very beneficial.


    I am not a big supplement user, but I do like to use a topline supplement on my own horses and my client's horses to build and maintain topline musculature.


    Good luck to you! I hope this helps and that he makes a full recovery! Lisa Borzynski, DVM, Wisconsin Equine Clinic and Hospital

  3. I am trying to rehabilitate a 28-year-old half Arabian with a tear in the front SDFT (small, of unknown etiology). I have been recommended both shock wave therapy and therapeutic ultrasound therapy. What is the difference and which might be the most beneficial? He has been used consistently for light pleasure until this summer. (View Answer)

    I'm sorry to hear about your old guy! It's a testament to good care that you are still riding him at that age! 


    There are numerous injections such as stem cells and PRP and physical therapy modalities available now to help with healing of tendon and ligament injuries in horses. Choosing which therapy or combination of therapies to use depends on the size, chronicity, and location of the lesion, as well as the availability of each treatment and your budget!


    Of course, the most important is tincture of time! Most tendon and ligament injuries will heal with time and some degree of controlled exercise. Cold hosing, anti-inflammatory treatments, and a support wrap are also beneficial in the early stages.

    There is some controversy over the use of injections and physical therapy modalities and what advantages they provide. The goal of most of these is to try and improve the quality of healing to have the most physiologically normal structure when healed. They do not necessarily speed the time of healing. Many of the physical therapy modalities such as shockwave, therapeutic ultrasound, and therapeutic laser have been adapted from human medicine.


    Since I have not seen the ultrasound, I can't make a specific recommendation either way. I would say that in my hands, if there was just a very small tear, I would probably just recommend the cold hosing, wrapping and an anti-inflammatory such as a bute or topical diclofenac. I would restrict the turn out space, so that he can't get up too much speed and further injure the tendon. I would hand walk him for 20–30 minutes per day until a recheck ultrasound at about four weeks.


    If you are interested in adding one of the other treatments, I would probably go with therapeutic ultrasound or therapeutic laser rather than shockwave in this case. I use all three to some degree in my practice. They all produce a type of wave (ultrasound uses sound waves, laser- light waves, shockwave-pulse waves) that in theory stimulate and activate cells and cellular activity. I do not use shockwave for acute cases. I tend to use it for more chronic conditions and for bony lesions. It is also the most expensive.


    At his age, there can be some complicating factors that can delay healing such as overall health, nutritional status, and metabolic concerns such as Cushing's, so be sure to address these if present.

    Good luck to you! Hopefully, you will  be out riding again next summer! Lisa Borzynski, DVM, Wisconsin Equine Clinic and Hospital

  4. What would be your suggestion for rehabilitation for a serious hamstring injury? (View Answer)

    The rehabilitation process will depend a great deal on the extent of the damage. An ultrasound examination by your veterinarian will be incredibly helpful in designing and and monitoring your rehabilitation program. Depending on the injury you have, it may take 6 to 12 months to heal.

    For the first 2 weeks, you will probably need stall rest with limited handwalking, cold hosing and anti-inflammatories. If you have an experienced physiotherapist, you could begin some passive range of motion in the first few weeks. 


    As the pain and inflammation decrease, you may be able to walk more, start some gentle massage and cross frictional therapy, and start static stretches/isometrics.


    After the muscle is fully healed, you can begin under saddle work and gradually increase the amount of work.


    If you have therapeutic laser available, I have had great success with it for these types of injuries in all phases of healing. They can help with the initial pain and inflammation and later can help with mobility and reduce the amount of scarring.

    Be sure to work with your veterinarian to tailor a program for your horse. Lisa Borzynski, DVM, Wisconsin Equine Clinic and Hospital

  5. My horse recently developed laminitis, which has been attributed to a keratoma in the hoof. Can you explain what a keratoma is, and how it can produce laminitis? The coffin bone has dropped and there is also evidence of rotation. Can a horse with these issues become pasture sound? We are working with an excellent lameness farrier. (View Answer)

    Unfortunately, keratomas can be a real bugger to manage! A keratoma is a benign mass made up of keratin that develops between the hoof wall and the distal phalanx, also known as the coffin bone. They typically form a cylindrical lesion originating at the level of the coronary band and are often not detected until they have traveled down the dorsal hoof wall. They will sometimes cause a bulging of the dorsal wall.


    The pressure of these space occupying lesions within the solid hoof capsule can cause damage to the laminae, as well as the coffin bone.


    The best treatment is surgical removal of the mass, especially in your case where the horse has developed laminitis. In cases without laminitis, surgical removal can be curative, but depending on the degree of laminitis your horse has, removal of the mass at this point may destabilize the entire foot.


    I would recommend that you work with a surgeon on this case, as well as your farrier, to unload the front of the hoof wall and toe region, treat the laminitis and decide whether surgery will be an option. Lisa Borzynski, DVM, Wisconsin Equine Clinic and Hospital

  6. My horse is a 14-year-old Paint gelding. He had debridement surgery in the right hind foot, subsolar abcess and was septic pedal osteitis. The surgery site has grown to the bottom of the hoof wall and his shoes are back on. I would like to know, coming from complete stall rest, the best rehab option for getting him back to performance level? I understand there are no quick fixes, I would just like to know where to start. (View Answer)

    I’m glad to hear that your horse has healed and that he is ready to start back to work! If he has been on stall rest during his recovery, then begin turn out as approved by your veterinarian.


    For any horse that has had prolonged time off, whether for an injury or for the winter, I recommend starting slowly with some basic fitness work. 


    Assuming your horse is safe to ride at this point, a sample back-to-work schedule would be:

    Week 1 - 20 minutes of walking under saddle per day

    Week 2 - 25 minutes of walk 

    Week 3 - 25 minutes of walk, 2 minutes of trot, then another 5 minutes of walk

    Week 4 - 25 minutes of walk, 4 minutes of trot, 5 minutes of walk

    Week 5 - 25 minutes of walk, 6 minutes of trot, 5 minutes of walk

    Week 6 - 25 minutes of walk, 10 minutes of trot, 5 minutes of walk

    Week 7 - 25 minutes of walk, 15 minutes of trot, 5 minutes of walk

    Week 8 - 25 minutes of walk, 20 minutes of trot, 5 minutes of walk


    During this initial eight weeks, you can work on long and low, stretching and suppling, and very slowly add collected work. After this time period, you should be able to resume his previous level of Western Performance work. Be sure to have your saddle checked to make sure it still fits properly. Time off can mean loss of topline and can cause a change in saddle fit.


    Obviously, if your horse is showing any signs of lameness during this time, contact your veterinarian immediately. Lisa Borzynski, DVM, Wisconsin Equine Clinic and Hospital

  7. How effective is pentosan in preventing or treating arthritis? (View Answer)

    That is a very good question and it depends on who you talk to! There are very few studies on the use of pentosan in horses. The studies that have been done showed improvement in the cartilage of horses with experimentally induced arthritis, but no improvement in pain scores. There are no studies to suggest it would prevent arthritis. Pentosan is typically given as 4 weekly intramuscular doses and then monthly.


    In my personal experience, I have had limited success with it in my horses and my patients. Some horses seem to respond well and others not at all. Side effects are rare and are primarily injection site swelling. However, it is not approved by the FDA for intramuscular use, so it is considered off-label uses and if there is a problem, you have no recourse. Lisa Borzynski, DVM, Wisconsin Equine Clinic and Hospital

  8. My horse was diagnosed with Arthritis in his right front fetlock area. He had an MRI, and was given a shot of Hyraluronic Acid and Osphos. He has been on stall rest, with hand walking, and minimal turn out for 9 months now. He is doing much better and the limp is gone. How can I bring him back into condition for weekly trail riding? (View Answer)

    We probably need to know a little bit more about your horse’s condition. It sounds like it was trauma induced if it was diagnosed on an MRI and you have had to rest the horse. Most often when people refer to “arthritis”,  they are referring to a degenerative condition of the joint. That is the most common type of arthritis and doesn’t typically require nine months of rest.


    So, if your horse did have some type of trauma to the joint, it is important to know whether it is healed. If you have not had a follow up MRI, that may be a good idea to determine what level of work your horse can perform.


    If you have the all clear to begin work, then I would follow a program similar to what I recommended in an earlier question posed within this forum. 


    This is a sample plan that I use for most horses that have had prolonged time off whether for an injury or for the winter. This assumes that they have been on some sort of turn out already and are safe to be ridden.


    Week 1 - 20 minutes of walking under saddle per day

    Week 2 - 25 minutes of walk 

    Week 3 - 25 minutes of walk, 2 minutes of trot, then another 5 minutes of walk

    Week 4 - 25 minutes of walk, 4 minutes of trot, 5 minutes of walk

    Week 5 - 25 minutes of walk, 6 minutes of trot, 5 minutes of walk

    Week 6 - 25 minutes of walk, 10 minutes of trot, 5 minutes of walk

    Week 7 - 25 minutes of walk, 15 minutes of trot, 5 minutes of walk

    Week 8 - 25 minutes of walk, 20 minutes of trot, 5 minutes of walk.

    If at any point your horse seems lame again, then stop and have your veterinarian out again. Lisa Borzynski, DVM, Wisconsin Equine Clinic and Hospital

  9. My 20-year-old Paso Fino gelding developed a stifle issue. My veterinarian recommended rest and bute. How long should he "rest" and what are other effective treatments? (View Answer)

    I would need to have more information about what the stifle issue is. There are many different problems that can develop with the stifle. It is a very complex structure equivalent to the human knee. Did your veterinarian take any x-rays or perform an ultrasound? That would help diagnose the underlying cause and would help direct the treatment and rehabilitation protocol.


    In a 20-year-old horse, the most common issue would be arthritis. If it is a completely new issue, perhaps your veterinarian thought it was just a strain or sprain. I would follow the course of Bute and rest that was initially recommended and then have a re-check if he is not sound at that point. I probably wouldn't wait more than a few weeks before having your follow up. Lisa Borzynski, DVM, Wisconsin Equine Clinic and Hospital

  10. My 23-year-old Quarter horse mare started with signs of lameness in her shoulders and front legs about 10 months ago. We have owned her since she was 4-years-old with no previous health issues other than two bouts of lyme treated with doxy. We have treated her again for lyme disease with holistic treatments and two more courses of doxy, including some holistic chiropractic, acupuncture and massage but to no avail. Some days she can hardly move her front legs. Other days she walks more freely. She is currently on two grams of bute plus a quality senior joint supplement. She was on prevacox for several months but does better on bute. The general consensus is that she has arthritis from an old injury that occurred two years ago when she was kicked by another horse, which did not appear to be a serious problem at the time. She has been seen by three different veterinarians. Any thoughts on what may be going on or treatment that might make her more comfortable? (View Answer)

    I am sorry to hear about your mare. It sounds like a very frustrating case and it sounds like everyone is working very hard to sort it out. Some cases can be very baffling!


    If you have had three veterinarians involved, I'm assuming that she has had a thorough lameness evaluation, flexion tests, nerve and/or joint blocks, radiographs and possibly ultrasound. Since I don't know the specifics of the findings, I will give you some general thoughts.


    Since you have the history of the knee injury and it sounds like you have evidence of arthritis, that is a good place to start. Carpal arthritis is often a career ending and sometimes life-threatening injury. Horses carry 60% of their weight on the front end and the knee is a high motion area, so even mild arthritis can be very painful. You should be able to block or numb the pain in the joints with local anesthetic to rule this in or out.


    Some options for treatment include joint injections, laser or ultrasound therapy, or surgery to fuse the joint depending on which joint is involved. Anti-inflammatories and Back on track knee boots can also be beneficial.


    My first thought in a Quarter horse with chronic front limb and shoulder pain is always palmar foot pain. If the lameness has been blocked to her foot or fetlock, I would consider an MRI. There are many problems that can be missed with an x-ray and an ultrasound is not a very good option for the foot.


    Other soft tissue injuries in the lower limb should have been picked up during your previous evaluations.


    Primary shoulder issues are not common and can be a bit tricky because of the muscle mass and limited ability for diagnostics, but a thorough evaluation with flexions, joint block, radiographs and ultrasound should help pick up most issues.


    If you haven't already, I would also evaluate the neck. The nerves to the front limb exit through the vertebrae in the neck, so neck pain or nerve impingement can cause front end lameness.


    One last thought would be nuclear scintigraphy, if available and you wanted to pursue it.  A bone scan can give you information about the neck and body that we can't always see with radiographs or ultrasound. The downside is that it may miss some chronic issues. Lisa Borzynski, DVM, Wisconsin Equine Clinic and Hospital