“Lameness” Following Diagnostics + Treatment

[spurofthemoment]

I’m in a position almost ALL horse people find themselves in: the horse is “not quite right” - not outright lame/unsound, but definitely a little off. Not off enough to avoid riding per the vet. Because of this, we run into issues that can be written off as training issues (heavy on the forehand, rushing to/from jumps at certain gaits, bucking at certain gaits, etc.).

So, we shell out the money for diagnostics and treatment. But when we think we’ve found and treated the cause, we don’t see any quick improvement with the training issues despite hearing “you should see an improvement in X amount of time.”

I’m right at the step where I shell out the money for diagnostics and treatment. But I’m hesitant - after working with a chiro and incorporating improved diet and specific exercise plan, I truly think my horse has made improvements (muscularity and postural-y). Yet, we still sometimes have those “training” issues. Granted, it hasn’t been but less than 1/4 of a year since I’ve started down this path. I’m worried that if I do spend the money on the diagnostics and treatment, I’ll still be where I am right now.

At what point does the “pre-habilitation” stop working? Is it unfair to assume that horses are bit like humans when it comes to addressing a biomechanics issue? I know my conformation for running is not great - I’ve got two knock knees. But with appropriate cross training, properly fitting equipment, and mindfulness of my form, when I run, I don’t feel pain. I’m not at the age or pain level where steroid injections or advanced medical treatments are typical (I’ve been above average active all my life, but am by no means a body builder or marathon runner), and neither is my horse.

I guess what I’m asking here is - at what point do we decide our “not quite right” horses we’ve been carefully training and stretching and adjusting need the high-cost diagnostics and injections/corrective treatments?

I come from having a horse as a kid 15 years ago, and I feel like there’s so much more to equine performance now-a-days. In between then and now, I was lessoning and leasing school horses. I’m so new to this world of equine sports medicine and what’s training-related and what’s a quirk and what’s true pain. It feels like we can almost always find SOMETHING with every horse, and we as horse owners always try to do the best for our animals. With everything out there now, it almost seems like riding the horse isn’t a viable option for any of them!

[Demerara_Stables]

There’s a lot to unpack here but at first glance I’d say that any sort of pre-hab program won’t show linear progress. When you’re getting a horse fit, they’ll get muscle sore, maybe start to compensate, and maybe aggravate some other joint/ligament/muscle by overuse. If you think your horse has been improving but there’s still something there, make sure you’re getting regular visits by a massage therapist and chiropractor/acupuncturist. They will be able to tell you if there’s still some soreness going on and if it’s moving around. I only get worried when muscle soreness is in the same spot for a month or more and hasn’t changed. If it moves or gets better and worse that’s probably just the course of building fitness. It takes a long time to get a horse fit (of course depending on where you’re starting and where you want to get to), even longer if you’re fixing poor movement patterns and incorrect muscle memory.

And don’t forget that what we see and call lameness isn’t always something that’s diagnosable. When you run for the first time after a long break, you’re muscle sore. You’re maybe very lame for a few days. If you’re asking your horse to work harder each day, as sometimes happens when you’re building fitness, they’re muscle sore everyday. Figuring out what work schedule is right for your horse is an absolute art and it’s different for every horse. It depends on their age, wear and tear, existing fitness, nutrition, turnout schedule, sleep quality, etc etc. Just like human athletes.

[spurofthemoment]

Thank you for that! His first chiro visit was tough and the veterinarian had a very hard time getting any sort of feedback from him because he was so tight everywhere. That’s when I started his “prehab.” His second session, two months later, was MUCH more productive, he was a more willing participant, and she was able to pinpoint some places where he was showing soreness. Perhaps these might be jumping off points? My normal vet noted some pain previously that the chiro noted, so maybe there is something to it.

Your point about consistent soreness in the same places vs all over when building fitness was super helpful!

[Demerara_Stables]

I have had some horses that take three or four times with the chiropractor to accept being adjusted (because they are so sore) and my personal horse still will not allow needles in some parts of her body. Two months seems like a long time in between treatments, the worst horses I have had get chiro/acupuncture every two weeks. Massages about the same cadence. Maintenance is about once monthly for each type of work.

Definitely pay attention to the areas that the chiropractor and vet pointed out, but when I am working with a horse in rehab, I always make sure that I get to a point with the chiropractor and massage therapist where their bodies feel good consistently before I involve the sports medicine vet, unless I have previous diagnostics that tell me otherwise. So much soreness comes from compensation and lack of movement/turnout that I address all of that first before I spend a lot of money on diagnostics. If the horse has any swelling or heat or is obviously lame on one leg I will go to diagnostics first, but if it is just a general NQR I take my time. I’ve had horses take over 6 months to develop enough top line to even be ridden comfortably so it really all depends on where you are starting.

Also if the horse is under saddle don’t forget to involve an independent saddle fitter.

[spurofthemoment]

So I wasn’t sure how often to have the chiro out - I had previously heard that the more you do it, the less effective it is, hence why I waited two months.

Thank you so much for sharing your experience. I think what’s giving me pause about having the sports medicine vet out is the fact that I could very well pay a lot of money just to be told “keep doing what you’re doing.” Which would honestly be best case scenario. It’s just harder to wrap my head around that - maybe if I equate it to spending tons of money at a horse show for a chance at a $1 ribbon, I’ll be able to justify it better to myself!

[Demerara_Stables]

You’re welcome! I’ve been doing it for a while - always happy to help others.

Do you have a regular vet that has seen the horse already? My vet (who is board certified in rehab) will do phone consults or do a shorter exam that isn’t a full work up, but only because she’s seen all of my horses. Ideally the vet has seen the horse before and you can tell her what’s going on and she can make recommendations. My chiro is also a vet and communicates with my regular vet so we’re all on the same page. If the sports medicine vet hasn’t seen your horse, maybe they’ll do a consult visit without a full lameness work up (flexions, blocks, etc), but I’m sure they’ll at least want to see the horse move, and give some sort of exam.

Chiro isn’t less effective if you do it more often, but figuring out a cadence is sometimes hard. The horse may not need to be adjusted twice a month, but if something is really out, you want to keep checking it (maybe every two weeks) to make sure it stays. If something has been out for a while, the muscles around that area have adjusted to account for it, so you’d want to get a massage then the adjustment a few days later, and it might go out again in short order.

For example, the photo below is my 3yo in mid March, 2 weeks after she came to me. She’s not perfectly square behind, but that spine and pelvis is jacked up. She was totally sound at the walk, and 2/5 lame on the LH at the trot, only when trotting slowly. I don’t have any after photos, but her spine and pelvis are about 90% improved 4 months later and she’s totally sound. She had a full vetting with clean x-rays and good flexions at the end of February, so I know there’s nothing going on that I can’t see. It took a few massages and 4-5 chiro/acupuncture appointments over 3.5 months to get her fixed, and it wasn’t cheap, but it was way cheaper than going full on diagnostics. I think she’s a great example because she’s young and had a fresh PPE so I know that the misalignment caused the lameness. How she got that way, who knows… she’s 3.

ETA I found before and after video

Video April 11
https://photos.app.goo.gl/YWzBwscDP1aPuJ9w9

Video July 22
https://photos.app.goo.gl/1qszsP8ipCMBAaNF7