NQR In the Hind End- Thoughts?

Hey everyone! Long-time lurker, first time poster. My gelding, Hawk, (11 yr, Paint) has been NQR in the hind for about a year now. The problems started out as a refusal to pick up the right lead canter. We then started leaning more and more to the inside when heading right and gaining an overall lack of propulsion from the hind end. Towards the end of last summer, Hawk had also picked up a tendency to buck when cantering uphill on the trails.
-Had the saddle fitter out and bought a new saddle. She’s adjusted it since then as well.
-Had a trainer watch me to check my own balance in the saddle. She confirmed that I’m riding straight. She noted that Hawk would occasionally cross-canter and that he had a tendency to swap leads quickly if he did pick up the right lead to start with. She also popped on him and while she was able to pick up the correct canter lead on a few attempts, it was difficult. She suggested lots of bending and lateral work as well as having a chiropractor check him.
-Chiropractor (aka sports medicine vet) came out. Noted that Hawk was sore in the SI region under palpation. Adjusted Hawk but no difference.
-Same vet confirmed that Hawk was subtly lame on the RH. (He bucked on the lunge line when asked to canter to the right during the evaluation, which was a first for him as long as I’ve had him.) Hawk is still sore in the SI region. Flexions did not worsen the lameness but we still radiographed the hocks- fine. Tried ultrasound guided injection of the SI. Hawk had a few days on stall rest and gradually built back into under saddle work over the next couple weeks. The lameness was improved but still present off and on.
It’s now been almost 2 months since the SI injections. Hawk does now pick up his right canter lead regularly. However, we still have a general lack of propulsion. He had several weeks of lighter work due to my work schedule and when I popped on for a walk/trot session yesterday and he’s once again mildly lame in the RH. I have the vet coming out again on Monday, but I wanted to see if anyone had any suggestions about what we might be missing. Thanks!

It’s a complicated joint, but sounds perhaps like stifles? Quite similar presentation to my mare.

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Any sort of weird on again, off again lameness, I test for Lyme as a rule-out. Not sure if that is a potential issue where you are located or not.

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Hmmm could certainly be stifles. Especially with a reduced workload. Stifles are complicated and finicky, and often can cause bucking and radiating soreness. Did the vet flex his stifles or just the hocks?

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@phantomhorse Lyme is definitely a possibility. I’ve pulled a lot of ticks off him as his field is pretty overgrown in the spring and summer. I’ll have the vet check that.
@Nottingham @fivestrideline We did flex the stifles but I don’t think we did radiographs of them. I’ll talk to the vet about doing a more thorough check of that joint!
Thank you for the suggestions!

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I would check things like Lyme, and it might be time to xray the neck. That said SI injections don’t always work. It depends on what’s going on in there.

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Agree with others to check stifles. Stifle and SI soreness can often appear together as compensation for the stifle can lead to bad posture that impacts the SI. Also check his hoof angles.

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You may want to take radiographs of the hind hooves as well.

Negative Palmer Angles are sometimes responsible for lamenesses that appear to be higher up.

Not very expensive as diagnostics go, and useful to have anyway

Good luck.

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Definitely would check for Lyme, maybe take rads of the feet/neck, and a hard look at those stifles.
In the meantime you can try doing some stifle strengthening/rehab exercises (tail pulls, stretches, good walking hills or raised poles, backing) as they probably aren’t going to hurt and honestly I think most horses could benefit from them even without a clinical issue.

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I had nearly the exact thing with my app gelding back in October. He had been getting progressively stiffer and more reluctant (“lazy”) but it was so gradual that I didn’t really realize something was going on. Then one day I got on and it was like he had zero impulsion from behind. This isn’t a big moving, thrusting horse to begin with, he’s bred for western pleasure, but he literally felt like a gaited horse that just shuffled. His “trot” was impossible to post and he eventually refused to canter anymore. Then he started refusing to lay down anymore. He’d TRY to lay down, but couldn’t do it. Just not comfortable enough.

Vet came, did flexions, hocks and stifles were the culprits according to flexion (and she’s an osteopath, for whatever that’s worth to anyone). She suggested Adequan because he also had some stiffness over the SI/back area. So, I started it. He began to improve, but still not as much as I wanted. Had her back, did x-rays (not sure why we didn’t orginally) and they showed arthritis in hocks…right more than left…and evidence that he’s trying to fuse. Stifles actually looked okay.

We added a daily pill of Equioxx for him. Voila. Sound as a dollar, laying down, getting up, running and playing in the pasture, fun to ride. Probably the best he’s felt (all around, not just when ridden) since I broke him to ride (he’s 14 next month and I broke him as a 2yo…which I wish I hadn’t).

He’ll get Adequan every 6 months and Equioxx every day of his life from now on as far as I’m concerned. He’s a happy boy.

I hope you can find a similar solution to your fella’s issues. It’s so frustrating when they can’t tell us what hurts.

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Because he is a stock breed, I would consider testing for pssm type 1. Also pssm type 2. Both can cause canter issues, swapping leads, and bucking.

My type 2 mare can’t canter without swapping behind. She had her stifles and SI injected because they thought it was pain related.

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^^ what I was going to suggest, along with a close look at the feet.

Thanks again for all the responses folks! Stifles, Lyme, hooves, and neck are all on my list now.
I lunged him today and he looked fine but the minute I got on I could tell he still was off behind. The trainer confirmed he was tracking shorter with his RH (she also watched him on the lunge and said he looked fine then) and she felt that he wasn’t flexing as much in his hock on that leg, though it could be due to the shorter stride. Like I said, the radiographs of the hocks were fine so I don’t think it’s that, but who knows at this point.
@RhythmNCruise I’m glad to hear your guy is doing better! I’m almost hoping I can just give some Adequan or Equioxx and have my guy feeling better.
@4horses @Heinz_57 Do they have a test for pssm type 2? I guess I haven’t really considered pssm because he’s never had a tying up episode.

My mare never had a tying up episode until later in life. So it can still be pssm, just not severe enough to cause tying up. It presented as lameness because her muscles were tight which resulted in choppy movement and occasionally toe dragging behind. But mainly she could not canter without swapping leads and crow hopping. She wanted to canter, just couldn’t do so comfortably.

Stifles, Lyme, EPM, PSSM all things to check. EPM testing can be a blood test and field neuro test - my 4yo aqha mare was ever so slightly nqr for months, trainer and barn friends all thought it was baby horse attitude, daughter (riding) said it felt so much worse than it looked in video…and that was the ticket. Fortunate to have a trainer who listened and a vet who looked very closely.

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I’d be tempted to do an Equioox trial, unless the horse fails a neuro test. At his age, you could spend a LOT of money to track down an exact diagnosis, for which the first line treatment is pretty much the same – Equioxx. If it doesn’t work, then you can drift further down the expensive rabbit hole. If cost is of no importance to you, no harm in doing a full workup…but at that point where you are looking for 5 different things, I kind of feel like the next step is a nuke scan to pinpoint what you are looking at.

If he fails the neuro test, lyme/EPM/KS are the next things I’d investigate.

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I’ve spoken with his regular vet (not the sport medicine specialist) and we’re going to test for Lyme. She doesn’t feel PSSM is worth checking because the lameness is more one sided. I looked back over my notes from the last lameness exam and it looks like we did actually radiograph the stifles. The sports med guy will be out on Friday and we’ll go over more testing options/treatment plans then. In the mean time, Hawk kicked up a fever after his vaccines and is stuck primarily on stall rest this week. Poor guy!

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Sorry for the delayed update. The sport medicine specialist was out on Friday and we went through the testing gambit. Flexions, blocking, ultrasound, radiographs… everything. Other than the fact that Hawk is distinctly lame in the RH (more so than last time) and never blocked sound, it all looks good. The vet’s only suggestion was a bone scan or retirement. Obviously not the news I was hoping for.

I am sorry you did not get any clarity. While it seems awful to say, I hope the Lyme test comes back positive as that would at least have a potential treatment plan.

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What did you Xray? Interesting that it didn’t block sound but there are areas you can’t really block that could cause it up in the axial skeleton.