Poll sensitivity, back pain, hock pain, what am I really dealing with?

Time for some group think here.

10 y/o OTTB mare in regular but moderate dressage based work. Plenty of turnout, plenty of easy rides. Saddle fits well, is maintained every 6 mos. Dental work UTD.
In March she started going lame behind. Swapping leads and being light behind at the canter. Dragging at the trot. Not normal for this horse. Also noted reluctance to back out of trailer. I knew from past experience she needed her back injected (lower lumbar).
Vet appt in April. Vet reviewed hock films taken in August '20. Noted there was sclerosis of the proximal MT3 (suspensory) which was not present on PPE (2017).
Opted to inject hocks and back and see how it went. If not satisfactory, possible Osphos or ? Of note, her first back injections were August of 2019, but then an unrelated issue in October 2019 resulted in an Osphos injection. Vet and I wonder if that is what allowed the back injections to last as long as they have (from 8/2019 to 3/2021).

Okay, it’s been almost 8 weeks. She’s been pretty darn good until today. Today I noted possible discomfort in the RH, and when lunging to the left - left lead canter, looks like might be heading towards being ‘light behind’ again. She rode okay but I didn’t push the issue.

When I got off, I went to scratch her neck like I always do, and she flinched and jerked her head away. She does not want me touching the right side of her poll area. At all. I had the chiropractor out about 3 weeks ago and her poll was out, he adjusted it and she was decidedly not happy about that.

She twists her head when riding, and when lunging. She’s done this since the day I got her, and in thinking on it seems to only be when tracking left. I have seen her do this in the pasture also.

She is NPA behind, but I have an excellent farrier who is on top of it.

I’m at a loss where else to go with diagnostics and/or pain management. I’ve done ‘bute trials’ with no discernable difference. I do keep her on methocarbamol (Robaxin).

Stifle xrays were clean, altho she does have mild UFP, which really has disappeared as she’s gotten stronger.

Another oddity, when I get on (I use a 3-step mounting block), if I get on from the left side she can be reluctant to stand or get next to the block. If I mount from the right side, she’s fine.

So, COTH’ers… ideas? Thoughts? Experiences? Where would you go with this?

Occam’s Razor.

Was already thinking suspensory by the fourth sentence. Then you mentioned it, then you mentioned NPA.

NPA really donks up a horse. Their whole body gets sore. Most of the time it is their suspensories but it also makes their hocks, backs, and even shoulders sore. I’d keep on fixing that issue, and if you’re concerned possibly pull a lyme titer. If anything contributes to overall body soreness worse than NPA, it’s lyme.

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Okay @beowulf be a little more detailed please, lol. The NPA I get. What I don’t get is how she could have sclerosis in August of '20 - but was NOT lame at all - films were taken only as an offhand thing at that time. We did not take new hock films in April - it was just a different vet at the clinic who felt it might be “something”.
What I also don’t understand is how, by keeping the NPA corrected, why is she still getting so sore? She stands better, moves better…

I wish they could talk sometimes. I’d sure like to know. I will mention the lyme to my vet but?? She raced in Idaho, Nevada, Wyoming, Oregon. Maybe?

Another thought…is it possible by correcting the NPA there is more “pressure” on the stifle? Possibly worth looking at the stifles again?

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As frustrating as it is they don’t read their x-rays - and sometimes bilaterally lame is very subtle.

NPA is insidious. We (collective) think of it as a hoof issue. Because it really stems from the hoof – but it isn’t just the hoof. It’s all of the surrounding structures too.

I’ve yet to see NPA present without thin/sore soles and suspensory soreness. It’s one of those things the longer it hangs around the further up the horse it reaches – and by the time you or I visually see the NPA profile, it’s been in the works a while. It changes how they stand; they tend to camp under themselves more, which puts pressure on their hocks, their stifles, their backs.

My experience with NPA is it takes a long time to resolve the physical complaints. I have also seen it cause UFP.

The head tilt could be something different, and unrelated.

Do you have a video of her then and now?

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I have some video but nothing of note.

You are spot on with what NPA causes; right now I’m wondering did I not see it when I got her or did my former farrier cause/exacerbate it? That actually might make some sense as it was several months after I got her that I started seeing the telltale bullnosing. She was barefoot when I got her.

I don’t know. At the vets we could tell she was NQR but there wasn’t anything to block.

Maybe she was okay the way she was and I shouldn’t have tried to “fix” her; maybe I should have left her barefoot behind; maybe by fixing her I caused something higher up to become pinched or otherwise painful.

I feel damned if I do and damned if I don’t.

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It sounds like she’s got a lot going on already. Rather than looking for more things, I would re-evaluate your approach on the existing things. So maybe some good regular massage work instead of the chiro and back injections. I really hate chiro, full disclosure. And once you start on the back injections route you can’t really go the massage route. Not sure that’s very helpful, just a thought. Maybe dial things back a bit, try to get her body feeling better while her feet get straightened out. Maybe go back to barefoot?

I would be ultrasounding the suspensories. It might not be the (or the only) problem, but it is relatively easy and inexpensive compared to chasing down unknown issues in the back, stifles, poll, etc. Hock blocks and injections can seep into the proximal suspensory so that could explain some improvement from the hock injections.

I’m a little confused about this. Does she currently have NPA or are you saying she tends to NPA but your current farrier is keeping her in better balance? How long has the current farrier been working on her? I would be strongly scrutinizing her feet too. Unfortunately there are a lot of well-credentialed but not-so-great farriers out there, and vets that don’t understand hoof balance well at all. On a PPE I had a top sports medicine vet compliment a pretty crappy shoeing job with obvious and significant NPA. It’s scary.

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Until this is fully resolved, it’s going to take time for everything else to heal

Not all changes are responsible for any discomfort

You first said “She is NPA behind”. What does “keeping the NPA corrected” mean at this very moment? Is the internal structure still NPA, but with wedges, at least the hoof-pastern angle is properly aligned? How long ago did that happen?

@Libby2563. @JB.
Regarding the NPA. This farrier has had her for 2 1/2 years now and we take regular farrier films as well as a 5 week schedule.
What happens is he can get her upon trim to a +3 and by the time 5 weeks is up she’s back to 0. It’s an improvement over where she used to be! We did 4 week cycles for over a year when we started.
I have excellent vets also.
Because she’s an OTTB… and wasn’t well managed physically…. Some of this I could not have known at PPE. I went back thru my pictures and even tho I didn’t take hoof pics then, I could see she was short toed (barefoot brood mare trim) but I don’t see any evidence of NPA. BUT - when I found my pics of what my current farrier had when he started her, OMG. I am horrified.

I am not going to lay all the blame for whatever ails her physically at her feet. Call it a hunch, my gut, whatever but there’s more going on. When a horse who normally wants to be loved on and scritched and hugged around the neck violently objects, something’s wrong. This after the only thing you did was ask her to carry herself straight (weight equally and not kink the neck as a body evasion).
She couldn’t do a carrot stretch between the legs a year ago, now she can. That’s great it’s a huge improvement but with “letting go” is apparently some physical baggage. I’m trying to find it, understand it, and decide the best way to manage it.

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My first thought was cervical arthritis or some other kind of neck issue. Have you had her neck x-rayed?

Yes. All normal.

Wow that is a LOT of changing in 1 cycle. Some more investigative work needs to happen to find out why she’s dropping 3* in just 5 weeks.

Is barefoot with boots and option? I’ve just assumed she’s in shoes. If she’s growing a butt-load of vertical toe and inverting her feet, barefoot, with boots with wedge pads for some period of each day, might be something to look at. Or maybe simply being barefoot (if she is comfortable) and swiping at those toes a couple times a week might be an option

The Equine Documentalist on FaceBook is very good at explaining and showing how to correct/manage NPA. He uses lots of data (xray and equipment that accounts for footfall and swing phase, toe first /heel first, medial/lateral landing). Through the use of the data before and after corrective shoeing he is able to show improvement.

I find regular chiro work is well complemented with massage therapy. It may take a few cycles.

@jawa. Yes I’m familiar with his work and follow it.

@JB. It is a lot, I agree. This last time, we put her in wedge pads, just to see what happens. We’ve avoided using them until now. Her changes are worse on the right than the left.
Farrier has brought up being barefoot behind, I was the one who dismissed it. Maybe I need to revisit the idea? I’d need to find boots tho. What would you suggest?

Are the heels still growing forward, rather than down? What is the angle of the tubules at the heels?

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After looking at some of my pics from when we started, they are finally growing more down than forward.

Hoof growth… just takes so darn long.

It occurs to me, that in changing her posture, THAT is what is allowing her heels to grow down instead of only forward. Hmmm… because when standing camped under, by its very nature puts all the pressure on the heels. Now that she’s standing more correctly, the weight load is distributed more equally around the entire hoof.
Also, she used to have a very prominent ‘croup bone’ (tuber sacreal?) and those are now normal appearing - flat.

I honestly don’t know what brand boot would be best for this, other than potentially one that allows for wedge inserts…

This is crucial. NPA that has caused postural changes and compensations is a back and forth fixing process. Posture will continue to impede better hoof growth while it’s being worked on, but continued incorrect hoof loading will impede better posture, so it’s a constant work in progress to help each of them at the same time

Do you do any in-hand work with her? Any chance you could find a rehab specialist of sorts who will work with you and her on movement patterns, and not just stationary chiro/massage type work?

OH - Surefoot pads! Check into those - those might be exactly what you need right now

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