Sticky stifle and the dressage horse - need advice

[Helicon]

I have a wonderful 5 year old horse who has sticky stifles, particularly the left. I am looking forward to a great career with this talented horse and I would like to manage her stifles in the best possible way. I would love to hear from other rides and trainers on how you have successfully managed this problem.

I am starting with the conservative approach of conditioning. I have read that hills, cavaletti and backing are all good for stifles. I have read that circles, lateral work and cantering are hard on stifles. What is a dressage rider to do?

My vet wants to blister the ligaments. I am hesitant, so we agreed that first I will try a more intensive conditioning program for a month. She has been in regular work already.

I have heard mixed reviews about estrone, especially for mares.

What has worked best for you and how did your horse handle upper level work when the time came?

[Blume_Farm]

My mare injured her stifle on the lunge line which resulted in upward fixation of her patella (which is what you are describing). I did lots of hill work both in trot and canter for 8 weeks. That helped a lot but ultimately I had to have her stifles blistered. She now does super once warmed up. When she first comes out her stifle is a bit “sticky” especially in cold weather. However, once she is warmed up it does not bother her. I do find that half passes are the hardest for her but other lateral work not at all.

[dwblover]

My horse’s stifles used to stick horribly. I finally figured out he goes 200% better barefoot behind. Honestly I can’t remember the last time his stifle got stuck.

[mswillie]

My horse de-conditioned a lot when he was on stall rest. He tends toward loose stifles anyway and he came up pretty sore behind when I started him back into regular work.

I’m now doing a lot of riding on hills and rolling terrain. We started the beginning of April and I have noticed significant improvement. I’m still keeping arena work to a minimum and avoiding small and tight figures.

I also made some nutritional changes which may or may not be indicated for your horse. (Mine is a very easy keeper and in an effort to keep him at a decent weight he didn’t get enough vitamins/minerals etc.)

The vet is on board and for the time being he is recommending sticking to the more conservative approach. We can’t undo a procedure and while it’s my understanding that internal blisters usually don’t cause problems I’m not willing to do it if a more conservative approach is working.

I’m in this for the long haul and I’m in no hurry. One additional benefit I’ve noticed is that my horse is becoming much more forward than he was.

It may well take the rest of the summer to get him fit. Just another part of the journey.

[Countrywood]

http://www.wiwfarm.com/stifle.htm

A good article on subject.

My horse and I are not competition level but I do dressage for its own sake and some trail riding. He has a weak/loose stifle. I have not tried stifle blister but the iodine solution mentioned in article sounds fairly non invasive and I might ask my vet about it.

the long trot set/conditioning really does help as well as riding every day if possible. Interesting that the article mentions inflammation, I find my horse does better with MSM supplement. I find that if I ride with a bit of a more light seat vs a full, heavy “dressage seat”, he does much better , more forward and confident. My horse does better with hind shoes as they provide support and traction.

[Countrywood]

http://www.equinepi.com/pdfs/stiflearticle.pdf

A more in depth article…I am going to study it later.

[Countrywood]

I wonder if low jumps help condition a horse with a weak or loose stifle as well. It seems as if it would as they have to rock back and balance themselves.

I am a chicken and only do cross rails but I have a hunter trainer ride mine over jumps sometimes, (still low ones), and he loves it, and seems more comfortable and balanced at canter for a week or so after jumping.

[emirae1091]

Walking cavaletti or low cross rails is a great exercise for this! I am currently doing it (and hills and trot work) to help my mare build her hind end up.

Start with poles and work your way up. Mine took a while to catch on, because we jump, so she naturally thought she was supposed to trot in front of the fence. Now that she understands what I’m asking (although I still think she doesn’t understand why, because she snorts in protest once she knows what we’re doing!) I can stay in two point and it’s easier for her.

[Gimbalist]

I have one with stiffle issues and gave up on doing any advanced dressage with him. He’d be good for long periods then suddenly can barely move. His is visibly clicky.

My vet mentioned that at a recent conference the stiffle “expert” said lots of reinback and transitions along with cavaletti and hill work.

[Countrywood]

Mine became a “rideable pet” due to his stifle issue.

I bought him as a project for little $ so it didn’t bother me too much but I had hoped at one time to do low level competition. He just gets really cranky with too much dressage work/circles …I have not tried the stifle blistering but I might and perhaps that would be enough to make a difference…no idea why my vet never suggested it.

Perhaps with a younger horse with a good fitness program and the stifle blistering it could go well…it would be interesting to learn if any advanced horses overcame or was able to compete despite the issue.

[Denali]

I co-own a mare who is now an FEI eventer. I have had her since she was a green broke 5 year old. I also was the lameness technician at Texas A&M Large Animal for almost 4 years.

Her stifles were always sticky. Never locked, just caught. I chose to rely on conditioning to help her. She improved a great deal with just fitness work. She went all the way through her first CIC* that way (think WAY more fit than any of my FEI dressage horses) However, when she got down time after after the 1*, she got ‘sticky’ again quickly. There was no way that I could expect her to stay in that level of work all the time. She needed to be able to have 2 weeks off with turnout without getting sticky.

There is an option other than blistering. It is called fenestration. A standing surgery where they insert a blade into the medial patellar ligament along the tendon fiber direction and then twist the blade 90*. This tears/roughens the tendon fibers without severing them. This is done in several locations along the tendon. As the damage heals, the scar tissue tightens the tendon down, eliminating the laxity that causes intermittent catching.

We had this done. I had my reasons for preferring this to blistering… mostly because I felt it was more guaranteed results and did not want to go through multiple procedures. I also have a very close relationship with my vet, so it was easy for us to have a conversation and decide it was best.

I WISH I HAD DONE IT SOONER. There was performance issues in her dressage work that I had never attributed to the stifle stickiness, as it seemed so controlled by the conditioning work. It isnt pain free for them when those stifles catch, and my mare had some anxiety about things that frequently can trigger sticking. As she recovered from the surgery and became more and more confident that the ‘sticking’ was gone, her performance improved dramatically.

Again, I really regret not doing it sooner. She has continued to move up the levels in eventing, without any more trouble.

I personally witnessed the procedure done multiple times on others horses while I worked at TAMU. None of those cases had negative side effects, and neither did my mare.

Just my story! Hope it helps you some.

[CJBean]

[QUOTE=Denali;6996388]

There is an option other than blistering. It is called fenestration. A standing surgery where they insert a blade into the medial patellar ligament along the tendon fiber direction and then twist the blade 90*. This tears/roughens the tendon fibers without severing them. This is done in several locations along the tendon. As the damage heals, the scar tissue tightens the tendon down, eliminating the laxity that causes intermittent catching.

We had this done. I had my reasons for preferring this to blistering… mostly because I felt it was more guaranteed results and did not want to go through multiple procedures. I also have a very close relationship with my vet, so it was easy for us to have a conversation and decide it was best.

I WISH I HAD DONE IT SOONER. There was performance issues in her dressage work that I had never attributed to the stifle stickiness, as it seemed so controlled by the conditioning work. It isnt pain free for them when those stifles catch, and my mare had some anxiety about things that frequently can trigger sticking. As she recovered from the surgery and became more and more confident that the ‘sticking’ was gone, her performance improved dramatically.

Again, I really regret not doing it sooner. She has continued to move up the levels in eventing, without any more trouble.

I personally witnessed the procedure done multiple times on others horses while I worked at TAMU. None of those cases had negative side effects, and neither did my mare.

Just my story! Hope it helps you some.[/QUOTE]

Denali, I am curious what is the recovery time frame for the horse when you have this procedure done? My mare has been having sticky stifles for quite sometime, I almost gave my vet the go ahead to perform this procedure a couple of years ago but then I backed down. I find that my mare’s sticky stifle is holding us back from really advancing through the levels.

Circles are difficult for her and I have found my mare also develops anxiety when we ride where she thinks her stifle is going to catch.

I would appreciate any info on what the recovery time period is like on that procedure.

[Countrywood]

http://www.pfha.org/pdf/articles/StickyStiflesEnglishandSpanish.pdf

Article references the healing time after fenestration, sounds very reasonable. I may look into this or the blistering for my horse, as I do think the stifle slipping makes him anxious and I wish my vet had mentioned these options…

[DownYonder]

We just did a similar procedure to the fenestration Denali mentions, in combination with blistering. Instead of a blade, the vet “split” the ligament fibers in several places with an 18-gauge needle and then injected a counter-irritant. Both techniques result in scar tissue, which tightens the ligament and helps secure the patella in a location where it can track properly without catching the distal end of the femur. This vet says he has done this procedure over 1200 times, with excellent results.

As for rehab - the horse can be fairly stiff and sore afterwards from inflammation, but they want it moving around anyway for several days afterwards. We were advised to keep the horse moving as much as possible for the first 36-48 hours after treatment. We lunged him several times the day of the treatment, and he was also hand walked about 1/2 mile every few hours, and we repeated this program for the next few days, along with walking up hills under saddle. Then he started back to light ring work on a long rein, with more walk/trot sets up hills. So far, so good - it’s been 3 weeks now, and the trainer thinks the horse is already using that leg much better.

[Helicon]

I appreciate all the great input, especially the success stories.

Denali, which vet at A & M? Please feel free to PM if you prefer. I like the idea of it being a standing procedure. How long ago did you have it done? Was it a one time treatment?

I have heard blistering has to be repeated - Blumefarm did you only have to do it the one time?

Downyonder, did you have your procedure done at Atlanta Equine? I read they do something similar. Can you share who was your vet? I asked my vet about this procedure but he was not familiar with it.

My vet did mention tendon splitting but he said in his opinion that blistering was equally effective and easier. I wonder if blistering makes fenestration more difficult to do later…?

Has anyone tried Estrone, especially on a mare?

Anybody out there doing upper level dressage with a horse that has recovered from a sticky patella?

[mishmash]

I have an 8 year old gelding, very straight behind, who has sticky stifles. He short strides behind off and on, but it defintitely is helped by working 6 days a week. We are second level, schooling 3rd. Small canter circles are harder for him, and collection is harder for him. He is good at lateral work, and using it in my warmup seems to help. BUT-the more he does, the better he gets. Now, he only catches maybe once a week. Giving him too much time off, or stalling him, or a long trailer ride will make him catch more. He does occasionally catch during a test-judge usually comments on rhythm not being clear. Only one judge has ever questioned his soundness, and does it every time I show him under her.
I have looked into the surgeries, but they have risks, one of which I believe is increased risk of arthritis.
He has been worked up twice for this, including hock and stifle xrays (they were clean), and all the vets can ever find is the upward fixation. I do have him on Adequan, and SmartFlex III.
I tried the Estrone, but with no success.
So my suggestion is work, work, work. With mine, the more he works, the better he is.

[Countrywood]

I wonder, from the bio mechanics point of view, what is stressed more in upper level work, aka collection and canter pirouettes , the stifle or the hock?

I wonder, if let’s say a horse was of course not ready for collection/canter pirouettes, if one could “test” for this, by conditioning the horse first, and then teaching it piaffe in hand? In other words, if a horse could sit in piaffe and not come up sore and not have the stifles pop out, would that be a future harbinger for being able to hold up in future higher level demands?

The issue it would seem to me though is the circles, and small circles in canter. The circles are where it seems the stress is the most that brings out the stifle sticking, or slipping, as perhaps the more the joint is asked to support horse in a small radius, the more out it is likely to slip.

I doubt we’ll ever reach upper levels but I am encouraged from this thread to talk to my vet about the blistering. My horse has the most trouble holding a circle at canter, and the stifle literally slips out and he feels like he is falling down behind…he never ever fell, is very agile on his feet, but it understandably makes both him and me reluctant to do smaller or even 20 m canter circles and no way to escape that in dressage.

It is not popular in this country to teach advanced moves out of order, but in Spain and Portugal they teach even young horses to piaffe and passage. I wonder if teaching that in hand at least and then perhaps under saddle would strengthen the stifle joint, aka get the horse accustomed to sitting before the stress of asking to sit in collected canter circles?

A bit of a rambling post, but one has to look at how these horses are managed that might be different from others. I totally agree that daily work makes a huge difference and long trot sets and trail work helps…mine is on Adequan and the MSM seems make a difference as well.

[DownYonder]

[QUOTE=Helicon;6996961]
Downyonder, did you have your procedure done at Atlanta Equine? I read they do something similar. Can you share who was your vet? I asked my vet about this procedure but he was not familiar with it.

My vet did mention tendon splitting but he said in his opinion that blistering was equally effective and easier. I wonder if blistering makes fenestration more difficult to do later…?[/QUOTE]

Not done AT Atlanta Equine, but by Dr. Grisel from Atlanta Equine - very knowledgeable and skilled sports medicine vet with a very good eye and much experience working on sport horses up and down the eastern part of the U.S.

It is a standing procedure (horse is heavily sedated), and Dr. Grisel came to our barn to do it. It was a fairly quick procedure, too - sedate the horse, do the punctures, inject the counterirritant - done.

I believe he mentioned that in his experience, the combined splitting with blistering lasts longer than just blistering alone. He also said he prefers the puncture technique using a needle rather than splitting by a blade, because he doesn’t have to cut the skin, so much less chance of infection. I was surprised - and very pleased - by how “uninvasive” it was.

One really interesting thing was how he described the horse’s stifle ligament as feeling “like jello” when he palpated it. He said it should feel “like rebar”, the way the horse’s other stifle felt. We will be doing a reevaluation in another month or so, and it will be interesting to see how the treated ligament palpates at that time.

[mishmash]

Countrywood, I have found that my geldings stifles only seem to slip on a straight line. I have never noticed it circling. I do not know if the difficulty with collection is due to straight hind legs, the upward fixation, or his personality, which tends to be go-go-go. Perhaps a combination of all three? We do do a little baby piaffe, and he does not seem to find it hard. Collecting the trot is pretty easy-canter was difficult. We started just asking for a stride or two. Now he can collect enough for the second level work, and we are asking for a few strides of what my trainer calls “very, very collected”.

[Countrywood]

Thanks for reply, mishmash.

Now that I think more on it, must be something about the canter work itself that makes the stifle vulnerable…re, the weighting of just one hind leg in the push off phase. In trot, even the most collected version such as piaffe/passage, there are a diagonal pair of legs on the ground supporting the weight.

My horse exhibits same issue with stifle slipping at canter on lunge as under saddle. Very consistent how it happens.

Oddly enough, if I canter him on a large circle and set poles out, he canters MUCH better and does not slip at all! I think because that forces him to use himself and really pick up his feet.

Trot pole work and cantering over poles helps too.

I wonder if swimming against a current would help such horses I read in one article it could. We do have a therapeutic swim lane nearby , at a track that is open to outside horses for a fee, but I am too stressed out and tired to trailer my horse there. I suppose for us blistering is an option I want to explore (plus me not being so lazy and setting out the poles and doing more focused work with him)