Stifle Injury - Rest/Rehab, Injections and Eventual Return to Work?

My Rocky (see my profile photo!) slipped on April 23rd while pacing very nervously in a bad storm and injured the stifle in his left hind. He was on total stall rest at my instructor’s (I do not have a barn) for 3+ weeks and then came home and stayed in two small outdoor pens (one under trees for shade) for another few weeks. We had a run of horrible torrential rains and violent storms and I finally had to move him to his normal paddock (about 1/8 acre) because I could not keep ahead of the flooding in the pens.

Going back to my instructor’s barn was not an option due to his mental state of “I am DONE” with staying in a stall. He is generally a very quiet, laid-back horse but being stuck in a stall was really wearing on him. He did not get excited – he got very, very blah and dull and began to go off of his feed (I posted earlier when I brought him home when I was worried about too much alfalfa hay in his pen).

Our veterinarian came out to see him on June 1st and was not thrilled that Rocky was in the paddock vs. the pens, but did say he was about 95% back to normal and that he should continue to rest and he would check again in another month. I have kept him in his paddock and have also let him out to walk quietly to his favorite place in a grove of trees. His mental state is now completely back to normal – bright eyes, perky ears.

One thing the veterinarian says we will probably do once we think Rocky is recovered enough is to inject his stifle. I don’t know if he means to inject both or just the one with the injury. What does everyone think about stifle injections? I have never had a horse that had injections before.

Rocky is 25 years old and he and I trail ride about once or twice a week - but not if it is too hot, too cold, rainy or windy – or if we have had recent rains which make the trails slippery. Basically we are easy going trail riding buddies and he is exercised regularly in the fall, some of the winter and some of the spring and he gets summers off because it is easily 95 degrees with 100% humidity by 9 AM in the summer. We start up with lessons again in late August when my son is back in school with an eye toward lessons and trail riding x2 each week by October.

I am wondering what I might plan to do with Rocky to help him strengthen himself and become fit again after all this time off. Are there walking or walk-riding routines I can do to help him strengthen his stifles? Our trail rides do have downhills and uphills, although “by agreement”, we don’t do super steep uphill or downhill.

The good thing is it is almost as if he knows our veterinarian wants him to limit his movement because what he does is walk toward this grove of trees and there he stands, eating a little and snoozing in the shade, pretty much all day, and then he walks back to be near his feed dish promptly at 7 PM, “where’s my supper?” So he has not become fat, he is just not super fit. He is a TWH whose natural body shape is fairly lean. Our farrier has left off his back shoes for the last two shoeings since I am not riding him obviously, and because pounding on his left rear foot is uncomfortable as the injury heals. The farrier noted on Saturday that Rocky looks really good and that he seemed much more comfortable having his feet done this time. The last time the farrier came was 4 weeks post-injury and now it has been 9 weeks.

Thanks for any insight anyone can give me. I am nervous about injections – my farrier says they are very safe and I do trust my veterinarian, but I am a worrywart. I want Rocky to recover fully so we can keep enjoying our nice trail rides and lessons. I just wonder – is there any other thing we can do that is non-invasive? Or am I worrying needlessly?

SCM1959

Sorry you are going through this with your older guy! I am well versed in stifle issues with the TWH. Although it’s not entirely clear what the nature of your horse’s injury is, I would do the following as part of the treatment/rehab:

  • Injections per your vet
  • Pentosan or Adequan for regular/ongoing use
  • Possibly a joint supplement if you want to try that
  • Consider Equioxx if needed long term

For riding, start building strength again with lots of walking- do that for a week or two before any gaiting. Then short sets of about 5 minutes on straight stretches or up slight hills. I wouldn’t overdo the hills just yet as you don’t want to stress the stifle too much, but some incline is good. I would avoid arena work, circles and lunging at this time.

What did he injure specifically?

Been there, done that. What we did was long (well, built up to long) hand walks including hills (started with little ones, worked up to bigger ones. Walked over everything he could step over–first poles, then small jumps and logs, then bigger things. If he could step over it without jumping, we walked over it. I was lucky in that I was at an eventing barn and we had a small cross-country schooling course that we could walk on to rehab! IIRC, we walked in hand for 6 weeks or so, then under saddle, just walking, for another month before building in trot and then canter. He was sensible enough in turnout and his pasture was on a gentle slope, so our vet felt regular turnout did more good than harm. It was a long process, but he healed completely and has had no need for any injections. He is on a joint supplement now for overall maintenance, but (knock on wood) has never had problems with his title since. He has jumped (small stuff, up to 2’6") and trail ridden extensively, among other things with no issues. He’s 23 but thinks he’s five…

He injured his stifle in his left hind. He stood holding his foot off the ground and put it down very gingerly and then snatched it right back up. One night in a stall at my instructor’s barn allowed him to walk on that foot very carefully. We are now 10 weeks out and veterinarian will come for another check at the end of next week.

SCM1959

What part of the stifle specifically? Did he injure his patella, menisci or cruciate ligament etc?

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Yes, it’s important to distinguish a joint injury from a soft tissue one. X-rays and a ultraound can tell you a lot. At 25 he is likely to have some arthritis though so bear that in mind. Also forgot yes, walking over poles is very good for building strength in the stifle too. I’ve found stifles are tough to manage and you often have to do several treatment modes (especially on an older horse) for treatment to be effective.