Stifles

[B-burg_Dressage]

I’ve got an 11 year old OTTB. He raced until he was 5. Retired due to bilateral medial sesamoid fractures. (Just fun fact, not necessarily relevant to today’s topic other than that he’s got some mileage.)

Last summer he presented with an ever so slight unsoundness. Most noticeable tracking left at the trot. Had the vet out and she did a lameness exam. He flexed positive in his front fetlocks, hocks, and stifles. She felt with how he was moving that it was his right stifle causing most of our problems. She blocked it and he went out completely sound. So we injected. Happy days and everything was great.

Recently he presented the same way as last summer (just under a year and a half from our last injection). Had the vet out again and did both stifles this time (based on how he was presenting to her). It’s only been a few days so I don’t know yet if they worked.

But, does anyone have any ideas or experience with stifle issues? Are there any exercises or changes in management or training that have helped?

I grew up where joint injection was not a common occurrence. I’m happy to do it if that’s what keeps him comfortable, but I also like the idea of managing it in other ways to prolong his career. I did start him on equithrive joint supplement last year after the first injection.

We’re schooling second level dressage. He gets about two days of more focused schooling rides. Two days of easier, basics-focused rides. One day of “on the buckle” ride that’s usually walk only. We do regularly ride out of the arena and ride on hills when the ground isn’t wet. He gets turned out on rolling acreage during the day and in a 1/3 acre lot at night. Very rarely stalled.

Any ideas?

[JB]

What exactly was the diagnosis of the stifle(s)?

[B-burg_Dressage]

Well, she didn’t mention any sort of specific diagnosis honestly. Which in my head just means general arthritis/degenerative joint issues. Which I know doesn’t get better.

But I also know for my human joint issues, strengthening certain muscles and physical therapy help me manage pain. So I guess I didn’t know if there was something like that?

[JB]

Bummer. I just figured things would be different if it was just some general effusion, or arthritic changes. I would expect maybe lighter work for the effusion to see if it would resolve.

But, not knowing his current fitness level, I would say that a conservative approach would be a lot of LSD work this Winter, incorporating pole work, and very careful hill work, to strengthen the quadriceps muscling to support the stifle. Core work, flexibility work, all help keep any one part from doing work it’s not equipped to do (well)

Without more info, I wouldn’t do any circle work for a while, and would probably do minimal canter work, just using transitions into and out of the canter as more means of strengthening the muscles.

[Marla_100]

The 3 exercises for stifle strengthening:

Hill work
Cavalettis
Backing Up

I’ve seen the hill work do more than the other 2.

[No1]

All of those ideas are great.

You could also do a round of Adequan to see if that prolongs the time between injections. A year and a half is pretty good though. The horse is young, but has had a lot of miles.

[B-burg_Dressage]

Ok, upon further conversation.

She was treating mild effusion/swelling in the joint. Her diagnosis was overall positive. She said to give him a week off then start back slowly with a lot of walk and not many circles. But by a few weeks we should theoretically be back to what we were doing before.

But it sounds like generally hill and pole work are in our winter plans. I very rarely do pole work, so that will be good for us either way and introduces a new way to build his stifle support.

[B-burg_Dressage]

I can definitely bring Adequan up to my vet.

Yes, I do feel 11 is fairly young? But as you said, he’s had a lot of miles. And I know joint injections are pretty common for sport horses, but I wasn’t sure if we were just at that point to keeping him comfortable or if there was more I could do. Not quite ready to retire him yet.

[JB]

ok, so this is good! I do think a Winter of going back to some basics, meaning, maybe a few weeks of purposeful walking, really marching along, and then bringing trotting, poles, and hills into the mix is a great idea.

If you don’t have the Klimke book on Cavaletti, I highly recommend it. You can spend all Winter slowly working up through the exercises

[B-burg_Dressage]

I’ll add it to my Christmas list!

[eponacelt]

Hill work and cavaletti are good for stifles as was already mentioned.

BUT - Getting regular injections every 6-12 months for a horse of that age doing 2nd level+ isn’t ridiculous. It will make him happier in al the work, and potentially stave off other issues where he tries to compensate for painful stifles and misuses some other part of his body. You would be hard pressed to find any horses competing at the higher levels that don’t have some level of maintenance to keep them performing at their best.

[skipollo]

Plenty of hills. It doesn’t have to be a hard work either–honestly going for a nice loose relaxing walk over hilly terrain does a TON for their stifles (and their fitness) without adding a lot of wear and tear on them. My very stifle-y horse does so much better when I’m able to get him out doing low impact hill work regularly. Tons of turnout also helps, the more the better.

He also gets them injected 1x/year. Joint injections really aren’t that big of a deal, very normal especially for horses in mid/higher level work. My horse gets bilateral stifle and hocks done and it makes a world of difference for him.

He’s also on a liquid HA joint supplement. It seems to help extend the “life” of the injections. I use Hyaluronex. I’ve also used HylaLube with really good results.

I also really keep on top of his feet/angles. Poor angles/NPA can make their entire hind end sore. Just another thing to think about.

[B-burg_Dressage]

Thanks guys! I know a ton of horses get injected but it’s not something I’ve had to deal with before so it feels better hearing that it’s probably normal for his age and level of work.

I guess I’ve ridden higher level horses that weren’t mine and I wasn’t in charge of their medical needs. And I’ve owned horses that were only really training/first level and didn’t require a whole lot. It’s also entirely possible that since I was a kid back then I wouldn’t have even noticed a slight change in stride like I do now.

But we’ll go forward with a focus on stifle fitness and I’ll budget in injections in our future.

Good news, we did a tiny bit of trot yesterday and he felt AMAZING. So they seem to have done the trick again this year.

[Limerick2017]

Has anyone tried Pro Stride for stifles? Or for anything actually. It sounds like a very positive addition to sport horse medicine.

[Roni4444]

I’ve done PRP November 2019 and it helped tremendously. Planning on another one 12-28- 14 months of smoother gaits

[Limerick2017]

That is really good to hear. I know stifles can be hard to treat.

[syreino]

I did ProStride for my mare’s stifle this summer. She had a catastrophic injury 8 years prior and wasn’t expected to come sound. She did come sound and she did great, even starting her distance career last year, until she came up lame in May. ProStride was in early June, but it still took several weeks after the initial two weeks rest period before she was sound. We spent a lot of the summer just walking hills, but she’s now back in full work (reduced due to winter now though) and has been fine. Her injury was to the medial collateral ligament (shredded, it’s muscles holding her stifle together) and I work really hard to keep her sound. I don’t yet know when or if she will need another injection, but I won’t hesitate if she does.

[SonnysMom]

I have had a lot of luck with weekly IM injections of estrone for stifle issues. Relatively inexpensive.

[Jersey_Fresh]

Have you taken radiographs of the joint? If the joint is clean, have you tried blistering/estrone?

I’ve got a coming 6 yr old OTTB who is big and lanky and we have struggled with stifles this year. He has been slipping for a few months and then came up lame, flexed positive, so we injected the RH stifle and it helped. But he still slipped so I had a second opinion from a sports med specialist vet, and she watched me ride and said had a low grade (1.5/5) lameness kind of overall but flexed fine all over. Rads for his stifle and hocks were perfect and his suspensory blocked without issue (this horse cannot be blocked in the stifle or hock safely).

Anyway, it’s so frustrating and I can commiserate with you. Anyway, she suggested overall hind end weakness was attributing to his issues. So we blistered the stifle and enter gluteal area, and he got put in major booty boot camp. He gets estrone every other week, he’s out side almost 24/7, and his week consists of 2 days of hills (we don’t have big hills so she suggested weights or bell boots behind as well), 2 days of raised cavaletti during our dressage week, 1 day lunging in a Pessoa and 1 day either a lesson or light walk hill hack. He’s not jumping much right now because it’s the off season but come spring I’ll work that in.

We also flipped his back shoes but that was an old school thing for the slipping. She also suggested using an equiband for his flat work since he’s not particularly motivated to push from behind (and I have some physical things going on right now making me somewhat weak in the saddle).

It has made a HUGE difference in just a few months. He went from not engaging that RH as as result being extremely fussy in the bridle and tripping 10+ times a ride to being much more even both directions, going round and slipping maybe 1 or 2 times. I do think this is something I am going to have to stay on top of always and we may have to inject his stifle and/or blister again in the future. I hope some of this helps you.