Upward Fixation of the Patella (mild)

[fermecinqsens]

My mare was recently diagnosed with upward fixation of the patella. I’ve noticed recently that she has a bit of a hitch in the hind end and drags her toe intermittently. Vet came out for a lameness exam and all flexions came back clean (actually after some of the flexions she was even more bouncy than normal!). Lunging on the small circle revealed the toe drag. Vet suggested I try to strengthen the quads before resorting to the stripping surgery given that it’s quite mild (I’ve never heard any clicking or anything like that – just the toe drag and slight hitch).
I didn’t notice this issue this summer/fall (I bought her in late spring) but presumably that is because I was doing some trail riding so she was having to go up/down hills. Also the previous owner was jumping her regularly whereas I primarily do dressage so perhaps the jumping was helping keep the quads strong?
Anyway, I’m stuck in an indoor arena right now and will be for the next couple of months so looking for some quad-strengthening ideas from anyone who has had success with their horse with the same condition. Cavaletti? Jumping? Poles? What actually helps?

Vet says that the condition isn’t painful so I shouldn’t worry about continuing to work her. I’m more concerned about the dressage judges noticing the hitch if I can’t make it go away?..

[fermecinqsens]

Also, is there anything that will be physically more difficult for her due to this condition that I should be aware of? For instance, backing up, collecting, etc?

[JB]

Mild UFP doesn’t warrant the surgery anyway - not sure why the vet even went there as the “last resort”

As little stall time as possible, as much work as possible.

Proper Dressage/dressage work helps, as it asks the horse to sit and push and carry weight and engage the hind end, all of which strengthen all the important parts back there. But yes, incorporating cavaletti work into the regular routine is beneficial regardless of the horse, but particularly so for UFP horses. Walk and trot is all you need.

Rein backs are also very good, just start and build slowly - it’s hard.

Work and work and more work. Make SURE the selenium and vitamin E levels are adequate - blood test is the only way to know for sure, don’t assume they are/aren’t fine based on what you’re feeding.

[Doctracy]

Poles,cavelletti,turn out and hills. I had a horse who was pretty bad as a yearling and two year old. He ended up an APHA Champion,Superior western pleasure/halter and,after I gelded him,as the leading horse in the state at western riding,reining and trail. He did so much better once I got his weight down from halter,made sure his front feet were sound and did a bunch of trail riding on hills. I actually fox hunted him a couple of seasons,along with novice eventing. The more fitness I did,the better he did at everything.
He also had pedal osteitis on his front feet. Make sure your horse’s front feet are sound.
Interestingly,I’ve also had an Akita and a chihuahua with the exact same patella problem. Again,fitness was key. I was number one in the nation for open level obedience with the Akita. The jumping actually helped him with his issue.

[Texarkana]

How old is this horse? Is she still growing? Because I’ve known a lot of youngsters who have incidents of upward fixation of the patella while they are growing, yet “grow out of it” as adults. Just thought I’d throw that ray of hope out there.

[LarkspurCO]

[QUOTE=JB;8468773]
Mild UFP doesn’t warrant the surgery anyway - not sure why the vet even went there as the “last resort”

As little stall time as possible, as much work as possible.

Proper Dressage/dressage work helps, as it asks the horse to sit and push and carry weight and engage the hind end, all of which strengthen all the important parts back there. But yes, incorporating cavaletti work into the regular routine is beneficial regardless of the horse, but particularly so for UFP horses. Walk and trot is all you need.

Rein backs are also very good, just start and build slowly - it’s hard.

Work and work and more work. Make SURE the selenium and vitamin E levels are adequate - blood test is the only way to know for sure, don’t assume they are/aren’t fine based on what you’re feeding.[/QUOTE]

This, and I would like to suggest riding in deep snow if you can.

My young horse is rebuilding strength after a long layup and his stifles were very loose, in terrible shape. One of the vets recommended water treadmill and said this is the best way to build up the hind end. Of course I do not have one of these nearby, but we got a couple of big snows recently so I started walking him through the deeper areas and drifts, a sort of “frozen water treadmill” if you will. It’s a great workout and he improved dramatically in a short time.

[RedRogue]

I’m dealing with this right now with my 5 year old. Gave him some time off after his first couple of shows and low and behold it showed up with the time off. Sounds about exactly the same as your horse. I’ve got my fingers crossed he’s going through a growth spurt which is leaving him with angles that are increasing the issue, but we shall see.

Anyhow, what I’ve been told/read is:
-Avoid circles
-Avoid hard ground
-Avoid time off

• Hill work (especially walk/trot)
• trotting poles
  -make sure your horse is using it’s hind end

We’ve done one treatment of accupuncture and vitamin B12 injections to the joint, which was at the initial diagnosis about a month ago, after I gave him a month off. My horse has an in/out and I get out to work him 5/6 days a week. Because of the madness of Christmas and poor weather, I’ve been able to just get him out enough for basic fitness, and haven’t noticed a tonne of change.

Good luck with your mare!

[fermecinqsens]

My mare is 6 so no more growing.
She has had blood work done for previous hair growth issue (was deficient in cooper and zinc).

Deep snow is a good idea!
I’ve read that more turnout is best. Does it matter if it’s turnout on hills or just any turnout? Unfortunately she’s stuck in a small paddock except for 3 afternoons a week. Will see if BO will give her turnout every day given her issue.

Why avoid circles?

I noticed tonight when I let my sister ride her (don’t usually EVER see anyone else ride her) that after doing cavaletti/poles on a circle a few times each direction she got especially hitchy. Was strange to see since when we did the flexions she was totally sound so why would the harder cavaletti work make the hitch more pronounced?

[Texarkana]

At 6 years of age, there could still be some growth or muscling/hormonal changes contributing. Heck, my own mare went through a huge growth spurt at 7 years! I think with good conditioning and management, there’s still a chance this could just be a temporary “phase.” Stay positive.

[JB]

Circles for any real work should be avoided for all stifle issues, whether that’s UFP or injury or whatever. It’s just a lot of torque on a joint that’s having issues.

As much turnout as possible, even if just a smaller pen. As long as it’s bigger than the stall, it’s better. If you can get her out in a bigger area more than 3 days a week, do it.

[beowulf]

we’ve dealt with (and owned) a few with weak stifles and/or UFP (the two are not synonymous, sorry for my poor wording). the best strategy is all turn out, no stall, as much work as possible, no small circles or repetition of patterns. ligaments tend to do poorly with repetition - so as JB said, avoid lots of small circles as it is a lot of loading stress on a weak limb.

for maintenance, i’ve always liked to see these guys on an sel/E regime, msm, estrone, and shoes behind if they are in a T/O situation where it is feasible.

for work - conditioning rides moving out are best, think brisk march. trail rides as often as possible across all types of terrain - i used to do 2-3 conditioning rides a week and then used to spend 1 or 2 days doing just hills at the walk/trot. you don’t want to mosh in hill work with conditioning or interval training - it should be either or - less stress on the limb, less stress on the horse. the ring was reserved for lessons and i tried my best to keep them out of it. riding in snow is great but remember that snow is very resistant and requires a lot more work than water - it’s best to build up to riding in snow rather than just tackling the trails after a 3 foot snowfall.

[vxf111]

[QUOTE=beowulf;8469524]
we’ve dealt with (and owned) a few with weak stifles and/or UFP (the two are not synonymous, sorry for my poor wording). the best strategy is all turn out, no stall, as much work as possible, no small circles or repetition of patterns. ligaments tend to do poorly with repetition - so as JB said, avoid lots of small circles as it is a lot of loading stress on a weak limb.

for maintenance, i’ve always liked to see these guys on an sel/E regime, msm, estrone, and shoes behind if they are in a T/O situation where it is feasible.

for work - conditioning rides moving out are best, think brisk march. trail rides as often as possible across all types of terrain - i used to do 2-3 conditioning rides a week and then used to spend 1 or 2 days doing just hills at the walk/trot. you don’t want to mosh in hill work with conditioning or interval training - it should be either or - less stress on the limb, less stress on the horse. the ring was reserved for lessons and i tried my best to keep them out of it. riding in snow is great but remember that snow is very resistant and requires a lot more work than water - it’s best to build up to riding in snow rather than just tackling the trails after a 3 foot snowfall.[/QUOTE]

100% agree with all of this. Even a brisk walk up a gentle sloping hill is better than a w/t/c ride in circles in the indoor. Keep them moving and out of the stall as much as possible and terrain, terrain, terrain (within reason).

[fermecinqsens]

[QUOTE=vxf111;8469927]
100% agree with all of this. Even a brisk walk up a gentle sloping hill is better than a w/t/c ride in circles in the indoor. Keep them moving and out of the stall as much as possible and terrain, terrain, terrain (within reason).[/QUOTE]

Ok cool - yeah I wasn’t sure how much going up hills we would need to do to help this. So if I can even just get in a quick hand walk up a hill a couple times a week sounds like that will be useful?
Any specific exercises in the arena? During the week I don’t get to go to the barn during daylight hours so we will be stuck in the arena 5 days a week even if on weekends I can get her out.

[LarkspurCO]

[QUOTE=zorse;8470279]
So if I can even just get in a quick hand walk up a hill a couple times a week sounds like that will be useful?[/QUOTE]

Yes but riding up the hill would be better. If you’re hand walking try backing her up the hill. Start small and build from there because it’s hard work.

[TWH_Girl]

Have been dealing with a bum left stifle on my 5 yr old for 5 months now. He will be getting stifle blistering on 1/22/15. I have learned more than I want to know, and this is not always a straight forward, clear cut condition, that strengthening alone can solve. Toe dragging and a hitch is indicative of a lot more than UPF, including stifle or hock joint issues.

How did your vet determine UPF? Have you done any blocking to the stifle joint? If the horse does not have classic UPF symptoms, sometimes, it is a two-fold issue and other things need to be ruled in/out before you can address the entire problem.

This is what I learned from my vet (his words, not mine):

• stifle synovitis (joint inflammation) often occurs secondary to UPF, especially if disengagement (release) of the patella from the medial femoral trochlear ridge is frequent and somewhat violent.
• these horses will therefore exhibit symptoms consistent with synovitis (such as joint effusion, response to intraarticular anesthesia, improvement pursuant to injection, etc.) even though it is secondary to a non-painful (biomechanical) issue
• synovitis is observed in just over half of the horses evaluated with UPF
• visible hesitation in the pelvic limb as it initiates the cranial (forward) phase of the stride (i.e. flexion) from the extended position is evident upon close inspection in horses with UPF. This is generally not apparent in horses with primary joint disease.
  -UPF frequently manifests in horses with long-term neurologic disease (EPM, etc.)
  -try the bute test- give 2 gm bute for 3 days straight, ride your horse, and determine if horse responds or not. This should differentiate between inflammatory-mediated (i.e painful) and non-inflammatory mediated (i.e. non-painful problems). The absence of a strong positive response to this test would effectively rule-out primary joint disease (arthritis).

Riding in deep snow can have it’s own issues with tendon/ligament tears or pulls. I wouldn’t want to trade one problem for another.

[StormyDay]

When my pony was still growing, he locked his stifle after he locked himself in a stall (don’t ask ). The vet injected a muscle relaxant+estrogen mix into the area and within an hour he was fine again, and he has never had a problem since. Maybe you could look into trying this? It certainly wouldn’t hurt, and it was cheap (I think I paid 40$ for the shot).

[JB]

@zorse;8470279

Ok cool - yeah I wasn’t sure how much going up hills we would need to do to help this. So if I can even just get in a quick hand walk up a hill a couple times a week sounds like that will be useful?

To start, yes, that would even be the preferred thing to do, hand walk. Hills are hard, so starting in with unweighted work is the better deal, especially (assuming) she’s not turned out at all on those hills. 2-3 times a week, 5-10 minutes hand walking to start, walk straight up if they aren’t too steep, zig-zag down the first several days regardless, progressing to walking straight down. Make her march right on up, and don’t let her just “fall” down it

Any specific exercises in the arena? During the week I don’t get to go to the barn during daylight hours so we will be stuck in the arena 5 days a week even if on weekends I can get her out.

Transitions. Walk the corners for now, trot any straight sides and the diagonals. No canter work for at least several weeks to maybe 2 months while you’re working on the other stuff. Ok, you could kick in some canter transitions coming out of the corners, but keep it to transitions, and the straightaways for now, and just a bit.

[LarkspurCO]

[QUOTE=TWH Girl;8470449]

Riding in deep snow can have it’s own issues with tendon/ligament tears or pulls. I wouldn’t want to trade one problem for another.[/QUOTE]

As long as you are sensible about it (stick to areas with familiar footing and avoid hard crusty snow) there is nothing wrong with walking in deep snow. I am talking 12 inches up to 18 inches deep. Horse must pick up his feet. Like any exercise you adapt it to your horse’s level of fitness and don’t overdo it.

My horse is rehabbing from a suspensory tear and this has been a good, safe workout for him.

[beau159]

My horse Red also has a mild stifle issue on the right side. He developed it at about age 7, despite already being in regular work. It showed up in our barrel racing turns. Fortunately, he has never locked up but he will crossfire. If you have a helper walk him and place your hand on the stifle, you can actually feel it “catching” every so often. No popping sound. If I let him get strung out at the trot, he get that feeling like he stepped in a hole in back.

In mild cases, it’s pretty rare to go the surgery route.

As most everyone has said, it is important to keep riding the horse on a regular basis. Keeping them in shape keeps those ligaments more tight.

Hillwork is good (backing up a hill is REALLY good, although hard!) I have been told that walking or loping up the hill is more desirable than trotting.
Caveletti are good.
Making sure the horse travels collected is good.
Pasture turnout with hills would be most ideal.

[cnm161]

My pony had a similar issue when she was younger (3-4 yo). I made it a habit to ask her to back up several times while walking to/from turnout as a mild form of exercise that really strengthens the hind end. I’m not talking about a backwards scramble-- just walk 20’, back up 5’, continue on. Rinse, repeat.

I’d start there before going to the heavy hitters. Kiwi’s slipping stifles resolved fairly easily and we haven’t had an issue since. She’s now 8 and schooling 3rd level dressage.