Viable long term alternatives to joint injections

[halt]

@Obsidian Fire

@luvmyhackney No, she is not shod behind. There hasn’t been a compelling reason to do it yet, and not knowing for sure, I didn’t want to take the chance of added stress.

I would take her most recent rads as compelling reason, if you’re saying your horse’s hocks have changes.

I hate hind shoes on most horses, but I’ve found it can really make a difference in horses that seem to have some very minor issues. I was surprised a few years ago in the major difference in one of my TBs’ ways of going. I had only put hind shoes on him because we went through a horrible dry spell and the ground was so hard that his hinds were chipping… turns out he must have been underperforming for years because he moved completely different with hind shoes on.

That really changed the way I started looking at horses and their hind feet. I think a lot of them are just fine barefoot but if in work, could really use the extra protection. A lot of them won’t give 110% behind because their soles or walls are sore, it can become more obvious in collection work but in a horse that is just putzing around or in light work I can see how it can be overlooked.

I would think a horse that has some issues behind would benefit, in general, from hind shoes - partially because I’ve met many horses who are barefoot behind and their tenderness behind is never as obvious as tenderness up front is, so a lot of them have chronically sore hind feet, underperform in subtle ways, and protect themselves in such a way that it compounds their issues behind.

[Obsidian_Fire]

@halt, that is an interesting POV and it does make sense. I will discuss options with my farrier. OTOH, we don’t know at this point if the toe dragging is hock related OR higher up in her hips (ie, one hip higher than the other).

On an aside, doing some googling… Reading thru Dr. Ramey’s stuff. If he’s “right” about it all (various joint therapies)… well it just leaves me scratching my head wondering why I bother at all.

[luvmyhackney]

@Obsidian Fire

@luvmyhackney No, she is not shod behind. There hasn’t been a compelling reason to do it yet, and not knowing for sure, I didn’t want to take the chance of added stress.

Put some shoes on behind before you inject and see what you get. They make a huge difference with horses with hock issues.

[quietann]

I agree with trying shoes, as an alternative to getting the vet in, doing injections etc. especially if you know the hind end isn’t quite what it should be.

Hind shoes made all the difference when my mare’s rehab from suspensory surgery stalled out.

[mvp]

@equiniphile

My vets are very skeptical of the oral HA. The absorption of HA when taken orally is way too low to be effective.

The intra-articular injection “cocktail” is crucial in ensuring that the healthy cartilage is not destroyed. Correct me if I’m wrong, but I believe for younger horses, triamcinolone and hyaluronic acid are most effective at promoting healthy cartilage, while vets often use a high ratio of Depo to triamcinolone or HA to speed up joint fusion in older horses with evidence of existing effusion.

That matches what my vets have told me. HA doesn’t have the tissue-thinning effects of steroids. And Depomedrol isn’t the only steroid out there. Others have differing strengths and half-lives.

For low-motion joints like the lower joints of the hock, I wouldn’t care about destroying cartilage and speeding up the fusion process. For high-motion joints, I’d ask my vet if he/she thought we could just do HA and that prophylactic antibiotic and get good results. My information might be out-of-date, but I have been taught to be conservative about putting “steroids” (in general) into high-motion joints.

And, of course, you need to keep the horse moving (and well-balanced in his feet) afterwards if you want to get the most bang for your buck out of joint injections.

[WildandWickedWarmblo]

My horses went through Legend injections before adequan and after hock injections when they were young. I did not see a difference in their health. I do see results from Cosequin and chia seeds which they have been on for years now. So I’m skeptical when their vet chiropractor says to use Adequan in their old age. (Horses have vet specialists for everything now, including a chiropractor vet specialist in addition to their other vets.)

[Simkie]

@Obsidian Fire

On an aside, doing some googling… Reading thru Dr. Ramey’s stuff. If he’s “right” about it all (various joint therapies)… well it just leaves me scratching my head wondering why I bother at all.

Good lord, Ramey is usually wrong. Flat out WRONG. At least about parts of what he’s saying. Back away from Ramey, and go read the actual research papers. Why on earth would you pick HIM as a source?

[Obsidian_Fire]

@Simkie

Good lord, Ramey is usually wrong. Flat out WRONG. At least about parts of what he’s saying. Back away from Ramey, and go read the actual research papers. Why on earth would you pick HIM as a source?

I didn’t. I was just doing a general google search about long term steroid injections and am reading whatever pops up. Doesn’t mean I take it to heart. :rolleyes::no:

And, I am reading research material - mostly human since it’s the easiest to find, but still. Better than nothing.

As for hind shoes before injections, I don’t know. It certainly made no difference in my past experiences, and my horses were shod by good farriers. Doesn’t mean it wouldn’t work this time, just hard to know where to spend the money first. I compare it to my own knees; I have OA, putting rx orthotics in my shoes to ‘balance’ me did not do a damn thing for my knee pain. Other (non pharmaceutical) things have helped, but not that.

[luvmyhackney]

Depends on what is causing the issue. Shoes behind are cheap compared to joint injections. If horse was mine I would shoe and start of Adequan or Pentosan. I’m not big on injecting joints straight out of the gate without trying less invasive treatment first.

[Guilherme]

Adequan is a very effective medication when used IAW label directions. We’ve done with with multiple horses over the years and have been very satisfied with the results. It is not cheap but it has genuine clinical science behind it (not just reams of testimonials).

Cosequin also has also been proven effective in clinical trials at Auburn at a minimum. One of the vets we’ve worked with over the years was a student there when the testing was done. He said the protocols were followed and he trusts the results.

Once you get away from those two items I’m not sure how much real science there is behind the meds. We’ve tried Pentosan with marginal results and Previcoxx with no discernible changes at all. But as not every horse will respond positively to Adequan or Cosequin not every one might respond to Pentosan or Previcoxx.

I would not waste my money on anything sold over the counter unless they’ve got a double blind, clinical study behind them. I don’t know of any that do.

G.

P.S. We’ve done joint injections, too, with great success. I prefer something less intrusive but they do work.

[digihorse]

I would first address the hips. When those are even, and allow the horse to flex the joints below equally, as well as extend the joints below equally, then you will have a better base to judge other treatments. I have seen again and again where the lower legs are addressed and treated with no results and when you look at the hips and the back you can see why. I would also add that, you can have a good farrier do bad things to the hind feet, which will make the horse sore above. Some, I own one, you must trim to the leg and ignore the foot, or you make the stifles sore. The key is how does the horse need the feet done to compliment his structure and biomechanics. Not all farriers will actually look at this relationship.

[Obsidian_Fire]

@digihorse

I would first address the hips. When those are even, and allow the horse to flex the joints below equally, as well as extend the joints below equally, then you will have a better base to judge other treatments. I have seen again and again where the lower legs are addressed and treated with no results and when you look at the hips and the back you can see why. I would also add that, you can have a good farrier do bad things to the hind feet, which will make the horse sore above. Some, I own one, you must trim to the leg and ignore the foot, or you make the stifles sore. The key is how does the horse need the feet done to compliment his structure and biomechanics. Not all farriers will actually look at this relationship.

Well I agree with you in that we need to figure out how to get the hips to STAY level. Chiro can put them “back” all she wants, but unless they stay… and I haven’t figured out what’s causing them to be uneven in the first place. I almost think a shoe on one foot but not the other - force that dragging hind to stay “up”. For lack of a better explanation. Until it muscles up enough to stay there. Or it may never. I don’t know.

Farrier said, quote: “she’ll still drag it with shoes on.” end quote. Me (smacks head against wall) (thinks to self) Yes, I know Einstein. Can’t you come up with a better answer than that?

I will make a vet appt. Dr Revenaugh is pretty good at discerning things higher up, not just below.

@Guilherme , Adequan works out to about $50/month, no, not cheap, but not out of the realm of affordability either. The irritating thing is that I must get a vet Rx to order it. Otherwise I’d already be doing it.
I am glad to hear it worked for you. I am considering Cosequin ASU. Maybe. I already double dose liquid HA and I think the stuff does work.
In spite of good ol’ Doc Ramey’s opinion…:lol::lol::lol:

[Montanas_Girl]

@Obsidian Fire

Well I agree with you in that we need to figure out how to get the hips to STAY level. Chiro can put them “back” all she wants, but unless they stay… and I haven’t figured out what’s causing them to be uneven in the first place.

This horse is off the track, right? Pelvic fractures are surprisingly common in racehorses, we are now learning. Do you have x-rays of the horse’s pelvis/hips (will probably need to haul to a vet school or large clinic to have them done)? All the chiropractic treatment in the world won’t magically remove an old fracture, if that’s what you’re dealing with. Just a thought!

[Spotless]

**My experience may be different because we are “treating” navicular, but I assume it would be very similar for hocks.

My gelding (9 this year) was diagnosed with navicular last summer. We’ve had great luck with your normal steroid injections into the coffin joint. Only lasts 2.5 months, which I’ve heard/read is average for that location. Tomorrow we are trying out the IRAP injections which I have heard great things about. My vet said that you can get a year out of the IRAP treatment, and one horse he injected even went to 14 months. In my area, it’s only about $100 more.

[Simkie]

I don’t recall if surpass has been mentioned, but that can also be a useful modality to manage joint issues. Best to apply twice a day. The Frisbie Surpass study showed improvements in pain scores and well as within the joint itself.

Helpful when one or two places are problematic, less helpful when the problem is widespread or difficult to pin down.

[Obsidian_Fire]

@Montanas_Girl

This horse is off the track, right? Pelvic fractures are surprisingly common in racehorses, we are now learning. Do you have x-rays of the horse’s pelvis/hips (will probably need to haul to a vet school or large clinic to have them done)? All the chiropractic treatment in the world won’t magically remove an old fracture, if that’s what you’re dealing with. Just a thought!

:no::sigh: Please don’t say things like that!! OY!

I made a vet appt. It’s not til the 19th. Cross your fingers.

[findeight]

Yeah but, if you got unevenness in the hips, you have to consider it. That tight, metal starting gate is pretty unforgiving of silly, excited colts and there’s many other ways even non racers can suffer fractures and dislocations that never show as acute lameness or injury but will haunt and create numerous mild NQR symptoms for years if not life. Shows up much more these days with our better diagnostics.

[Montanas_Girl]

@Obsidian Fire

:no::sigh: Please don’t say things like that!! OY!

I made a vet appt. It’s not til the 19th. Cross your fingers.

Don’t panic! It’s a good thing to rule out. My understanding is that a lot of these horses cope surprisingly well; you just may not ever get completely even hips/movement, if that is the problem.

[beau159]

@Obsidian Fire

Okay so I need to clarify my questions a bit. Horse in question is an OTTB, age 7. Been off the track 2 years. Ran on county fair tracks, so not great.
PPE’d fairly clean - no chips anywhere - but xrays show mild/moderate changes in the hocks. Also has a fused lower lumbar spine (a bit of roached back) but no KS.

WHERE are the changes in her hocks? Are they in the upper “mobile” joint or the lower “non-motion” joint?

WHAT kind of changes? Fusion? Decreasing joint space?

On both hocks, left and right?

@Obsidian Fire

She drags her left hind. Now, chiro had an interesting point in that her hips were uneven, so is the toe dragging higher up, or lower? She seems to bend each hock equally, but I’m not a vet.

I agree with the others that I would investigate further on WHY her hips are uneven.

I think you need to know more about your horse, before deciding what treatment/management course is going to be the best for her longevity.

@Obsidian Fire

As I condition this mare, I note certain oddities here n there, such as the toe dragging, and she can get really tired (and thus crabby) really fast when working on 20m circles for any length of time. I spend as much time doing straight lines as I do circles and I also work over poles frequently, and we do a lot of work at the walk. We are not cantering yet. She also occasionally seems to “trip” over herself behind, like she isn’t able to get one hind out of the way of the other quickly enough. She is not neurologic.

“Tripping” usually means a stifle problem… but in your case where you know she drags a toe and has uneven hips, the dragging toes will make them more prone to tripping too.

Of course, she could be sore in the stifle too, if she’s compensating and walking funny because of her crooked hips.

[Obsidian_Fire]

@beau159, it is the lower hocks, not upper. I never ever ever would’ve bought a horse with changes in the upper hocks.

Truthfully, I think stifle and/or higher up.

And yes, compensatory issues…oh boy…that’s a whole other can of worms. Anything I can catch now, will only help.

I have a very good lameness vet, so I will have some sort of feedback soon.