Hi everyone, Whinny here! In the previous installment of my Lameness Series, we talked about what you might notice if your horse is lame and needs a visit with one of my Springhill vets. This week, we’re going to talk about what happens once you make that appointment! There are several parts to a lameness exam that help my vet figure out the problem, and you might see her doing some or all of these things to check out your horse. Some types of lameness are more obvious and won’t require all the steps, but for a more subtle lameness, each of them can be a piece in the puzzle to find the source of the problem.

Physical Exam

My vet will do an exam to look and feel for abnormalities in the horse’s body. She will look at his conformation and muscle symmetry. She will check out his posture to see if he stands squarely, since abnormal stance can give clues to the areas of discomfort. His hooves and shoes will also be evaluated carefully – I’m sure you have heard the saying “No hoof, no horse” – the angles and health of the hooves are critically important to soundness. My vet will feel your horse’s limbs for heat or swelling and evaluate his tendons for thickening or pain. She’ll feel the limb pulses to look for areas of inflammation. The joints will be palpated for swelling and taken through their range of motion. The exam will often include an evaluation of the back muscles for tension or sensitivity, especially with a hind end lameness.

 Hoof Testers

You may see my vets use a big metal instrument to squeeze your horse’s hoof. That instrument is called a hoof tester and it checks for sensitivity when pressure is applied to certain areas of the hoof. My vet’s knowledge of the anatomy inside the hoof helps her to determine what pain in a certain spot means. Sensitivity in one area may indicate laminitis, whereas another spot may signify a problem with the navicular bone. Hooftesters can also be used to locate the position of a hoof abscess so my vet can open it up to drain.

Flexion Tests

You may see my vet holding up your horse’s leg for 30 or 45 seconds and then asking him to immediately trot off – that’s a flexion test. The purpose of a flexion test is to accentuate pain that may be coming from a joint, in order to localize the part of the leg that is bothering your horse or to look for a subtle problem that isn’t immediately apparent. Specific joints are flexed in turn to check the response to that area. If your horse has an arthritic hock, for example, flexing the hock may make him trot off more lame than he was without the flexion. That can help my vet determine the part of the leg that needs treatment. Flexion tests aren’t always a black or white answer, but they can be a useful puzzle piece in some cases. My vet uses her experience to know the appropriate position, time, and pressure for a flexion test, since it’s possible to get an inaccurate assessment if you flex the joint too hard or for too long. It’s also useful for her to flex the same joint on both the left and right sides to compare how the horse responds.

Nerve or Joint Blocks

Have you ever gone to the dentist and had a shot to make your tooth numb for a filling? That’s basically the same thing as a nerve block my vet may use during a lameness exam. When my vet “blocks out” an area on your horse’s leg, she is temporarily numbing it to see if that region is the source of the pain. If the correct spot is numbed, your horse won’t look lame anymore since he won’t feel the pain. Unless there is an obvious abnormal finding on her physical exam, my vet will inject a numbing agent into specific anatomical areas until she finds the one that takes away the lameness. Nerve blocks are an injection to directly numb a nerve and the area it supplies feeling to, while joint blocks will inject the numbing agent right into a joint, which is a sterile procedure. Blocks only lasts a couple of hours though, so don’t confuse them for a permanent treatment, they are just a way of finding where the problem is so it can receive the appropriate therapy.

Imaging

Once my vet has determined which leg your horse is sore on and which part of the leg is the problem, she will often recommend imaging to get a look at what’s going on inside. This is most often an X-ray (radiograph) or ultrasound. Generally speaking, X-rays look at bone and ultrasound looks at soft tissues such as tendons.

Occasionally, advanced imaging such as CT or MRI is needed, but the majority of cases can be diagnosed with the imaging equipment my vet carries in her truck. Once a specific diagnosis is made, she can recommend the best treatment to get your horse sound and back doing those things you want to do with him!

If your horse has something going on, make sure to give my team here at Springhill Equine a call to schedule a lameness evaluation. They are amazing at what they do!

Until next week,

~Whinny

P.S. Are you missing out? In addition to my amazing blog, this website also has the biggest equine podcast in the world, a huge video library filled with how-to’s and seminars, a series of best-selling books, and direct access to some of the best equine veterinarians on the planet! I’m just a small (pun intended!) part of a fabulous team of equine professionals here at Springhill, and I want to make sure you are taking advantage of everything we have to offer. And most of it is free! So take a minute to explore the rest of the website while you’re here. I promise you’ll find something you can use to make the world a better place for your horse.

Hi everyone, Whinny here! It’s starting to cool off a teeny bit here in Florida, and a lot of you are gearing up for the riding season! We don’t want anything to get in the way of the fun stuff you’re planning with your horse this Autumn. My Springhill Equine vets love to keep your horse feeling good and performing up to his potential, no matter whether you’re a show jumper, reiner, trail rider, or anything in between!

Lameness evaluation and treatment is one of the most common things they work on. But the first step is for you to recognize the start of an issue at home, so let’s talk about what to look for. Some lameness is really obvious, like if your horse is limping badly on one foot, but a lot of the time it’s much more subtle! You may just notice a change in his performance, such as trouble making tight turns around the barrel, difficulty picking up one canter lead, or acting cranky out on the trails. Once you notice something is amiss, here’s what my vets will look for when they’re evaluating your horse move.

What does lameness look like?

If you drive by my clinic, you will often see horses being trotted up and down the grass outside the clinic while my vets watch them. This is the Springhill technicians’ favorite part of the day. They just love the healthy exercise, especially at noon in July and August! 

So what does it look like when a horse is lame? It can be an obvious limp in a forelimb lameness. Your horse may not want to bear weight on the leg or may have a pronounced “head bob” when he walks or trots. For a forelimb lameness, think “down on sound” – meaning the head bobs downwards when the sound (non-lame) leg hits the ground. So, if the head bobs down when the left front foot hits the ground, the lameness is on the right front leg. For a mild lameness, there may not be a super obvious head bob, especially when he’s moving on a straight line. My vets will also listen to the sound of his footfalls – a lame horse will land softer on the foot that hurts, as he shifts his weight to avoid pain. If both forelimbs hurt equally, you might not see a head bob, but your horse could look stiff when he’s moving, or rock his weight back onto his hind end to take weight off the front.

Hindlimb lameness is evaluated differently than forelimb lameness. It may look like a “hip hike”, toe dragging, or a shortened stride on the lame hindlimb. It can also just manifest as problems picking up or keeping the canter leads, lack of impulsion, or even “crow hopping” or bucking.  Don’t worry if you aren’t sure, hindlimb lameness can be tricky to see – that’s what my vets are for. If you’re feeling like something doesn’t seem right, just call us!

Some lameness is more subtle than others. If your horse is quite sore, my vets may just need to see him walk and may not need him to trot. For most lameness cases though, the horse is evaluated at the trot, because the symmetrical nature of the normal trot gait makes abnormalities more apparent. Sometimes my vet will ask to see a horse canter to check out how the hind end moves. She’ll want to see the horse move on a straight line and may want to see him moving in a circle (such as on a longe line) to see how positioning his limbs on the inside or outside of the circle will affect his lameness. Some lameness is only noticeable when the horse is turning. The ground surface makes a difference too – your horse may look fine on grass or soft sand but be sore when the ground is harder. That’s typical of a hoof problem or arthritis. A soft tissue injury like tendinitis may be more painful on deep, soft footing. So my vet may ask her tech to jog your horse on an asphalt surface instead of the grass to check out the difference.

Here’s one thing I want you to understand – horses don’t lie about lameness. Their brains don’t work that way. Your horse isn’t “faking” a lameness when you ride him just because he doesn’t look as lame when you see him cantering in the field. He isn’t capable of that. Some things, like the additional weight of carrying a rider, or the specific motions he is asked to do under saddle, just make a lameness more apparent. So, if you notice lameness when you ride, just schedule a lameness exam with my vets instead of thinking your horse is being tricksy.

In my next blog on the lameness exam, we’ll talk about the steps my Springhill vets take to determine what’s hurting your horse, and how to help him!

Until next week,

~Whinny

P.S. Did you know the humans here at Springhill Equine have the biggest, most popular equine veterinary podcast in the world? It’s called Straight from the Horse Doctor’s Mouth. Each episode (and there are over 130 and counting) covers a horse-health topic and is directed at horse owners so they can learn how to take the best care of their horses. You can check it out right over on the Podcast Page of my website, or subscribe on Spotify, Apple Podcasts, or wherever you get your podcasts.

Ah, the subtle lameness. This is often a source of medical mystery for my Docs. For me, it’s like a good Netflix drama. Is the problem even what you think it is? One minute you’re sure it’s the left rear leg, but it turns out it’s really the neck, and sometimes it isn’t even a lameness! It’s a neurologic issue, or even a muscle disorder. I tell you, it’s high suspense around here! How do my Docs even begin to unravel the mystery? Read on while I drop some cat wisdom on you.

Start at the Beginning

Everyone always wants lameness exams to start with trotting, or riding, or something where they can show off the lame part. My Docs never start here. It’s even more important with the vague lameness. They start by talking with you about what’s going on. The story is often long, complicated, and can have some subtle plot points. 

It may be that it all started with a day where Flicka didn’t feel quite right. From there, some days have been good, maybe some bad. There could be a buck when turning left and picking up the canter. There could be a skip when coming down to a trot from the canter. All those little clues help my Docs begin to formulate an idea. That idea is just that, an idea. It’s likely to change as more information is added, but it’s the starting point of what’s really going on. Much like that Netflix show, there may be some false clues in here, but without exploring them all, my Docs often can’t know what’s real and what’s not. 

Hands On

We’re still not going to run the horse around. The next step is a full cat scan… er, human scan. I’m generally very involved from a supervisory standpoint for this part. My Docs will poke, prod, flex, extend, and turn all your horse’s parts while standing still. 

Each Doc goes through this a little differently, but the general idea is to get their hands on every part of your horse, and to move those parts through their normal range of motion while standing still. This is often very telling about where horses are stiff, sore, or generally reactive. Excellent clues are gained from this section of the exam. Those ideas from earlier are expanded upon, modified, and sometimes changed all together. 

Finally, We Move

Once there has been time spent on history, and hands laid upon the horse, then we head out to see how they move. Generally, my Docs start on grass footing. They watch the horse walk away from them, towards them, and from the side. They will often watch, and then video. Then they do the same at the trot. Depending on how that goes, next may come flexions, or heading to a hard surface to see what happens there, or some circles in both directions. 

Different problems show up in different places. Some things don’t like hard surfaces, some don’t like soft, some don’t like to be on the inside of a circle, and some object strongly to being on the outside of the circle. Especially with a subtle lameness, my Docs are going to run through a lot of scenarios. They are also going to video a lot of those scenarios and watch them in slow motion. Slow motion can really highlight an area that isn’t moving normally. Turns out those phones are good for something more than Facebook! 

A Cautionary Tale of Flexions

Flexions are a let’s stress this area and see what happens kind of test. They are far from perfect, but they can sometimes point to an area that hurts when it’s bent, held, and then asked to move. However, flexions can lie in all sorts of ways. Occasionally, there’s a well-performing horse with no issues that trots off like it has a broken leg when flexed. More often there are lame horses that trot off exactly the same when flexed. Flexions add information to the mystery; they don’t solve it!

Even More Moving

With a subtle lameness, my Docs will often have you ask the horse to perform their normal job. My Docs will watch the horse go through their paces. They nearly always video this part, especially if faster gaits or quick turns are involved. Even my Docs are only human, and videos help them see the subtle changes going on. For many of these not-so-obvious lamenesses, it takes until this step to really fully complete that inkling of an idea that happened way back at talking to you about history. 

Next Steps

Depending on all the previous steps, the next step can be a variety of things: blocking, radiographs, or ultrasound. Blocking involves numbing an area to see if the problem stops. There are obvious issues with this system. Sometimes you have what we call an unblockable area. Many back and pelvis issues fall under these categories. The other issue is some horses really change the way they move when some part of their body is numb. Last week we had one that held his leg up in the air because his foot was blocked. Very, very difficult to continue a lameness like that! There was nothing to do but wait for the block to wear off and try a different plan. Ah horses. 

Some areas my Docs image before they block if they are suspicious. Proximal suspensories often fall in this category. To block them, you have to put liquid where the ultrasound then looks, which makes it look like you have a really, really bad suspensory issue when it might just be your block. Some areas, like backs, don’t always respond great to blocks so x-rays or ultrasound may be the next step. 

Next, Next Steps

After narrowing down their ideas to a primary problem, my Docs will work on a plan to address that primary issue. This may involve injections, rehab therapy, spinal manipulation, acupuncture, a change in tack, or any of a number of things. Often there is a combo pack of things that need to be done to help these horses. Rarely is it a let me give your horse this magic injection (or pill) and all will be fixed! 

Subtle lamenesses can be frustrating. Making sure you have reasonable expectations for the process, and knowing the results often require a lot of work can help everyone arrive at the best answer for the horse. Unlike Law & Order, the perpetrator isn’t always found in 47 minutes. Sometimes it can be an 8-episode series, and there’s no binge watching allowed. We hope for a 2-3 episode max series to solve the mystery, but horses have their own ideas about what’s entertainment.

One thing I didn’t mention was the rider. An unbalanced rider can make it difficult for the horse to do all the things. That’s a whole different blog, and may require some professional help for the rider (physical therapist to figure out your body, mental therapist to help you accept that you’re not perfect, etc). My humans just released a podcast episode about that very topic called Unbalanced Riders, so make sure you’re subscribed to the show, or head over to the Podcast Page of my website to listen in!

Until next week,

~Tony

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