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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