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Stifle lock after injury to hip
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Lis
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 Posted: Wed Jul 20th, 2016 06:02 am
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Hello, At the time that my horse injured herself she had been out of work having only the occasional pleasure ride on a loose rein. There was no onbvious lameness in the paddock however before her ride, when cleaning her front right hoof, she dropped onto her right knee. This was out of character. Out riding she did a shuffly trot but I didnt push her as it was her first outing on her own in a long time. When turning up a steep hil she stretched out at trot but came back to a walk very quickly after. I assumed she was puffed however when I reached the top of the trail and placed her into a trot I noticed very subtle lameness. I walked her back home. About a week later I took her out again as I thought she may have sprained herself lightly. When out at trot again I noticed the very subtke lameness. The other rider with me could not see it. She suggested working her a little more to see if she worked through it and would come sound. She didnt. When I got home I called vet/ chiropractor. Her lameness was now becoming very obvious even at walk. The vet/ chiropractor did not find the problem but gave me exercises to do with her. It made her more sore and she began dragging her toes. I stopped the exercise. Slowly over weeks she began to improve. Later, nearly 3 months later I was able to finally get a reputable osteopath out. After manipulating the leg this was his finding - She is presenting with a 1/5L hindlimb lameness & notable assymmetry through the pelvic region. Investigation presented there to be a partial disassociation to the lateral cartlidge over the L lateral illial wing (tubae coxae) this is the origin of the tensor fascia latae and rectorus femorous thus affecting the function of this limb and resulting in a shortened cranial phase. This is affecting the correct mechanical function through the femrotibial joint and creating the painful response in the flexion of this limb.

I also felt the piece that was loose. I later discovered where she would have done the injury as she used to run through a gate at speed. The post had a corner piece that stuck out slightly at the top. I gave her just paddock rest.

3 months later she had massive improvement but the osteopath noted that she was still moderately positive to flexion and the stifle was catching intermittently.

6 months later after paddock rest with some hills, a year after her injury, this stifle lock has improved. She still doesnt use that leg the same as her other hind although walking up hills she will step up. She often rests both hind legs and yawns a lot. I started some hill walks on a lead with her and when she returns to her paddock yawns a lot, although does yawn a lot before leaving sometimes too. The next day after a walk I noticed her dragging her hind toes. I also noticed going down the hill it seemed difficult. I decided to long rein her down the hill the next time so I could watch from behind and noticed a tiny like flinch between the hock and rump on each hind as she stepped down the hill. It made made me think that she might be catching both hind legs slightly, particularly her left hind. She takes very small steps with the hind legs down the hill, sometimes dragging the toe. She will often step out to the left when backing up. Prior to the injury she would get a little jerk when placing her hind on the ground after cleaning it out so that leg may have been prone to stifle lock prior to the injury. She also has a crushed wither from a very young age before I got her, she is nearly 14. I started the hill work to help strengthen the hind and to help stretch the injured leg as I thought that there may have been a shortening of tendons from lack of proper use of the leg. I was going to put her in foal to try and help stretch and loosen the tendons ( worked for me with my injured hand, it returned to normal).

I began reading your work about how everything is connected and important including that muscle that joins the hip. With her injury to her hip will she be permanently unsound? I don't want to hurt her but figured that she needed to start using it if there was a chance of full recovery. She doesnt limp now, just doesnt use it properly although did limp slightly at trot for a few steps when lunging on a gentle slope. Is it true that hill work is great for stifle lock? This mare used to be straight in her action and naturally well balanced. She has never had enough rider work to cause damage, I kept having babies. After the injury she would step to the right of her track with her left hind. I am trying to find all the bits about the best exercise for stifle lock on your site. I am purchasing Manola Mendez work in hand dvd. Do you have a DVD or program I can purchase?

Lis
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 Posted: Wed Jul 20th, 2016 07:27 am
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Just an addition to my previous description, I said that after the injury she would step to the right of the track with her left hind. Part of this is that her toe turned in on that leg/the leg rotated in very noticeably. This has improved dramatically. I did find the turned in toe strange as I had read that dropped hips often resulted in turned out toes.

Thank you for your time. My main question is will she be permanently unsound or have stifle locking problems due to this injury? Do you think the relaxin that will be produced in her body while pregnant will help her to make a full recovery as it did with my hand? Does hill work help with stifle lock?

Also the jerk she did when placing her left hind leg down after cleaning her hoof prior to the injury was only occasional.

DrDeb
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 Posted: Wed Jul 20th, 2016 01:39 pm
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Lis, I've done you the favor of pulling up the relevant paragraph from my answer to someone else who wrote in here years ago with much the same problems:

"Ahh. Well,... by the "wing" I assume you mean the ASIS (anterior superior iliac spine) or ASIE (anterior superior iliac eminence), otherwise called the tuber ilium or the point of hip.

When they fracture that and it sinks in, that is called "knocking down a hip". It is the most common way to fracture the pelvis....

The law of physiology says that all soft tissues will shorten to meet the space available. By knocking down the hip, the distance between the point of hip and the patella will be significantly shortened. This will cause the tensor fasciae latae muscle to have to change its configuration, probably in such a manner that it will not adequately be able to perform its function of holding the patella off the femoral hook to the degree or at the right time to prevent the stifle from catching.

We may therefore expect that if the trot becomes at all vigorous, the animal will catch its stifle; and will probably catch it quite hard, not just a "stick" but hang it up there hard.

If you do not understand this brief description, then you can google previous discussions here on the topic, or especially, go get the back issue of Equus Magazine where I illustrate it. It was in the recent conformation series, one of the articles on back function; I presented a photo of a horse that had a knocked-down hip. Go look at this and read what it says, and think about it.

The prognosis for a horse with knocked-down hip is limited. Increase the chances that the horse will be able to trot faster without catching by beginning with backing up one step at a time, in hand; and graduated courses of cavalletti with half-halt before the grid, so as to teach the transition which asks the horse to coil the loins. Under-saddle walk-halt-walk and walk-halt-back3-walk transitions will also be helpful. Think, Sarah, why these exercises which aim at strengthening the horse's ability to coil the loins would also help prevent him from catching the stifles. Remember the double subsystems that you learned about in class which make up the whole hindlimb reciprocating apparatus: the lower or minor system, and the upper or governing system."

There is no cartilage at the point of hip, Lis; your horse bashed into a post or the frame of a doorway leading into an aisle or her stall, or a gatepost, and the result is that she incurred a hairline fracture to the point of hip or ASIS. This part of the pelvis is a heavy, bony knob, and you are correct in stating that the tensor fasciae latae muscle attaches there. The rectus femoris does NOT attach there. It would be easy to get yourself straightened out on the anatomy if you would take the time to go get an equine anatomy book, and study the pictures in it.

Nonetheless it is very important that the tensor fasciae latae attaches at the point of hip, because this muscle (the "TFL") controls the height and the timing of the position of the patella. The "collapsing" your horse was experiencing, and the "subtle lameness" are due to the patella not getting held up long enough, or not at the right time, to prevent it rubbing or actually catching on the hook that's on the end of the femur. The horse uses this hook when at a standstill to lock one or both hindlimbs so that it can snooze while standing up, but it is a very bad thing if it catches or even partly catches or "rubs" while he's in motion.

Now you need to learn how stifle-catching works, and this is one of the most common questions that gets asked in this Forum. Now it's your turn to use the Google Advanced Search function -- go to the Forum home page and read the directions that tell how to use that to search just this Forum. Then search for where we have already discussed this by using keywords "stifle catching", "locking stifle", "upward fixation of the patella".

You also need to learn how to properly condition a horse so that the stifles will never catch -- unless the horse is very badly conformed, with very open or 'post-legged' hind limb angles, it is possible merely by proper conditioning to completely prevent this problem. On the other hand, the way most people ride and train, they actually promote the problem. It will be up to you, Lis, to decide which way you'd like your life to go with respect to this. There are many hints and more-than-hints in the suggested threads pointing to how the proper conditioning is to be done, and this will become more and more clear to you as you begin to understand that the stifles do not function alone, in a vacuum; their function, or dysfunction, is intimately related to the function, or dysfunction, of the animal's back.

So, on that theme, here's one more piece of homework/research which I would appreciate it if you would do. Go to our main website at http://www.equinestudies.org and click on "Knowledge Base." Then download the three key articles that I ask all students to read. They are free, and all you have to do is click on them to trigger the .pdf download:

"Lessons from Woody" -- a horse must be made straight before he can go round.

"True Collection" -- a horse that moves round will rarely or never catch its stifles.

"The Ring of Muscles" -- part II on collection.

When you've finished this reading and research, I'll be happy to answer any further questions that you may have. -- Dr. Deb


 

Lis
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 Posted: Thu Jul 21st, 2016 01:54 am
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Thank you so very very much for your help Dr Deb.


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