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Exercises for a stiff shoulder?
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megan
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 Posted: Mon Apr 5th, 2010 10:32 am
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Dear Dr Debs,

I am new to this board and am very impressed by the wealth of knowledge and sensible advice that can be found here. I have recently acquired a horse with a number of physical issues, and would very much appreciate any suggestions or advice.
He is a 6 year old Lipizzaner gelding, brought over from Hungary two years ago. He was entire until then, and from the ages of 2-4 was cross tied in a stall, unable to turn around or lie down, and just brought out to be lunged once a week. The cross ties were weighted, so he had to use the muscles underneath his neck to pull his head down to eat.
His began his ridden career here in the UK, and this has added to his issues. He was initially started using techniques which exacerbated his tendency to go ‘upside down’, with a hollow back and high, contracted neck.  He was then ridden for almost a year by someone who addressed his high (and anxious?) head carriage by pulling his head down, and holding it there. He was also jumped in an ill fitting saddle.
When he came to me, he was very sore in the lumbar region, dragging his hind toes down hills, with underdeveloped hind quarters.  He always rested either of his back legs. He had a dramatic dip in front of his withers, and large, hard muscles underneath his neck.
He has very upright front feet which, when x rayed, revealed pedal bones that are significantly tilted (the back of the pedal bone is being ‘pulled’ upwards by the digital flexor tendon), with a resulting degeneration of the lateral cartilage.
He has little muscle in his shoulders, and the assumption is that the shortened muscles and tendons in his forelegs are the cause of the pedal bone tilting. He dragged the toe of his inside foreleg on a circle in walk on both reins, and seemed to have a very limited range of movement in his shoulders. He was resistant to being asked to trot (none of this was ridden I should add) and has developed a ‘toe’ flinging trot when he does.
He has now had a number of treatments from a chiropractor, which has relieved the pain in his lumbars, and he is beginning to be able to lift his feet (rather than drag his toes) when walking down hill (I take him out in hand and ask him to walk very slowly down hills). The chiro has also freed up areas in his neck and poll, and I am working on neck flexions (twirling) on the ground, and lowering and extending his neck on cue. The dip in front of his withers is now not as pronounced, but I assume the muscle improvement along his back is going to be a longer term job.
His left shoulder seems better, but there is still a problem with his right shoulder, and I would really appreciate any tips on ways to help free it up. (Obviously, I don’t know what has caused it, it could be an injury, or a result of the time in the stall while growing, or from the ill fitting saddle etc etc). On a circle to the right, the right shoulder does not have any upwards movement (he seems to only use backwards/forwards movement), the stride is shortened, and he drags his toe. It is heavy to lift, and he finds it hard to put it forwards onto the foot trimmers stand. He ‘appears’ to prefer to weight it-if you ask for a stride of shoulder in to the left (so the inside shoulder is the right one) he is very resistant to it, but finds it easy on the other rein.
I have had him for just over two months, and am only working him in hand currently.

I’m sorry if I haven’t made any aspects of this clear. I have attached a photo of the day I got him, although I don't think it adequately shows all of the issues I have described.
Many thanks

Attachment: feb 10.jpg (Downloaded 577 times)

DrDeb
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 Posted: Mon Apr 5th, 2010 10:11 pm
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Hello, Megan, glad to have you join us here in the Forum.

I am going to tell you in a word what I see in the photo you present: a 100% normal horse.

This is what I see. I see normal hoof angles, a lovely neck without any remarkable muscular overdevelopment anywhere, nice clean shoulders, a good broad back with normal covering of muscle, and correctly articulated legs presenting good "bone" substance. The head is good, normal for a Lipizzan with the convex facial profile, lovely intelligent eyes bespeaking very little internal trouble. The "dip" where the crest of the neck attaches back to the withers is not due to injury, but instead simply to the fact that the animal has a good high set of withers plus a fatty crest, larger than a TB's, both because he was recently a stallion and because Lipizzans are a cresty breed in general.

You tell me, however, that the animal has this whole long raft of troubles. This makes me think that you are to some degree under the thumb of a manipulative chiropractor who wants you to do repeat business. There is not anything wrong with the animal's shoulder or neck or haunch muscling, as to its degree or shape or thickness, I repeat.

I also would ask you to post the X-Rays by which the rotations of the coffin bones in his feet were diagnosed. If you have not had X-Rays, then you do not have a diagnosis, of course. But if you have had a set of X-Rays taken, then you can post them here so that I can see what your veterinarian who made the diagnosis has seen.

One of the things I have noticed lately, Megan, among quite a few new horse owners, especially women, is that instead of saying "I just bought a horse", they say "I just rescued a horse." I appreciate how much more magnificent this makes the person feel. But the truth is -- you just bought a horse.

The type of stall that this animal was kept in is the norm throughout many countries of Europe, including the Spanish Riding School's old stables in downtown Vienna. The weighted cross-ties are actually chains that run through rings mounted in the sides of the stall. The chains are long enough to permit the animal to reach around and bite a fly, and most of them do learn to lie down in them. This type of arrangement was also the norm, in former times, in all livery stables, such as those that used to populate London to serve the taxi industry. It is not abuse to keep a horse in such a manner; it is merely part of the horse's work. That you can provide him a box stall (which used to be called a "loose box" precisely because the horse was not tied in it) is grand, but no basis for judging the people who kept the horse before you purchased him. They did their best under the circumstances of their country, and the horse shows no physical damage from it that I can see. You are now going to do YOUR best under the circumstances that are the norm where you live.

As to riding the horse: unless your veterinarian tells you that he he is lame, you should be getting about it. It is much more efficient to supple a horse under saddle than any other way -- which is not to say that proper hand-stretching and ground work are not also very helpful. But you bought the horse (I presume) in order to ride him, not NURSE him.

This is the pitfall so many women fall in -- there are half a dozen of them even at the barn where I board my own horse. They are nurses, and from what I can see, not one of them will ever really be a rider. My belief is that the major reason that they nurse their horses (there is always something or other wrong with their horses) is that, in truth, they are not very competent horsewomen and not very accomplished riders. Very understandably, therefore, to get on a horse and ride it scares the willies out of them. Nobody should ever get on a horse they feel afraid of, so I certainly am not judging them for not getting on, nor do I ever try to push them into getting on.

However, the one thing I do try to make intolerable for them is any failure to acknowledge that FEAR is what is holding them up. And their fear is based on several things -- personal history in part of course -- but also it's based on IGNORANCE. When a person simply does not know how to train a horse -- what needs to be done first, what next, and what the appropriate balance and rate of progress is -- then it is only to be expected that the smallest difficulties will prove to be insuperable. When fear and ignorance block the person from getting on and initiating an effective program of suppling and conditioning, then GUILT steps in there and says, "well you can't sell him", and it says "well you can't kill him", and it says "and you also can't just give him away". So being caught in this way between being unable to ride and being unable to cut the horse loose, the woman very commonly turns to NURSING. That way, she can spend endless hours petting, grooming, bandaging, picking, walking, doing various little things she thinks of as therapies, and spending a comforting amount of money on the chiropractor who is only too glad to have found another gullible and cooperative victim.

So Megan -- is this a description of what's going on with you? Or is your horse really in some kind of trouble not evident from the photo? Have you been riding him? Has your vet TOLD you NOT to ride him? If not -- then please write us back and say what your program for the first week intends to include, and I'll be glad to advise you as to what further direction you may take.

You're extremely lucky to have landed this animal; I'd give a nickel for him myself, as being a good specimen of his breed and a great partner with whom to learn some of the finer points of horsemanship. -- Dr. Deb

megan
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 Posted: Tue Apr 6th, 2010 07:17 am
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Dear Dr Deb,
Thank you for your reply, and I am thrilled that this is your response to the photo of him. I very much hope that he is every bit as good as you have said he is, I currently have him on loan with a view to buy.
I have been advised not to ride him at this time by both my vet and trimmer, until he is sufficiently improved. The chiro said I could ride him as a remedial course of action, although he would rather I walked him in hand to begin with due to the terrain around here, (which is what I have been doing).  My vet says that at the moment he would fail a vetting, hence I called in the chiro, who is not booked to come again at the moment. All three individuals have told me that he is lame, but none has recommended any costly treatments for him, so I ‘hope’ that I am not being duped.
I have attached an x ray, I hope that helps.
I can understand many of the things you have suggested I think about, in terms of a ‘Munchausens by proxy type’ affliction with this horse. I am pretty sure that is not what is happening here-I got this horse in the hope of progressing my riding, this discovery of his physical issues is not something I envisaged. I have neither the time nor inclination to unnecessarily nursemaid a horse!
Tough as it is to hear, it is always good to be challenged, and your concerns about my motivations are valid ones, and I have thought about them long and hard. Of course I greatly value your opinion, or I would not have ventured on here to ask for advice.
I am pretty certain I am not scared of riding him, so I don’t think that is an issue (I have ridden him and it wasn’t a worrying experience). I own two other horses who I regularly ride, and I ride several horses for other people. I would not consider myself to be an expert horseperson by any means, but I don’t tend to have confidence issues.
My plan for the next weeks are to continue doing what I am currently doing, which includes daily stretching of the right front leg with a couple of basic exercises that I have been shown, then walking in hand once the muscles are released and stretched; in- hand work with the intention of mobilizing his shoulder (such as shoulder in, counter bends; voltes; rein back etc), and ponying him out and about from another horse.  When he is sufficiently improved, I will begin to ride him.
I would be more than happy to start riding him, as the routine is an arduous one and as you quite rightly say, I am not spending all of this time and money to walk him round our lanes by choice (I have a dog for that!). So, if you think that my time would be better spent riding him, then I would be over the moon.  I very much hope that he is the horse I can ‘learn the finer points of horsemanship with’, and look forward to hearing what you think the next steps along the way might be.
Many thanks for your reply,
Megan

Attachment: x ray 1.jpg (Downloaded 529 times)

DrDeb
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 Posted: Tue Apr 6th, 2010 08:07 pm
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Megan, great. I am now convinced that you are not a kook. One never knows on the Internet, so you must forgive the fact that I feel it necessary to give new correspondents a bit of a vetting before I invest a lot of time and energy into whatever the concerns.

Great X-Ray. Looks like he has indeed contracted the tendons a bit, and also some incipient sidebone.

You will want to work with your farrier to move those heels back. A line connecting the medial and lateral buttresses, i.e. the rear apexes of the buttresses, should cut straight across the rearmost expression of the frog. In other words, your goal is to get the buttresses back as far as the frog. This will have the effect of not only flattening the foot somewhat -- it is too 'cuppy' in the sole now -- but also getting the frog to the correct 'lowness' with respect to the ground. If you stand the horse on a level concrete slab, the frog should be low enough to clear the cement by the thickness of a credit card, so that you can push the card in from the back about 1/2 to 3/4ths of an inch, but any farther forward the frog is right down on the ground so that you can't push the card in any farther than that.

Now as to your original question. Pauline Moore has come in here many times very helpfully and explained how to do limb stretches. So if you're not up on that protocol -- the most important part of it being how to WAIT while the limb is being held until it released to you and thus gives you permission to take more -- then use the search function to look up Pauline's posts. Our onboard search function is overwhelmed by our sheer volume, so the way to do this now is go to the Google homepage, click on 'advanced search', put in your keywords, and then also be sure to put our address (http://esiforum.mywowbb.com) in the bottom slot so that it will limit the search to only this forum.

I think manual stretching is basically a pain in the ass, but that does not mean that it is of no benefit. It is of great benefit, the point being that I am not inclined to load my own back when there is any alternative. However, in the beginning there may be no alternative and so PROPER manual stretches are a must-do.

Once those have become a regular part of your routine, and the animal seems to be enjoying them or at least neutral -- not trying to pull his leg back all the time -- then you can proceed to things that are both easier on you and more fun for both parties. The first would be to teach him the plie bow, otherwise called the 'camel stretch bow'. In this bow, the horse places both forefeet to the front and spraddled a little bit. Then he lowers his head all the way to the ground, curls it back between his forelimbs, and reaches his muzzle backwards at least to the girth area and at maximum to a point below the sheath. In doing this he must lower his forebody while standing upright upon the hind legs, so that his withers dip way down while his butt stays up in the air.

A very supple horse who is accomplished at this maneuver will dip so far that his elbows touch, or nearly touch, the ground, with the fore hoofs extended as far as they will go to the gront. I have had young horses that would touch both the elbows and the chest to the ground; in which case there is nowhere for their head, which then either merely comes back to the chest or else you can teach them to stretch it out to the front, parallel to their legs (this is the true 'camel stretch').

Most older horses will never go this far, but you can and should expect them eventually to get their nose back past the girth area. This still provides a considerable stretch to all structures on the rear aspect of the forelimbs, plus the entire topline from the poll to the soles of the hind feet. It is an exercise I would never leave out of any horse's program.

Begin, as you must, in a small way, first by teaching the horse to pick up his foot and hand it to you. This is a nice little thing to have on any horse's accomplishment list anyway; much nicer than having to 'pick up his foot'. He should be the one who picks up his own foot. To pick up his own foot, he must lean AWAY from that foot. So the very first thing you teach the horse is to lean away, and you reward him, at first, for so much as breaking his knee when he takes the weight off the desired limb.

Then, when this is easy, you teach him to pick it up and then set it down onto a target. A feed sack or an old chunk of tarp works great for this; weigh the corners down with rocks. You should be in the arena or on some other moderately deep, nonslip footing, so that when the horse puts his weight on the sack there is no danger of it slipping out sideways. If there is, then use a rubber mat for a target instead.

Then bring the horse up to the edge of the bag and let him smell it etc. so he's not afraid to step on it. Have him walk over it a few times. Then park him up just to one side of it, facing it, have him lift up his foot, and then use the butt of your short whip or stick to tap him on the back of the ankle, cannon, or forearm (whichever works best) so he'll keep it up in the air and then swing it forward and set it down on the sack. Reward for this. If he seems not to understand that what you want is for him to swing the leg forward, catch the foot when it comes up and physically place it on the sack for him. Rub the leg so as to draw his attention into it. You want him to place it on the sack AND put weight on that foot. When that happens, reward him for it. Peck at this a few times every day until you can get first one, then the other foot both placed on the sack.

Once he'll put both feet out to the front -- and it doesn't have to be far, six inches will do although more like a foot or even more would be nice, so that he is 'sawhorsed' in stance somewhat. Now add on the next part, which is to lower his head to get the treat (I use little one-inch-long bits of carrot that I bite off and spit out as we go along). At first he need only lower his muzzle to his coronet bands; you put the carrot down there and talk him into lowering his head down there in order to get the treat. Withdraw the treat if he moves or unweights his forefeet, tell him 'no', then reposition him on the target and start again. Reward when he stays put and combines it with receiving the treat from your hand placed between his two fore hoofs.

When that's reliable after a few days, then you need to make sure that when he puts the forefeet to the front they are spraddled enough to permit enough room between his knees that his eyeballs can pass through. To get the horse to spraddle, have him place the first foot forward, then at the moment when the second foot is about to move, reach in there with the butt of your whip or your short stick and tap him on the inner aspect of that leg, so he'll set it wide.

Now when he will do that, you go day by day a tiny bit farther back with his muzzle: first from a line between his fore hoofs, then the heels of the hoofs, then inch by inch farther back each day. You will know when the horse thinks it's too hard, if he looks at the treat, looks at you, and then hangs up there a long time before he comes down and back. Or else seems to lose interest, or tries to get the treat by going around to the side or picking your pocket. If he does any of these things, put the treat in an easier spot and have him go down and get it from there. Then try again in a somewhat harder spot. This is to tell him, 'yes I understand that stretching kind of hurts sometimes, but I sure do appreciate how hard you try.'

Now, if he really has contractions in the fore tendons, very likely when he goes down he is going to make 'spider legs', i.e. he will not want to stretch the fore hoofs straight out forward, but instead he will flex his knees and/or roll over his ankles. If he does this, put a hand-stretch or two in between 'bow' sessions and see if that does not help. I have heard people declaim that 'spider legs' are a 'resistance', but there is NO SUCH THING as 'resistance'. When the horse makes 'spider legs' he is trying to tell you something, i.e. that he has contractions and that stretching down to get the treat from under his belly kind of hurts. So he avoids the hurt or tingling feeling in his forelimbs by 'spidering'.

You cannot stop a horse from doing this and you should not punish him for doing it. Just keep up with the stretches and use the appearance of 'spidering' as a highly useful sign of where the horse is truly at: for no horse will ever overstretch himself through being asked to bow. The long-continued, daily practice of bowing will, even in the absence of manual stretching in my experience, eventually completely cure the 'spidering'. You will need to bow him two or three times every day, from now until the day he dies. I will often do this last thing before I put him up after a ride; but sometimes we do it at the beginning of the session also, if the horse is feeling playful and/or if I think he came out of the paddock a bit stiff.

Finally, as to riding him: if you can possibly get your vet's permission to ride him, it would be very helpful. Assure the vet that you are planning on doing no more than walking. And then when you get that permission, go at the following which, if the horse moves so badly he is hollow, implies that they were never done correctly or even at all in the first place -- and since these things ARE in the 'first place', they need to be done!

1. Vigorous energetic walk. All he can do without becoming bothered, unlevel, or restive. Walk the legs off a goat!!!! (See attached image of me and Oliver, which shows big walk step, untracking and consequent good depth of bend, and head twirling).

2. Change from the longest step at the walk that you can get to absolutely the tiniest step you can get -- like you were going into a herd of calves and pussyfooting to push just one out without chowsing the rest of the cattle. When you change to tiny, do it by imagining that your arms are indwelling his forelimbs -- DON'T do it by pulling back with your hands. You move your arms and your body tiny, and try to get him to come along with you.

3. Change from vigorous energetic long-stepping walk to tiny, back to long. Count 50 long, 10 tiny, 50 long.

4. While you're doing this, bend him on mild serpentines, corner to wall to quarterline to wall to corner, the classic old warmup exercise.

5. When thoroughly warmed up, start cutting perfectly round 10M circles at a medium-sized walk. DO NOT LET THE WALK GET DRAGGY -- keep the energy up, just choose a step length that isn't too difficult for him. The object here is to GET TO THE RIBS.

6. You will likely not be able to get to the ribs at first, because he'll need help by you twirling the head and untracking. So back when you're doing shallow serpentine in step 4, you can also be playing with getting his head to fall off. And remember, that the circle is literally made by the inside hind leg untracking; if it does not untrack, you don't have any bend. So he should be 'following' your inside leg with his inside leg when you ride the shallow serpentine. Then you put it all together on the 10M circle.

7. Do three or four 10M circles left in different parts of the arena, so you go once or twice only around any one circle, then walk off on a straight line to some other spot, and repeat the 10M circle to the opposite direction. When this is going smoothly, then morph it into figures of eight composed of tangent 10M circles.

8. You will also want to start the horse on backing one step at a time; this will help him bow, as there is undoubtedly remnant tension in the hamstrings which this type of backing up relieves. Complete directions for starting that on the ground are given on the audio 'Mannering Your Horse' disks, and it's more efficient for me to tell  you to go get that and listen to it than to write it all out again here.

This ought to be enough to provoke some thinking, reframe some priorities, and get you started. Let us know how reforming the feet goes. Adam Till might want to jump in here with one of his graphic analyses, too -- always very helpful to look at the colored lines. Best of luck, and don't worry about how he travels upside-down for the next two years; just teach him Square One, because unless you have Square One, you will be lacking the one most important thing that you have to take with you throughout your journey. -- Dr. Deb

Attachment: Forum Oliver engagement untracking circle cprsd.jpg (Downloaded 500 times)

Tutora
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 Posted: Wed Apr 7th, 2010 03:24 am
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What a beautiful photo of Oliver--it's my favorite of all the ones I've seen of him, and probably among  the most pleasurable of any ridden horse photo I've seen.

AdamTill
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 Posted: Wed Apr 7th, 2010 03:24 pm
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Hi folks,

Here's the best markup I can do with this xray, since it's of a fairly small area. Few comments:

1) the xray looks like it was taken shooting up obliquely under the foot or down on the foot, since you can see what look see both wings of the coffin bone. It's nice when they're taken directly from the side, since the angles are truer.

2) no hairline marker was used...typical, but a bit annoying. By placing a radio-opaque marker (thin strip of lead etc) at the hairline, you can see if the coffin bone has decended into the hoof capsule (called distal decent). Vets only seem to do this with founder cases, but it's often a useful pathologic indicator even on "normal" feet like this. Really only takes a second, and makes the xray much more useful.
Ex:
http://www.easphotography.com/Horses/General/XrayInPhoto.pdf

3) the joint spacing between P2/P3 is very uneven...generally don't see this. It's probably the best indicator that there would likely be a tendon issue here. Compare that to the joint between P1/2...much more even.

4) the standing angle is VERY high for what looks like an otherwise normal coffin bone. 3-5 degrees is generally regarded as normal. In a case where there wasn't tendon involvement, I say that these heels should be worked lower over time, but go with what the vet is saying here. For now, just know that this isn't normal.

You can monitor the coffin bone angle by measuring the depth of the foot in the collateral grooves (the groove between the bar and frog). With the end of a hoof pick on a freshly trimmed foot, compare the depth at the back of the foot to the depth of sole at the tip of the frog. The line joining the two points will be the same as the coffin bone angle in the foot, since the sole thickness from those points to the coffin bone has been proven to be uniform.

I use a little guage that I keep with me, so that I can get consistant measurements. The big block measures 0.75" long, which is a normal measurement for depth of groove at the back of a foot. The most I've even seen in a healthy foot is 1", though in high heels that can get MUCH deeper. The small measurements are 0.25", which is the most I'll adjust a heel on an average trim.



5) Though the coffin bone doesn't look clubby, you can check to see if the foot is a true club most easily from the bottom. If the frog is narrow and contracted, then the heel is unnaturally high. If it's wide and healthy, then the heel can't/won't be able to be lowered until the body issues higher up the leg resolve (club feet generally aren't seen in horses without issues further up the leg).

6) Breakover is long on this foot (too much toe along the horizontal plane). The Natural Balance/Hoof Rehab websites have good info on setting breakover from an xray. Just remember to not adjust breakover and heel heights dramatically at the same time, or you risk setting up (healthy) landing forces that will cause the pathological heels to be overloaded. Slowly does it.



Hope that helps,
Adam

megan
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 Posted: Wed Apr 7th, 2010 09:32 pm
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Dear Dr Deb
Many thanks for your detailed and thoughtful reply, it is very much appreciated. 
With regards to the feet (and thank you also for your analysis Adam-I am no foot expert, so I am going to have to re-read what you have written several times to really ingest all of the information) I think this is the plan that my trimmer and vet have agreed upon...The heels are certainly too high and too far forwards, but they are loathe to address this too drastically, too quickly, ‘if’ the feet are responding to problems higher up (which the general consensus is that they are).
So, my trimmer has begun to work on the heels, but he is regularly checking whether more foot is being thrown down to compensate for the shortened tendons. He came up yesterday and was pleased; the foot seems to have maintained its balance from the last trim, so hopefully he will be able to take a little more next time. The frogs are wide and healthy, so I think, from what you described Adam, that this would support the diagnoses that this is a tendon issue? It seems that the feet and muscle issues are going to have to be addressed in a complimentary way, and that neither is going to be improved by any kind of quick fix.
Dr Deb, I will begin to teach him the camel stretch bow immediately! I am already pretty fed up with the manual stretches, as I think it will be me needing the chiro if I cannot find a less labour intensive method soon!  The description of how to train him is very clear, thank you for your time with this.  I will report back when we are a little way down the line with this exercise - I look forward to starting it.
As I am likely to have to continue the manual stretches at least in the short term, I will certainly search for some more information from Pauline Moore.  I have already found Pauline’s advice in the thread about the Gluteal rupture very useful.
I will speak to my vet about beginning to ride this horse, but I don’t think he will have too many concerns if he knows we will just be walking in the school, and I think he trusts my judgement.  I am anxious not to undo what I have already achieved in terms of improving his physical condition, but I can see that if we are to really progress, then working under saddle would make a significant difference. Also, it is hard for me to do in-hand work at a faster walk, as I struggle to keep up (particularly if I am on the outside and we are working on a circle). I will keep these sessions short to begin with; with a focus on relaxation and quality, and will monitor how I can progress with each session.
Thank you again for your time, and for the inspiring photo of you riding Oliver.
Megan

Pauline Moore
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 Posted: Wed Apr 7th, 2010 11:05 pm
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Hello Megan - Just a couple of thoughts to add to the excellent advice from Dr Deb and Adam.

With horses like this it is always hard to know where the primary problem originates - did the contracted tendons cause the raised heels or did lack of cushioning protection in the back of the foot cause the horse to be reluctant to weight his heels, resulting in a shortening of the tendons?  You'll probably never have a definitive answer but there is a lot that can be done to change the way the horse chooses to use his feet and legs. 

The radiograph image shows there is a less than desirable distance between the end of the coffin bone and the outline of the heels.  Research done by Prof Robert Bowker suggests that a minimum distance of at least half the total length of the coffin bone is needed to be indicative of sufficient fibrocartilage in the digital cushion to provide support and protection to the bony structures of the foot - any less means the horse will not want to put his heels down first with each step, ie not enough cushioning, too uncomfortable.

No matter how careful the trim and how well the manual stretching is done (more on that later), if the horse does not have sufficient thickness of digital cushion he will not weight his heels which means the problem will never be totally fixed.  To cut a long story short, the best way to entice a horse to weight his heels is to have hoof boots into which a soft pad can be inserted.  The softness of the pad is not to provide cushioning (that has to come from within the foot) - the softness provides tactile stimulation of the sensory nerves in the frog, a kind of 'waking-up' of nerves that have not been in use for a long time.  This in turn causes the horse to want to put his heels down first, which starts the process of developing fibrocartilage in amongst the thin, fatty tissue of an underdeveloped digital cushion.  It is the fibrocartilage that provides substance, protection and shock-absorbing properties so the horse ends up very comfortable on his feet - like us wearing comfy running shoes.  The good news is that it is never too late to develop fibrocartilage - I have seen this with my own eyes on a 19-yr old horse in the last 12 months.  Your farrier/trimmer may already know this so perhaps you could discuss with him.  If you need more info, don't hesitate to ask, it can be very confusing if you are new to the internal workings of the foot.

Once the tendons have shortened you will need to do lots of manual stretching, much like the exercises I discussed in the other thread about a gluteal tear, but you need to be able to do this without hurting yourself.  Both you and Dr Deb have stated you find manual stretching difficult which tells me neither of you have ever been shown how to do it without straining yourselves.  I hear this frequently from my clients and when I see what they are actually doing it closely resembles a wrestling match!  Done properly, manual stretching is easy and effortless, relaxing and enjoyable for both horse and handler.  If someone can pick out a hoof and lift a light saddle without too much trouble, they can stretch - just about anyone can do this.  I did try to describe 'how' on the older thread (title Stretching, I think) but it is difficult to convey in words what is easy in practice.  If it would help, I could probably get some photos organized to show how the handler should stand and use her own bodyweight as a counter to the weight of the limb being held, but this might take a few days - let me know if anyone would like this.

Best wishes - Pauline





leca
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 Posted: Thu Apr 8th, 2010 12:14 am
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Adam is there anyway you can reduce the width on your pics?  It would make for an easier read if I/we didnt have to scroll across for every line.

lighthorse
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 Posted: Thu Apr 8th, 2010 02:51 am
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Pauline:  Thank you for the offer.  I for one would greatly appreciate any information on methods and techniques, dos and don'ts, where you start on the horse, etc.  I had wondered if you ever had made DVD on the subject.  I'm sure I'm not the only one that would like information.  Thank you again, Mauri

Tammy 2
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 Posted: Thu Apr 8th, 2010 03:09 am
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I would love to see pictures of your stretching techniques Pauline.  

 

AdamTill
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 Posted: Thu Apr 8th, 2010 03:57 am
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Pauline might have something, but Basic Equine Stretching by Nancy Spencer (video) comes highly recommended as Equinology supplementary material.

DrDeb
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 Posted: Thu Apr 8th, 2010 04:41 am
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Pauline, I don't THINK I've been wrestling with horses whose limbs I've manually stretched. And I did not really mean that I feel any strain -- hyperbole in expression is what that mostly was, although of course I do remember times when I've had a horse spook, stiffen up, lean on me, or try to pull away, which can jerk the person off-balance and can indeed get one's back into trouble. Bless my elderly teacher for teaching me to plan on letting go before the horse's lack of balance or focus mandates that they have to pull away. One learns eventually. These days, as I have said, I would much rather the horse HAND me the leg, and I have also said the most important thing is to learn to wait for the horse to release his leg before taking more stretch.

This all having been said, I nonetheless repeat that I think doing manual stretches is a pain in the ass. This because it takes time away from what I bought the horse for, what the primary object of horse ownership is -- which is doing work and/or having fun on horseback. Like the bumper sticker says: "I'd rather be ridin' ". Or if that's not possible, at least playing with teaching so-called 'tricks' from the ground!

But nevertheless my dear, do please go ahead and post anything you want to about therapeutic technique -- you have many insights to share and much experience.

I would also like to ask for a clarification as to what you said you'd heard at the Bowker seminar. What does he mean by 'half the length of the coffin bone'? In other words, does he mean half the length of the coffin bone as measured parallel to the solar plane? And then, exactly from what point to what point are we to compare this half-length? From the posterior apex of the coffin bone to the most posterior point of the bulb of heel (i.e. horizontally, straight backwards?) Or from the most posterior point of the coffin bone to the apex of the buttress (i.e. on a diagonal line downwards and backwards?).

This is a great realization and observation, that there is a feedback loop between thickness of digital cushion : willingness to strike on the heel : development/maintenance of thick digital cushion. Since we're able to post and discuss hoof X-rays here, it would be most helpful to know exactly where these estimations of thickness are to be made -- then Adam can start drawing them in!

Also -- I know exactly what you're referring to as resulting from the use of foam-padded boots, having seen Dr. Jane's horse make such progress in Adelaide, for example. But....is this the only way that we can influence this? What have you observed regarding type of footing? For years until recently, I kept my horses in an area where the soil is a silty sand, and the only 'firm' footing you could get would be if it were grassed over. Nobody ever has to truck in arena footing where I live, it goes down hundreds of feet as being an old fore-glacial dune field. So all you have to do to make an arena is scrape the grass off. Horses that live and work on this footing are literally forced to obtain full frog, sole, and heel pressure at all times, because every time their foot strikes down, it sinks in at least a couple of inches.

This would be great if it weren't also a double-edged sword. Because dry sand is unstable, i.e. yes the foot sinks in but it also tends to wobble somewhat from side to side, horses that live on it are also much more prone to developing ringbone. The analogy to be made in case anyone doesn't understand what I mean here, is that if you go for a jog on the beach, nobody jogs in the dry sand if they can help it, because it is exhausting and it will also kill your knees. Instead you jog closer down toward the water, where the sand is wet and firm and stable.

Recently I've moved Ollie to a barn that is some 25 mi. from where he used to be, and ergo not on the same geologic formation. The substrate where he now lives is a sandy clay, much firmer and much more water-retentive. My point is that (as you know Pauline) I recently had Ollie's feet X-Rayed. Your post now makes me think that I should get another set of X-rays at the same time next year. I would like to see if the change in substrate by itself creates changes in the configuration of his feet (my farrier will be the same guy, doing the same things). In fact, we could solicit X-Rays here from anyone who would post them -- what I would like to see is if there is any consistent relationship between hardness of substrate or the type of substrate, and the development of high heel/contracted heels/contracted tendons/thin digital cushion.

Once you help us by specifying where Bowker says we are to be measuring to estimate digital cushion thickness, I want to start by looking at that on Megan's X-Rays but also on Ollie's, because I know that Ollie is (at the present time, so far) not at all reluctant to strike on the heel. -- Dr. Deb

DrDeb
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 Posted: Thu Apr 8th, 2010 05:00 am
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Adam, thanks for your good work on this. Megan -- the most important thing Adam has told you is about the 'unevenness' of the joint between the short pastern and coffin bone. It is markedly wider posteriorly and narrower anteriorly.

This indicates not only that there are likely tendon problems, but that the problems relate to an UNBALANCE in the tension (or degree of contraction) in the tendons. It also hints that there may be a laminitis issue here, i.e. that the laminae near the top of the coffin bone are not properly adhering, and this is creating a net downward rotation of the top of the coffin bone. In other words, the coffin bone, although it looks like it's standing too steep, is actually tearing off the internal surface of the hoof capsule at the top, and is rotating CLOCKWISE, thus creating a wider joint surface posteriorly.

This bespeaks of strain on the deep flexor tendon as opposed to that of the superficial digital flexor, and also on the impar ligament of the navicular bone. Definitely you should discuss this observation and possibility with your vet. If he or she agrees, you might just be wise to get that set of boots that Pauline has mentioned: he might need to be in high-density foam all the time, as a means of pushing that coffin bone up or holding it up. In cases of laminitis, this has been proven time and again as an almost miraculously effective way to help traumatized laminae to achieve re-attachment.

Adam's observation about shortening the breakover is also important: roll or rocker the toe as much as possible.

If detached laminae are part of the scenario, there is absolutely no doubt that getting them to re-attach will relieve strain on the deep flexor tendon and help to get it back in proper tensional balance with the tendon of the superficial digital flexor and also the suspensory apparatus. This will in turn magnify the effectiveness of any stretching program you engage upon.

I am more interested in this the more I look at it, and we would all, I think, love to hear your report as to what your vet says. If you need advice as to what boots to buy, EMail Pauline or me privately and we'll recommend brands. I've had good luck with mine and like them very much, and I think Pauline has another brand she likes.

And Adam, absolute kudos to you for noticing the joint anaomaly, which I did not see at first. -- Dr. Deb

Dorothy
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 Posted: Thu Apr 8th, 2010 07:07 am
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Hi Dr Deb and contributors,

What interesting information!

I have heard that pea gravel is a good footing for horses, however creating a big enough area to get sufficient movement room can get rather costly. Horses' toes dig in a bit, and the pea gravel give alot of sensory stimulation and support to the soles and frogs. Dr Bowker calls this a 'conforming surface'.

The particular weather conditions we have had for some of the last 6 weeks here in England has caused soft, but not sloppy mud, which has made really good 'dirt plugs' in the horses' feet. This too gives alot of stimulation to the soles, frogs and sulci, and all their feet are very good with it.

Megan, if you want any information on where to get hoof boots in the UK, please do pm me.

I shall keep reading for your updates!

Dorothy

 

 


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