Podcast Episode 38: Lameness that hides — stifle problems

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Ever wonder what the vet is thinking when your horse has a tricky lameness, like stifle issues?

In this Horse Mysteries Solved podcast, I share what vets are thinking regarding stifles.

Then, we talk about alternative practitioners viewpoints.

Most important takeaway?

That the primary cause of chronic stifle issues is (about 80% of the time)…..in the opposite hind leg.

“What?! She can’t be serious,” your brain may shout.

Shout all you want. Come along and hear my reasoning. All comments welcome.

Links Mentioned:
TBT Taster Series
What Does My Horse Want

Transcription:
Renee (00:01)
Hey, friends. This is Dr. Renee Tucker, equine veterinarian and developer of the Tucker biokinetic technique. Okay, today I thought we’d talk a little bit about one of the lamenesses that tend to hide. And today we’re talking about stifle lamenesses.

Renee (00:21)
Now, I want to talk about this, not like, oh, here’s the cause, and you go x ray, and here’s what you can do, because you know what? You can look that up online. I’d like to give you my perspective in three different ways. One is my veterinary experience of over 25 years. So I’m going to share what a veterinarian would think and then talk about how an alternative medicine practitioner might start thinking.

Renee (00:47)
And then lastly, how a TBT person would start thinking. Because they’re all different. This does not mean one is better than the other ones. Every one of these might be the best thing at the time for a horse with a stifle issue, but I just want to share these perspectives so that they’ll help you better understand what we’re thinking. Because sometimes what the horse owner is thinking is entirely different than what the vet’s thinking, or vice versa.

Renee (01:18)
So here we go. First of all, let me shock you all, because it’s fun. Here’s my thought. My experience has shown me that in a chronic stifle situation, a good 80% of the time could be higher than 80. But I’m actually going out and limb here.

Renee (01:39)
I’m going to say 80% of the time or more chronic stifle lamenesses. That primary cause I always talk about, that primary cause is in the opposite hind leg. Yes, that’s right. Now, I’m not saying there’s not an issue with the current stifle diagnosis. That’s right, man.

Renee (02:01)
All the stifle is hurting. But why? I’m always about the why. The why is all the ones I’ve seen, it’s usually the other hind leg, which is kind of sad, really. But let’s talk about it so you guys will know and you can help your friends, too.

Renee (02:15)
All right. Stifles are in the lamenesses that hide category because they’re so strong. The stifle is analogous to our knee, and our knee actually is way less strong than a horse’s stifle. That stifle is wrapped with thick, strong fascia, all kind of fascia and ligaments, collateral ligaments, annular ligaments. It’s so strong that we’re taught in vet school.

Renee (02:48)
Here’s a secret. Now, if you feel any swelling in a stifle. So the veterinarian is feeling the stifles. Look. Feeling for swelling, because it’s hard to see down there.

Renee (03:00)
If it’s coming from the stifle joint. And that’s called effusion. That’s just swelling from the joint is effusion. If it’s coming from there, there is a serious, serious problem. Because that stifle is so incredibly tough.

Renee (03:19)
That if it’s showing a problem, there’s a real problem. So that problem, obviously, has to be dealt with. All right. As always, my question is, why did it get there in the first place? This is talking about chronic, remember?

Renee (03:34)
So I’m not talking about if a horse has an unfortunate fall and traumatic landing in the pasture. That alone can tear a stifle ligament on the inside. That’s awful. Right. But I’m not talking about those.

Renee (03:48)
Those are generally not the ones that I see. Those are usually a little bit obvious in that the horse is perfectly sound and then suddenly is lame. We know the cause, and we’ll do the best to fix our cause. But meanwhile, most of the ones that are out there are kind of hidden, because what is the veterinary perspective on ace stifled lameness often, at first? Well, as a veterinarian, we are taught that if this lameness is in the hind end, to keep it simple and follow the statistics.

Renee (04:27)
Statistics are. Most of the hind end lamenesses are in the hawk. That’s just what they say they are. And so we do our hawk stuff first to make sure we rule out the hawk. For some veterinarians, that’s just.

Renee (04:42)
Well, let’s just inject the hawk and see what happens. Sometimes it helps, sometimes it doesn’t. It doesn’t sound good to do that right when I’m saying it. But the thing is, if we did it in a more, I don’t know, straight, logical manner, we’d actually have to start at the foot, and we have to flex the foot joints down there. And block all the pastern and fetlock and trot them off again.

Renee (05:10)
And then x ray all that, and then say, okay, well, we’ll come back when we know more. And then they’d have to do then the hawk, and then the stifle, basically go up the leg. Now, that bill for you would be astronomical. So that’s why we actually do use these statistical probabilities. So I’m not trying to blame people here.

Renee (05:33)
I’m trying to give you revelation behind why does the vet do what the vet does? The vet’s taught to find the pain and fix the pain. And most commonly in the hind leg, the pain is coming from the hog. Okay? Right.

Renee (05:48)
But in this hidden stifle lamenesses, they start generally with you being able to feel an offness. So off is where they’re not really lame, but sometimes they feel weird or off or crooked or. Some people report it feels like they stepped in a hole, but there wasn’t a hole, or they tripped, but they didn’t really. It’s so hard to explain. That’s what they tell me, because it just feels wrong.

Renee (06:17)
Now, many things can just feel wrong. Disciple is one of them. So if you tell the vet that it just feels wrong and you can’t see the lameness, you can feel it, but the veterinarian cannot see it. Now, it’s tough because we don’t have that many tools. If we can’t see it normally, we love to see it, then we can block the lameness and confirm the location.

Renee (06:43)
But if we can’t see it, all we can do is feel for pain, for swelling, things like that. That is useful if it’s there. But like I said, stifles make it tough because they are tough. So instead, they’re going to flex the hawk, as I mentioned. But when you do a hawk flexion, it does primarily flex the hawk, but it also flexes the stifle, and it does affect the hip, and it does affect the sacraliac and the lumbar, just to be clear.

Renee (07:13)
But for our stifle issue here today, you might get a positive flexion test to a hawk flexion test, but the cause was a stifle. Nevertheless, your poor veterinarian is still going by statistics saying that, hey, look, let’s just inject the hawk and find out. Hey, fair Enough. Guess what? As I believe I talked about in an earlier podcast, when you inject any joint, it goes to all the joints.

Renee (07:40)
So that’s not necessarily bad. I’m just saying it’s not that helpful as a diagnostic. All right, so until the point where your veterinarian can take an x ray of the stifle or block it directly, like into the joint, which isn’t that easy, then they can get a real diagnosis if there’s something to find in there. And let me give you an example for things you can find in a stifle that would be wrong is torn stifle ligaments on the inside you may have heard of for people getting a cruciate tear, an anterior cruciate tear, posterior. Those are ligaments that are within the knee.

Renee (08:22)
And horses have those as well. And if those tear in a horse, you’re going to need surgery. And that’s the way it is. That’s okay. They can come back from that.

Renee (08:32)
And the other common thing would be OCD, which stands for osteochondritis desiccants. Science is so sciency, isn’t it? Look at all those words. Okay, we have all these ruins, apparently, so we can communicate properly in other languages by using sciency talk. But really, it’s sort of annoying.

Renee (08:52)
Anyways, what it means is the cartilage in the joint is dried up. That’s what desiccans means. So it’s desiccating, drying, and because it’s dried up, it kind of can move away from the bone, kind of flap around in there a little bit. It’s not completely off of the bone. That would be a floater, but it’s still attached, but not really performing well.

Renee (09:18)
So that also requires surgery in most cases. It depends on the veterinarian there and the x rays. So that’s where veterinarians are at with stifle issues. Find the pain, x ray, possible MRI, and then is it ligaments or OCD? Then surgery.

Renee (09:41)
That’s it. I’m not knocking it. I am sharing with you. That’s what we got. All right.

Renee (09:47)
So an alternative practitioner will do their best to also help with the stifle issue, which has probably been diagnosed already by the vet. They’ll come in, and this can be anybody, okay. Any type of modality. And again, I’m not knocking anything. That all helps.

Renee (10:05)
So it’s going to be a massage person, acupuncture, Reiki, anything we know, all alternative practitioners know, everything is connected. So not only are we going to work on the stifle, but they’re going to. Let’s just go with massage. The massagers, sorry, masseuse is. Do they call it masseuse?

Renee (10:26)
Okay. I don’t know. But anyways, the massage person is going to work on stifle associated muscles, but also realize that both the hip and the hawk, because the stifle is having trouble, they’re also going to be overused and sore. So they’ll work on the hip and the hawk, and they’ll go up to pelvis and even maybe lower leg, because they realize it’s all connected. Let me help this whole leg and even up to the pelvis.

Renee (10:57)
This is wonderful. The horse will love this. So that’s great. If you have a really good alternative practitioner, they’re going to try to find you some really check for some other reasons. Couple ideas they might check for is looking for contracted heels.

Renee (11:17)
If you have contracted heels in your horse, particularly in the hind end, this is the best analogy I got. It would be you wearing high heels, not stilettos. Let’s be fair. But high heels and trying to run a track. It can be done.

Renee (11:38)
It can be done. Let’s just say those shoes won’t come off your feet. It can be done, but you have to move your joints differently than you normally would. And in those cases, the stifle does definitely get overused. So that would be something they would look for.

Renee (11:57)
Another nice thing they might look for you is asymmetries in the muscle. They would want to make sure that you have the same muscle development, right hind versus left hind. All those can be clues. If it’s subtle, it’s not that big a deal. But big changes give us a definite sign there’s a problem.

Renee (12:20)
Another good thing that people can do is check what I call the walk versus trot. So it’s a general rule. All right, general. I mean, like, general. Okay.

Renee (12:34)
It’s not all the time, but it can just help you if you don’t know where to start. All right, so if you watch the horse walk, or in this case, you can watch the rider go. If this mysterious offness or lameness is more obvious at a walk than a trot, generally speaking, that’s an alignment problem. It’s just straight out misaligned. It doesn’t work well if it’s misaligned.

Renee (13:07)
All right, if it’s more obviously off or lame at a trot, generally speaking, then that is a soft tissue problem. By soft tissue, we mean pretty much everything that’s not a bone. Bones. Bones are fairly hard. So soft tissue can be muscle, tendon, ligaments, theoretically fascia, cartilage, that type of thing, but something physical.

Renee (13:36)
All right, so that can be helpful. Just checking the walk versus the trot and how it compares for that issue.

Renee (13:47)
Let’s see. Generally, and this is not a dig, this is how we’re trained. Veterinarians are not going to watch this lameness at a walk that much. Why? Because it’s harder to see the lameness.

Renee (14:02)
It’s harder to see the head bob at a walk. Usually the trot, because it’s more concussive, makes it more obvious. So that’s why veterinarians are not typically going to do the walk versus truck. Some might. Let’s see.

Renee (14:17)
So that will be your alternative practitioner. Oh, and I got a story for you. Okay, look, why am I bringing this up, you say? Well, I just saw a case a couple of weeks ago. This poor horse, 23 years old, paint, sweet old guy.

Renee (14:32)
He’s doing lessons for the walk trot. Little kids, right? Well, he’s been fine as well as people know. And then he tripped. Apparently, he tripped one day during a lesson.

Renee (14:46)
It didn’t seem like a big trip. No one fell off or anything. He just tripped in the hind end, and he came up lame. And I’m like, oh, dude. Because he’s like, so lame.

Renee (14:57)
So lame. And the vet had already been there, and they’re like, the vet can’t do anything, they call me. And this horse, I’m sorry, I forget his name, but it’s just adorable. I want to say patches, but that’s not it. Sorry, non patches horse.

Renee (15:13)
Okay. He can totally weight bear on his left hind, but he cannot even move his right hind. He can’t flex it. He can put some weight on it. Occasionally he’ll stand there and put all of his weight on his right hind for a bit.

Renee (15:32)
So that’s helpful, because that tells me it’s not broken. If there’s a fracture anywhere, they will not full weight bear, period. Okay. All right. So I know it’s not broken, but he won’t bend it.

Renee (15:48)
So that means he can’t walk straight with it. Right. When a horse moves his leg forward, they have to bend the joints to get it to not run on the ground. So instead, he is bringing his right hind around in a circle. I’m like, oh, this poor guy.

Renee (16:09)
Now, I’m expecting many things to be wrong in the right hind because that’s the lame leg, and there was plenty of misalignments. So I’m like, okay, cool. Got those fixed. And then I checked his symmetries, guys, I’m thinking that the right hind is the problem. So the right hind will probably have less muscling because it’s potentially been a problem for a long time.

Renee (16:33)
No, it was shocking that right hind had double the muscle of the left hind. And I was like, what? Are you kidding me, guys? That poor guy, he tripped on the good leg. Ow.

Renee (16:54)
So he’s been having trouble a really long time. I am not joking with my percentages here. I’m not exaggerating. The left hind was almost emaciated. That’s too strong.

Renee (17:05)
That would be an exaggeration. But compared to the right, it was shocking. So he’s had a problem with his left hind for so long that the right hind was picking up all the slack, getting more muscle, doing all the work, being strong until he tripped and I believe pulled the muscle and his stifles somewhat involved. But that’s not really the problem. The problem is the left hand.

Renee (17:34)
So my point is, this has happened many times in my career where I’m working on a stifle issue and the other leg has less muscle. But I can’t think of a case of a chronic stifle where it wasn’t the case. That’s why I said 80%. So if you’ve got a stifle issue, please take a look at your muscle symmetries and of course your contracted heels and potentially alignments. Hey, before I forget, if you go to one of my websites, where does myhorsehurt.com?

Renee (18:13)
There is a free video series that’s for primary cause videos, I’m sorry, I forget our official title, but there’s four videos. They’re less than 10 minutes, ten to 15 minutes, I think, and they’re free. You just sign up so you can get those. If you’re interested in more kind of how to’s, like what causes what and what. You can do that type of thing if you would like that.

Renee (18:37)
So lastly, as a TBT practitioner, I get to sort of cheat and ask yes no questions of the horse because energy is awesome. Energy has a positive and a negative, just like a battery or a magnet. We and all living bodies, people, horses, dogs, cats, we are electromagnetic. So you can learn to ask just electromagnetic questions and get yes no answers. So as a TBT person, I could go to this horse who I was seeing and say, okay, is this leg a primary problem today?

Renee (19:20)
And I’d get a yes. Okay, that’s pretty obvious, right? Because he’s kind of dragging it around. But then I could say, well, is this leg the prime?

Renee (19:30)
I don’t have the exact right words. I’m just trying to give you the idea. Is this issue primarily caused by the right hind leg? And I’d get a no. Is it primarily caused by the left hind leg?

Renee (19:43)
Yes. Great. And then you go from there. Is it primarily in the hip or the stifle? I get a yes.

Renee (19:50)
Is it the hawk? No. Pet lock? No. Foot?

Renee (19:53)
No. Trimming? No. You can learn to ask all these questions, as silly as it might seem, in my where does what? I forgot the name of it again.

Renee (20:05)
Yeah, no, that’s right. What does my horse want? That’s just a short course that shows you how to do yes no answers. That’s our prerequisite to our course, where we fix everything in the body I believe everything is fixable. Give it enough time.

Renee (20:23)
All right, I think that’s all for now. Chronic stifles 80% of the time. Primary cause is the opposite hind leg. If it’s some traumatic stifle case, generally speaking, it’s either ligament being torn or strained or OCD. Okay.

Renee (20:45)
And I think that is it for now. Please, please do let me know any questions you might have. I really appreciate everyone who has commented and shared. I appreciate that I got my report from last year, and this podcast has gone to 41 countries, and I am really shocked and happy and really appreciate everybody listening. I really appreciate your time.

Renee (21:09)
Sorry I’ve been really mumbling my words today, but hopefully you all can hear me and feel my appreciation for you. All right, I’ll talk to you guys later. Bye.

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4 Comments on “Podcast Episode 38: Lameness that hides — stifle problems”

  1. Hi Dr Tucker I have a 2yr old TB gelding whose stifles catch and sometimes lock but hes not lame. He is weak and thin and was inclined to do high speed take offs early after his arrival here. He looks suspect over the lumber area which I have treated and had long toes. I am building him up and gently exercising him. Is there any alignment areas that could be affecting this or do you think he has stretched ligaments?

    1. Hello Diane,

      Thanks for your comment. It’s difficult to know, not having seen the horse in person, as I’m sure you realize. Something that might be helpful: I find many locking stifle horses can improve with selenium.

      Most feed bags have selenium listed, but it is often not very absorbable. I recommend Dynamite Premium Selenium (with Vit E). It is inexpensive and can make a big difference.

      Other than that, the stifle itself could be misaligned. “Stretched ligaments” aren’t really a thing. as they don’t stretch much. Tendons/muscles stretch, but not ligaments.

      Hope this helps,
      Renee Tucker, DVM

  2. Hi Dr Tucker
    I have a 2yr old trotter who I believe injured his near side hip,he got his off side hock caught over a rail.
    He appears to drag his near side foot as you turn him to the right . Turning left he seems fine.
    Are there any alignment exercises we could be doing to help him.
    Cheers
    Amanda

    1. Hi Amanda,

      I’m sorry to hear about your horse. There are not really alignment “exercises” to do. He would just need alignment. So either a chiropractor or Tucker BioKinetic Technique (TBT) person would be your best bet.

      Stretching exercises might be helpful, or other modalities such as Masterson to loosen his muscles.

      But again, he just needs alignment, especially with a traumatic injury.

      Good luck,
      Renee Tucker, DVM

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