Ask The Vet

by Melissa McKee, DVM, McKee-Pownall Equine Services

P ain in the body can result in awide array of signs, from some-thing obvious, like a sudden

head nod or limp, to a more subtle andinconsistent change in performance.Identifying, diagnosing and managinga low-grade musculoskeletal issue isimportant because a slight injury canprogress towards a more serious anddamaging problem if not caught in theearly stages.

Lameness can be, to some extent, "inthe eye of the beholder." While a lightpleasure/hack horse can get along quitewell with significant issues such as heelpain syndrome or hock spavin, andwould not be considered lame for theirintended purpose, the same lesions wouldquickly cause limping and performanceissues in a more intensively trained showor race horse.

When checking for lameness, recruit ahelper. Ask them to ¡og your horse on firmlevel ground as you watch, from the sideand the back, for signs of unsoundness.

In addition, there are other health problemsthat can mimic subtle lameness, makingidentification and diagnosis quite challenging.

So, if something doesn't seem quite right aboutyour horse, but you are not sure if it is due to amusculoskeletal issue or something else, here aresome suggestions on how to perform a basiclameness assessment.

SIGNS OF LAMENESSBehavioural changes are often the first clue that

something is wrong, and can include:• Increased anxiety in the stall manifested as

weaving, cribbing, sitting in the water bucketor up against the wall, digging up piles ofshavings and standing with the heels elevatedon the pile, uneasiness stepping from the softstall bedding onto concrete.

• Misbehaviour for the farrier.• Reluctance to go to the show ring or arena

(rearing, spinning etc.).• Misbehaviour during work (grabbing the bit,

shying, rushing etc.).

Some problems are discipline-specific:Hunter/Jumper: Rushing fences, stopping, driftingat take-off, hitting rails in front or behind,cross-cantering or breaking into trot approachinga jump, always landing on a particular lead.Dressage: Deterioration of collected and lateralwork, anticipating movements, shifting haunchesinside, unlevel during extended movements.Western Performance: Blowing barrels, extremeanxiety before runs, won't sit down for slidingstops, poor spin in a particular direction, fallingout of lope.Driving: On a shaft or line, breaking stride,choking down.Racehorse: Lugging in/out, difficult in the startgate, switching canter lead repeatedly.

If any of these issues have recently developedwith your horse, it can be an early indication thatthey are suffering from discomfort, and thesebehaviours are a result of anticipating that pain oran attempt to relieve/avoid it.

ASSESSING THE SITUATIONBefore you call your veterinarian, you can start

gathering information and assessing your horseright away to help determine what is wrong. Evenif you end up making an appointment for aprofessional visit, your observations can provideuseful information for your vet as they workthrough diagnosing the problem.

The exam starts in the barn, with carefulobservation and palpation to detect abnormalities.

Run your hands all over the back and legs to detect abnormalities such as heat,swelling, and pain on palpation.

Gently grasp and flex each ¡oint to detect pain and abnormal range of motion.

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A Word About ThermographyThermography units range from simple "heat guns" that

auto mechanics use to measure temperature of a specific

point, to sophisticated thermal cameras the render an

image of the horse in a range of colours linked to surface

temperature.

Many people use thermography to identify areas of

increased temperature on a horse's body and legs and

then assume that confirms a problem area. Thermography

cameras are a terrific tool to identify saddle fit issues,

because they can identify abnormal pressure points under

the saddle that restrict circulation or create inflammation.

Beyond that, however, this tool is very susceptible to user

error and environmental factors, as well as oversimplifying

the meaning of surface temperature variations. There

are so many internal and external factors that will affect

the findings and cause potentially misleading results.

Superficial bruises and skin scrapes, exercise, haircoat

variation, recent use of bandages or topical treatments,

sun exposure, ambient temperature and drafts can all

diminish the validity of the results, especially with the

point-and-shoot heat gun.

In addition, horses are very efficient at constricting

blood vessels in the distal limb as part of their normal

thermorégulation system. It is quite common to find

that feet are ice cold at one time, warm at another, and

sometimes one cold and one warm at the same time.

Legitimate thermographie imaging requires that a horse

is kept in a temperature and draft controlled environment

for several hours with no recent use of bandages, rugs or

topical treatments. The further away from ideal conditions

you are, the less reliable your results will be.

Thermography can be useful for confirming hot spots

and for tracking fluctuations in a specific structure, but it

will never replace skilled palpation. I would be very wary

if anyone were to diagnose and treat a horse using solely

this technology.

An example of a thermography image. Each colourin the spectrum represents a certain temperaturerange: blues and greens for cooler regions; yellow,red or white-hot for the areas with the most heat.

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Palpate the digital pulse by gently feeling the vessels as theyrun over the sesamoid bones at the back of the fetlock.

DO A VISUAL INSPECTIONStand back and look at your horse. Is there an obvious

asymmetry in his muscling? Get up on a stool and(carefully) look down on his back from behind. Dramaticdifferences in back muscling can be evident from thisperspective. Is he constantly resting a hind leg or pointing aparticular front foot.' Some sore horses prefer to stand as ifthey are on a circus ball, while others will camp out behindto relieve pain.

CHECK HOOVESTake a good look at his feet. Is there an obvious

mismatch.' One front foot is often narrower and moreupright than the other. While many horses are born thisway, foot shape can also change with lameness. The foot onthe sore side will contract while the foot on the sound sidespreads out because it constantly is taking a bit moreweight. Hind feet can become dubbed off from toedragging, and horses with hind limb pain often develop asteep medial wall/flared lateral wall conformation due totheir 'stabby' gait. On horses with unpigmented hooves,you can often see reddish bruising in the lateral wall aswell.

Pick up the foot and examine the shoe/hoof wear.Normal wear is typically a little more extensive at the toe,but otherwise should be fairly symmetrical. Extreme wearon the lateral or medial branch is indication of unevenlanding patterns.

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GET HANDS ONRun your hands over his neck, body and legs. Eeel for

any heat, tenderness, filling in joints and tendon sheaths,lumps and any painful reactions when you applypressure to a suspect area.

Pick up the legs and flex the joints. Does one have areduced range of motion compared to the opposite side?Does he flinch when you apply pressure?

Remember that horses accumulate wear and tear overtime, so their legs won't feel perfect. The key is toidentify anything new and different from the usualnormal.

Gently lay your fingers over the digital blood vesselson the inside and outside back corners of the fetlock toassess the character of his pulse. Remember to bepatient here because the horse has a much slower pulsethan we do, so wait several seconds before assumingyou're not in the correct spot. A strong or throbbingpulse on one leg can point to inflammation in thefetlock or foot.

OBSERVE MOVEMENTOnce you have finished your in-barn inspection, it is

time to observe your horse in motion. Ideally, youshould watch him both on straight lines in-hand, andon the lunge or working in a round pen.

Starting in-hand, find an area with firm level footingthat gives you at least 30-40 metres of a straight path soyou can watch him properly between up and downtransitions. It really helps if you have trained your horseto jog properly on a lead shank - obedient, forward and

Having an experienced ground person watch you ride can providevaluable feedback.

attentive, not treading on your heels or weaving all over theplace. You will need a helper to jog your horse so you canwatch. The generous use of treats can encourage thecooperation of both horse and human in this endeavour!

Stand to the side and have your horse trotted back andforth past you. Look for uneven strides, head nodding (thehead bobs up as the sore front leg hits the ground, in an effortto reduce loading of that limb), toe dragging and stumbling.

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This horse recently developed unusual swelling in thepastern, a clue to why he was short-strided on that leg.

Next, go to the end of the runway and trot the horseaway, then towards you. From this perspective, you canobserve hip hiking (one hip rising up more than the other,as the horse favours that sore hind leg), stabbing the hindfeet (in extreme cases this is called plaiting or rope-walking), a kinked tail and interference. Also, watch thedrop of each fetlock when the foot hits the ground. If oneleg is sore, that fetlock will drop less than the othersbecause they are shifting weight away from that side.

Don't forget to use all of your senses here. Subtlelameness problems are often heard rather than seen,because both diagonal pairs in a normal trotting horseshould sound exactly the same. A tentative landing on oneside often translates into a quieter, higher pitched "clop."

Moving on to the lunge, observe walk, trot and canter inboth directions. In addition to the characteristics alreadymentioned, you can now observe how your horse balanceson a circle. See if they bend normally or turn like a buswith the inside shoulder popped in, watch for normalup-and-down movement of the back vs a flat rigid one withno coiling or flexion of the hindquarter. Ask for lots oftransitions and notice if they repeatedly favour or overloada particular leg throughout. A lot of horses with hind limbor back pain will have difficulty holding a canter lead, andwill break into trot or cross-canter.

Also consider the footing; does the horse look betterwhen lunging on soft ground rather than trotting in handon the driveway? Even if you don't observe a head nod, ashortened gait on hard ground is very typical for bilateralUmb pain, usually in the front end. While these horses

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A pointing stance is typical of front leglameness, usually from foot pain.

usually have sore front feet or fetlocks, theoverall impression is that they are shufflingand tight in the shoulder.

TRAINING YOUR EYEOf course, spotting lameness takes a lot of

practice, so try to observe any horse youencounter as it moves about. You will besurprised at how much gait asymmetry exists,even in supposedly normal, functional animals.Here are some tricks to help:• Help train your eye by applying a masking

tape flag to the poll, and one on the point ofeach hip. This will direct your attentiontowards a head nod or hip hike as the horsemoves.

• Try to evaluate your horse next to a fence orkickboard with a level upper edge, whichmakes it easier to track asymmetrical bodymovements.

• Trot is the easiest gait to spot most lamenessissues because it is forward and symmetrical.

IS IT LAMENESS, OR SOMETHING ELSE?There are many other health and training

issues that can mimic a lameness problem, orfurther complicate an already existing one. Ashort list of more commons ones include:• Gastric or colonie ulcération• Neurological conditions such as wobblers or

EPM• Muscle problems such as tying-up or PSSM• Dental pain• Respiratory disease• Poorly fitted/inappropriate equipment• Training issues

Place a small "flag" made of adhesive tape on the point of each hip. When youobserve the horse from behind, the flags will help you pick out asymmetricalmovement of the pelvis, which is commonly seen in hind limb lameness.

Many horses are continually coping with severalperformance-affecting issues at the same time,making them a tricky puzzle to solve. In addition,the situation is constantly evolving so what was aminor problem a few months ago could be a verysignificant one now. Early detection andmanagement is the key to success, iß

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