Thistle, Intermittent Lateral Fixation of the Patella

Over the last two weeks Thistle has began having a slight difficulty walking, even stumbling with her rear legs occasionally. The problem was likely complicated when we introduced Aliy to the herd by separating the three horses into individual stalls. Thistle in one, Aliy in the middle, and Archer on the opposite end. By the second week of separation from Archer Thistle had begun pacing the fence, digging a trench with a deep hole where she pivoted for the return trip.

Thistle has an Intermittent Lateral Fixation of the Patella. We haven’t been able to determine the cause, it could have been the loping transitions Thistle and Cadence were working on or it might even have been caused by a fall Thistle took months ago. We don’t know what may have been the cause. The pacing she was doing because she was seprated from Arche is the most recent issue but we don't know if that was the source.

When Cadence first noticed the stumbling she contacted the equine chiropractor but chiropractor wasn’t able to visit for another two weeks. Thistle rarely stumbled except on rocky ground which made it difficult for us to pinpoint the problem area. Hooves or leg? Nevertheless when the chiropractor arrived she immediately knew what it was wrong and shifted the patella back into place on Thistle’s left rear and checked the right rear as well, which was ok.

Diagnosis:

Intermittent lateral Fixation of the Patella

“Horses can develop a condition known as fixation of the patella. This shows up as an intermittent locking of the joint. In the most serious cases the joint is completely locked such that the leg is extended backward and the horse can only drag his leg forward without being able to flex the stifle joint. More often the locking occurs only briefly during locomotion resulting in a jerking to the gait when the stifle joint goes from extension to flexion during motion.” (Novick, 2004) http://novickdvm.com/patella.htm

Intermittent Lateral Fixation of the Patella (ILFP) is common in foals, young horses, and the Quarter Horse breed. Generally found in horses that have underdeveloped core muscles and/or are overweight by 50 lbs or more. ILFP is associated with movement that straightens and extends the rear leg. (Hyperextension of the rear leg)

Treatment varies depending upon severity yet the majority of horses with ILFP recover with treatment:

• Physical therapy (exercise & stretching)

• Medications (estrogen and/or glucosamine)

• Internal blister treatment

• Surgery

Treatment Overview: ***(Important Do Not Confine the Horse)***

• Exercise: In-Hand initially and later ridding (limit turns), walking, backing, trotting in a gradual progression. Canter can be preformed near the final weeks of therapy.

• Stretching, hold for 10 to 30 seconds (Stretching results are improved with 30 second holds if the horse will allow). Repeat 3 times on both hind limbs with a rest period between each stretch. It is important that stretching be done correctly so not to produce further injury.

• High Flexion: Bring limb up passively into a fully flexed hip and stifle position and hold.

• Protraction: Bring the limb forward under the horse's belly.

• Retraction: stretch the limb backwards past the tail.

• Adduction: Stretch the hind limb toward the midline under the horse's belly.

• Strengthening, hold for 6 seconds or longer.

• Lateral tail pull: Stand to the side of the horse, grasp the tail at mid-length of the tail bone and carefully pull the horse’s pelvis toward the side. The horse does not need to be standing square.

• Single leg standing; Pick up and hold the opposite hind limb and hold for 10 to 30 seconds. Pick-up diagonal front leg and hold for 10 to 30 seconds.

• Message, Improves bond as well as gait, increases blood and oxygen flow to the affected area and aids in reducing strain in muscle used to compensate for the injury. (We used a variation of T Touch for Horses.

• Cold therapy, (We used Ice Cup method) Fill a paper cup (for horses we use a large paper cup) ¾ of the way full and freeze. When ready to use peel the paper from the top down leaving about an inch at the bottom. Holding the papered end apply the ice to the injured area standing away from any kick zones. Be sure to keep the ice moving to avoid causing an tissue freezing on the horse’s leg.

• Encourage herd behavior: i.e. movement.

• Discourage the horse from resting the injured leg.

Note: It may take a few days for swelling to go down, use cold therapy and if desired also apply essential oils, such as lavender to reduce swelling and ease any pain. Recovery depends on the diligence of strengthening the associated muscle groups and improving the elasticity of the ligaments and tendons.

Thistle’s Therapy Plan

Week One

1. Walking, In-hand, warm-up, straight path, 10 to 15 mins.

2. Stretching

3. Message

4. Walking, in-hand increase duration and speed as horse is able (Goal 30 mins per day).

5. Ice Therapy

Week Two If horse has improved

1. Walking, in-hand, warm-up, straight path, 10 to 15 mins.

2. Stretching

3. Message

4. Walking in-hand, Increase duration at a comfortable speed, add back horse intermittently approximately 10 ft at a time (Perform enough backing to equal 5 mins of backing exercise) (Can also add in walking up and down gradual inclines. Additionally if horse is able add in backing-up and down gradual inclines as well). (Goal one hour exercise each day).

5. Stretching

Model for Quality Backing

Each step should be equal in length.

Horse should not drag toes, picks up the leg and hoof and places it behind.

Horse backs in a straight line.

Strides should be swift not hesitant.

Week Three If horse has improved

1. Walking, In-hand, warm-up, 10 to 15 mins.

2. Stretching

3. Message

4. Walking with impulsion in-hand with intermittent backing, (Backing should equal 5 mins). Begin alternating walking with trotting. (The trot to walk transition is the most beneficial) Vary footing as well as incline. Gradually increase duration of exercise to working longer than an hour, comfortably.

5. Stretching

Model for Walking with Impulsion

Impulsion refers to the horse’s ability to apply power by pushes off with the hocks as they travel. To teach impulsion to the horse use backing and immediately transition into a walk encouraging the horse to bring its hocks up underneath the body.

As the horse improves trotting can be used to promote impulsion. When trotting the horse transition the horse to a walk and immediately ask for the trot again.

Week Four If horse is trotting with long strides.

1. Walking, In-hand, warm-up, 10 to 15 mins.

2. Stretching

3. Message

4. Walking with impulsion in-hand with intermittent backing, (Backing should equal 5 mins). Continue walk/trot and trot/walk transitions. Varied footing and inclines. Increase resistance by walking horse through water, snow, or pulling, such as a carriage or tire (Training may be required for safety) Add in ground poles, spaced 2 or more horse lengths apart (Begin with 2 poles and work up to 6 poles spaced far enough apart to allow an active resting period between pole sets . Gradually increase duration to working longer than an hour comfortably.

5. Stretching

Week Five If horse has continued to improve begin lunging (or round penning) with a bit, bridle, and surcingle and side reins (Different attachment point for the reins activates different muscles groups). Use of a Posoa is also beneficial.

Use of Tack

Horses in bit, bridle, and surcingle with side reins (or saddle) learn to carry themselves better, recruiting more muscles, while lunging. Developing better self-carriage than horses lunged in a halter.

1. Walking with some trotting, In-hand, warm-up, 10 to 15 mins.

2. Stretching,

3. Message,

4. Lunge large circles only in a bit, bridle, and surcingle with side reins.

Walking with intermittent backing, (Backing should equal 5 mins or more). Continue walk/trot and trot/walk transitions. Vary footing and inclines, ground poles (Decrease the spacing). Increase resistance by walking horse through water, snow, or pulling, such as a carriage or tire (training may be required for safety). Perform in-hand lateral work, side-pass, bending on the circle, leg-yield, etc… Gradually increase duration working longer than an hour as comfortable.

5. Stretching

Weeks Six through Seven Horse should continue to improve.

1. Walking with some trotting, In-hand, warm-up, 10 to 15 mins.

2. Stretching,

3. Message,

4. Lunge large circles in a bit, bridle, and surcingle with side reins. Add in canter with canter/trot and trot/canter transitions. Continue walking with intermittent backing, (Backing should equal 5 mins or more). Continue walk/trot and trot/walk transitions. Vary footing and inclines, ground poles (working toward caveletti work). Continue lateral work. In addition increase resistance by walking horse through water, snow, or pulling, such as a carriage or tire (Training may be required for safety) gradually increase duration working longer than an hour as comfortable.

5. Stretching

Week Eight If horse has continued to improve ridding can begin by following a gradual application of the Week Six and Seven Therapy Plan. Additional activities can be added, slowly as the horse improves. However, tight turns and jumping should be avoided until a significant period of time has pass without the horse presenting any instability of the patella.

Maintenance

After 12 Weeks the horse may be shifted to a maintenance schedule if there has been no reoccurrence of ILFP. Maintenance should be preformed 3 to 4 times each week. It is essential that the horse continue with stretching and strengthening exercise as well as maintain proper body weight and core strength.

*** As we receive new information this blog will be updated. ***

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