Working Through the Issues

Author: Lisa Haldane. I’m writing this to give you the perspective of an owner who has been attempting to excel in the sport of cutting, with what should be more than adequate financial resources, access to trainers, and good horses, but with limited and inconsistent success through 2014 (12 years into the journey).  The joy of this sport left for several years but I persevered because there is something precious at the core of it, something really special that is possible with these tremendous equine athletes and I’m looking for a better way.

The sport of cutting is unique amongst equine sports because the horse is thinking and acting at liberty, with no use of the reins.  This is not an exhibition of the freedom that the horse has, it’s a display of an extremely high level of training, discipline, fitness, and accuracy in both the horse and the rider.  I have much more to say about this, but the focus here is to present the story of a horse I owned with enough detail that you will understand the complexity of the issues that competitors can be dealing with.

Lilly’s story:

In this photo, Lilly is five years old and competing with her trainer at a cutting show in Tejon Ranch, California.  She did well at this show as part of the seasoning process to get her to the point where she would be solid enough for me to show her.  This was in August 2011, by May 2013 and she was still not solid enough for me to get through a class.  We purchased her for $25,000 and spent at least that much again trying to develop her.  To us, this was a lot of money, though to many in this sport, it was not enough to buy a finished horse.  The trainer was thorough and cared greatly for this horse; it wasn’t an issue with training but with her health and my abilities.  Setting my abilities aside, I’ll tell you her story in the hopes that you will realize that there is so much more to the development and maintenance of a performance horse than you might think.  Being an equine bodyworker I thought I could work out her issues, but they were way beyond my ability to cope.

We purchased Lilly when she was a four-year-old after she had about nine months of recuperation from what seemed like an innocent injury that occurred during a show where she clipped her left front superficial digital flexor tendon with her left hind foot during a stop much like the one in the picture.  After I bought her the trainer put her back into training, showed her several times, and then I decided to bring her home to continue on with showing her myself.  Sometime between her last show and my home the left front leg became sore….

Over the next two years, we tried several approaches to recovering her for the show pen.  Throughout the entire time, I supported her with bodywork but this didn’t resolve any of the main issues.  She didn’t accept bodywork well, and would try to bite and kick, so I found that I could only work on her very lightly which taught me how much I could get done with very little effort, just softness.

• We evaluated her proprioception at the recommendation of an equine dentist and found that she had a poor sense of stability when blindfolded. He found her molars to be in poor occlusion and felt this might be the cause of her poor proprioception (not knowing where she was placing her feet) leading to the hind feet periodically hitting the front tendons when she was shown.  Ultimately it may have been a contributor but was not the primary issue.
• She had a lot of scar tissue in the left front leg where the original impact to her tendon had been. She had received stem cell and subsequent plasma-rich platelet (PRP) therapy at the injury site. There was an area that was continually vulnerable to swelling and heat.  She would periodically go unsound just as we were attempting to get her ready to show again.  During this time she was getting Surpass applied to the leg before work to reduce swelling and getting iced daily after her training sessions.  The result of the Surpass, other than taking down inflammation, was that the daily rubbing brought down the scar tissue in the leg to where it began to look normal. This period of trying to bring her back lasted about a year and I was ready to give up on her.
• Tried a different vet, Dr. Ross Rich of Cave Creek Equine Surgical and Diagnostic Center, who is known to be an excellent diagnostician. He watched her travel, performed nerve blocking to isolate the location of lameness, and also did a slow-motion video at my request so I could share it with my students.  The results of his evaluation and treatment are attached for you to read.  The slow-motion video is below.  When you watch the video, it’s hard to see the issue if you don’t know what to look for, but pay particular attention to how she places her hind feet, especially when she makes a turn.  The right hind foot tends to float around before she places it down.

Dr. Rich was suspicious that there could be pressure on the cervical nerves in the lower neck and also the spinal column in this area.  He did x-rays to confirm that she did have a reduced foramen opening at several of the lower cervical vertebrae.  He also felt it was very likely that the joint capsules of these vertebrae had excess fluid build-up and were likely putting additional pressure on the nerves.

He found that she had a similar problem in the lumbar area due to the way she traveled in the round pen, not using her back, and her hind legs not coming up properly underneath her.

Dr. Rich did an ultrasound-guided injection of the joint capsules of the lower cervical vertebra and lumbar vertebra (see report).  Within 24 hours all the swelling was gone from her left front leg and to date, she’s not taken an unsound step.  It turns out the primary issues were:

1. Lilly had arthritis in the lower cervical vertebrae which caused a reduction in the size of the foramen where the nerves leave the spinal column to supply the front legs.
2. The same arthritis had likely created a reduction in the internal space of the cervical vertebra where the spinal column passes through. Rich has explained that the nerves feeding the hind legs travel along the outside of the spinal cord and that if there is a restriction of the spinal cord it will compress these nerves and impact the movement of the hind legs.  This would be similar to a horse being a wobbler.
3. Lilly has moderate arthritic changes in the lumbar vertebra which affect the way she uses her back.

Once sound, Lilly was able to be shown by a professional, but I was still not able to get her through competitions without coming up against problems at the end of the run.

This is where my limitations became evident.  I ended up selling Lilly thinking that we weren’t a good fit and it took the next horse to teach me that my physical limitations and the way I was riding had the rest of the answer as to why I couldn’t get her shown.

She’s a powerful horse with a short back and hind legs that come deep underneath her in the stop, which lifts her back.  I had always been taught to sit deep in the saddle and press on the horn, which set me in the middle of her back such that when she would stop and make that powerful turn it would tend to bounce me right up out of the saddle.  I also learned that I had a rotation in my pelvis which resulted in me putting uneven pressure on my legs, which interfered with her ability to turn correctly.

There’s a hint in the photo above as to part of what I needed to do.  In this class, we had a really good run, and you’ll note that I’m not sitting back and deep, but am right up at the front of the saddle where there is the least amount of movement in her back, hmmm……

I ended up selling Lilly to someone who, fortunately, didn’t have these problems and she has gone on to be very successful for her new owner.

The points I want to bring out here are:

1. Bodywork is effective for relieving tension and increasing range of motion as well as reducing anxiety and pain, but will most likely not be able to resolve the primary issue that is causing pain.
2. It takes dedication and determination to continue searching for the source of and remedy for the primary issue. You have to keep pursuing it to the extent you have the resources and the desire to invest in the particular horse.  Be analytical and look at actual results.  If the issue isn’t gone, keep looking.
3. Consult with the best professionals you can find and trust them to do their job, as you get better educated and continue to ask questions you’ll decrease some of the time and expense it will take to get to the bottom of things.
4. The Masterson Method™ of Equine Performance Bodywork emphasizes the difference between primary and secondary issues. In the bodywork, we are often relieving tension and restriction related to long-standing primary issues so the same tension patterns and anxiety will return until the primary issue is resolved. In this case, the primary issues were pressure on the nervous system and likely proprioceptive issues related to over-floating of the teeth, the secondary issues were left front leg lameness, restriction in the movement of the back, and hitting off the front legs with the hind legs during big stops. We need to discover the primary issues to achieve long-term results.
5. I’ve learned how much work I have to do on myself, as well as the horse, to bring this team together. My trainers could probably see my issues, but their job is training the horse and teaching me to ride, I had to ultimately be responsible for getting deep into understanding and maintaining my own body to get through this, an ongoing work.
6. What I would do differently now.
   1. With each horse we’ve purchased that was already trained, it has taken two full years to work through the physical issues to get to the point that we felt they were physically comfortable. The soundness of a pre-purchase exam is not the same as the soundness required to compete in this sport.  For me, as an amateur, to ride them they need to be as physically comfortable as they can be.  This is like peeling an onion to get to the bottom of things.  Then we build back up from there, but if possible we need to keep them fit in the process so we can see if we are making progress.
   2. We pay a lot more attention to how the teeth are managed now. In Lilly’s case, her issues were many, we learned that the teeth were part of it when it was discovered that the premolars and molars were not in contact from overfloating, which added to her proprioceptive challenges.  You might ask how we know this.  It was demonstrated to us by our equine dentist when he blindfolded her and we tried to lead her off, she was very unsteady in her walk.  She was relying on her vision to know where her feet were.

Dr. Rich’s comments and report on Lilly

Lisa,

Attached below are Lilly’s neck radiographs showing significant narrowing of the C5-6 and C6-7 neural foramina, because of the enlarged arthritic dorsal facet joints. These enlarged joints can cause pressure on the nerve roots or in more severe cases the spinal cord.

Lilly’s lameness exam November 29, 2012: Slow Motion Video: Performance Evaluation – 

This mare has previously injured both front superficial digital flexor tendons, but they appear healed at this time. She has had some ongoing lameness issues that have gone undiagnosed. Today, she is 1/5 lame on the RF on circles to the left, and 1/5 lame LF on circles to the right. On the straight, she appears to sound on both fronts. She has mild proprioceptive deficits in both hands, the right hind slightly worse than the left hind. She has decreased lateral bending of the neck in both directions. The non-tender to hoof testers both front feet. She does not canter normally behind either direction, on either lead behind. Holds her lumbar spine and pelvis rigidly at the canter, and does not advance her pelvis forward normally at the canter. No stabbing of either hindlimb.

No edema, tenderness, or joint/tendon sheath effusions of any of her 4 limbs. ULF: mild positive on both hinds. LLF: negative both hind. Nontender over SI joints. Block Rt. Stifle MFT jt.: no change in canter behind. Suspect cervical spine nerve root compression at C4-7, with possible mild spinal cord compressive lesion at C6-7 causing mild hindlimb proprioceptive deficits. Also has osteoarthritic changes of the L4-6 dorsal facet joints bilaterally, and suspect osteoarthritic changes of the lumbosacral intertransverse joints causing the abnormal cancer behind.

Ultrasound-guided injections of the C4-7 dorsal facet joints, L4-6 dorsal facet joints, and the lumbosacral intertransverse joints with HA, triamcinolone, and/or betamethasone were performed. If her hindlimb proprioceptive deficits persist, then I recommend a cervical myelogram with oblique views of the caudal cervical vertebrae to evaluate for spinal cord compression by the enlarged dorsal facet joints. Spinal cord compression by the dorsal facet joints cannot always be identified with standard lateral radiographs during cervical myelography, but can usually be seen with oblique views of these joints during cervical myelography.

Please feel free to contact me if you have more questions. Thank you for the opportunity to evaluate and treat your horses. I would be happy to evaluate your other horse once the horse returns to Arizona. Just let me know.

Sincerely,

Ross Rich

Ross Rich, DVM, PA-C (Equine Surgeon & Owner)
CAVE CREEK EQUINE SURGICAL & DIAGNOSTIC IMAGING CENTER
(Specializing in Equine Lameness, Orthopedic Surgery & Sports Medicine, Performance Problems, Diagnostic Imaging & Equine MRI, Regenerative Medicine (Stem Cells), and Respiratory Problems)
34705 N. 14th St., Phoenix, AZ 85086
Office: 623-581-5508  Fax: 623-516-0934
www.cavecreekequine.com