Ride the horse - not the x-ray

[frankieduck]

Curious to hear people’s thoughts on something that’s been doing the rounds recently.

For anyone who hasn’t come across it yet, the idea is essentially this: If a horse isn’t showing any clinical signs of discomfort, does it really matter what shows up on x-rays?

I find it quite thought-provoking. On one hand, we’ve definitely overlooked signs of pain and discomfort in horses for years, often dismissing them as just "behavioural." But on the other hand, I’m seeing more and more horses go through extensive investigations, injections, even surgery - only to come out the other side no better, or sometimes worse.

Of course, if a horse is clearly telling us something’s wrong, tail swishing, reluctance to work, explosive behaviour, general unhappy demeanour etc. - then of course it should be investigated. But I do wonder how much of what we’re seeing nowadays is linked to horses not getting the correct work and routine to support them physically and owners instead wanting ‘something to fix’?

I know of at least three horses in the last few years who were sold from very well regarding professionals- fit, strong, competing at a good level – bought by amateur homes to show a new rider the ropes. Within months of stepping down, they were diagnosed with various issues, often KS. I genuinely wonder were these horses actually "broken," or did the lack of correct, consistent work allow physical niggles and weaknesses to surface?

KS is a very invasive surgery, especially the ligament snip, and I see many horses that don’t come back as strong as before, at the same time the ones that do are the ones who have been rehabbed thoroughly and correctly. Are we becoming too quick to send horses off to the vets hoping they’ll come back fixed, without first addressing their workload, posture, and overall condition?

I know this is a bit of a ramble and a can of worms, and I’m definitely not preaching. I’ve sent my horses to the vets many times at the first sign something might be off, often to be told everything is fine. But I am also guilty of going further and further down the rabbit hole of trying to find ‘something’ - there must be a reason they rush that jump, or struggle with that canter lead, or bucked me off once on a windy day in November etc.

I suppose I’m just interested in the broader conversation- what are your thoughts on all this?

 

[HopOnTrot]

Why were they x-raying a perfectly healthy horse if there wasn't an issue?

 

[frankieduck]

Why were they x-raying a perfectly healthy horse if there wasn't an issue?

If you mean the horses I mentioned that I knew personally, that wasn't my point. I was curious about whether the step-down from being ridden correctly and having a good strong core and topline, to being 'let down' and ridden less correctly had contributed to physical issues surfacing.

There was actually a really interesting study done though, in Ireland I think, will see if I can find it. Where they blind x-rayed a random population of horses showing no clinical lameness signs and found 70% presented with x-rays that indicated a KS diagnosis.

 

[Lady Jane]

I think your points are valid. A fit apparently healthy horse could develop a problem with a less able rider but if that rider doesn't have the skill to fix a problem found on the scan then treatment may be a good option. Scans can show things of no consequence eg my horse kept going lame but then went sound too quickly for me to get the MRI done. My vet wanted a particular vet to do the MRI as he said most horses would show 'something' on a scan and he wanted to focus on what he thought was the problem. 3rd lameness episode he didn't come sound and scans proved the suspected issue. If you get xrays for a vetting its a tricky one. Another horse had perfect xrays but developed problems which couldn't be diagnosed as xrays/MRI/ scintigraphy were all clear.
I also think we want to 'treat' rather than turn away for a year as we had to do years ago before we could MRI. Is that better than treatment and loads of box rest? Who knows......

 

[frankieduck]

I couldn't find the original study that I read but there was a similar one done in Germany which is interesting reading - https://www.researchgate.net/public...cial_reference_to_the_'Kissing_Spine-Syndrome'

I'm probably going off on a tangent here, but I see many horses diagnosed with KS that do not come back after treatment and are found to have a hind-limb issue contributing to the issue - are we jumping to a KS diagnosis too quickly?

 

[Caski]

Well, I come from an age where Dr Green was the chosen method to get most horses right with, in extremes, box rest. It didn't always work and horses generally didn't live as long, but times have changed and we have enhanced diagnostics, very expensive vets and by comparison, very expensive horses!

Who knows what is the right way?

 

[VictoriaSponge]

Are we becoming too quick to send horses off to the vets hoping they’ll come back fixed, without first addressing their workload, posture, and overall condition?

This, yes. Perhaps not too quick, but I would like to see a more holistic approach from all equine professionals and owners.

I also think we want to 'treat' rather than turn away for a year as we had to do years ago before we could MRI. Is that better than treatment and loads of box rest? Who knows......

Absolutely. Treating one area of concern with box rest inevitably causes others.

I agree to a certain extent op, that it’s easy to fixate on fixing one “issue” without taking into account the impact on the body and mind as a whole. Horses are flight animals; they are programmed to hide signs of distress, so we do need diagnostic techniques to look beyond obvious symptoms of discomfort.

But speaking from a human medicine perspective, it can be ridiculously difficult to get two specialists to look beyond their area of concern and think about a person’s overall quality of life, rather than just prescribing a drug that should “fix” the issue they are contracted to treat. To some extent I think this is mirrored in the horse world.

 

[JFTDWS]

That works both ways though.

How often do we hear people saying "he's being a knob, it's behavioural because his scans and x-rays were clear". Like that makes it OK to ignore the horse's obvious discomfort.

I do agree that, with some horses, there's scope for working on posture, and managing physical issues - I do think people turn to veterinary solutions for what could be solved more effectively with better management and a more appropriate job. But humans are generally just rubbish.

 

[ihatework]

Huge topic. One of my favourites. Will try and find some time to come back and structure a brain dump in due course.

 

[BurntontheoutsideTurkey]

I think this is can of worms territory. Yes good riding and postural training must help in holding off or preventing problems that would surface in some (perhaps many) horses with less good riding and training. But how many riders/trainers who are truly of this calibre are available for the horses who need them? Not enough, I suspect. Should many horses not be ridden if they don't have access to a rider/trainer who can help them? And how often is a 'good' rider simply a strong and talented rider who can hold a horse together and get a performance out of it when it does in fact have a problem and this problem is all too evident with a 'lesser' rider?

 

[frankieduck]

This, yes. Perhaps not too quick, but I would like to see a more holistic approach from all equine professionals and owners.

Absolutely. Treating one area of concern with box rest inevitably causes others.

I agree to a certain extent op, that it’s easy to fixate on fixing one “issue” without taking into account the impact on the body and mind as a whole. Horses are flight animals; they are programmed to hide signs of distress, so we do need diagnostic techniques to look beyond obvious symptoms of discomfort.

But speaking from a human medicine perspective, it can be ridiculously difficult to get two specialists to look beyond their area of concern and think about a person’s overall quality of life, rather than just prescribing a drug that should “fix” the issue they are contracted to treat. To some extent I think this is mirrored in the horse world.

Thank you! I think you summed up what I was trying to say much more clearly and quickly

 

[frankieduck]

I think this is can of worms territory. Yes good riding and postural training must help in holding off or preventing problems that would surface in some (perhaps many) horses with less good riding and training. But how many riders/trainers who are truly of this calibre are available for the horses who need them? Not enough, I suspect. Should many horses not be ridden if they don't have access to a rider/trainer who can help them? And how often is a 'good' rider simply a strong and talented rider who can hold a horse together and get a performance out of it when it does in fact have a problem and this problem is all too evident with a 'lesser' rider?

Interesting for sure! I do often wonder how much of the problems modern horses develop, have come from the way we have changed in the way we own them and ride them. On the one hand we are much more aware of issues and have better veterinary expertise and knowledge which is brilliant. At the same time, horses used to hack for miles, they were worked regularly, spent less time in an arena and often had a good break being turned away once a year.

How much is modern management playing into all of this?

 

[BurntontheoutsideTurkey]

Interesting for sure! I do often wonder how much of the problems modern horses develop, have come from the way we have changed in the way we own them and ride them. On the one hand we are much more aware of issues and have better veterinary expertise and knowledge which is brilliant. At the same time, horses used to hack for miles, they were worked regularly, spent less time in an arena and often had a good break being turned away once a year.

How much is modern management playing into all of this?

Equally arena work has a way of showing up issues that are much less evident when working in a straight line and not 'in an outline' - as well as probably contributing to the development of certain issues that weren't there before. How many horses of the past that hacked and hunted, say, did so despite having problems but could manage because the work was more biologically appropriate? Impossible to know. I spent a long time trying to nudge a friend to the realisation that her horse was broken (her trainers rode him and got a tune out of him, and then laughed and called him lazy) but when she moved to a yard with an indoor and a better surface (ironically) she really started to get on with improving his schooling and then he broke in a terminal way that was obvious to everyone.

 

[lizziebell]

I do believe that if you go looking for a problem, then you will find one, no matter how small.

 

[TheMule]

Knowledge is power. I get things scanned or x-rayed if I have a little question mark- I know my horse very well and I know if something is slightly different to normal. That might then tell me all is ok, to back off and give a month of easy work to let something minor settle, or if a bit more intervention is required.

 

[stangs]

Gone on a ramble but


“If a horse isn’t showing any clinical signs of discomfort, does it really matter what shows up on x-rays?”

In theory, no. I was talking about this with my physio the other day, and she commented on the fact that many people have a degree of pelvic rotation or disc herniation, which might cause intense sciatica for some people but no pain for others. Having strong and healthy back muscles makes you considerably less likely to experience pain.

In practice, however, how many people can actually identify clinical signs of discomfort, particularly as some horses internalise pain/stress for than others? The warmblood who does kite imitations is far more likely to get a lameness work-up than the cob who’s “too lazy to work properly.”

I do also think that the lack of correct work is also a big issue. De Kunffy writes that the first stage of dressage is rehabilitation, helping reform the inherent, habitual or other crookedness of the horse. But in a world where many people treat dressage as “stressage”, a boring activity to just get the horse’s neck down and round, and toes flicky, largely for aesthetic purposes, how often are people actually schooling for that first rehabilitative stage?

And if you’re not addressing (whether through ridden dressage, clicker trained in-hand work, or anything in between) the crookedness and bracing when it’s small, then the horse is only going to get more crooked, meaning an increased risk of injury, which leads to box rest, which leads to loss of muscle and further crookedness, and so on.

Or, in OP’s example, are these KS-x-ray horses deteriorating because they’re no longer ridden by people who can hold a lame horse together (as Burntoast says) or does the loss of correct work mean loss of muscle mean the bad x-rays become a real problem?

 

[Flame_]

Yeah, I arrived at this conclusion years ago. Stop enthusiastically investigating chronic stuff, deploy rest and conditioning, and encourage the horse to remain as active and strong as possible whist never pushing it into distress territory. I'm all for a few steroid injections for the most likely sore spots too.

 

[frankieduck]

Gone on a ramble but


“If a horse isn’t showing any clinical signs of discomfort, does it really matter what shows up on x-rays?”

In theory, no. I was talking about this with my physio the other day, and she commented on the fact that many people have a degree of pelvic rotation or disc herniation, which might cause intense sciatica for some people but no pain for others. Having strong and healthy back muscles makes you considerably less likely to experience pain.

In practice, however, how many people can actually identify clinical signs of discomfort, particularly as some horses internalise pain/stress for than others? The warmblood who does kite imitations is far more likely to get a lameness work-up than the cob who’s “too lazy to work properly.”

I do also think that the lack of correct work is also a big issue. De Kunffy writes that the first stage of dressage is rehabilitation, helping reform the inherent, habitual or other crookedness of the horse. But in a world where many people treat dressage as “stressage”, a boring activity to just get the horse’s neck down and round, and toes flicky, largely for aesthetic purposes, how often are people actually schooling for that first rehabilitative stage?

And if you’re not addressing (whether through ridden dressage, clicker trained in-hand work, or anything in between) the crookedness and bracing when it’s small, then the horse is only going to get more crooked, meaning an increased risk of injury, which leads to box rest, which leads to loss of muscle and further crookedness, and so on.

Or, in OP’s example, are these KS-x-ray horses deteriorating because they’re no longer ridden by people who can hold a lame horse together (as Burntoast says) or does the loss of correct work mean loss of muscle mean the bad x-rays become a real problem?

I find all this super interesting. I was actually booked in for an operation on my back for a herniated disc. While I was waiting for my op date my surgeon advised I do as much as possible to strengthen my core to support by back ready for the recovery period, so I embarked on several weeks of gentle exercise, walking and pilates. By the time my appointment rolled around my surgeon decided at my pre-op that I had actually improved so much I was no longer a candidate for surgery and to keep doing what I was doing.

Of course it's not always that straightforward, and an added layer of complexity when you're dealing with animals that can't sit down and tell you how sore something is or what is bothering them, or not.

 

[frankieduck]

Equally arena work has a way of showing up issues that are much less evident when working in a straight line and not 'in an outline' - as well as probably contributing to the development of certain issues that weren't there before. How many horses of the past that hacked and hunted, say, did so despite having problems but could manage because the work was more biologically appropriate? Impossible to know. I spent a long time trying to nudge a friend to the realisation that her horse was broken (her trainers rode him and got a tune out of him, and then laughed and called him lazy) but when she moved to a yard with an indoor and a better surface (ironically) she really started to get on with improving his schooling and then he broke in a terminal way that was obvious to everyone.

I think this is also very valid. I currently have 2 highly sensitive horses, outwardly they both show signs of what I would immediately assume would be ulcers, had them both scoped and came back clear. Years ago I had a very laid back horse, he would light up on the hunting field but was bone idle doing anything else. In hindsight and knowing what I do now, I think he probably had ulcers. To look at him you would say he did not present as a typical horse with ulcers - but the signs were there (hated being groomed but too polite to do more than pin his ears, resistant off the leg, protective of his food, had endured a long journey over from Ireland), he went for several vet investigations to see if we could find a cause of his laziness but ulcers was never mentioned to me, presumably because he was a fat ISH and not your 'typical' ulcer case.

 

[emilylou]

I find all this super interesting. I was actually booked in for an operation on my back for a herniated disc. While I was waiting for my op date my surgeon advised I do as much as possible to strengthen my core to support by back ready for the recovery period, so I embarked on several weeks of gentle exercise, walking and pilates. By the time my appointment rolled around my surgeon decided at my pre-op that I had actually improved so much I was no longer a candidate for surgery and to keep doing what I was doing.

Of course it's not always that straightforward, and an added layer of complexity when you're dealing with animals that can't sit down and tell you how sore something is or what is bothering them, or not.

Exactly this. The problem can still be present but if the supporting structure is strong and comfortable then the symptoms can disappear. I've just finished a fabulous hunting season on a horse that has navicular, bilateral hind PSD and a number of other niggles/injuries. However he is fit and well conditioned from his work, rehabbed properly after all his injuries and kept sound by not doing aggravating activities. If he was unfit or asked to do work that aggravated his issues (eventing on hard ground) then he'd break. But as he is, he is very comfortable and would probably pass a 5 stage vet, but would scan horribly.

 

[BurntontheoutsideTurkey]

And it depends on the exact nature of the pathology - some issues can be effectively cured by the right work (and may deteriorate without), and some can't (they need rest or medical intervention), but can still be masked by a strong skilled rider, and given the average person's ability to see when a horse is 'off' or slightly lame even.

 

[sbloom]

Sorry, not read replies, but the sooner we universalise an understanding of what correct movement is the less any of this will be an issue. We do not strive for correct horsemanship, as owners we tend towards the "entitled" direction, even though everyone loves their horse very much. If we had better training and management, and better observation skills, then we would more easily be able to change how we ride, saddle/tack, management in all ways, and have fewer issues, whatever shows on an xray.

 

[LEC]

If you mean the horses I mentioned that I knew personally, that wasn't my point. I was curious about whether the step-down from being ridden correctly and having a good strong core and topline, to being 'let down' and ridden less correctly had contributed to physical issues surfacing.

There was actually a really interesting study done though, in Ireland I think, will see if I can find it. Where they blind x-rayed a random population of horses showing no clinical lameness signs and found 70% presented with x-rays that indicated a KS diagnosis.

Of course if something is not worked correctly then it will have issues. It’s like you sitting at a desk. If you sit correctly and do all the correct breaks, have right kit etc you won’t have issues, if you change one thing like chair then you might be ok for short term and just have a minor niggle which is fine, if you changed everything like desk, chair etc then you will ultimately suffer.

 

[Cloball]

In people, sometimes horrendous arthritic x-rays have minimal symptoms and vice versa, the problem with animals is they can't tell us and a lot of people aren't great at reading their discomfort. I worry we extrapolate from human examples to much and ignore what might actually be symptoms of discomfort in polite and stoic horses and fail to investigate further screaming horses with clear x-rays.

In the other hand I'm a crock of a human with chronic pain and perfect MRIs

 

[Amy May In A Manger]

Well, I come from an age where Dr Green was the chosen method to get most horses right with, in extremes, box rest. It didn't always work and horses generally didn't live as long, but times have changed and we have enhanced diagnostics, very expensive vets and by comparison, very expensive horses!

Who knows what is the right way?

And good and prompt treatment aside, Dr green always seems to be the best medicine.

 

[pistolpete]

When my first horse went sort of wonky the first time my vet advised to work him hard for a week to see if it would show the area of concern more clearly. He got stronger and was less wonky in a week! He did have C6/C7 neck issue which was discovered years later but I did just enough to keep him ticking over. I back off when he couldn’t cope. Sometimes for a year. Think the vets would have put him down 10 years before twisted gut killed him. So I ride the horse not the X-rays but very mindfully!

 

[spotty_pony2]

Completely agree with this. I’ve heard of some horses who have horrendous findings on x-ray and it’s never caused them any problems and there are some who are clean on x-ray and they are very lame. I have much more faith in mri than x-ray for identifying unless it’s an obvious bone break.

 

[U.N.Owen]

This phrase was coined for horses that were failing vettings on x-rays but with other owners were then going to the Olympics etc

It fails to mention all the ones that don't (which I imagine far outweighs the ones that defy the x-rays).

Not for horses that you've x-rayed and think there is an issue and then ignore

 

[frankieduck]

This phrase was coined for horses that were failing vettings on x-rays but with other owners were then going to the Olympics etc

It fails to mention all the ones that don't (which I imagine far outweighs the ones that defy the x-rays).

Not for horses that you've x-rayed and think there is an issue and then ignore

I’m not suggesting ignoring an obvious issue at all. It’s more, as another poster explained much better than me, are we relying too much on an instant diagnosis and finding ‘something to fix’, rather than looking at the whole horse holistically?

I’m very lucky that my own vet takes quite a holistic approach and will often say to me “yes we can inject this to help short term, but you need to strengthen X and Y to support the horse going forward”. But I see many horses that seem to be stuck on the production line of getting this and that injected, back in for more investigation, ligament snips, bone shaves… coming back weaker than ever.

Essential I guess my pondering is, have we forgotten how to step back and look at the whole horse un favour of what we now view as ‘quick-fixes’ available to us?

I use the example of KS because I’m on a few FB groups around rehabbing KS and find it really interesting to see how much of successful rehabilitation comes from the veterinary treatment versus those who really focus on the horses posture, strength and management going forward.