Vetinary physio for lame horse- does it work?

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SilverFilly

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Bare with me! This is a long one!

So my new and sparkly event horse is lame...in both back legs! He has not been worked for over a month with previous owner nor has he been worked on anything other than a lunge for 15 mins with me and one day he comes in lame! I have had two vets down to assess, no heat or swelling and they cannot pin point where his pain is coming from, basically without me spending 2.5k on investigations, they're stumped! They have recommended a physio come out and assess him, I've never had a physio out for anything other than my eventers have stiffened up slightly after a competition. Basically my question is, can a physio help in this situation? Vets are stumped and I don't think my sensitive TB gelding would tolerate having multiple nerve blocks injected into both legs!

TIA x
 
Get a different vet! Investigations won't cost 2.5k for a start, and any vet worth his/her salt will be able to narrow down the location of a lameness. I can't quite believe that a vet would refer to a physio, when they don't know what's wrong with the horse - that's gross professional misconduct.
 
A physio can certainly help by pinpointing any muscle tightness which could give tb vet a clue as to where to look.

My boy failed a vetting when I got him with a sore back and dragging his hinds. A physio sorted out the tightness in his back and was pretty sure it was a hind limb problem. It turned out not to be, but just a simple sore back probably caused by a poorly fitted saddle.
 
I know a vet (not mine), who referred a lame horse to a physio as they felt the lameness was coming from somewhere else, although they did no investigations to come to this conclusion.

Anyway, that aside, Polly appeared 1/10 lame on one rein on the lunge at the vetting. She had just come back into work after an accident and lacked a lot of muscle. Vet was pretty sure that the hindleg lameness was due to lack of muscle and that she wasn't using her leg properly. I took the chance and after a 6 week plan set by the physio, with lots of walking, hacking and exercises, she is now totally sound on the lunge.

She was only 1/10 though.
 
I would want to have a decent explanation as to why an event horse missed over a months work mid season and has then been sold, did you get his veterinary history before purchase and have a thorough vetting, to me it sounds as if he may have arrived with an injury that was not showing at the time of viewing/ vetting and I would start by getting the bloods run and having a look at the history before getting into investigating this.

If it does seem to be recent, since purchase, then I would probably give it a short break, have an ACPAT physio to assess and if nothing obvious shows ask for a referral to a specialist vet where they can get to the bottom of it but it will add up and you will probably not be covered by insurance as it showed up so soon after purchase, I think in the circumstances it is fair to refer for physio because the OP will not be insured and we all know how quickly investigations run into thousands.
 
be positive said:
I would want to have a decent explanation as to why an event horse missed over a months work mid season and has then been sold, did you get his veterinary history before purchase and have a thorough vetting, to me it sounds as if he may have arrived with an injury that was not showing at the time of viewing/ vetting and I would start by getting the bloods run and having a look at the history before getting into investigating this.

If it does seem to be recent, since purchase, then I would probably give it a short break, have an ACPAT physio to assess and if nothing obvious shows ask for a referral to a specialist vet where they can get to the bottom of it but it will add up and you will probably not be covered by insurance as it showed up so soon after purchase, I think in the circumstances it is fair to refer for physio because the OP will not be insured and we all know how quickly investigations run into thousands.
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Hi! I bought my horse from my best friend, she is epileptic and has unfortunately had to sell as her seizures and black outs have become worse, she used to get a warning when she was going to pass out but she doesn't now, so it's become dangerous to be around horses, she is currently in hospital undergoing brain surgery in the next couple of days. Despite me buying from my friend he still had a 5 stage vetting which he flew through.

My vet has been out twice to him, she first looked for abscesses which came up negative. She then did a full lameness assessment (Trot up, lunge work, flexion tests etc) flexion tests were positive so he's clearly in pain but she cannot pin point where he is in pain as he just reacts to anyone touching his leg. No heat, no swelling, uncomfortable on circles and in straight lines.

My vet is one of the top equine vets in the country (Leahurst teaching hospital in Chester) they have never let me down with any of my eventers in the past sl I trust them 100%.

I have only had my boy a week so I cannot claim on my insurance for these investigations as I have a 14 day exclusion clause :( they wanted to take him into the hospital, nerve blocks In both legs and imaging (which costs £1,200 alone!!) however he is a big sensitive TB so will not tolerate multiple needles in one leg let alone 2 so we are going down the small paddock rest, Bute and physio route before I have to break open the piggy bank and maybe go to bank of dad.

So frustrating because I just want to help him :(
 
Auslander said:
Get a different vet! Investigations won't cost 2.5k for a start, and any vet worth his/her salt will be able to narrow down the location of a lameness. I can't quite believe that a vet would refer to a physio, when they don't know what's wrong with the horse - that's gross professional misconduct.
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Please see my reply above :) explains all! Imaging they want to do costs £1,200 alone!
 
That is a good reason for him being off and as you are her best friend it is likely he has just had a slip or something in the field since he arrived with you, I would certainly rest him and have physio at this stage, it may resolve with no further intervention if it is acute, I think people often jump in doing too much too soon when all they need is a few weeks off to either heal or allow the real problem to show up more clearly.
 
be positive said:
That is a good reason for him being off and as you are her best friend it is likely he has just had a slip or something in the field since he arrived with you, I would certainly rest him and have physio at this stage, it may resolve with no further intervention if it is acute, I think people often jump in doing too much too soon when all they need is a few weeks off to either heal or allow the real problem to show up more clearly.
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Thank you :) I was hoping he had maybe just skidded in the field or done some tiny splits when he's been having a mad moment In the field (excited TB in new livery yard, you can imagine the pocket rocket I had on my hands the first few days!) when the physio comes it will be coming up to two weeks since he went lame, fingers crossed he comes sound for me! 🤞🏻
 
SilverFilly said:
Please see my reply above :) explains all! Imaging they want to do costs £1,200 alone!
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I still think this is odd - if she carried out flexion tests, which were positive, then she DID pinpoint where he's lame, so it would be very easy to scan/xray the joint that was positive on flexion (and it wouldn't cost more than a few hundred quid) I'm fine with the "rest and see how it goes" approach -there's no shame in going down that route at all.

I'm just a little confused about what Leahurst has said - one of the Uk's leading teaching hospitals saying they can't figure out what's wrong with a horse that's lame on flexion, and referring it to a physio. Something very strange there - there's a big difference between suggesting resting a horse for a few weeks and giving it a few physio sessions to resolve a bit of muscular tightness - and saying "Don't know what's wrong with this lame horse - call a physio.
 
Auslander said:
I still think this is odd - if she carried out flexion tests, which were positive, then she DID pinpoint where he's lame, so it would be very easy to scan/xray the joint that was positive on flexion (and it wouldn't cost more than a few hundred quid) I'm fine with the "rest and see how it goes" approach -there's no shame in going down that route at all.

I'm just a little confused about what Leahurst has said - one of the Uk's leading teaching hospitals saying they can't figure out what's wrong with a horse that's lame on flexion, and referring it to a physio. Something very strange there - there's a big difference between suggesting resting a horse for a few weeks and giving it a few physio sessions to resolve a bit of muscular tightness - and saying "Don't know what's wrong with this lame horse - call a physio.
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I've always understood that you can't isolate one joint on a flexion and that nerve blocks are then required.

The horse is needle intolerant. They want him in hospital to do further tests, understandably. And they are, being a hospital with expensive manliness to finance, suggesting a full range of tests. That's what Leahurst does. My friends horse was given a full body scan before they nerve blocked, and of course the nerve block showed he was lame in a foot just where we all expected!

Owner has rightly rejected that on the grounds of cost, and hopefully will find out what we used to know in the old days, before these expensive techniques existed, that a spell out at grass will sort him out without any more expense.
 
ycbm said:
I've always understood that you can't isolate one joint on a flexion and that nerve blocks are then required.

The horse is needle intolerant. They want him in hospital to do further tests, understandably. And they are, being a hospital with expensive manliness to finance, suggesting a full range of tests. That's what Leahurst does. My friends horse was given a full body scan before they nerve blocked, and of course the nerve block showed he was lame in a foot just where we all expected!

Owner has rightly rejected that on the grounds of cost, and hopefully will find out what we used to know in the old days, before these expensive techniques existed, that a spell out at grass will sort him out without any more expense.
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I agree, if the vet flexes the entire leg - but if they do it properly, flexing each joint individually, it will be obvious which joint is causing the horse discomfort, so that is the joint that should be investigated. If the horse isn't reactive to flexion, then I agree that extensive investigation is the only way to go, IF the owner is going down the clinical diagnostics route. This horse was apparently reactive to flexion though, so I would have thought that £2.5k worth of diagnostics would be extreme overkill.
If you re read my earlier post, you'll see that I said I didn't have an issue with the "rest and see" approach. It's probably what I'd do.

If Leahurst is charging huge amounts of money for full investigations of the entire horse, when they have a positive flexion to guide their diagnosis, they should be called to account for it. It may be a good way to make their money, but it's not an ethical way. I've had professional dealings with them in the past, and Id didn't get the impression that they operated like this, but I guess you don't always see the true picture.
 
Auslander said:
I still think this is odd - if she carried out flexion tests, which were positive, then she DID pinpoint where he's lame, so it would be very easy to scan/xray the joint that was positive on flexion (and it wouldn't cost more than a few hundred quid) I'm fine with the "rest and see how it goes" approach -there's no shame in going down that route at all.

I'm just a little confused about what Leahurst has said - one of the Uk's leading teaching hospitals saying they can't figure out what's wrong with a horse that's lame on flexion, and referring it to a physio. Something very strange there - there's a big difference between suggesting resting a horse for a few weeks and giving it a few physio sessions to resolve a bit of muscular tightness - and saying "Don't know what's wrong with this lame horse - call a physio.
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From what I can gather, they would have to pull the horse in for a full lameness work up, obviously at cost, which I think OP would rather not do straight away (do correct me if I'm wrong OP), rather than Leahurst saying they don't know whats wrong with it, get a physio.
 
Auslander said:
I agree, if the vet flexes the entire leg - but if they do it properly, flexing each joint individually, it will be obvious which joint is causing the horse discomfort, so that is the joint that should be investigated. If the horse isn't reactive to flexion, then I agree that extensive investigation is the only way to go, IF the owner is going down the clinical diagnostics route. This horse was apparently reactive to flexion though, so I would have thought that £2.5k worth of diagnostics would be extreme overkill.
If you re read my earlier post, you'll see that I said I didn't have an issue with the "rest and see" approach. It's probably what I'd do.

If Leahurst is charging huge amounts of money for full investigations of the entire horse, when they have a positive flexion to guide their diagnosis, they should be called to account for it. It may be a good way to make their money, but it's not an ethical way. I've had professional dealings with them in the past, and Id didn't get the impression that they operated like this, but I guess you don't always see the true picture.
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I think many vets now rely on the machines far too much and have lost the art of feeling what is wrong, my horse had a firm diagnosis of why he was lame and was sent in to hospital for a fairly straightforward op which was done standing yet they still ran through the whole range of tests inc an MRI to "confirm" that he had a fractured splint bone, he had a bill for around £2.5k for diagnostics and less than £1k for the op, he actually did have another injury that was totally missed out despite all the tests being done so yes I do think some will run tests to help finance their practice.
 
be positive said:
I think many vets now rely on the machines far too much and have lost the art of feeling what is wrong, my horse had a firm diagnosis of why he was lame and was sent in to hospital for a fairly straightforward op which was done standing yet they still ran through the whole range of tests inc an MRI to "confirm" that he had a fractured splint bone, he had a bill for around £2.5k for diagnostics and less than £1k for the op, he actually did have another injury that was totally missed out despite all the tests being done so yes I do think some will run tests to help finance their practice.
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Urggh - it's just not right! I had the vet out a few weeks ago, for a non-specific "not rightness" - horse was obviously not sound, but damned if I could work out which bit of him was hurting. Vet watched him walk, trot and turn, agreed that he looked wibbly wobbly, rather than lame, then flexed him systematically, and pronounced that it was both hocks. Owner didn't want xrays/scans, so vet medicated both hocks, and horse is now sound. Bit speculative, but the outcome was good - and it only cost the price of a call out, examination, and steroids. He used the phrase "Old school" at one point, and I thought at the time that it's a bit sad that an eyes and hands diagnosis is now considered to be old school.
 
Auslander said:
Urggh - it's just not right! I had the vet out a few weeks ago, for a non-specific "not rightness" - horse was obviously not sound, but damned if I could work out which bit of him was hurting. Vet watched him walk, trot and turn, agreed that he looked wibbly wobbly, rather than lame, then flexed him systematically, and pronounced that it was both hocks. Owner didn't want xrays/scans, so vet medicated both hocks, and horse is now sound. Bit speculative, but the outcome was good - and it only cost the price of a call out, examination, and steroids. He used the phrase "Old school" at one point, and I thought at the time that it's a bit sad that an eyes and hands diagnosis is now considered to be old school.
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Sadly it is "old school" the vet I now use after the fiasco of my horse and what he went through being "diagnosed" is hands on, he came out and immediately picked up the SI injury that had been overlooked by the hospital who declared him sound.
 
scats said:
From what I can gather, they would have to pull the horse in for a full lameness work up, obviously at cost, which I think OP would rather not do straight away (do correct me if I'm wrong OP), rather than Leahurst saying they don't know whats wrong with it, get a physio.
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Hi scats :) you are correct, they wanted him In for a full lameness work up which includes blocks, scans and multiple man hours watching him trot up. As he is lame in both back legs, the number of blocks needed doubles (obviously) and right now I just don't think I want to put him through it. He's a highly strung eventing TB who hasn't been worked properly in a month so he is a handful at the best of times, let alone someone trying to stick needles in his legs! It has only just hit the 7day mark since he went lame, if he had done the splits or a skidding halt in the field, I wouldn't expect him to be coming right yet! Id like to give him between 2 and 3 weeks before I even start looking for an improvement :)

Vets are just confused as there is no "X marks the sore spot" on him, and no heat or swelling to guide the way! He is reacting to everything, he's basically saying "ow" to his whole leg being touched so I can understand the vet being baffled about where exactly he is sore :)
 
Aus- we too managed to flex a hock... it was query hock/stifle at the time, physio thought stifle :p. Decided it looked dodgy, shoves some steroid in rather than nerve block and hey presto.

OP you have choices you wait and see
you get the physio
you take him in reminding them that he is not insured, is not a referral but a first opinion case and they do not have to throw everything and the kitchen sink at him diagnostically if you ask them not to but be a little more systematic about it.
 
The reciprocal apparatus makes it impossible to flex the hock without the stifle and fetlock unless something very severe is going wrong.
 
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