Here is a similar story:
A 4-year-old castrated male Miniature Horse was evaluated because of severe right hind limb lameness of 5 days' duration. The diagnosis of craniodorsal luxation of the right coxofemoral joint was made by physical examination and radiographic imaging. Closed reduction was attempted but was unsuccessful. Surgical reduction was successfully performed, using toggle pin, synthetic capsular reconstruction, and trochanteric transposition techniques. No postoperative complications were observed. Follow-up 26 months after surgery revealed no recurrence of the luxation and no evidence of lameness. These surgical techniques are used successfully for repair of coxofemoral luxations in small animals. To our knowledge, there has been no report of these techniques attempted in horses. These surgical techniques may have merit for the treatment of coxofemoral luxations in small equine patients.
The end.
A few years ago, when I was a vet student, I was three or so weeks out from a three day event with a 17 hand, 9 year old Thoroughbred horse. He had been going great guns when I noticed that for about three hours a day he would try as best he could to sit on his feed bin. Now this feed bin was of the metal variety that hung on the fence, so it was about 1.1 metres off the ground.
Everything about the horse otherwise was normal, and he was being cantered twice a week and I think at that stage he was up to about four four minute canters at around 450 mpm. I talked to a few various horse people, and the general consensus was that it could be a ‘back problem’. I was given the name of a reputable ‘back person’ at a race track in Sydney so off I went.
Two hours in the pouring rain, in Sydney traffic, trying not to get lost in the back streets surrounding the racecourse. A pot bellied, unshaven man dressed appropriately in thongs, stubbies and T-shirt greeted me and introduced himself as the ‘back man’ who had been recommended to me.
He briefly asked what I did with the horse and then started poking and prodding before reefing and pulling all four legs at all bizarre angles, seemingly not satisfied until a very audible crack was achieved. When he got a crack, he grunted his approval and then moved on. After about three minutes of leg reefing, from the back pocket of his stubbies he produced a Slazenger tennis ball with which he produced about a half dozen more cracks along my pride and joy’s spine.
After a terrifying ten minutes of reefs, cracks and grunts he informed that my horse had been out in the left shoulder and right hip and that he should be right now and that would be forty bucks. Feeling utterly ripped off rather than relieved, I drove home thinking how difficult it had been to put a Kelpie’s dislocated hip back in under a general anaesthetic, apart from the fact that the dog had walked into the clinic where I was doing prac work absolutely three legged lame.
So, when I got home I wasn’t overly surprised when my horse went straight back to sitting on his feed bin.
The structure and function of a horse’s back is very intricate and complex and if I tried to describe it here in full I’m sure even the Editor would fall asleep reading. Basically there is bony vertebrae supported and surrounded by ligaments and muscles. Cervical vertebrae are in the neck, thoracic vertebrae have ribs attached, lumbar vertebrae are next, then sacral vertebrae attach to the pelvis and caudal vertebrae are the tail.
The main muscle that runs parallel to the spine is known as the longissimus dorsi and as the name suggests it is the longest muscle in the body. It is made up of small bundles which attach to each of the vertebrae combining to form a muscle body that runs either side of the spine and also attaches to the pelvis. In between each vertebrae there is several articulations (joints). O.K that’s enough anatomy for the moment.
How do we know if our horse has a sore back? Does your horse resent being saddled, buck, shake his head, is he stiff on one rein, does he resent collection, refuse at spread fences or combinations, become cross-gaited or disunited in the canter, dip his back when you hose him with cold water, not travel straight, dip his back when you first get on, does he sit on his feed bin, does he flinch when you poke him with your thumbnail, or is he just not performing well?
Well, if the answer is yes to any of these then your horse may well have a sore back, it may also have a perfectly normal back. The complexity of the structure and function of the back and the wide range of non-specific signs of back pain make a definite diagnosis difficult.
To complicate it even more you can have two different horses with exactly the same lesion or problem and one will tell you that he is dying and the other one will go out and win. As a cynical trainer once said to me ‘if the bastards could talk they’d probably lie!’
If you are unsure if your horse has a back problem think about the onset of signs. Has he always been like it, or was it only after he flipped over backwards off the tailgate of the truck? Is it just since you got a new saddle, or since you started playing around with passage?
Sore backs that are very painful and sudden onset are much easier to say, yes it’s definitely the back that’s the problem, than those mild niggling on-and-off temperamental changes that creep up on you over six months. Ask around. Get experienced horse people (not just vets) to look at your horse while he’s doing whatever it is that makes you think that he has got a sore back. Make sure that it’s not a leg lameness that is the underlying cause of the sore back. It can be worthwhile to administer a short course of anti-inflammatories to see if that makes any difference.
Once you’ve decided that your pony has a sore back, is that a specific enough diagnosis? Unfortunately there is still a huge amount to learn about medical conditions that affect the equine back. So when medical science is inadequate it opens the door for witch doctors to move in, crack a few joints, mumble a few spells, collect a fee and drive off saying ‘that’ll fix it’. Quite often there is an immediate improvement, soon followed by a return of the signs of a sore back.
With any back problem, no matter what the underlying cause, there will be quite a lot of guarding or spasming of the muscles around the affected area of back. This restricts the mobility of the spine and is quite uncomfortable. Manipulations, massage and other forms of physiotherapy will reduce this spasming and allow the muscles to relax and return to normal function, but if the underlying cause is not resolved then the problem will more than likely return.
Have you got a good back person in your district? I do, Cathy Oates is her name. How do you decide if they are good or if they are witch doctors with the gift of the gab? Ask around. Do they diagnose the same problem and describe the same treatment for every horse they see? Do they ever say that there is nothing wrong with this horse’s back, the problem may lie else where. Have they done any formal training? Is there any science behind the yarn that they are spinning? Do they give you follow up instructions as to how your work should continue with the horse? Have they ever cut up a spine or a hip or shoulder joint before they say that they are out?!
As far as vets go, there are numerous vets around that specialise in backs (Jack Laing, my first boss is one) and they have usually done further education courses in chiropractics or acupuncture. It is a good idea to source these vets out if you have a chronic back problem to help with long term management and to get an idea of the prognosis or the likelihood of recurrence.
As far as I’m concerned, I’m no back expert, I could tell you if it’s got a sore back, if it’s bad, if you need to go to a referral hospital for scintigraphy or good radiographs, if Cathy may be able to help, or if a short course of bute and a rest with a gradual re-introduction of work via lunging with a chambon may be called for.
The known conditions that affect the back in the thoracicolumbar region include:
* Deformities of the vertebral column (scoliosis, lordosis, kyphosis, synostosis, sacralisation)
* Soft tissue injuries (muscle strain and spasm, ligament damage, tying up)
* Fractures(dorsal spinous processes, vertebral bodies and neural arch)
* Other vertebral and articular lesions (spondylosis, kissing spines, osteoarthritis and fusion of articular and spinous processes, chronic sacroiliac instability and spur formation)
Conditions which are alleged to cause problems for which there is currently no definitive scientific evidence in the horse include:
* Vertebral subluxation or malalignment of dorsal spinous processes
* Intervertebral disc prolapse or herniation
* Pinching of nerves to structures around the thoracicolumbar spine.
Once you’ve decided that your horse has a sore back then your management of his back pain will vary from case to case, but your options include:
* Rest. Very useful and important in severe cases. Doesn’t always mean complete rest but rather a reduction in the workload that the back does.
* Management. Replace saddle. Use gelpad. Change work routine. Attempt re- schooling. Attention to rider’s methods.
* Medication either orally or injected into the sore area of the back.
* Muscle relaxants. Pentosan if a degenerative joint condition is suspected.
* Physiotherapy. This is very important in low grade chronic back pain. Heat therapy. Ultrasonic therapy. Muscle stimulation. Magnetic field therapy (magnetic rugs). Swimming. Graduated exercise program.
* Manipulative therapy either standing or under general anaesthesia
* Natural Medicine. Acupuncture, using either conventional or laser methods (I still remain very open minded about acupuncture).
* Radionics, homeopathy, iridology, faith healing I am very sceptical of these methods
* Surgery for compound fractures of the withers and possibly for kissing spines.
Until we know more about the biomechanical and functional anatomical aspects of the horse’s back and the conditions affecting it, then definitely diagnosing the problem and successfully managing the back in performance horses will remain a big challenge to vets, ‘back people’ and horsemen alike.
Go to http://books.google.com/books?id=R6sCAAAAYAAJ&pg=PA290&lpg=PA290&dq=dislocated+horse+hip&source=web&ots=2GMqRndfRX&sig=XibKufg0qCKKT6gY9VIqxz1g43o for more info.