Let's Talk Hocks

First off - still no word from Groton House yet. The suspense is killing me!! But in other good news, both my checks for Riga Meadow and for Area Championships were cashed today, so that means I got into both of them. Yes!


Now, here's the topic I worry about ALL THE TIME but still don't have any solid conclusions about, so advice and comments are all appreciated. As you may or may not know, last year in the early summer, Gogo started doing little things like chipping fences and taking rails in competition. She was never really lame per se, but there was something weird going on. Something wasn't right. I took her to the Equine Specialty Hospital in OH, and via flexions, blocks, and radiographs, we isolated the problem to her right hock (flexed 1 out of 5 on the lameness scale, so it wasn't bad!). I had one of two options, the first being hock injections, and the second being very proactive and less invasive maintenance. I opted for the second choice, seeing as she had only just turned 7, she was only showing BN, she wasn't really lame, and there were a lot of options to keep her comfortably going. I am anti-injection when I can be. So, we started her on Adequan and Cosequin, and the chipping and dropped rails disappeared. Her dressage work improved, and her overall condition and comfort level went way up.

Fast forward to now. She's in much harder work, and I worry about her comfort level. She's still on the Adequan, and we've switched to the Cosequin ASU, which is a good product even though it's damn expensive. When I put her on the lunge the other day, she looked outstanding. She's jumping really well, hacking really well, and doing dressage work really well. But there are little, subtle things that worry me. Today, her first day back to dressage work after the chiro adjustment on Tuesday, was similar to the last time she got adjusted in that she needed to figure her readjusted body out a little bit. She was very good, up until I did a few canter lengthenings on the left lead. She seemed a bit hot to trot after that, and I did a simple change across the diagonal onto the right lead. And, well, we kind of blew up a little. She didn't go crazy really, she just sort of did the head in my lap thing, and stopped steering for a few. We eventually got a few decent strides and then went right back to trot, but it was interesting that it was on the right lead, her generally weaker side (and mine too). When she was adjusted, through the applied kinesiology Dr. Amery found no hock soreness (he can tell where the horse hurts through certain points in the body, and it seems to be spot on as far as I can tell), but he need to make adjustments to her left SI as opposed to her right - compensating for the right hind? Who knows. The other thing she was doing today, very consistently, was when we would go to halt, she'd leave her right hind behind her, which isn't abnormal, but whenever I'd ask her to move that leg forward in the halt, she's comply, but she'd just rest it instead of bearing weight on it. Unusual. But then again, the most sore spot he found on her was beneath where the cantle sits on her right side, so maybe she was still sore from having that adjusted? Or here's one more option - I tend to sit crookedly to the right, and I'm very much so in pain and in need of an adjustment myself, so maybe it was me causing the crookedness? I don't know. Also though, when she was in the crossties, 90% of the time she was resting the right hind. She tends to rest both hinds a lot when standing around, but is that relaxation, or is that discomfort?

She's not lame. She's jumping really well. She's progressing fast in her dressage work. But I still worry. I want to delay hock injections for as long as humanly possible, just because a) I hate being so invasive b) anytime anything goes into a joint there's risk of infection and DEATH and c) long-term use of steroids can lead to cartilage degradation. There's a very good article here on joint injections and joints themselves, and there are bits of information on there like this:

"The lower motion joints of the hock are unique in that they are a major origin of subclinical performance issues (commonly sore back syndromes and poor movement and push from behind), yet are not essential for movement of the hock. For this reason they can be viewed in a radically different manner than other joints within the horse. In fact, if these joints were to magically be removed from your horse, they would maintain their full athletic scope and ability without the downside of persistent, low grade discomfort which often accompanies arthritic change.
For this reason, long term comfort of the horse and relief from the arthritis is the primary goal of lower hock joint treatment, NOT continued motion and flexibility of these low motion areas. This is a very important concept to grasp as joint comfort and treatment for joint function are not necessarily the same. Granted, high motion joint treatments such as Adequan, Legend (intravenous hyaluronic acid), intra-articular hyaluronic acid (HA) and low dose, short acting steroids do play some role in creating comfort. However, all of these drugs are aimed primarily at restoration of a more “normal” joint environment. The primary goal being preservation and regeneration of healthy cartilage. In lower hock joints we often take a different approach. As these joints are not necessary from athletic performance, their more reliable comfort becomes the primary goal somewhat at the expense of the cartilage involved. For this purpose, long acting steroids (the most potent anti-inflammatory available) are used."

Now, from this you can derive a few things. The lower hock joints are not important in a horse's mobility directly. Horses with fused lower hock joints perform effortless and, more importantly, pain-free. BUT, the road to a joint actually fusing is a painful and long one. So, the primary concern of a joint like this isn't to maintain mobility, but to maintain comfort and minimize inflammation. By injecting the joint with powerful steroids, you can dramatically reduce inflammation and drastically increase the horse's comfort, BUT you also take the risk that the cartilage will sustain gradual and permanent damage. Osteoarthritis doesn't heal. It doesn't go away. It's there for life, and it can only get worse over time, which is why the diagnosis was horribly depressing. There's no reason Gogo won't be able to go on and lead a rich and fulfilling competitive life, but it needs I need to be careful.

And careful I am. I use bute before and after hard workouts. I wrap, cold-hose, and use liniment and poultice regularly. I maximize turnout time, encourage movement, and provide lengthy warm-ups and cool-downs. She's on Cosequin ASU, and gets regular Adequan (and Pat says I can have some of her Legend too). I rarely jump her over 3' at home, and I rarely jump her more than once every two weeks. I don't lunge her anymore (well, there's a more complicated training issue behind all that but regular lunging also compounds the arthritis issue). I handwalk all the time. So is she still uncomfortable on some days? I don't have an answer for that. I honestly don't know. It could be this, it could be that. She's going so well that I have no reason to suspect hock pain, but when she does things like rest her right hind a lot, I still worry.

Shannon and I brainstormed all afternoon. Joint injections would mean relief if she is feeling discomfort. They might also add to her long-term soundness and performance. But, they also might contribute to her long-term unsoundness. I feel as though they are inevitable, and I'm okay with that - it'll probably have to happen next spring. But for now, we came up with some other ideas - using HPQR gel on that hock, using poultice on that hock, continuing the use of bute before and after a hard workout day, possibly looking into Surpass, adding Legend to our arsenal, and looking into the Back On Track hock wraps. I've heard nothing but totally positive things about their products, and we have a horse here who has the mesh sheet and the leg wraps. It does seem to make a difference. I'd rather try this than traditional magnets, because I dunno how I feel about magnets in all honesty. Back On Track, on the other hand, seems legitimate.

I just want her to be comfortable, happy, and able to perform her job pain-free for as long as possible. I don't know if she's achey, but I sure know that I myself get pretty ouchy on some days. She's not lame (and is moving better than ever really), is jumping great, galloping well, and hacking perfectly. So am I just creating bigger issues than need be? I don't have any idea. But I do want to avoid invasive actions until I feel that what I'm doing isn't helping enough.

Any other ideas? Opinions? Input?



PS - I apparently got some special award from Mystic for being the Area I Adult Rider with the second lowest score. Dunno what it is, but I'll set you know once they send it to me in the mail!