Lameness, Part II
Determining History and Cause
Mairen looks around briskly at the gathered herders and begins, "Alright in my first lesson I explained a bit about how to tell which leg a runner is limping on. Today I would like to go into a bit more depth on the subject, although we will save the actual causes of lameness for another day."
Mairen leans back against a wall as she continues, "Now first in general when you have a lame runner you need to consider the history of the injury. What that means is that you need to consider a few factors that very frequently can cause or contribute to the runner's lameness. These are things like the obvious questions, 'Did the runner get kicked by another runner?' 'Has the runner picked up a stone in its hoof?' or 'Did the runner stumble badly while being exercised?'. All of those questions are important, but also it's vital to know things like when the runner was last shod, has the runner been sick anytime in the recent past, and how has the lameness presented."
Mairen pauses for a moment to let everything sink in. "I'd like to elaborate here for a bit on what I mean by presentation of the lameness. I think this is one of the single most important parts of the history of the injury. The other information can give you pieces to your puzzle but the presentation will help you to decide how to treat the runner. You need to know if the injury presented suddenly - for instance, was the runner sound when you rode out, then limping on three legs when you returned, or has the runner been stiff and sore in the mornings for months and works out sound after light exercise? In this way you can begin to identify how long the runner has been lame and just what it may need to help it heal. With a sudden onset you can be pretty sure that the runner was injured recently, but with the on and off symptoms of some lamenesses the runner may have injured itself long ago and never healed properly. Most often the recent injuries are the easiest for us to treat but we can do things for the long term ones as well."
Mairen leads Nighthawk from his stall and pats his neck before turning back and continuing, "Now that you have managed to ferret out the history and you know how the lameness presented you can proceed to the next step. First you will conduct an exam, the gait evaluation at a trot, as I described before, to determine if possible which leg the runner is favoring. Next we will proceed to what is called a flexion test. I've decided to use Nighthawk for this because he is old enough that he may have some joint stiffness due to his age. The flexion test will help us determine if the lameness is a joint problem or not. Alright Lisa, will you come hold Nighthawk's head and trot him off quickly when I say to, please."
Mairen hands the lead to Lisa and moves to stand by Nighthawk's left shoulder, "What I am going to do is to flex his leg tightly and hold it that way for a moment, then Lisa will trot him off briskly. The forced flexion will cause any pain he may have in his joints to increase for a few moments. By trotting him off immediately after flexing the joints we can often see a very perceptible limp. Also we can more closely identify the particular joint by flexing only one or two joints at a time once we know there is a problem."
Running her hand down the back of Nighthawk's leg, Mairen catches the hoof as he lifts it into the air. Holding the hoof firmly, Mairen lifts it until it touches the elbow then pushes upward on the knee with her other hand to flex the elbow. Mairen leans into it and says as she counts off time under her breath, "Runners are strong and this does take a certain amount of effort to force them to hold the flexion. If they fight you so much that you are unable to perform the test, then you should stop - it may mean it's so painful that they will not stand. If it is that painful, then we will not use this test as that would be cruel and unfair to the runner. Alright Lisa trot him off now." Mairen says the last as she drops the leg and steps back in one motion.
Mairen turns to watch Nighthawk move off her eyes following his movement intently. Nighthawk tosses his head and balks at trotting, requiring a smack from the leadrope on his rump by Lisa to get him moving. As he finally moves off he is hardly placing any weight on his left foreleg for the first few strides.
Mairen nods and calls to Lisa, "Thank you now trot him back this way so that we can all see him from both angles." Nighthawk tosses his head as he trots back alongside Lisa, his gait evening out as he returns til the lameness again becomes barely perceptible.
Mairen pats Nighthawk and smiles at Lisa, "Thank you Lisa; if you don't mind you can put him back in his stall now."
Turning back to the herders with an intent look, Mairen says, "Now, in that short moment we learned quite a bit about Nighthawk's lameness; if we combine that with what we all know of his history, we can come up with a pretty good diagnosis and begin to think of treatment. We know that Nighthawk is old and is frequently stiff, you saw that he was very lame right after the forced flexion, but he was less so after he trotted a bit. His problem is most likely just aging joints, but now we can be pretty sure that that is what it is. We need to know this because what if he had been injured in the paddocks and we assumed he was stiff because of his age? He could get worse from an injury rather quickly."
This lesson will be continued in Part Three .
