25/02/2023
💁♀️ Let's Talk... Understanding the Stifle... What you "Knee'd" to know.
I was reading a medical article written in 1988 that talked about how our knees just weren't designed to keep up with the demands of life and how it was estimated that nearly 55 million people experienced knee pain at some point during their lives. Those numbers are insane to me for something written 35 years ago! I feel like people are even more active now. I know I was a sophomore in high school the first time I injured my knee. I made it 7 years before I finally had enough wear and tear to need surgery. Through muscle, fascia, and soft tissue an imbalance pretty much anywhere in the body will lead to strain on the knees, so it's not hard to see how so many people suffer with pain.
So I thought it would be fun to do a comparison post just to give owners a relatable understanding of what their horse may feel, but as I researched I realized how far behind the research is on the stifle. One article I read basically stated that for decades it was overlooked because of lack of diagnostic options. So for decades we have been treating our overworked knees, but what about our horse's "knees"?
The stifle is designed to flex and extend the leg. Much like our knees, the joint moves forward and back like a hinge. The leg is able to move forward and back, but cannot move sideways... Mine moved sideways pretty easily during a basketball game once, and that will sign you up for a month of crutches...
Abrupt stopping, quick turns, extending, jumping, rotating, sliding, flexing and slipping all cause wear and tear to the joint. Over time inflammation builds and you start to see a shift in gait. The wear patterns of the feet change... If you don't believe our feet change, just look at the worn off outside heel of any old cowboy's boots and it will mirror the horse that is loading the outside of the hoof and breaking over the outside of their shoes.
Our body starts to create compensation patterns to avoid painful movement. Our muscles begin to contract and restrict movement which creates more inflammation in the joint. Now this issue becomes more noticeable with a shortened stride, reluctance to work or move forward, and refusal to load the affected leg on the inside of a turn. I can speak from experience, if you don't trust the leg to hold you without giving out, you darn sure don't want to dump all your weight on it. I feel like that is why you see so many horses commit to the turn and then bail out of it and run down the wall or rear up.
In nearly 2 decades of doing massage, I can honestly say that 100% of chronic knee clients also had lower back pain and hamstring pain too.... Once you start favoring that knee, your back will end up involved. We see the same mirrored patterns in horses. Our spines may be very different, but pain is pain.
Knee pain and ankle pain are commonly found together in chronic cases. Guess what joint mirrors our ankle? If you guessed the Hock, you'd be correct. The thick calcaneus bone that makes up your heel is the same thick bone you can see and feel on the back of the hock.
In people we see knee pain begin to cause pain in the feet, but in horses I feel like negative angles in the hoof lead to stifle issues. A large number of stifle horses we see are also NPA on the hinds.
Though there are a lot of similarities, the two joints have some unique differences too. Where our knee has a single patellar tendon, the stifle has 3 patellar ligaments that allow the patella to lock in place so the horse can rest while standing. Don't try this yourself... Because our knees are straight and not angled like our horses, locking your kneecaps for too long will cut off blood flow to the lower leg and you will faint. That's why they say... Don't lock your knees if you're nervous! Google it if you need a laugh.
Horses don't technically "sleep" as they have to be lying down to achieve REM sleep (which helps to nourish the nervous system), but they can definitely doze off and relax a great deal. REM sleep is important for healing and I have observed that it takes between 30 to 60 days post-stifle surgery for a horse to lie down to rest at night in their stall. So imagine going 60 days without a good night's rest... The definitely plays a factor in the body's ability to heal, where a person can easily elevate an injured knee and watch binge Netflix while their body heals.
The difference in angle gives the horse's stifle a bit more protection and stability, so knee injuries are going to outnumber stifle injuries by a fair amount. We also tend to find more ways to have trauma injuries to our knees due to contact sports, falling down stairs,, horse wrecks, bumper pull hitches.... and whatever other crazy messes we get ourselves into while our horses are spending their time leisurely grazing. For the largest joint in both bodies, I find it interesting that it is also the weakest. So having the rest of the body fit is the best prevention against injury.
I hope this gives you a little something to relate to if you have a horse with stifle pain. Though we aren't exactly the same, I feel the more we can relate and understand the behavior of our equine athletes... The better connection we can have with our partners.
(Images from Google)
