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I have written quite some blogs about balancing the front-end about the horse so now I decided it’s time to put some thought on paper about the hind. The more I travel and the more horses and people I meet, the more I see them struggling to some degree with the same ‘issues’. It is therefore I ALWAYS ask the owner to walk the horse up and down (hard surface) beforehand. Very often I spot issues within the hip-hock-stifle line. In this blog I will elaborate on coxofemoral issues.

While there is more and more attention for higher-up induced lameness (such as SI induced lameness), coxofemoral issues are often still not recognised as it poses us with some diagnostic challenges, which I will explain later.

For the purpose of this post, I’ll elaborate on the Anatomy & Biomechanics in a simplified way. To understand the hip, we first must understand its function and relation.

The pelvis forms the link between the vertebral column and the hind legs through the sacroiliac (SI) and hip joint (coxofemoral). The SI attaches the sacrum (5 fused vertebrae right after the last lumbar L6) to the pelvis whereas a little further down the hip attaches the femur to the pelvis. The SI has very restricted movement dependent on the relative position of the pelvis. There is more movement when the pelvis is correctly tucked under compared to a rigid neutral position. In contrast to the SI joint, the hip joint allows more movement, guiding the hind leg in all kinds or directions such as Flexion & Extension, Abduction & Adduction and Medial & Lateral rotation.

In order to prevent hypermobility and to perform its function optimally, the hip is protected, stabilized and assisted by a layer of fat, (accessory) ligaments and big hind end muscle groupings such as the quadriceps and the hamstrings. These muscles often perform multiple functions, creating close interconnection with the hock and stifle. For example: Rectus Femoris (quadriceps) flexes the hip while extending the stifle. Semitendinosus (hamstrings) extends the hip and hock joints while flexing the stifle. Biceps Femoris (hamstrings) extends the hip, stifle and hock, and FLEXES the stifle joint. The Tendor Fasciae Latea flexes the hip joint and extends the stifle while tensing the Fascia Latea. The Illiopsoas (Psoas major & Illiacus muscles) flexes the hip joint and rotates the femur.

This makes a proper functioning of the hip joint essential for any desired ridden performances while ensuring the horse’s health. Any dysfunction will hugely impact the horse’s ability to properly carry our weight. So what can be the causes of coxofemoral issues?

- Birthing Most foals land to their right side upon birthing. This doesn’t always go smoothly and can lead to mostly SI problems but could also affect the hip joint and result in asymmetry or compromised joints from the start. In turn, the birthing process might also have huge impact on the mare’s hip when the foal gets stuck or when the birthing canal is too narrow.

- Breeding Most modern horses are bred to produce spectacular movements and to perform at top sport level. To do so, its often desired that a horse shows hypermobility and high thrust. Extreme flexibility usually comes compromises function over spectacle.

- Trauma Any hard impact such as a kick, fall, accidents can damage, compromise, luxate or even fracture the hip joint and will have a huge impact on the entire biomechanics of the horse.

- Secondary trauma Coxofemoral problems often go hand-in-hand with other (unrecognized) biomechanical issues. Very often, its initially ligament damage that wasn’t originally recognized. Due to interconnection nothing can be fully isolated and its always questioning what causes what (chicken and the egg). The hip is closely related to big hind end muscle groupings but also other joints such as the hock and stifle, all influencing each other. But also disbalance in the jaw and feet could lead to disbalance in the hip (twisting the pelvis) and vice versa.

- Diseases

Not many pathologies are described so far, but as with any joint, the hip could also develop osteoarthritis.

- Natural asymmetry

Naturally, horses have a preferential side on which the muscles are more developed than on the other side.

- Training The hip joint is essential for developing carrying power. While there is a lot of talk about engagement, ‘riding the back’ and collection this is often exactly lacking. In my previous blogs I already wrote about the importance of and open and lifted front end as a condition for the hind legs to engage in the first place.

Many horses are trained too much on the forehand with too little self-carriage and either with too much or no contact at all in the reins. Too much pressure comes from working backward. No contact at usually comes from a wrong interpretation of lightness. While riding with a lot of pressure and round frame is already very widely discussed, I do want to stress out that too long and low is also putting more weight on the forehand and ultimately disengaging the pelvis. A long neck is an organical result from correctly supporting its base so the horse can lengthen into the hand rather than mechanically asking the horse to lower its nose, dropping the weight down.

If the weight is on the front and dropped down into the shoulders, the hind legs can’t step forward properly. Then, the extension phase become bigger than the flexion phase, increasing thrust and decreasing carrying power. To produce more thrust, the hind legs will move in a straighter position, resulting in more concussion in the joints. The figure 8 motion of the pelvis becomes flat, compromised and rigid instead.

This way, a horse simply can’t collect anymore. To understand this, its important to remember the essence of the exercises rather than its picture. For example, lateral exercises build up for collection and are to be performed in a balanced sideways – forwards motion. Let’s look at the travers where a horse is asked to bring the haunches in while moving straight with the shoulders, keeping an inside (lateral) bend and slight flexion at the poll (stelling). To do this, the outside hip brings the leg inwards to the point of balance (adduction) while the inside hip has to come forward. This can be performed on 3 or 4 tracks. However, very often the exercise is performed over 4 tracks OR the inside hind leg is travelling sideways as well to create more spectacle for the eye. To do so, a lot of thrust is needed to prevent the horse from falling apart and the essence of the exercise becomes lost while creating enormous strain on the hip and its intimate relations as it has to perform and extreme range of motion. Another example: piaffe is not the same as having a horse picking up its legs in a trot diagonal on the spot. This is a slow horse doing a leg trick. True collection is MAXIMUM power coordination which is an organical result of good training rather than a mechanical goal.

It is also therefore that a horse can extend as much as it can collect. With extension not meaning to go faster, but for a horse to take larger steps forward. So collection and extension are closely intertwined. Collection is no true collection without being able to properly transition more forwards again. These are not separate exercises; they are part of each other.

So this balance of thrust versus carrying power needs to be maintained at ALL times. We need both. Without thrust the horse can’t travel forwards properly. Without carrying power, the horse can’t properly carry our rider weight. It’s a constant energy cycle which we must ALLOW and GUIDE instead of trying to CONTROL and CREATE.

To allow, this means we need to be able to follow. And this is also where many riders struggle. Too often I see riders (including myself!) heavily moving forwards and backwards in their hips, putting more weight one seat bone than the other and tilting in the waist. To really follow the movement, we need to be able to follow the ‘barrel’ swing instead of just pushing forward-backwards with our hips (pushing our horse more to the front). Following the barrel swing means our own hips need to go with a figure 8 motion and stretch the psoas. If we’re unable to do this, how can we expect our horses hip to move freely? Remember that most rotation in the spine occurs in the thoracic area which is right under the saddle. Therefore, our own crookedness or uneducated seat might be responsible for tipping and twisting the pelvis.

Despite the hip being so important, issues are still often underestimated or simply not recognized. This might be due to some diagnostic challenges:

- The hip is located deep within. As mentioned before, its well protected by a layer of muscles, ligaments and fit. So therefore you can’t directly palpate the hip joint. You can however directly palpate most of the hind end muscles (apart form the Illiopsoas which you can only indirectly palpate) connected to the hip joint.

- Assessments for lameness are usually only performed in walk and trot on both hard and soft surface. While lameness indeed is most (obviously) visible in these gaits, hip problems are usually most visible in canter. This is because coxofemoral problems might give a lot of ‘vague’ or ‘subtle’ signals which not necessarily show in obvious lameness OR are not recognized as a (subtle) lameness. In canter, the signs become much more clear. Often riders also experience the most problems and/or resistance in this gait.

- Any procedures around the hip joint, such as arthrocentesis is tricky and always needs to be done with utmost care due the proximity of the sciatic nerve.

As with all my blogs I can’t give exact tailor-made practical advice on paper but here are some general tips that might help you to ensure a healthy functioning hip joint:

- IMPROVING your horse starts with YOURSELF! Are you balanced in your seat? Can you follow the movement in your own hips? If you can’t your horse can’t as well.

- OBSERVE & PALPATE. Although the hip can’t be palpated directly, you can both observe and palpate any asymmetry, atrophy or damage in the hamstring and/or quadriceps. Experiencing any problems with collection or canter? Can you see a clear figure 8 motion in the pelvis in walk? Are the hips symmetrical when your horse is standing square? Is there any rotation in the hind legs?

With a little training of the eye, a hip joint rotation is quite visible in motion from behind. The horse will pick up the leg, land and then twist/ rotate the entire leg before picking up again. It’s usually easiest to see when looking closely to the feet upon landing. When the entire leg rotates the hock (and sometimes even stifle) usually does so as well. But when you ONLY see the hock its more likely an indicator of a hock issues than hip joint. So really look at the entire hip-hock-stifle line to determine what looks to be the primary cause.

- Build on LATERAL WORK. Through correct lateral work we can very precisely train hind leg muscles in such a way that they can stabilize the hip joint. For the hip, this is most functional in walk and IN HAND before adding extra weight.

- ESSENCE instead of PICTURE. Exercises are meant to be functional, not to look super fancy, which is often a fashion. What is looking fancy now might not be considered fancy in the future. Only with essence in mind can exercises be functional for the horse.

- WALK, WALK, WALK. When your horse is resisting the canter, changes lead all the time, speeds up, changes posture etc., take it seriously and work on it in walk first. The walk is one of the hardest natural gaits to improve, but once you can improve the walk, the canter will also be improved as a result.

- It’s NEVER JUST TRAINING. It’s always a combination of management, bodywork and training.

So look at your horse. Feel your horse. Ask for help or guidance if you’re struggling. Your horse will be thankful!

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