Treatment of Proximal Patellar Hesitation (PPH): STEP ONE
Proximal Patellar Hesitation (PPH) involves structures that reside just outside and in front of the stifle joint.
Horses have a normal "locking mechanism" associated with their stifle area that allows them to maintain limb extension without considerable muscular effort. This mechanism is called a "stay apparatus" and primarily involves the patella (knee cap), the bottom end of the femur (medial trochlear ridge), and three distal patellar ligaments (ligaments that attach to the knee cap and tibia below the stifle). Horses also have a stay apparatus in the front limb and therefore have the ability to sleep while standing. The horse's stay apparatus is perfectly normal.
The problem arises when this locking mechanism inadvertently occurs (or "catches") during movement. It generally results in a hypometric (toe-dragging) gait with a delayed forward phase to the stride. Unlike most soundness problems that we observe in the horse, this problem does not involve inflammation and pain (i.e. it doesn't hurt).
See what this looks like:
Initially, we recommend the following treatment:
Corrective shoeing. The idea to is minimize any conformational disadvantages that make IUPF more likely to occur. Cost: $48 for a Farrier Prescription and possibly $25-50 more for the shoeing. We will be happy to provide you with a written Farrier Prescription upon request.
Fitness training/ hill work. In our opinion, your horse's performance will improve dramatically with fitness training. Since we are specifically interested in strengthening the muscles and ligaments associated with the distal patellar (stifle) apparatus, we are going to recommend exercise in the form of hill work. Eventually, we would like your horse to be working for AT LEAST 45 minutes per day AT LEAST 4-5 days per week for AT LEAST 30-45 days before we decide to pursue more aggressive treatment.
If your horse is not experiencing a high level of fitness work, we are going to have to gradually increase work intensity in an attempt to prevent injury. Please see our Fitness Training Startup Schedule HERE.