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Kirsty Bolderston Veterinary Physiotherapist MSc MRAMP, Norwich (2026)

07/05/2026

This week, I want to talk about another pathology that is perhaps sometimes overlooked. This one is a little more hock-focused.

We hear a lot about hock pathologies — arthritis being one of the most common, bone spavin, bog spavin, thoroughpins, capped hock… all very real, very common.

But there are other structures in and around the hock that don’t get talked about nearly as much, and yet can have a really significant impact on how a horse moves and feels.

One of those is the retinaculum.

I’ve also put together a short video with some images and clips showing retinaculum-related pathology and what this can sometimes look like in practice… you’ll find it in the comments!

The retinaculum is a band of dense fibrous connective tissue. Its role is to stabilise and guide tendinous structures as they pass around a joint, helping them track correctly and move efficiently during locomotion. Around the hock, these supporting structures play an important role in stabilising the tendinous structures around the calcaneal region, particularly the superficial digital flexor tendon (SDFT), as it passes over the point of hock (tuber calcanei).

When everything is functioning as it should, you don’t notice it. The tendons track smoothly, movement is efficient, and the hock appears stable.

But when that system starts to break down, things can change quite quickly.

I’ve now seen a couple of cases over the past year where disruption to these structures has been associated with hock pain, swelling, and varying degrees of lameness — sometimes quite obvious, sometimes more subtle.

There are a few different ways this can happen.

In some cases, the retinaculum can become lax. That might be influenced by conformation, repetitive strain over time, or changes in how the horse is loading the limb — often as a result of compensation elsewhere. Inflammatory processes within the joint, such as early osteoarthritic change, can also influence the behaviour and integrity of the surrounding soft tissues, including the retinacular structures.

At the more severe end of the spectrum, there can be traumatic damage or rupture, meaning the structure is no longer able to do its job effectively.

When that stabilising support is compromised, one of the key things we can see is the SDFT starting to slip out of position as the limb takes weight. Most commonly, this is to the lateral side of the point of hock, although I have also seen medial displacement occur.

This can be quite striking visually.

The hock may appear enlarged when the limb is weight-bearing, and then look more normal when unloaded. In some cases, there is genuine swelling alongside this, but in others what you’re actually seeing is the tendon sitting where it shouldn’t.

I’ve seen this present intermittently and quite subtly, and I’ve also seen it occur consistently with every step — particularly where there has been more significant disruption to the retinaculum.

From a clinical perspective, this isn’t just a localised “hock issue.”

If the tendon is repeatedly slipping out of position, it’s being exposed to abnormal mechanical stress. Over time, that can lead to irritation, wear and tear, and degenerative change within the SDFT itself.

And that’s where things can start to have a wider impact.

The SDFT plays a really important role in supporting the limb during weight-bearing and locomotion. It helps control extension of the distal limb and contributes to energy storage and release during movement. If it becomes compromised, you don’t just lose efficiency — you start to alter how the entire limb loads.

The gastrocnemius tendon can also become involved. Although it is a separate structure, it is very closely associated with the SDFT around the point of hock, and both contribute to the function of the reciprocal apparatus of the hind limb. If there is instability, inflammation, or abnormal tendon tracking in this region, it can create a surprisingly chaotic mechanical environment around the calcaneus, potentially placing strain on multiple surrounding structures rather than just one isolated tendon.

That can then place additional strain on other structures, change movement patterns, and in some cases contribute to further compensatory issues higher up the limb or elsewhere in the body.

So whilst the primary issue may sit with the retinaculum, the knock-on effects can extend further if these associated structures aren’t considered together.

In terms of management, veterinary involvement is essential, particularly where there is lameness. Anti-inflammatories, including corticosteroids, may be used to reduce inflammation and discomfort, and in some cases this can improve stability if inflammation is a contributing factor. In more severe cases, surgical stabilisation may be considered.

From a physiotherapy perspective, we’re looking at the bigger picture.

That means supporting not just the hock, but also the tendons and surrounding soft tissues being affected, whilst also addressing how the horse is loading and moving as a whole.

Modalities can play a really useful role here alongside a structured rehabilitation plan.

Radiofrequency (Indiba) works at a cellular level to promote tissue healing. It helps improve circulation, supports metabolic activity within the tissues, and can encourage processes involved in repair — including collagen synthesis and cellular activity. In structures like the retinaculum and the SDFT, that can be really valuable in improving tissue quality and supporting healing where there has been strain, inflammation, or degeneration.

Class IV laser also supports healing, particularly through its effects on inflammation, pain modulation, and cellular activity. It can help create a more favourable environment for tissue repair and is a really useful tool when managing both acute and more chronic presentations.

Therapeutic ultrasound works slightly differently, using mechanical energy (sound waves) to influence the tissues. It can be particularly helpful in the later stages of healing, where we’re aiming to improve fibre alignment and tissue organisation — something that is especially relevant when we’re thinking about tendon health, such as the SDFT.

In practice, I will often choose modalities based on the individual case — what stage of healing we’re in, which structures are most involved, and what the overall goal is. It’s rarely a one-size-fits-all approach.

In more severe cases, particularly where there has been a complete rupture of the retinaculum and surgical intervention isn’t pursued, we do have to think carefully about what is fair and appropriate for the horse long term. Without that stabilising structure, the mechanics of the limb are significantly altered, and asking that horse to continue in work may not be in their best interests.

In my opinion, in those situations, retirement is often the kindest option.

That doesn’t mean we stop supporting them altogether. Maintaining comfort and managing secondary strain — particularly within the SDFT — is still really important, and modalities such as therapeutic ultrasound can be a useful and more accessible way of doing that in the long term.

As always, it’s about looking at the whole horse and making decisions that prioritise both function and welfare.

07/05/2026

Updated Service Guide & Price Lists as of 1st May 2026. Better late than never 😅
Any small furries (feline, exotics etc) are priced the same as the canine services. Any large animal (sheep, cows, goats) are priced the same as the equine services.

28/04/2026

Let’s talk stifles… because I do think they’re getting overlooked 👀

(And for those more observant of you, no I’m not treating a stifle in the photo, but Lottie was having a lovely time so she’s my model for this particular image just for being pretty 🤩😅)

In practice, I see a lot of horses where the hocks get the spotlight first — and don’t get me wrong, hock pathology is incredibly common — but I do sometimes wonder whether we’re a little slower to consider the stifle as a primary contributor.

Because actually… stifle-related issues are not rare.

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The stifle relies heavily on the quadriceps femoris muscle group for stability. These muscles sit at the front of the thigh and are responsible for extending and stabilising the joint, particularly when the limb is taking weight and controlling movement.

When I think stifles, I always think down;

Downhill
Slowing Down
Downward Transitions

These things all require deceleration, encouraging the quadriceps to work hard to control the limb as it accepts weight. Rather than just pushing forwards, they’re acting like a brake — stopping the joint from collapsing and keeping everything stable.

That type of work is called eccentric contraction — the muscle is working while lengthening to control movement.

If we’re not regularly asking for that kind of controlled “braking” work, those muscles simply aren’t developing the strength they need to properly support the stifle.

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And this is where, in my experience, location really starts to matter…

Particularly here in Norfolk.

We are so flat.

Our horses live on flat land, they graze on flat land, and even for those of us who enjoy hacking, the options for proper hill work are limited.

They’re not walking up and down gradients.
They’re not stabilising on uneven terrain.
They’re not getting that natural variation in movement.

So a lot of our horses just aren’t getting that input — not in turnout, and not consistently in work either.

Which means we have to be more intentional.
We have to work a bit harder.
We have to do a bit better for our horses’ stifles.

Because if the environment isn’t doing that job for us, it’s up to us to provide it through their work.

And if you don’t have hills — which many of us here don’t — you can absolutely replicate that stimulus through your ridden work. Lots of well-ridden transitions, particularly downward transitions, and variations in pace (a bit of “speed play”) can be incredibly effective. Anything that encourages the horse to rebalance, come back onto the hindlimbs, and control movement rather than just push forwards will help engage those stabilising structures.

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When we talk about stifle pathology, we’re not just talking about one thing. It’s a complex joint, and there are several structures that can be involved.

Osteoarthritis within the stifle is something we do see, and it can present quite subtly. You might notice reduced impulsion, difficulty with transitions (especially downward ones), stiffness behind, or a horse that just doesn’t feel quite right. In some cases, particularly where there is bony change, you may also see reduced flexion through the limb and alterations in how the limb travels, but it’s rarely one obvious sign.

From a treatment point of view, this is where veterinary input is key. Corticosteroid injections are commonly used and can be very effective — they reduce inflammation and therefore reduce pain within the joint. But they don’t remove or reverse the osteoarthritis itself. It is a degenerative condition, so whilst we can manage it, support it, and often slow its progression, we can’t undo the changes that have already occurred.

Alongside that, you’ve got options like Arthramid, which works quite differently. Arthramid is a polyacrylamide hydrogel that integrates into the synovial membrane of the joint. Yes, it reduces inflammation and pain — but beyond that, it helps to improve the quality of the joint environment itself. It supports the synovial lining, improves lubrication, and contributes to more normal joint function over time. So rather than simply masking symptoms, it provides a level of biomechanical and biological support within the joint, which is why, in the right cases, it can be a really valuable longer-term option.

From a physiotherapy perspective, osteoarthritis is never just about the joint itself.

If that stifle isn’t functioning optimally, something else has to pick up the slack. And that’s where we start to see compensatory patterns developing — sometimes obvious, sometimes very subtle. One horse might overload the opposite hind limb, another might shift through the lumbar region, another might change how they load through the forehand. There are common trends, but no two horses compensate in exactly the same way.

So the approach isn’t just to look at the stifle — it’s to look at the whole horse.

Identifying gait adaptations, recognising compensatory movement patterns, and addressing areas that are under increased strain all form a big part of managing these cases. Because often, it’s those secondary issues that start to limit performance or comfort just as much as the original joint pathology.

Alongside that, physiotherapy can utilise a range of modalities to support the tissues at a cellular level — helping to improve circulation, reduce inflammation, and create a better environment for ongoing tissue health.

So whilst we can’t reverse osteoarthritis, we can absolutely support the horse around it — and in many cases, make a really meaningful difference to how that horse feels and functions.

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The menisci are another key structure — two crescent-shaped pieces of fibrocartilage (medial and lateral) that sit between the femur and tibia. They act as shock absorbers and are also rich in mechanoreceptors, meaning they play a role in proprioception as well as load distribution.

When the meniscus is involved, horses can feel a bit uncoordinated or unstable behind, sometimes struggling with balance rather than showing a clear lameness.

If a meniscal injury is suspected and not improving with conservative management, arthroscopy may be recommended. This is keyhole surgery into the joint, where a camera is used to visualise the structures directly, and any damaged or frayed meniscal tissue can be debrided to reduce irritation. In that sense, it’s not just masking symptoms — it’s directly addressing the source of the problem.

But that’s not the end of the story.

Rehabilitation is absolutely key afterwards. This is where physiotherapy comes in to rebuild strength, restore stability, and support the surrounding structures so the joint can function as well as possible. Depending on the modalities available, we can also support tissue health more directly — improving circulation, influencing tissue quality, and creating a better environment for healing.

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Upward fixation of the patella — or “locking stifles” — is another one we see. This is where the limb gets momentarily stuck in extension before releasing. It’s more common in younger or weaker horses, but body condition can also play a role, as carrying excess weight increases the load through the system and can make that release less efficient.

In many cases, management is focused on strengthening and conditioning, particularly through the quadriceps, as improved muscle function can help stabilise the system and reduce the frequency of locking.

Veterinary intervention is sometimes used, but often the primary approach is conservative.

One thing that’s worth considering, though, is what happens during those locking episodes. When the patella becomes caught and the horse then tries to release it, that repeated catching and release can place strain on the surrounding soft tissues, including the patellar ligaments.

Over time, that can contribute to irritation, inflammation, and reduced tissue quality.

So it’s not just about stopping the locking — it’s also about supporting the structures that are being repeatedly stressed.

This is where physiotherapy modalities such as Indiba radiofrequency or Class 4 laser can be really useful, helping to reduce inflammation, support tissue health, and improve the resilience of those soft tissue structures alongside a strengthening programme.

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We also see OCD (osteochondritis dissecans), typically in younger horses. This is a developmental condition where cartilage and bone don’t form quite as they should, sometimes leading to fragments within the joint. Depending on severity, it can cause stiffness, joint swelling, or intermittent lameness, and is often treated surgically via arthroscopy.

Alongside that, we occasionally see subchondral bone cysts within the stifle — fluid-filled cavities within the bone just beneath the joint surface. These can be developmental or develop over time and, depending on their size and location, may contribute to lameness or reduced performance.

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Something else that’s worth mentioning — because it’s rarely just one thing — is why these issues develop in the first place.

In many cases, it’s a combination of factors rather than a single cause. Genetics and conformation can play a role, particularly in horses with straighter hindlimb conformation or those predisposed to reduced joint stability. Hoof balance is another big one — if the foot isn’t loading correctly, that force has to go somewhere, and the stifle can end up taking more of that strain.

Muscle weakness, particularly through the quadriceps, and reduced overall stability can leave the joint more vulnerable over time. Body condition matters too — horses carrying excess weight are placing additional load through the stifle with every step.

In younger horses, workload management is really important. It’s not about not working them — they absolutely should be worked — but too much intensity, too much concussion, or too much repetition before the musculoskeletal system has fully developed can increase the risk of issues like OCD or contribute to earlier onset joint changes.

And then there are the more acute factors — slips, trips, falls, or repetitive strain over time — which can contribute to soft tissue injury such as meniscal damage.

More often than not, it’s a bit of everything.

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What I find with stifles is that they don’t always present as a clear lameness. Quite often, it’s more about movement quality. Reduced engagement, lack of push, difficulty sitting or collecting, or just inconsistency behind.

One thing I do sometimes see, as part of that bigger picture, is a change in the swing phase of the stride. A hind limb may drift slightly away from the body or occasionally towards the midline, depending on what structures are involved. But that’s never something I look at in isolation — it always sits alongside everything else I’m assessing.

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If you suspect your horse may be dealing with a stifle-related issue, it’s really important to work closely with your vet—particularly if there is any sign of lameness or you’re trying to pinpoint the exact cause. As physiotherapists, we can absolutely assess, support, and manage these cases, but having a veterinary diagnosis allows us to be far more targeted with rehabilitation, as we understand exactly which tissues and structures are involved.

If your horse is sound but you have concerns around performance, posture, or movement quality, there is no harm in having a physiotherapy assessment carried out—early intervention can make a big difference.

It’s also important to keep your wider team in the loop. Your farrier may be able to offer additional support through hoof balance and limb loading, and your saddle fitter should be aware too, as compensatory or asymmetrical movement patterns can influence saddle fit during rehabilitation.

A collaborative approach will always give your horse the best possible outcome—after all, it takes a village.

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And all of this really comes back to how that horse is using — or not using — its body day to day.

Because if the environment isn’t doing that job for us here in Norfolk…

we need to make sure we are.

26/04/2026

***** FULLY BOOKED *****

📅 Rare Availability – One-Off Day in June

A little unexpected opening in the diary…

I now have Thursday 4th June available as a full working day, which was originally planned as a day off. As it stands, I have no bookings in, so I can travel in any direction depending on demand.

✨ A couple of important notes:

* This is ideal for standard physiotherapy sessions or initial assessments
* It’s not suitable for starting a course of Indiba therapy, as I’m otherwise fully booked until July
* For locations more than ~12 miles from Wymondham, I will need a minimum of two horses in the same general area (not necessarily the same yard)

📆 Aside from this one-off day, my diary is currently fully booked until July

If you’ve been thinking about getting something booked in, this is a great opportunity to secure a slot a little sooner.

📩 Please pop me a message if you’d like to book or discuss availability

20/04/2026

I had a really interesting conversation with a client recently that properly made me stop and think.

They’d watched a video from quite a big social media account where suspensory desmitis was being described as a neurological issue 🤯… and a neurectomy was basically presented as the only option.

Now — just to clear that up straight away — it isn’t neurological. It’s a musculoskeletal soft tissue injury, and whilst surgery can be an option in some cases, it is absolutely not the only route, and it doesn’t fix the underlying problem.

It just reminded me how important it is that we show people the whole picture, not just bits of it.

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Honestly, I see suspensory injuries all the time. Some weeks it feels like every other horse I see has some degree of involvement — whether that’s proximal, through the body, or into the branches.

And it’s very rarely down to just one thing.

In most cases, it’s a bit of a perfect storm of factors building up over time. Things like:
• repetitive, unvaried work
• foot balance and farriery
• conformation (you’ll often see things like straighter hocks or a more upright hoof–pastern axis)
• general weakness or lack of stability
• horses that are a bit more hypermobile and rely more on their soft tissues for support
• sudden changes in workload or surface
• and quite often, something else going on higher up — sacroiliac, hocks, stifles — that ends up overloading the suspensory

I also think we need to talk a bit more about young horses here as well. It’s not that young horses shouldn’t be worked — they absolutely should — but when the work is too much, too repetitive, or too high impact (jumping being a big one), you can end up overloading tissues that just haven’t adapted yet.

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If you think about what the suspensory actually does, it’s a huge part of how the limb functions.

It’s there to support the fetlock, control extension, and help store and release energy as the horse moves. When it’s not doing its job properly, something else has to pick up the slack.

In the hind limb especially, that often means more strain going through the hocks, stifles, and even up into the SI and lumbar region. So it’s never really just a suspensory issue.

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In terms of treatment, there are a few different routes vets might take.

Steroids are sometimes used to settle inflammation and pain, and they can help in the short term, but they don’t fix the underlying issue. And from a tissue perspective, they can actually inhibit collagen production and affect how well that structure heals if they’re not used carefully.

Shockwave is another one people often ask about. It’s used to stimulate a healing response and modulate pain. Some horses do really well with it — others, not so much. If I’m being honest, I probably see about a 50/50 split in real life.

PRP is a bit more of a biological approach — using the horse’s own growth factors to try and improve the quality of healing within the ligament.

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Then there’s neurectomy.

And this is the bit where I think there’s quite a lot of misunderstanding.

Yes, it can reduce pain. But it does that by cutting the nerve supply — it doesn’t repair the ligament, and it doesn’t restore normal function.

So you’re still left with a structure that may not be doing its job properly, and a body that’s still compensating… just without the same pain feedback.

From a biomechanical point of view, that’s something I personally find quite difficult, because the underlying issue hasn’t gone anywhere.

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You’ll also often hear the “just turn them away for 12 months” approach.

And yes — the ligament will heal.

But the question is how well it heals.

Without controlled, progressive loading, you can end up with quite disorganised scar tissue that isn’t as strong or functional as it could be. And that’s where re-injury risk can creep in.

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From a physio point of view, this is where we can really make a difference.

For me, that’s usually a combination of:
• the right therapy (I do use Indiba a lot in these cases)
• a properly structured rehab plan
• looking at the whole horse, not just the ligament
• and gradually building strength, stability and correct movement patterns back up

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Suspensory injuries aren’t quick fixes.

They need time, the right input, and a bit of patience — but when they’re managed properly, you can absolutely improve outcomes.

As always, work closely with your vet, but just know there are options, and it’s rarely as black and white as it might sometimes be made out to be.

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If you’re dealing with anything like this or just want a second opinion on how your horse is moving, feel free to drop me a message 🙂

15/04/2026

I’ve been meaning to share the rest of these for a little while now… 🤍

These beautiful images were captured by the incredibly talented earlier this year, and I honestly don’t think I’ll ever be able to thank her enough for them.

If I’m being completely honest, the start of 2026 has been a lot.
We very nearly lost Bobby after the car accident, Ollie developed a lump which—deep down—I suspected was a mast cell tumour (and sadly, it was), and although his surgery has gone well, the knock-on effects of everything have been tough. Bobby has been back and forth to the vets more times than I can count recently with gastrointestinal issues stemming from it… and tonight, Ollie has decided to throw in what looks like an eye ulcer for good measure.

It’s been one of those periods where it just feels relentless.

And I know it’s not just me. So many people I speak to at the moment are going through something—poorly pets, sudden losses, health worries, life just being… heavy. It really does feel like a tough season for a lot of us.

But in the middle of all of that, there are moments like this.
Memories. The kind you can hold onto.

This shoot gave me exactly that—time, presence, and something I’ll treasure forever. These photos mean more to me now than I could have ever anticipated at the time.

I won’t be sharing the ones with Jaxon on here, but here are the rest of my beautiful boys 🤍

If you’ve ever thought about booking a shoot—do it.
Don’t wait for the “perfect time,” because life has a funny way of reminding us that nothing is guaranteed.

Capture the memories. You’ll never regret it.

And if you’re looking for someone to do just that, I truly couldn’t recommend Hannah highly enough 🐾

10/04/2026

It’s always a great end to the week when you can help a special friend and enjoy a Poshio coffeeo. Looks like Lottie enjoyed it too 💕

05/04/2026

Happy Easter everyone 🐣🌼

I hope you’re all enjoying a lovely long weekend — whether that’s time at the yard, out with the dogs, or simply putting your feet up for a well-earned rest.

Just a little diary update from me — this time of year is always incredibly busy with the Easter holidays, bank holidays, and (finally!) some better weather creeping in. Everyone is getting back into work and preparing for their own “season,” whatever their discipline… and of course, the dogs keep me busy all year round with their latest antics and injuries 🙈🐶

I also have a little bit of time off planned towards the end of May, so between all of that, I am now mostly booking into June, with just the odd appointment available here and there beforehand.

If you’re thinking of getting something booked in, please do pop me a message sooner rather than later to avoid disappointment.

Thank you as always for your continued support and hope you’re all having a lovely weekend 💛

Kirsty x

31/03/2026

Price Update – From 1st May

I’ve been putting this off for quite some time, really hoping things might settle… but unfortunately, with the continued rise in running costs (especially fuel now sitting around £1.80 per litre locally 😬), I’m no longer able to absorb these increases within my business.

I haven’t changed my physio prices since 2022, and I honestly hate having to write this—especially knowing that everyone is feeling the effects of the rising cost of living right now. But I do have a plan to try and help out in certain circumstances (keep reading!)...

From 1st May, there will be a £5 increase to:

- Initial physiotherapy sessions (horses and dogs)
- Standard physiotherapy sessions (horses and dogs)
- Human treatment sessions
- Indiba Treatments (also now subject to minimum charge of £70)

To try and keep things as fair and flexible as possible, I’ll be offering the following multi-patient discount:

🤍 Within 12 miles of Wymondham
£5 off per patient when I’m seeing 2 or more patients at the same location
(horses, dogs, humans – any combination)

🤍 Outside of 12 miles
£5 off per patient when I’m seeing 3 or more patients at the same location

If you’d like to check whether you fall within the 12-mile radius, just drop me a message and I’m very happy to confirm for you.

I’ll do my best to message clients individually where possible, but as a small business without bulk email systems, I’m hoping this post helps reach most of you and gives plenty of notice.

Thank you, genuinely, for your continued support, your understanding, and for trusting me with your animals (and yourselves!)—it really does mean more than you know 🤍

Kirsty

Kirsty Bolderston Veterinary Physiotherapist MSc MRAMP

07/05/2026

07/05/2026

28/04/2026

26/04/2026

20/04/2026

15/04/2026

10/04/2026

05/04/2026

31/03/2026

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