New Ways to Heal

By Steve Chiasson, DVM, CVMA

It’s been a gruelling season but the end is in sight. Looking back, training camp seems so long ago, so many months of hard work, of getting in shape. Last season certainly took its toll on the team. Coaches, trainers, and even the owner commented on the past year’s success and the hard work that went into it. The off-season months were a time of some well-deserved rest. This year it seemed as if we were destined to repeat our performance. Some early successes had things looking optimistic, but then the setback… A leg injury, a sore back during rehab, and the emotional and psychological toll felt by everyone involved. The doctors, trainers, and coaches worked tirelessly to make sure we made a full recovery and finished the season strong. The many doctor exams, rechecks, and rehabilitation sessions were worth it. We’re going to have a successful and exciting ending to the season after all.

If you’re reading the above paragraph in Canada, chances are you might think it’s describing your favourite NHL player in the middle of the Stanley Cup playoffs. Go back and read it again from that perspective. You can imagine that high-performance athlete having incredible tools at their disposal for their health and well-being as an athlete. But really, all of those same things can be said for the equine athlete in your life. If you read the opening paragraph from the standpoint of your horse, all the same things apply.

We are fortunate to live in a time when there have been tremendous strides in equine sports medicine, and the services available to benefit horses and their riders are getting even better. 

Any riding horse can benefit from the advances in equine sports medicine, from the elite competitor to the weekend trail horse.Photo: Dreamstime/Vanessa Van Rensburg

What is Sports Medicine?

Human sports medicine is defined as a “branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise.” When we transfer that definition to the veterinary world, there is really no need to change anything about it. 

Typically veterinary medicine has fallen into two categories:

Companion animal medicine deals with household pets and livestock where the main goals of veterinary care are maintenance of good general health with a pain-free and enjoyable life. Most companion animals don’t have a “job” other than living with and being loved by their owners. 

Production animal medicine deals with livestock that are raised as food animals. This would include dairy and beef cows, poultry, pigs, and even aquaculture. While maintenance of health and animal welfare is important, there is also emphasis on production and efficiency of the industry. Veterinarians work with both individual animals and as broader consultants for the industry.

Sports medicine deals specifically with animals that have a performance aspect to their job in life. Primarily, this aspect of vet medicine deals with canine and equine patients, with a tip of the hat going out to the rodeo bulls, of course. The scenarios these athletes find themselves in are exactly the same as those we humans encounter, and as such they are equally deserving of the top quality medical care given to the weekend warriors or the all-star hockey player. Fortunately, there is no shortage of great options for providing this care to your horse.

What Horses Benefit from Sports Medicine?

What first comes to mind is the high-performance equine athlete competing in dressage, eventing, Western performance, jumping, racing, and other activities. But horses of any discipline can take advantage of the various advances in equine sports medicine, including the casual-use trail horse, the pleasure dressage horse, the hunter–jumper who shows occasionally, or the older companion horse who gets some regular lunging to keep in shape. While the budget and intensity of the medical attention may differ for these horses, the same aspects of sports medicine still apply if they are doing some type of performance. 

The Approach to Sports Medicine

Like the human side of things, the approach to equine health and peak athletic performance is moving from reactionary to preventive. It used to be that athletes, even professionals, would show up for the start of the season 30 pounds overweight, smoking a cigarette, with a lazy attitude about getting back in shape. In situations like that, it wasn’t hard to predict poor success with a high risk of injury. Fortunately that approach just isn’t tolerated anymore. Similarly with our horses, it’s well understood that poor preparation for the season will likely lead to less than ideal results, or, even worse - serious injuries.

Components of Sports Medicine

Even the basic services and healthcare need to be considered part of a sports medicine program. It wouldn’t make sense for a finely tuned athlete to have an underlying health issue the doctors and trainers don’t address. The preventive component to sports medicine is basic general healthcare with a few extras thrown in. This would include:

A proper nutrition program – This is absolutely essential to any athlete. Having a well-balanced diet with adequate fibre for gut health and a safe amount of carbohydrates goes a long way for maintaining good body condition and foot health. Specific dietary needs for sport horses include attention to vitamin E and selenium supplementation targeting proper muscle function and recovery from exercise. Every day, every horse should have 10 to 12 grams of glucosamine and 1500 IU of chondroitin. These are joint and cartilage support ingredients that are found in a variety of commercial products. It’s best to consult your veterinarian or nutritionist on balancing a diet for your horse. Also important to note is caution on any specific regulations for competition - consult your veterinarian regarding medications that may be included in supplements you are feeding.

Regular dental care – This topic was covered in the Spring Horse Health Checkup article. It goes without saying that the horse’s balanced diet needs to be chewed by comfortable, well-maintained teeth. Sharp points or cheek ulcers can be painful, or at least distracting, for a performing horse. Six-month oral exams should be done on all riding horses, and dental corrective procedures done as needed. 

Regular foot care – This is essential for any horse, and is especially important for the competing athlete. Your farrier who sees your horse regularly can give immediate feedback on foot conditions requiring special attention to stay in top shape. Depending on the discipline, your horse may need specific types of shoes to allow him to compete at the highest potential.

Baseline diagnostics – When things go badly it is very helpful to have a reference back to when things were all normal. This can include routine blood work screening pre-season, radiographs or ultrasound images of joints and tendons, and a baseline evaluation of soundness videoed and documented. The amount and complexity of diagnostics will be determined based on budget, the level of performance required, and the skill set of the service provider helping you with your horse.

Specific Sports Medicine Services

After you’ve covered the basics of health care for your sport horse, the really interesting sports-specific types of services come in. Some of these can be done in a preventive manner when performance is going well, while others are more applicable to treating specific conditions or injuries. 

Massage and body work – This is becoming extremely mainstream for performance horses of all levels - from weekend trail riding horses to grand prix jumpers. The focus of these treatments is identifying areas of muscular tension or restriction of movement and using massage, stretching, range of motion exercises, and manipulation to help reduce that tension. By its definition, this service is focused on the soft tissues of the body. There are many organizations offering training in equine massage and they may come with or without recognized certification by a recognized association. Make sure you are comfortable with the approach to treatment, and communicate with the caregiver regarding the therapy plan.

Chiropractic – This type of work deals specifically with manipulating the bones and joints of the body. This has become absolutely mainstream in human medicine, and is becoming increasingly popular for equine athletes. Manipulation of joints to mimic and achieve normal range of motion can be done anywhere on the body. Most commonly, chiropractic therapy tends to be requested for neck, spinal, and pelvic area discomfort. 

There are two big elephants in the room when talking about equine chiropractic services:

Elephant #1: Horses are huge, so how can this possibly work? That’s a fair question. The size of the bones, joints, and supporting muscle strength limits how easily these manipulations can be done. This question was answered for me when world renowned equine veterinary chiropractor, Dr. Kevin Haussler, was lecturing at a conference I attended. He was asked: “How can we adjust the spine of a 1000 pound horse?” to which he replied, “Very simply. With knowledge, and one joint at a time.” 

Elephant #2: Chiropractic certification. This topic is a minefield. Service providers can potentially be human chiropractic doctors (who have done additional training in equine therapy), veterinarians who have completed recognized chiropractic certification courses, and laypersons who have completed chiropractic-type training courses varying from hundreds of hours down to a weekend-long seminar. That is a huge variation in levels of competency. Make sure your provider is well qualified and can logically explain what they are doing and what they hope to achieve with your horse.

Related: Equine Chiropractic

Acupuncture and laser therapy – These are also excellent sports medicine treatment options for horses. This therapy can be used when painful conditions exist following an injury, or as part of a preventive maintenance program. Acupuncture (discussed in the July/August 2017 issue) focuses on interacting with the nervous system. Fine needles are inserted at very specific points in the body with the intent to stimulate the nerves both in that area and elsewhere in the body. The nervous system is complex but one of its design features gives us many access points to treat a painful condition in the horse. For example, neck pain can be treated locally with acupuncture stimulation on the neck, or at distant points lower down the leg or shoulder.

Lameness evaluation and treatment – Many of the sports medicine treatment options for the horse obviously revolve around pain somewhere in the body causing abnormal movement or gait. Part of choosing one of these treatment modalities is getting an accurate diagnosis of the actual problem. The steps involved in sports medicine soundness evaluations normally follow a standard routine:

1. Accurate history from the owner or trainer: This is the basis for the exam. Useful information is the duration of the problem, what performance is being affected, and any treatments that have been used to date.

2. Standing exam and motion exam: Hands-on physical examination of the horse is still our most valuable tool as veterinarians. Manipulating the horse, palpating anatomy, and observing movement at various gaits starts to isolate the problem.

3. Diagnostic tests: These can be flexion tests, nerve blocks to localize pain, objective computer analysis with Lameness Locator®, or even lab tests if there is suspicion of underlying causes.

4. Imaging: It’s safe to bet some type of diagnostic imaging will be used for most sports medicine lameness related problems. This may involve radiographs, ultrasound, or more advanced procedures such as MRI (magnetic resonance imaging) or bone scans. Treatment decisions are influenced based on the level of pathology in the affected tissues (e.g., How bad is the fetlock arthritis?) so knowing this information is critical.

ESWT (Extracorporeal Shock Wave Therapy) – This therapy uses high-energy sound waves that penetrate through soft tissue at customized depths to stimulate tissue repair, increase circulation, and promote blood vessel growth. Similar-looking to an ultrasound probe, a shock wave “trode” is placed on the surface of the body and specific settings are used based on the tissue being treated. The goal is to promote healing, reduce lameness, increase mobility, and relieve pain. Shockwave has been clinically proven to treat such conditions as osteoarthritis, tendon/ligament injuries (i.e., suspensory ligament injury), bone fractures, back pain, and wounds.

Shockwave therapy for injured structures stimulates better quality of tissue healing, pain reduction, and faster healing times. Photo courtesy of Dr. Steve Chiasson

Regenerative Medicine – This is the new hot topic in equine sports medicine. The body does an amazing job of repairing itself, but sometimes the length of time it takes or the type of healing that happens is not ideal for the equine athlete. 

Excessive scar tissue following a tendon injury, or hock joint inflammation from years of jumping may serve the purpose of stabilizing the area, but the athletic career may be significantly shortened in the process. Fortunately, advances in regenerative therapy have led to new methods of helping horses heal better, faster, and maintain comfort while they perform. 

Examples of regenerative medicine include:

1. Stem cell or PRP (platelet rich plasma) therapy: These treatments involve harvesting the horse’s own cells from the body or blood. Stem cells can be harvested from a variety of sources including fat and bone marrow. PRP is obtained from collecting blood. After collection and special processing, the concentrated cells are injected into damaged tissue such as an injured tendon. Growth factors and a supply of healing cells are delivered exactly to the area they are needed. The concept provides for both a more rapid healing time, and for better types of tissue produced compared to unwanted scar tissue. 

Discard plasma (left) and concentrated PRP for injection treatment. Photo courtesy of Dr. Steve Chiasson

Related: Stem Cells Could Speed Equine Healing

2. Conditioned serum: This has various trade names such as “Pro-Stride APS” (autologous protein solution) or “IRAP” (interleukin-receptor antagonist protein) therapy. The rationale behind this treatment is that there are natural anti-inflammatory products already present in the horse’s own blood. This makes sense because the body must have a way of turning off the inflammatory process after it has done its job. By taking a blood sample and using special processing methods to concentrate those anti-inflammatory products, we get a volume of very powerful natural medication that can be injected back into the horse. This serum is most commonly used for joint injections, and with great success. Beneficial effects can be expected to last up to 12 months, and the treatment avoids the use of steroid injections, which can have both positive and negative effects on the horse. Recent advances in these regenerative medicine systems have allowed us to perform these procedures stall-side in less than 45 minutes from blood collection to injection time, and do it cost effectively for any equine athlete.

Regenerative medicine uses the horse’s own blood as a source for safe, and effective healing components for damaged and inflamed tissue. Photo courtesy of Dr. Steve Chiasson

Blood is being processed to concentrate its anti-inflammatory products, creating a serum that will be injected back into the horse. This method is being used for joint injections with great success. Photo courtesy of Dr. Steve Chiasson 

Aquatic Therapy – Specialized centres with aquatic treadmills, swimming pools, and whirlpools are able to offer rehabilitation for injured horses that is not possible on a farm setting. While these are not very common yet, they are certainly very effective. Exercising with reduced weight-bearing for joints and injured soft tissue is much easier for the horse, providing it is done under trained expertise and in a safe environment.

Aquatic therapy can be very effective as it allows for exercise with reduced weight-bearing on injured joints and soft tissue. Photo: Canstock/Epstock

You’re Part of the Team

One aspect of equine sports medicine that must not be overlooked is the rider’s side of the equation. They say it takes two to tango, and this could not be truer for equestrian sports. Much of your success and enjoyment will come from things you do to prepare yourself for time spent in the saddle. It is fascinating to observe how asymmetries noted in the musculoskeletal system of a performance horse can match those of its rider. A rider struggling with his or her own core strength and balance will hinder a horse from performing at its best, and may even contribute to soreness in the horse as it compensates for an unbalanced rider.

One of the best things you can do to keep your horse sound and balanced is to get the help of a knowledgeable coach. Even experienced riders benefit from qualified “eyes on the ground” to help ensure that their bad habits are noticed and corrected before they become engrained problems. In addition, riders with specific injuries or weaknesses of their own musculoskeletal system often benefit from sports medicine treatments of their own as recommended by a physician, physiotherapist, registered massage therapist, or chiropractor. Riders may also find that cross-training in other sports and working on their own cardiovascular fitness improves their ability to ride effectively.

It’s a well-accepted fact that we should all try to be in the best shape we can be for optimum health. An active lifestyle with regular exercise has proven to have many health benefits. Just the fact you are reading this article means you likely throw hay, clean the barn, and ride a horse for exercise and enjoyment. The same benefits are realized for horses when they are kept active and in shape. We probably ask more of them as athletes than any other domesticated animal. Fortunately, they are more than capable of the challenges we throw at them to train and compete. With that demand on them, it is fantastic to have today’s modern capabilities to maintain them and treat them like the finely-tuned athletes they are. 

Related: The Wild West - Navigating Canada's Unregulated Horse Industry

Related: Choosing the Right Equine Therapeutic Modality

Related: Imaging for Horses - An Inside Look

Main photo: Dreamstime/Mreco99