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Influence of Discipline on Sport Horse Lameness

BEVA Congress is the once yearly opportunity for equine vets to get together and hear 3 days of world class speakers on a variety of subjects encompassing the whole gamut of equine work – from arthroscopy to zoonoses. This year I attended a very interesting session chaired by Sue Dyson where three vets involved at world class level detailed their experiences with discipline-specific injuries and compared and contrasted the differing stresses on animals competing at top level dressage, show-jumping and eventing. There was also a contribution from an endurance vet but unfortunately I had to dash out to get to a talk on Extensor Tendon Lacerations so I missed it. I tend to deal with more tendon lacerations than international endurance horses in my normal working life so you’ll have to excuse me! I’ve summarised the main points below and hope you find it interesting. Some are paraphrased, some repeated virtually verbatim. The recurring theme from all the vets was the importance of the vet having detailed knowledge of, and understanding the questions that were to be asked of the horse, and the format and factors involved at different levels of the particular discipline.

Dressage – Svend Kold DrMedVet RFP CUEW MRCVS, RCVS recognised specialist in equine surgery (orthopaedic)

Dressage horses rarely succumb to acute traumatic injuries and are more likely to display repetitive, accumulative subclinical injuries that may appear irregularly. You are rarely presented with a lame horse but more often a loss of performance, engagement or sub-clinical multi-limb lameness. Assessment of the dressage horse requires comparison of all three gaits, both with and without a rider, and possibly also assessment of lateral work, piaffe and passage. Many dressage horses presented for underperformance only reproduce the problem as a subtle resistance and sometimes only during a particular exercise or transition. It may be necessary to swap from ridden to lunge several times, swap from sitting to rising trot and to swap riders.

Common hindlimb lameness problems are associated with the supportive and propulsive structures such as the suspensory ligaments, hock and stifle. Proximal suspensory desmitis is the most common cause of hindlimb lameness in horses working at Medium and above. Pain from the medial femorotibial (stifle) joint  is also common.

The coffin joint and navicular bursa are the most common sites of forelimb lameness. Bilateral coffin joint problems are common and if mild may have been present for some time without being noticed.

In dressage the horse’s back and state of relaxation are key to success in training. The back is an almost permanent concern  in dressage as a strongly and correctly educated back is an essential requirement for engagement of the hindlimbs. With increasing demand for collection in the higher level work the hindlimbs are asked to come further and further under the body and the correct back posture becomes vital [this statement dovetails very neatly with a session I attended with Gillian Higgins of Horses Inside Out which I shall be writing up for E-Venting in the near future].

It is important to realise that some performance problems may not be clinical issues per se but that the horse (or rider) has reached the limit of its innate ability. This can be a difficult subject to broach!

Today’s artificial surfaces can be too compliant. Horses should (and must!) be trained on a variety of surfaces. Sand has been shown to present 1.36x the risk factor of modern synthetic surfaces.

30% of horses at Inter II and 50% at Grand Prix have had a significant episode of lameness during their career.

28% of all dressage horses have hindlimb suspensory problems to some degree during their career, >20% have back issues.

As an aside it is worth noting that Dr Kold could recite the scales of training – not all dressage competitors and even fewer eventers can do this! – and was au fait with the positioning, bend and aids for various lateral movements. This can only enhance a vet’s understanding of the way performance problems can manifest.

 

Show-Jumping – Phillipe Benoit DVM, French show-jumping team vet 1992-2000, FEI veterinary committee member

Show-jumpers are the short-distances runners of the equine Olympic disciplines. They are generally in the ring for around 2 minutes (compared with dressage tests at 8-10mins and eventers with a total of around 20mins). An average high level horse may jump 80 classes per year and they have a very high travelling mileage. Some virtually live on the road. There is no ‘season’ as such anymore.  They tend to receive short periods of training (maybe 20mins/day) at slow speeds and are subject to high concussive forces (especially on the forelimbs) and use an extreme range of back movement.

Again, the horse should be examined with and without a rider and a strong or very authoritative rider should be avoided. It is beneficial to observe the horse from cold in the warm-up giving importance to the freedom and range of movement of the shoulders and forelimbs and lateral and longitudinal movement of the pelvis. A small figure of 8 (10m) in trot can show discrepancies of bend and flexion and this should be observed in rising and sitting trot. Ask the rider for their feelings on the horse’s symmetry during this exercise. Canter may be the most telling pace and a useful exercise to illustrate resistances is a 10m circle in collected canter, extending the canter on a straight line, then collecting onto another 10m circle.

Some problems only manifest themselves over a jump, and some only in competition. Landing on a favoured leg or jumping toward one particular side may be the only signs of subclinical problems. The horse should be observed round a course and the vet should have some knowledge of how a particular course rides to be able to judge the ability of the horse to eg. jump a triple bar then compress his back and stride to shorten for an upright 5 strides later. Observe the horse round turns and through lead changes and parts of the course where it is required to extend or collect. Watching a horse jump through short one-stride doubles of verticals from the side and from in front can be  useful indicator of back and pelvic comfort. The shape of the bascule should be observed. Nerve blocking before re-jumping may be appropriate so long as sufficient care has been taken to rule out significant injury which may become catastrophic under these circumstances.

Changing behind is a common problem and may be indicative of injury, or not. Sometimes a rider can produce this effect unknowingly. It is often a sign of lumbosacral weakness or pain but can also indicate distal hock joint disease, proximal suspensory desmitis or stifle problems so you must evaluate all of these as well as the possibility of a schooling problem.

 

Eventing – Carsten Rohde MS DipACVS DipECVS, German eventing elite squad/team vet

Dr Rohde concentrated on the changing face of eventing and the changing demands on the horses. He used pictures of fences from the European Championships in Malmo to demonstrate the technicalities and gymnastic questions asked by modern courses.  In the 2000 Olympics the horses competed over a total of 23km. In 2012 this was 5.7km. This has decreased by a factor of nearly 4 in only 12 years. Fatigue problems such as exertional rhabdomyolysis (‘tying-up’), tendon injuries and fatigue-related falls are rarely an issue now. The increasing technicality in all three phases has changed the type of horse and the type of injury. In the old days horses were required to be brave, clever and bold. Now they must be balanced, supple, athletic and possess power and expression. They run many more times in a season. The  level of dressage and show-jumping is such that injuries often mirror those suffered by the ‘pure’ dressage and show-jumping horses.

To win a major 3-day or championship you now MUST finish on your dressage score [I didn’t like to point out Michael Jung’s SJ down at in Malmo] so your dressage becomes more and more important [at this point Dr. Rohde postulated that any FEI eventing dressage score >50 probably indicated a lame/sore horse, which I disagreed with – some, surely are just tense or not capable of the higher movements? However I guess if your frame of reference is Michael Jung and Ingrid Klimke then 50+ probably would indicate something significantly wrong. Mere mortals probably needn’t be too worried by this!].  

Other than the injuries mentioned by the previous two speakers relating specifically to dressage and show-jumping, osteoarthritis is a concern – predominately of the feet, stifle and facet joints. Trying to turn with big studs in can also cause rotation and inflammation of the coffin joints.

Due to the higher rates of repetitive training in the school now required to produce the suppleness and self-carriage necessary for the increasingly technical phases the classic career-ending injuries of yesteryear have been replaced by the chronic stresses and strains of the other disciplines. However there is now more scope to extend a horse’s career with careful management of these injuries.

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The Eventing Vet

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