Keeping high-level sport horses on the road can be a challenge.
The first objective is to ensure that the horse is able to compete, while maintaining athletic longevity. The second is to make the horse as comfortable as possible to help optimise his performance. Different disciplines have different injuries that are most likely to limit performance.
In eventing, wastage tends to come from superficial digital flexor tendon injuries, whereas ligament injuries and joint problems are more of a limiting factor in dressage.
Because the aim is always prevention rather than cure, the horse must be regularly monitored for any problems before they become significant. There is veterinary monitoring at international FEI events, where the horse’s soundness will be evaluated, but it is difficult to detect subtle problems in this situation. Medication control at these events precludes the use of many drugs, for instance phenylbutazone (bute) to treat slight stiffness.
There is a mystique around the treatment of high-level sport horses, but the majority of time it is just the proactive application of standard orthopaedic principles. The quality of riding and training has far more influence than the vet in keeping the competition horse sound.
Minimising wear and tear
Soundness and athletic suitability for the intended purpose are first assessed at the pre-purchase examination.
A slowly progressive training regime, without excessive time spent doing more stressful exercises, is important. The best dressage riders spend relatively little time practising high-level movements at home and many top showjumpers only ever jump at a show. There is obviously a balance between having the horse fit enough to compete while minimising mileage to stop excessive wear and tear.
Good farriery is vital, but the rider’s role in making sure that the horse is shod regularly is equally as important. The emphasis should be on maintaining good foot balance, rather than fitting a particularly fashionable shoe. Older horses should be shod sympathetically for any limb deformities, but without trying to force them back into a perfect conformation.
Regular physiotherapy and and other complementary therapies can also be helpful.
An equine MOT
Veterinary monitoring is different from sport to sport, so it’s important to have a vet who understands the demands of the horse’s discipline.
The event horse MOT normally takes place a week or so after a 3-day event. The horse is examined, trotted and his tendons are scanned. On the basis of this, a plan is made for any further monitoring or treatment as required — for example, a course of shockwave treatment for a niggling ligament problem.
Detecting a minor tendon injury at this point, often with no obvious clinical signs, can mean just a short period out of competition. Time off can be prolonged if an injury is missed and then blows up when the horse has his first proper canter back in work.
Ultrasound scans are therefore very helpful in picking up subtle problems. Reference scans to compare to are useful, as accumulated wear and tear changes can be difficult to differentiate from a fresh, mild injury.
A dressage horse MOT is normally undertaken when the trainer feels that there is poor performance.
Showjumpers have their routine checks when a rider considers performance is below par or when the horse is transiently back in the UK. Due to their itinerant schedules, horses may see various vets and receive varied treatments. It is important to establish an accurate history to do the best job.
Furthermore, different vets employ different strategies with respect to medication and wor-kup. Some prefer to nerve block and image any mild problems to try to identify any issues accurately, while others will proceed with treatment based on a very brief clinical examination.
Even an apparently trivial injury such as a splint can stop a horse competing at a major competition, if not picked up and treated early. A period of rest and patience in the early stages can often lead to less time out of work than a head-in-the sand approach of trying to carry on working the horse.
As an example, some niggling tendon sheath problems respond better to endoscopic (keyhole) surgery than to repeated medications. You can actually end up with a short recuperation period in the long-term with more aggressive initial treatment.
Joint issues may need ongoing medication. Oral supplements have somewhat limited efficacy, but may be beneficial in the maintenance of low-grade problems. Bisphosphonates, such as Equidronate, can be helpful in horses with more bony problems, although the response of individual horses is variable.
Intra-articular corticosteroids are the mainstay of joint treatment. In other circumstances, platelet-rich plasma (PRP) or autologous conditioned serum (IRAP) may encourage more healing response.
All systems go
The musculoskeletal system requires the most care and attention in the competition horse, but it is important not to neglect other body systems.
Simple things such as dermatitis, ringworm and skin sores can become a problem if not treated early. A number of competition horses have allergic skin conditions that can be difficult to manage, because of the amount they travel and the inability to exert strict control over their environment.
Similarly, lower respiratory tract conditions can be problematic because of the difficulty in creating a dust-free environment.
Dynamic endoscopy has been a major advance in the diagnosis of upper respiratory tract problems. The larynx can now be viewed during normal exercise, thanks to a special endoscope strapped to the horse’s bridle — a technique that has made treadmill endoscopy redundant.
Standing laser therapy can be useful for more minor wind conditions — the traditional Hobday procedure under general anaesthesia is rarely required.
From a nutrition point of view, the majority of sport horses just require additional salt and vitamin E. Some of the specialised high-fat, low-starch diets can be helpful, however, for horses prone to tying-up.
It’s worth having the horse’s heart listened to regularly. A number of horses developed an irregular heartbeat at Badminton this year and it is important to know that the heart was normal beforehand.
Understanding what’s competition legal
With drugs such as nonsteroidal anti-inflammatories it is very important to be aware of detection times for national and international competition. For phenylbutazone (bute), for example, we would normally allow approximately 7 days for withdrawal from the horse’s system. But other anti-inflammatories such as Metacam (meloxicam) have shorter detection times and are more appropriate for use close to competition.
Antibiotics are permitted, except procaine (white) penicillin. Some anti-ulcer treatments and Regumate for mares are also now allowed, as are vitamins, amino acids and fluids.
Shockwave therapy can be helpful in the management of some soft tissue problems, but its use is banned for 5 days before competition.
Routine joint maintenance therapies are now allowed during competition, after completion of appropriate permission forms, but must be administered by an FEI licensed treating vet. Hyaluronic acid products and anti-arthritic drugs such as Adequan and Cartrofen are currently allowed, as is the homeopathic drug Traumeel.
As always, check with your vet first.
Preempting a problem
Debate rages about prophylactic — or pre-emptive — “treatment”. This is commonly performed outside of the UK, most notably in America and continental Europe.
If a joint is inflamed, treatment into the joint with anti-inflammatory drugs such as corticosteroids is actually beneficial in the long-term. If a lameness problem has been accurately identified, even in a young horse, corticosteroid treatment may be appropriate. It is not necessarily the start of a vicious cycle of repeated injections.
It is not advantageous, however, to repeatedly treat normal joints, as this can lead to cartilage damage. An accurate diagnosis is preferable to “treat and see”. Not all corticosteroids are the same. Triamcinolone is considered to be protective for cartilage, whereas methyl prednisolone acetate (Depo-Medrone) is deleterious.
Systemic anti-arthritic drugs such as intravenous hyaluronic acid (Hyonate or Hy50) or intramuscular Adequan/Cartrophen can be used prophylactically — the only problem is the cost. They are more potent than oral supplements but less so than targeted local treatment.
Studies in racehorses in the USA have shown benefits in higher numbers of starts and more prize-money won with courses of Adequan and Hyonate. Other studies, however, have shown no significant difference.
This article was first published in the 22 May issue of Horse & Hound magazine