Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 4. Morphometric, microscopic and biomechanical properties of the digital tendons of the forelimb

Concurrent radiological and ultrasonographical findings in the forelimb proximal sesamoid bones and adjacent suspensory ligament branches in yearling and 2-year-old Thoroughbred sales horses

BACKGROUND

Changes in the proximal sesamoid bones (sesamoids) and the insertional region of the adjacent suspensory ligament branch (branch) are of particular importance in young Thoroughbreds sold at public auction. Little is known about the prevalence of concurrent ultrasonographical branch change, relative to the various grades of radiological sesamoid appearance.

OBJECTIVE

To examine the existence of concurrent radiological and ultrasonographical findings in individual sesamoid-branch units in sales horses; to determine whether there are any radiological findings that are consistently accompanied by a particular degree of insertional branch change, and to provide practical recommendations as to when suspensory branch ultrasonography may be warranted in a sales environment.

STUDY DESIGN

Prospective cohort study using an enrolled sample.

METHODS

Horses were enrolled with consignor permission from a large Thoroughbred yearling sale and five 2-year-old Thoroughbred sales the following year. Data from the radiological evaluation of forelimb sesamoids and the ultrasonographical examination of the adjacent forelimb suspensory branches were described.

RESULTS

A total of 2204 yearling forelimb sesamoid-branch units and 1336 2-year-old forelimb sesamoid-branch units were included, from 551 sales yearlings and 334 sales 2-year-olds. The proportion of yearling sesamoids with grade ≤1 vascular channels that had adjacent grade ≥2 fibrillar branch change was 1.2%. The same proportion for 2-year-olds was 3.8%, with medial forelimb sesamoids with grade 1 vascular channels overrepresented in 2-year-olds in this category. In yearlings, 31% of sesamoids with grade 2 vascular channels had adjacent grade ≥2 fibrillar branch change and 59% of sesamoids with grade 3 vascular channels had adjacent grade ≥2 fibrillar branch change. In 2-year-olds, 47% of sesamoids with grade 2 vascular channels had adjacent grade ≥2 fibrillar branch change and 67% of sesamoids with grade 3 vascular channels had the same. Only one yearling sesamoid and one 2-year-old sesamoid with radiological abaxial concavity had grade ≥2 fibrillar branch change.

MAIN LIMITATIONS

Hindlimbs were not included. Clinical examinations were not performed and the status of any past or present inflammatory process at the sesamoid-branch enthesis could not be inferred from radiographs and ultrasonographic images alone.

CONCLUSIONS

The existence and prevalence of concurrent radiological and ultrasonographical findings in the proximal sesamoid bones and adjacent suspensory ligament branches in yearling and 2-year-old Thoroughbred sales horses has been established. General recommendations have been made for selective branch ultrasonography on the basis of radiological sesamoid appearance. The results support a separate aetiology for radiological sesamoid abaxial concavity that does not primarily involve the suspensory branch insertion.

Is the fluid volume fraction equal to the water content in tendons? Insights on biphasic modeling

The mass density of highly hydrated soft tissues is generally assumed to be very close to that of the water, resulting that the fluid mass fraction (water content) being equal to the fluid volume fraction. Within this context, the present study aims to investigate whether such an assumption actually holds for tendon tissues and to what extent it may affect the constitutive characterizations based on biphasic (poroelastic) models. Once the water content was assessed by a classical drying assay, the fluid volume fraction was obtained based on an image segmentation approach. The main achieved results point out that the fluid volume fraction is ∼20% higher than the water content in the studied tendons (flexor digitorum profundus bovine tendons). Based on this, it is shown that the use of the water content instead of the fluid volume fraction may considerably bias the results drawn by biphasic modeling of tendons. Accordingly, a proper measurement of the fluid volume fraction is then required.

Survival Analysis of Training Methodologies and Other Risk Factors for Musculoskeletal Injury in 2-Year-Old Thoroughbred Racehorses in Queensland, Australia

Musculoskeletal injuries remain a global problem for the Thoroughbred racing industry and there is conflicting evidence regarding the effect of age on the incidence of injuries. The ideal time to commence race training is strongly debated, with limited supporting literature. There is also conflicting evidence regarding the effect of high-speed exercise on musculoskeletal injuries. There is a strong interest in developing training and management strategies to reduce the frequency of injuries. The types of musculoskeletal injuries vary between 2-year-old and older horses, with dorsal metacarpal disease the most common injury in 2-year-old horses. It is likely that risk factors for injury in 2-year-old horses are different than those for older horses. It is also likely that the risk factors may vary between types of injury. This study aimed to determine the risk factors for musculoskeletal injuries and dorsal metacarpal disease. We report the findings of a large scale, prospective observational study of 2-year-old horses in Queensland, Australia. Data were collected weekly for 56-weeks, from 26 trainers, involving 535 2-year-old Thoroughbred racehorses, 1, 258 training preparations and 7, 512-weeks of exercise data. A causal approach was used to develop our statistical models, to build on the existing literature surrounding injury risk, by incorporating the previously established causal links into our analyses. Where previous data were not available, industry experts were consulted. Survival analyses were performed using Cox proportional hazards or Weibull regression models. Analysis of musculoskeletal injuries overall revealed the hazard was reduced with increased exposure to high-speed exercise [Hazard ratio (HR) 0.89, 95% Confidence Interval (CI) 0.84, 0.94, p < 0.001], increased number of training preparations (HR 0.58, 95% CI 0.50, 0.67, p < 0.001), increased rest before the training preparation (HR 0.89, 95% CI 0.83, 0.96, p = 0.003) and increased dam parity (HR 0.86, 95% CI 0.77, 0.97, p = 0.01). The hazard of injury was increased with increasing age that training commenced (HR 1.13, 95% CI 1.06, 1.19, p < 0.001). Analyses were then repeated with the outcome of interest dorsal metacarpal disease. Factors that were protective against dorsal metacarpal disease and musculoskeletal injuries overall included: increased total cumulative distance (HR 0.89, 95% CI 0.82, 0.97, p = 0.001) and total cumulative days exercised as a gallop (HR 0.96, 95% CI 0.92, 0.99, p = 0.03), the number of the training preparations (HR 0.43, 95% CI 0.30, 0.61, p < 0.001). The age that training commenced was harmful for both dorsal metacarpal disease (HR 1.17, 95% CI 1.07, 1.28, p < 0.001 and overall musculoskeletal injuries.). The use of non-ridden training modalities was protective for dorsal metacarpal disease (HR 0.89, 95% CI 0.81, 0.97, p = 0.008), but not musculoskeletal injuries overall. The male sex increased the hazard of DMD compared to females (HR 2.58, 95% CI 1.20, 5.56, p = 0.02), but not MSI overall. In summary, the hazard of musculoskeletal injury is greatest for 2-year-old horses that are born from uniparous mares, commence training at a later age, are in their first training preparation, have undertaken little high-speed exercise or had limited rest before their training preparation. The hazard of dorsal metacarpal disease is greatest for 2-year-old horses that are males, commence training at a later age, are in their first training preparation, have undertaken little high-speed exercise or had limited use of non-ridden training modalities. Close monitoring of these high-risk horses during their training program could substantially reduce the impact of MSI. Furthermore, an understanding of how training methodologies affect the hazard of MSI facilitates modification of training programs to mitigate the risk impact of injury. The strengths of this study include a large sample size, a well-defined study protocol and direct trainer interviews. The main limitation is the inherent susceptibility to survival bias.

A Prospective Study of Training Methods for Two-Year-Old Thoroughbred Racehorses in Queensland, Australia, and Analysis of the Differences in Training Methods between Trainers of Varying Stable Sizes

Simple Summary

Musculoskeletal injuries present significant concerns for the global Thoroughbred racing industry. The development of training and management strategies to reduce injuries has been challenging due to conflicting findings about the risk factors for injury, and limited understanding of the role of different training methodologies. There is little published data on patterns of rest periods and exercise data and how these vary between trainers and between different racing jurisdictions. We describe training methodologies for 535 two-year-old horses providing 1258 training preparations and 7512 weeks of exercise. We investigated the variation in training methodologies between trainers from small, medium and large stable sizes. Significant differences were observed between trainers, with horses from larger stables accumulating a greater high-speed exercise volume, attaining training milestones more frequently and taking less time to reach their training milestones. We also highlight similarities and differences in training methods used in Queensland, Australia, and those previously reported from other geographic locations. A better understanding of training methods is an essential step towards reducing the impact of injuries.

Abstract

Worldwide, musculoskeletal injuries remain a major problem for the Thoroughbred racing industry. There is a strong interest in developing training and management strategies to reduce the impact of musculoskeletal injuries, however, progress has been limited by studies reporting conflicting findings, and a limited understanding of the role of different training methods in preventing injury. There is little data on patterns of rest periods and exercise data and how these vary between trainers. This prospective study of two-year-old racehorses was conducted in Queensland, Australia and involved weekly personal structured interviews with 26 trainers over 56 weeks. Detailed daily exercise data for 535 horses providing 1258 training preparations and 7512 weeks at risk were collected. Trainers were categorised into three groups by the mean number of two-year-old horses that they had in work each week over the study duration: (1) Small stables with five or less, (2) Medium stables with 6 to 15 and (3) Large stables with greater than 15 horses in training. Differences between trainers with small, medium and large stable sizes were evaluated using linear regression, Kruskal–Wallis equality-of-populations rank test if linear models were mis-specified or Chi-squared tests for categorical variables. Significant differences were observed between trainers, with horses from larger stables accumulating a greater high-speed exercise volume (p < 0.001), attaining training milestones more frequently (p = 0.01) and taking less time to reach their training milestones (p = 0.001). This study provides detailed data to which training practices from other locations can be compared. Presenting actual training data rather than trainers’ estimation of a typical program provides a more accurate assessment of training practices. Understanding how training practices vary between regions improves comparability of studies investigating risk factors and is an important step towards reducing the impact of musculoskeletal injuries.

Comparative anatomic and morphometric examination of the interosseous muscle, sesamoid ligaments and flexor tendons of the fetlock in South American camelids

This study presents a comparative morphological and morphometrical examination of the interosseous muscle (IOM), digital flexor tendons and associated structures of all four species of South American Camelids (SACs): Lama (Lama glama), alpaca (Vicugna pacos), guanaco (Lama guanicoe) and vicuna (Vicugna vicugna). Our findings show that the lamoid interosseous muscle and digital flexor tendons are very similar between species and differences, which have been reported previously, are possibly due to diverging examiner interpretation. Lumbricalis muscles were mostly found as single muscles in this study. The definition of the terminal and dorsal branches of the interosseous muscle is critically revised. The analysis of morphometric data indicates that the size of the individual has a substantial influence on the cross-sectional area (CSA) of the examined structures. Metacarpal/metatarsal bone width is a main predictor of CSA, while the factor species only shows significance in specific sample points. For lama and alpaca, no differences in CSA in relation to species as factor were found. The IOM shows the largest CSAs of the three examined structures in all species, which implies an important load-bearing function. Considerable individual variation remains unexplained by the mentioned factors. This lowers the prospect of CSA reaching diagnostic importance in SAC fetlock pathology.

The Risk Factors for Musculoskeletal Injuries in Thoroughbred Racehorses in Queensland, Australia: How These Vary for Two-Year-Old and Older Horses and with Type of Injury

Simple Summary

Musculoskeletal injuries (MSI) continue to affect Thoroughbred racehorses internationally, despite over thirty years of research into this problem. Studies of risk factors for musculoskeletal injuries report inconsistent findings. Consequently, developing training strategies to mitigate the risk of MSI is difficult. We identified factors associated with particularly high odds of injury in this population of racehorses. Two-year-old horses from primiparous mares (first foals born) are at increased odds of MSI, particularly dorsal metacarpal disease (“shinsoreness”). Two-year-old horses that have had a total preparation length of between 10 and 14 weeks also have increased odds of injury. Horses of all ages that travelled a total distance of 2.4–3.8 km (12–19 furlongs) at a gallop (faster than 15 m/s; 13 s/furlong; 900 m/min; 55 km/h) in the last four weeks and horses three years and older that travelled 3.0–4.8 km (15–24 furlongs) at three-quarter pace and above (faster than 13 m/s; 15 s/furlong; 800 m/min; 48 km/h) also have increased odds of injury. We recommend that these horses should be monitored closely for impending signs of injury. We also observed a non-linear relationship between high-speed exercise and musculoskeletal injuries. This highlights the importance of high-speed exercise to enable tissue adaptation to training. Finally, in some situations, increasing the number of days worked at a slow pace may be more effective for preventing MSI, if horses are perceived at a higher risk, than resting the horse altogether. Early identification of horses at increased risk of injury and appropriate intervention could substantially reduce the impact of musculoskeletal injuries in Thoroughbred racehorses.

Abstract

Musculoskeletal injuries (MSI) continue to affect Thoroughbred racehorses internationally. There is a strong interest in developing training and management strategies to reduce their impact, however, studies of risk factors report inconsistent findings. Furthermore, many injuries and fatalities occur during training rather than during racing, yet most studies report racing data only. By combining racing and training data a larger exposure to risk factors and a larger number of musculoskeletal injuries are captured and the true effect of risk factors may be more accurately represented. Furthermore, modifications to reduce the impact of MSI are more readily implemented at the training level. Our study aimed to: (1) determine the risk factors for musculoskeletal injuries and whether these are different for two-year-old and older horses and (2) determine whether risk factors vary with type of injury. This was performed by repeating analyses by age category and injury type. Data from 202 cases and 202 matched controls were collected through weekly interviews with trainers and analysed using conditional logistic regression. Increasing dam parity significantly reduced the odds of injury in horses of all age groups because of the effect in two-year-old horses (odds ratio (OR) 0.08; 95% confidence interval (CI) 0.02, 0.36; p < 0.001). Increasing total preparation length is associated with higher odds of injury in horses of all ages (OR 5.56; 95% CI 1.59, 19.46; p = 0.01), but particularly in two-year-old horses (OR 8.05; 95% CI 1.92, 33.76; p = 0.004). Increasing number of days exercised at a slow pace decreased the odds of injury in horses of all ages (OR 0.09; 95% CI 0.03, 0.28; p < 0.001). The distance travelled at three-quarter pace and above (faster than 13 m/s; 15 s/furlong; 800 m/min; 48 km/h) and the total distance travelled at a gallop (faster than 15 m/s; 13 s/furlong; 900 m/min; 55 km/h) in the past four weeks significantly affected the odds of injury. There was a non-linear association between high-speed exercise and injury whereby the odds of injury initially increased and subsequently decreased as accumulated high-speed exercise distance increased. None of the racing career and performance indices affected the odds of injury. We identified horses in this population that have particularly high odds of injury. Two-year-old horses from primiparous mares are at increased odds of injury, particularly dorsal metacarpal disease. Two-year-old horses that have had a total preparation length of between 10 and 14 weeks also have increased odds of injury. Horses of all ages that travelled a total distance of 2.4–3.8 km (12–19 furlongs) at a gallop in the last four weeks and horses three years and older that travelled 3.0–4.8 km (15–24 furlongs) at three-quarter pace and above also have increased odds of injury. We recommend that these horses should be monitored closely for impending signs of injury. Increasing the number of days worked at a slow pace may be more effective for preventing injury, if horses are perceived at a higher risk, than resting the horse altogether. Early identification of horses at increased risk and appropriate intervention could substantially reduce the impact of musculoskeletal injuries in Thoroughbred racehorses.

Reproducibility and feasibility of acoustoelastography in the superficial digital flexor tendons of clinically normal horses

OBJECTIVE

To evaluate the feasibility and repeatability of in vivo measurement of stiffness gradients by means of acoustoelastography in the superficial digital flexor tendons (SDFTs) of clinically normal horses.

ANIMALS

15 clinically normal horses.

PROCEDURES

For each horse, stiffness gradient index and dispersion values for SDFTs in both forelimbs were evaluated in longitudinal orientation by use of acoustoelastography at 3 sites (5, 10, and 15 cm distal to the accessory carpal bone) by 2 observers; for each observer, data were acquired twice per site. The left forelimb was always scanned before the right forelimb. Lifting of the contralateral forelimb with the carpus flexed during image acquisition resulted in the required SDFT deformation in the evaluated limb. Interobserver repeatability, intraobserver repeatability, and right-to-left limb symmetry for stiffness gradient index and dispersion values were evaluated.

RESULTS

Stiffness gradient index and dispersion values for SDFTs at different locations as well as effects of age or sex did not differ significantly among the 15 horses. Interclass correlation coefficients for interobserver repeatability, intraobserver repeatability, and limb symmetry revealed good to excellent agreement (intraclass correlation coefficients, > 0.74).

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that acoustoelastography is a feasible and repeatable technique for measuring stiffness gradients in SDFTs in clinically normal horses, and could potentially be used to compare healthy and diseased tendon states.

Role of moderate exercising on Achilles tendon collagen crimping patterns and proteoglycans

In this study, the morphological and morphometric changes in the collagen crimping pattern of Achilles tendon and metabolism/expression of tenocytes explanted from tendons of running (RUN) and sedentary (SED) rats were investigated to assess the effects of 12 weeks moderate running exercise. The number, the top angle width and the base length of each crimp in three different regions (proximal, central and distal) of RUN and SED tendons were measured with a polarized light microscope. The most significant morphometric differences in the crimps were detectable in the central region of the RUN tendons. In this region, crimps were fewer, larger and more flattened than those of other regions as a consequence of a functional adaptation of extracellular matrix to running, in order to increase tendon stiffness and force transmission efficiency. Conversely, the top angle width of the crimps reduced in proximal and distal regions of the RUN tendons, suggesting that these crimps might act as more reactive mechanical springs, able to store and improve the release of the stored strain energy in most loaded regions. Tenocytes explanted from Achilles tendons of both RUN and SED groups were cultured. Running influenced tenocytes which showed a significant increase in collagen type-I synthesis and proteoglycans production, suggesting enhancement of the loading transmission efficiency and facilitate inter-fibril and inter-fiber sliding.

Differences in the metabolic properties of gluteus medius and superficial digital flexor muscles and the effect of water treadmill training in the horse

REASONS FOR PERFORMING STUDY

Flexor tendon injury may be due to flexor muscle fatigue, contributing to fetlock joint hyperextension and tendon damage. A water treadmill provides resistance training on flexor tendon muscles, which might reduce the risk of tendon injury.

OBJECTIVE

To determine the effect of water treadmill training on the properties of the gluteal and superficial digital flexor (SDF) muscles and on cardiocirculatory response to a standardised exercise test.

METHODS

Five healthy unfit horses were trained on a water treadmill for 5 days/week for 4 weeks, starting with 5 min/day increasing to 20 min/day. Before and after the water treadmill training, an incremental SET was performed on a land treadmill to determine velocity at a heart rate 200 beats/min (V(200)) and resting gluteal and SDF muscle biopsies were obtained for biochemical analyses.

RESULTS

There was no measurable difference in resting concentrations of gluteal or SDF muscle glycogen, lactate, ATP or glucose-6-phosphate (G6P), or activities of citrate synthase (CS), 3-hydroxyacyl CoA dehydrogenase (HAD) and lactate dehydrogenase (LDH) after training and no change in V(200), Lactate, glycogen, G6P and ATP concentrations were 50% lower and type 1 fibres 30% higher in SDF compared to gluteal muscles. CS and HAD activities were similar between SDF and gluteal, while LDH was lower in the SDF muscle.

CONCLUSIONS

A more strenuous water treadmill conditioning protocol may be needed to induce a training effect in gluteal and SDF muscle and heart rate response. The low substrate concentrations and oxidative capacity of SDF may predispose this muscle to catastrophic fatigue during maximal exercise.

Risk factors for musculoskeletal injuries of the lower limbs in Thoroughbred racehorses in New Zealand

AIM

To investigate risk factors for injury to musculoskeletal structures of the lower fore- and hind-limbs of Thoroughbred horses training and racing in New Zealand.

METHODS

A case-control study analysed by logistic regression was used to compare explanatory variables for musculoskeletal injuries (MSI) in racehorses. The first dataset, termed the Training dataset, involved 459 first-occurrence cases of lower-limb MSI in horses in training, and the second, the Starting dataset, comprised a subset of those horses that had started in at least one trial or race in the training preparation that ended with MSI (n=294). All training preparations for horses that did not suffer from MSI for which complete data were available were used in the analyses as controls, and provided 2,181 and 1,639 preparations for the Training and Starting datasets, respectively. Multivariate logistic regression was used to evaluate risk factors, and results were reported as odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Horses aged > or =5 years were at higher risk of injury than 2-year-olds. Elevated odds of MSI occurred in horses in the Starting dataset that were training in the 1997-1998 year compared with the 1999-2000 year, and in those horses where trials comprised >20% of all starts in a preparation. Training preparations that ended in winter, and horses in their third or later training preparation, had lower odds of MSI compared with those ending in other seasons or the first preparation, respectively. Reduced odds of MSI were observed in preparations in which starts occurred compared with those that had no starts, and in the Starting dataset, preparations that included more than one start had a reduced likelihood of MSI compared with preparations that had only one start. In the Training dataset, preparations longer than 20 weeks were associated with reduced odds of MSI compared with those shorter than 20 weeks. Cumulative racing distance in the last 30 days of a training preparation was best modelled with linear and quadratic terms. Results indicated that increasing cumulative racing distances were associated with an initial reduction in the odds of MSI that then levelled out and finally appeared to increase again as the explanatory variable continued to increase. The risk of MSI varied significantly between trainers.

CONCLUSION

This study identified intrinsic (age) and extrinsic risk factors for MSI in training and racing Thoroughbreds in New Zealand. The risk of MSI initially decreased, then increased, as cumulative racing distance increased. Significant variation between trainers indicated management and training methods influence the risk of MSI.

Reliability and responsiveness of musculoskeletal ultrasound in subjects with and without spinal cord injury

Rehabilitation after spinal cord injury (SCI) aims to preserve the integrity of the paralyzed musculoskeletal system. The suitability of ultrasound (US) for delineating training-related muscle/tendon adaptations after SCI is unknown. The purpose of this study was to quantify within- and between-operator reliability for US and to determine its responsiveness to post-training muscle/tendon adaptations in SCI subjects. Two novice operators and one experienced operator obtained sonographic images of the vastus lateralis, patellar tendon, soleus, and Achilles tendon from seven SCI subjects and 16 controls. For control subjects, within-operator concordance (ICC [3,1]) ranged from 0.58 to 0.95 for novice operators and exceeded 0.86 for the experienced operator. Between-operator concordance (ICC [2,1]) ranged from 0.62 to 0.74. Ultrasound detected muscle hypertrophy (p < 0.05) following electrical stimulation training in subjects with SCI (responsiveness) but did not detect differences in tendon thickness. These error estimates support the utility of US in future post-SCI training studies.

The influence of exercise during growth on ultrasonographic parameters of the superficial digital flexor tendon of young Thoroughbred horses

REASON FOR PERFORMING STUDY

Conditioning by early training may influence the composition of certain musculoskeletal tissues, but very few data exist on its effect during growth on tendon structure and function.

OBJECTIVES

To investigate whether conditioning exercise in young foals would lead to any ultrasonographically detectable damage to the superficial digital flexor tendon or an increase in cross-sectional area (CSA).

METHODS

Thirty-three Thoroughbred foals reared at pasture were allocated to 2 groups: control (PASTEX) allowed exercise freely at pasture; and CONDEX, also at pasture, began conditioning exercise from mean age 21 days over 1030 m on a purpose-built oval grass track, for 5 days/week until mean age 18 months. Foals were observed daily, and underwent orthopaedic examination monthly. Ultrasonographic images of the superficial digital flexor tendon (SDFT) at the mid-metacarpal level of both forelimbs were obtained in all foals at ages 5, 8, 12, 15 and 18 months. CSA was validated (r(2) = 0.89) by determining CSA from digital photographs of the transected SDFT surface from 12 of the horses necropsied at age 17.1 months.

RESULTS

here was no clinical or ultrasonographic evidence of tendonopathy in either group and the greatest increase in mean CSA in both groups occurred between age 5 and 8 months. Across all age categories, there was no significant difference in mean CSA between the left and right limbs, or colts and fillies; there was a trend towards a larger CSA in the CONDEX group (P = 0.058).

CONCLUSIONS

There was no conclusive evidence for a structural adaptive hypertrophy of the SDFT, probably because the regimen was insufficiently rigorous or because spontaneous pasture exercise may induce maximal development of energy storing tendons.

POTENTIAL RELEVANCE

A moderate amount of early conditioning exercise against a background of constant exercise at pasture is not harmful to the development of the flexor tendons.

Human tendon behaviour and adaptation, in vivo

Tendon properties contribute to the complex interaction of the central nervous system, muscle-tendon unit and bony structures to produce joint movement. Until recently limited information on human tendon behaviour in vivo was available; however, novel methodological advancements have enabled new insights to be gained in this area. The present review summarizes the progress made with respect to human tendon and aponeurosis function in vivo, and how tendons adapt to ageing, loading and unloading conditions. During low tensile loading or with passive lengthening not only the muscle is elongated, but also the tendon undergoes significant length changes, which may have implications for reflex responses. During active loading, the length change of the tendon far exceeds that of the aponeurosis, indicating that the aponeurosis may more effectively transfer force onto the tendon, which lengthens and stores elastic energy subsequently released during unloading, in a spring-like manner. In fact, data recently obtained in vivo confirm that, during walking, the human Achilles tendon provides elastic strain energy that can decrease the energy cost of locomotion. Also, new experimental evidence shows that, contrary to earlier beliefs, the metabolic activity in human tendon is remarkably high and this affords the tendon the ability to adapt to changing demands. With ageing and disuse there is a reduction in tendon stiffness, which can be mitigated with resistance exercises. Such adaptations seem advantageous for maintaining movement rapidity, reducing tendon stress and risk of injury, and possibly, for enabling muscles to operate closer to the optimum region of the length-tension relationship.

The response of bone, articular cartilage and tendon to exercise in the horse

Horses can gallop within hours of birth, and may begin training for athletic competition while still growing. This review cites studies on the effects of exercise on bone, tendon and articular cartilage, as detected by clinical and research imaging techniques, tissue biochemical analysis and microscopy of various kinds. For bone, alterations in bone mineral content, mineral density and the morphology of the mineralized tissue are the most common end-points. Apparent bone density increases slightly after athletic training in the cortex, but substantially in the major load paths of the epiphyses and cuboidal bones, despite the lower material density of the new bone, which is deposited subperiosteally and on internal surfaces without prior osteoclastic resorption. With training of greater intensity, adaptive change is supervened by patho-anatomical change in the form of microdamage and frank lesions. In tendon, collagen fibril diameter distribution changes significantly during growth, but not after early training. The exact amount and type of protracted training that does cause reduction in mass average diameter (an early sign of progressive microdamage) have not been defined. Training is associated with an increase in the cross-sectional area of some tendons, possibly owing to slightly greater water content of non-collagenous or newly synthesized matrix. Early training may be associated with greater thickness of hyaline but not calcified articular cartilage, at least in some sites. The age at which adaptation of cartilage to biomechanical influences can occur may thus extend beyond very early life. However, cartilage appears to be the most susceptible of the three tissues to pathological alteration. The effect of training exercise on the anatomical or patho-anatomical features of connective tissue structures is affected by the timing, type and amount of natural or imposed exercise during growth and development which precedes the training.

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. Conclusions

This paper summarises and presents in context the main findings of an extensive series of studies of early training lasting 13 weeks in which the tissue responses of 2-year-old Thoroughbred horses were assessed using a combination of methods. Negligible clinical injury was detected and thus the study fulfilled the intention of investigating adaptive change rather than injury. Cancellous and cortical bone, some digital tendons, and articular cartilage responded to early training exercise to a greater or lesser degree. Clinical examination and ancillary diagnostic aids currently in veterinary clinical use are not sufficient to detect early abnormalities in metacarpo-phalangeal joint (MCPJ) cartilage found in both trained and untrained horses. Future work should centre on detection of such changes, on the precise registration of training workload, and on the manipulation of the responses of musculoskeletal tissues by careful investigation of the effects of introducing conditioning exercise at a young age.

Risk factors for injury to the superficial digital flexor tendon and suspensory apparatus in Thoroughbred racehorses in New Zealand

AIM

To investigate risk factors for injury to the superficial digital flexor tendon (SDFT) and suspensory apparatus (SA) of the forelimbs in Thoroughbred racehorses in New Zealand.

METHODS

Poisson and negative binomial regression, with exposure time represented by cumulative training days for each horse, were used to relate explanatory variables to the incidence rate (IR) of cases of inflammation of the SDFT (n=51), and injuries involving the SA (n=48) in a population of 1,571 commercially- trained racehorses over 554,745 study days. Only the first occurrence of an injury for any one horse was eligible for inclusion. Separate analyses were run for data from horses in training regardless of whether they had started in a trial or race, and using a subset of these data restricted to those preparations associated with at least one start in a trial or race. Results were reported as incidence rate ratios (IRR) and 95% confidence intervals (CI).

RESULTS

Male horses had a higher risk of injury to the SA (IRR 2.57; p=0.005) and tended to have a higher risk of injury to the SDFT (IRR 1.74; p=0.09) than female horses. Increasing age was associated with increased risk of injury. Horses aged 4 and > or =5 years were 6.76 (p<0.001) and 15.26 (p<0.001) times more likely to incur injury to the SDFT, and 2.91 (p=0.02) and 3.54 (p=0.005) times more likely to incur injury to the SA, respectively, than 2-year-olds. Horses were more likely to suffer an injury to the SDFT or SA in a training preparation that was not associated with any starts in official trials or races compared with those preparations that were associated with more than one start (p<0.001), and more likely to injure the SA compared with preparations containing one start (p=0.03). The IR of injury to the SDFT tended to be lower between November-January (IRR 0.78; p=0.08) and February-April (IRR 0.75; p=0.08) compared with August-October. Incidence of injury to the SDFT or SA was not associated with the cumulative distance raced in the last 30 days of a training preparation.

CONCLUSION

This study identified risk factors for injury to the SDFT and SA in Thoroughbred racehorses in New Zealand. Injuries were more likely in males, older horses and in horses in training preparations without any starts. There was no evidence of association between injury and cumulative high-speed exercise.

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 5. Kinematic effects

AIM

To examine the effect of race training on kinematic parameters of the trot in a sample of 2-year-old Thoroughbred fillies.

METHODS

Two-year-old Thoroughbred fillies that had been either trained for racing (n=7) or left untrained in small paddocks (n=7) were examined for lameness, and linear and temporal kinematic data were collected from video recordings of each horse trotted in-hand, 5, 9 and 13 weeks after the beginning of training. Horses were graded as: sound (Grade 0), suspected but not obviously lame (Grade 1), or definitely lame at the trot (Grade 2).

RESULTS

Mean velocity at the trot did not vary with lameness grade. Compared with horses classified as sound (Grade 0), horses classified as suspected or definitely lame (Grades 1 and 2) had shorter (2.55 (SE 0.02) vs 2.41 (SE 0.02) and 2.44 (SE 0.03) m; p<0.001) and faster (671 (SE 3) vs 645 (SE 1) and 647 (SE 4) msec; p<0.001) strides. None of the linear or temporal parameters measured varied significantly between the successive observation periods. When data from sound horses were pooled, the training group trotted at a higher mean velocity (4.22 (SE 0.08) vs 3.22 (SE 0.06) m/sec; p<0.001) and with a longer stride length (2.79 (SE 0.05) vs 2.18 (SE 0.06) m; p<0.001) than the untrained group. The stride duration was longer (669 (SE 7) vs 662 (SE 9) msec; p=0.01), stance period was shorter (34.1 (SE 0.6) vs 39.3 (SE 0.7) %; p<0.001) and mid-stance was achieved earlier in the stride (12.1 (SE 0.6) vs 13.1 (SE 0.2) %; p=0.001) in the trained than the untrained group. A longer swing phase in the trained group was associated with an increase in retraction time (9.2 (SE 0.2) vs 7.6 (SE 0.3) %; p=0.001).

CONCLUSIONS

These data indicate that early race training in young Thoroughbreds was associated with quantifiable changes in linear and temporal kinematic parameters of the trot, which were related to the race-training objective of improving the horse's ability to work at higher velocities.

CLINICAL RELEVANCE

Race training resulted in changes in the gait of non-lame horses at the trot, which should be considered during veterinary lameness examinations.

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 8. Quantitative back-scattered electron scanning electron microscopy and confocal fluorescence microscopy of the epiphysis of the third metacarpal bone

AIM

To characterise and explain the increase in density evident by computerised tomography (CT) and radiography in companion studies as a response to training, in bone in the palmar and dorsal regions of the condyles of the third metacarpal bone (Mc3) of 2-year-old Thoroughbred horses.

METHODS

Compositional back-scattered electron (BSE) imaging in scanning electron microscopy (SEM) and confocal scanning laser microscopy (CSLM) were conducted on polymethyl methacrylate (PMMA)-embedded mediolateral slices of the right distal Mc3 from seven 2-year-old Thoroughbred horses trained on a racetrack and seven untrained horses kept at pasture. One left Mc3 from each group was studied in transverse section planes. This study focussed on regions of Mc3 found to differ in density between the trained and untrained horses in companion studies using CT and radiography.

RESULTS

The increase of bone density in the condyles of Mc3 in trained horses compared with untrained horses occurred, without prior osteoclastic resorption, via the deposition of new bone on pre-existing internal surfaces. Within prior marrow spaces of cancellous bone, there was also rapid formation of immature strands and fronds of bone which were more cellular and mineralised, and more lamellar bone tissue was deposited on these new scaffolding elements in the trained horses. Both resulted in increased bone volume fraction (BVF). The microscopic mineralisation density of the bulk of the new tissue was lower than in pre-existing bone, and CT and radiography underestimated the increase in BVF. The new tissue was thus probably less stiff at the microscopic scale than pre-existing bone, though its addition would stiffen the global structure.

CONCLUSIONS

In Mc3 of all the trained horses, there were obvious differences in microscopic structure compared with those from the untrained horses. Moderate, industry-standard levels of exercise used to prepare young horses for racing induced the formation of new bone in non-bone spaces in bone tissue, such that the bone organ should better withstand later increased levels of exercise.

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 7. Bone and articular cartilage response in the carpus

AIM

To describe features of the morphology of the carpus, quantify the thickness of hyaline and calcified cartilage, and to describe the morphology and density of subchondral bone in the third carpal bone (C3) of young Thoroughbred horses in early training.

METHODS

C3 of seven 2-year-old horses in training and seven untrained horses matched for age, sex and breed were assessed by gross appearance, computed tomography, fine-structure radiography, image analysis of high-resolution photographs, and histology.

RESULTS

Macroscopic lesions in cartilage were few and mild, and not significantly different between groups. High bone mineral density (BMD), in some cases typical of cortical bone, was confined to the dorsal load path, and was significantly higher in trained than in untrained horses (p<0.01). In the most dorsoproximal aspect of the radial articular facet, apparently outside the dorsal load path, the BMD in both trained and untrained horses was significantly less than in other regions of interest (ROIs). Adaptive increase in density was associated with thickening of the (junctions of) trabeculae oriented proximo-distally. Hyaline cartilage was thicker (p<0.001) in the concavity of the radial articular facet than dorsal or palmar to it, and was thicker in the trained than untrained group (p=0.007). No such differences were detected in the thickness of articular calcified cartilage (ACC).

CONCLUSIONS

The rapid response of bone in C3 to relatively small amounts of high-speed exercise was confirmed. A previously unreported increase in thickness of hyaline cartilage was evident, perhaps indicating that this tissue may be more responsive than hitherto thought, at least to particular types of exercise at particular times. These changes occurred with little evidence of abnormality, and thus appeared to be adaptive to the exercise regimen. The model developed should be used for further definition of the exercise stimulus required to produce adaptive, protective changes in sites susceptible to athletic injury.

CLINICAL RELEVANCE

The data will serve as reference for use in subsequent imaging studies in which sophisticated aids such as magnetic resonance imaging (MRI) may be used to predict carpal lesions.

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 6. Bone parameters in the third metacarpal and third metatarsal bones

AIM

To determine the effect of a known training regimen on the size and mineral content of the third metacarpal (Mc3) and third metatarsal (Mt3) bones of 2-year-old Thoroughbred horses trained on racetracks.

METHODS

Mc3 and Mt3 of seven horses trained on grass and sand tracks were scanned at several sites using conventional quantitative and peripheral computed tomography (CT). Bone dimensions and density in the diaphysis and epiphysis were compared with those from seven untrained horses. Calcein label was injected in two clusters, during Weeks 9 and 12. The extent and rate of diaphyseal modelling was determined by confocal fluorescent microscopic examination of thin plane parallel sections of the mid-metacarpal region.

RESULTS

Volumetric bone mineral density (BMDv) of the epiphysis was markedly higher and of the diaphysis was slightly higher in trained compared with untrained horses, but greater bone size in the trained horses had the greatest effect on an index of bone strength. Active osteons, defined as Haversian systems containing calcein label, were fewer, of smaller diameter at the time of calcein injection, and had a greater bone apposition rate in trained than in untrained horses.

CONCLUSIONS

Conventional training of 2-year-old Thoroughbred racehorses over a 13-week period had a significant effect on bone size, density and strength index when compared to untrained horses.

CLINICAL RELEVANCE

Bone responded rapidly to early training. The data provide reference values and sites for use in longitudinal studies of commercial training regimens.

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 3.In vivoultrasonographic assessment of the cross-sectional area and echogenicity of the superficial digital flexor tendon

AIM

To determine if the superficial digital flexor tendon (SDFT) of young Thoroughbred horses changed in size and echogenicity in association with early race training.

METHODS

Cross-sectional area (CSA) and echogenicity were determined ultrasonographically at five levels of the SDFT of the forelimbs of 2-year-old fillies (n=14), corresponding to 4, 8, 12, 16 and 20 cm distal to the accessory carpal bone (DACB). Measurements were made before and after a 13-week period in which a trained group of seven horses was compared with another group of seven untrained horses.

RESULTS

Level below the accessory carpal bone had a significant effect on CSA and Level 8 was smaller than all other levels except Level 12, while Level 12 was smaller than Levels 4 and 20 but not different from Levels 8 and 16. There was a significant interaction between level and time due to effects observed at Level 8. The CSA at Level 8 measured pre-training was different from that of Levels 4 and 20 in both pre- and post-training groups (p<0.05), but when measured post-training was not different from any other measurement. There was also a significant interaction between treatment group and time. There was no difference between CSA for the untrained and trained groups at the pre-training observation (p=0.9), but post-training the CSA (pooled over all levels) in trained horses was significantly larger than that of the untrained horses both post-training (p=0.019) and pre-training (p=0.034), and was not different from the pre-training CSA recorded in the trained group (p=0.29). Treatment group had no effect on echogenicity (p=0.43), while echogenicity was less at the end of the trial in both trained and untrained horses (p<0.001).

CONCLUSIONS

Early training for racing was associated with an increase in mean CSA of the SDFT. Other factors such as age and maturity may play a role in limiting this increase.

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 2. Measurement error and effect of training stage on the relationship between objective and subjective criteria of training workload

AIM

To identify the magnitude and sources of error involved in simply quantifying the workload of a group of Thoroughbred racehorses in training.

METHODS

Data were obtained from seven 2-year-old fillies trained for 13 weeks on sand and grass tracks at various cantering velocities, and at the gallop in the last 4 weeks. Four fillies completed training and comprised a 'high exercise intensity' subgroup; three fillies did not complete all gallops due to lameness or injury and comprised a 'medium exercise intensity' subgroup. The trainer recorded the distance, time, track used, and subjective gait (SG; viz canter, 1/4-pace, 1/2-pace and gallop) of each horse each day. Data were analysed to describe the training programme and sources of variation in workload. A cumulative workload index (CWI) was devised to simply express distance and velocity aspects of the training programme.

RESULTS

The magnitude of errors in measurement of timing and distance were small but significant (<0.8%, p=0.01). SG was an inaccurate descriptor of velocity. Mean velocity of 1/2-pace decreased from 8.92 (SE 0.049) in Weeks 6-8 to 6.33 (SE 0.061) m/sec after the start of galloping sessions in Week 9 (p=0.01). Track surface had a significant effect on the velocity of 1/2-pace (p=0.001). The fastest velocity was recorded on the grass (9.06, SE 0.292 m/sec), followed by 'plough' (8.23, SE 0.152 m/sec), and sand (7.90, SE 0.132 m/sec) tracks. The CWI of the horses ranged between 1,085,000 and 1,634,000 (mean=1,428,000; SE 78,000). The average exercise intensity per week was 110,000 (SE 1,048). There were no significant differences between high and medium exercise intensity subgroups for the canter and 1/4-pace. The high exercise subgroup had a greater CWI for the 1/2-pace (839,000 vs 559,000; p=0.004), gallop (71,000 vs 31,000; p=0.001), and total index (1,580,000 vs 1,242,000; p=0.001).

CONCLUSIONS

The workload history of a horse can be accurately described using an index based on manual measurement of the time and distance worked.

CLINICAL RELEVANCE

Accurate and precise data on the training programme of performance horses are likely to enable greater differentiation of aspects of workload which are associated with both performance and injury.

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 1. Study design, and clinical, nutritional, radiological and histological observations

AIMS

This is the first in a series of papers reporting studies in 2-year-old Thoroughbred racehorses that aimed to determine the response of musculoskeletal tissues to early training on grass and sand racetracks. In this paper, the experimental set-up of the whole study is described, and nutritional, workload, and clinical, radiographic and pathological outcomes are reported, including semi-quantitative assessment of macroscopic changes in articular cartilage.

METHODS

The study group comprised 14 two-year-old Thoroughbred fillies reared entirely at pasture. Of these, seven were selected by a licensed racehorse trainer to undergo a 4-week period of initial training in which they were taught to accept saddle and rider, followed by a 13-week period of flatrace training at a racetrack (Weeks 1-13); the other seven fillies were confined to large grass enclosures and were not trained. Nutrient, including macro- and trace-element intakes were estimated. Distances cantered or galloped and average velocities were quantified for the trained horses. All horses were observed daily, weighed approximately weekly, and underwent a clinical lameness examination at Weeks 5, 9 and 13. Distal forelimbs were radiographed prior to Week 1, during Weeks 7-8, and again at the end of the study, when macroscopic changes in articular cartilage of the proximal surface of the proximal phalanx were also scored after staining with India ink.

RESULTS

Dietary intakes met or exceeded recommended requirements for all nutrients except sodium, which was low in the trained horses. Bodyweight increased throughout the study in the untrained horses, and increased until Week 7 and then decreased slightly in the trained horses. Mean velocity data were used to define three stages of the training programme: Stage 1 comprised canter in Weeks 1-4; Stage 2 comprised canter in Weeks 5-8; and Stage 3 comprised canter in Weeks 9-13 and galloping twice weekly. Four of seven horses completed training. These covered a mean distance of 179.2 km at mean velocities (excluding gallops) of 7.63 m/sec (SD 0.58), 8.99 m/sec (SD 0.56), and 8.43 m/sec (SD 0.74) for Stages 1-3, respectively, and galloped 4.45 km at 14.4 (SD 0.1) m/sec. The three horses that did not complete training became lame in Weeks 9, 10 and 11, and covered 147.9 km at velocities of 7.38 m/sec (SD 0.44), 8.88 m/sec (SD 0.33) and 8.43 m/sec (SD 0.59) and galloped 2.1 km. Overall, slight or intermittent lameness in trained horses was noted on 76/655 (12%) of horse observation days. Swelling was evident on 284/655 (41%) of horse observation days in the metacarpophalangeal (MCPJ) and metatarsophalangeal (MTPJ) joints (92%), palmar metacarpal tendon region (7%) or carpus (1%). Swelling of the MCPJ or MTPJ was not associated with obvious lameness. Radiographic changes were minor and no gross lesions in bone or tendon tissue were evident except for one case of dorsal metacarpal disease. Post mortem, the cartilage of some MCPJ and MTPJ had obvious wear lines and high lesion scores, which were not consistently related to clinical evidence of pain, lameness or joint swelling. Mean lesion scores were not significantly different between the MCPJ and MTPJ, or between trained and untrained horses.

CONCLUSIONS

Workload can be readily quantified in racehorses under semi-commercial training conditions. Obvious lesions in cartilage of the MCPJ or MTPJ were present in some trained and some untrained horses and not consistently associated with clinical evidence of lameness, joint swelling or change in other connective tissues.

CLINICAL RELEVANCE

Workload data in racing horses are likely to be highly relevant for studying the pathogenesis of changes in bone, tendon and cartilage during training, for training management and for risk analysis in racehorse populations. Although obvious cartilage lesions produced little clinical effect, such lesions have previously been shown to be progressive and to prejudice athletic capability. Detection of such occult lesions in young horses will require more sophisticated detection methods.