Evaluation of poor performance in competition horses: A musculoskeletal perspective. Part 1: Clinical assessment

Advances in the Clinical Diagnostics to Equine Back Pain: A Review of Imaging and Functional Modalities

Back pain is common in ridden horses. Back diseases in horses include Impinging Dorsal Spinous Processes, Ventral Spondylosis, Osteoarthritis of Articular Process, Intervertebral Discs Disease, Vertebral Fractures, Conformational Abnormalities, Desmopathy of the Supraspinous Ligament, Desmopathy of the Intraspinous Ligament, and Longissimus Muscle Strain. Back pain may also develop as a result of lameness (particularly hindlimb lameness). A poorly fitting saddle and an unbalanced rider are also considered important factors influencing the development of back pain in horses. The conventional diagnosis of equine back pain includes a clinical examination and diagnostic imaging examination using ultrasound, radiography, and thermography. Advanced diagnostic modalities of equine back pain involve the objectification of standard procedures through the use of algometers, a lameness locator, biometric mats, and the geometric morphometrics method. In addition to modern diagnostic methods, such as computed tomography and scintigraphy, advances in the diagnosis of equine back pain include the use of electromyography and functional electrical stimulation. The aim of this review article is to familiarize clinicians with the usefulness and capabilities of conventional diagnostic protocols and advanced diagnostic modalities. Although orthopedic examination and traditional diagnostic methods will remain the foundation of the diagnosis of back diseases, modern methods meet the growing expectations towards high-performance horses and allow for deeper diagnostics and objective monitoring of rehabilitation and training progress.

The effect of acute equine temporomandibular joint inflammation on response to rein-tension and kinematics

Background

Although the temporomandibular joint (TMJ) is the major contact point between the reins in the riders' hand, the bit in the mouth, and the rest of the horse under saddle, the role of inflammation of this joint on equine locomotion and rein tension is unknown.

Objective

To determine the effect of acute TMJ inflammation on rein-tension and horse movement when horses were long-reined on a treadmill.

Study design

A randomized, controlled, cross-over design.

Methods

Five horses were trained by one clinician to walk and trot on a treadmill wearing long-reining equipment instrumented with a rein-tension device and reflective optical tracking markers. Subjective assessment of horse's dominant side, and movement, were determined without rein-tension (free walk and trot); and with rein-tension (long-reined walk and trot). Continuous rein-force data from both sides were collected over ~60s from each trial. Movement was recorded using a 12-camera optical motion capture system. One randomly assigned TMJ was subsequently injected with lipopolysaccharide and the treadmill tests repeated by investigators blinded to treatment side. A second, identical assessment was performed 10 days later with the opposite TMJ being the target of intervention.

Results

All horses showed reduced rein-tension on the injected (inflamed) side. Increased rein-tension was required on the non-injected side at trot, to maintain them in the correct position on the treadmill post-injection. The only kinematic variable to show any significant change due to rein tension or TMJ inflammation during the walk or trot was an increase in forward head tilt in the presence of rein tension in the trot after injection.

Main limitations

Low number of horses and investigation of response to acute inflammation only.

Conclusion

TMJ inflammation changed, subjectively and objectively, the response to rein-input, but the horses did not become lame.

Application of the Ridden Horse Pain Ethogram to 150 Horses with Musculoskeletal Pain before and after Diagnostic Anaesthesia

The Ridden Horse Pain Ethogram (RHpE) was developed to facilitate the recognition of musculoskeletal pain. The aim of this study was to document changes in RHpE scores before and after diagnostic anaesthesia was performed to alleviate pain ± when the saddle was changed. One hundred and fifty horses underwent ridden exercise as part of an investigation of poor performance. The RHpE was applied before and after the interventions. Fifty-two (34.7%) horses exhibited a bilaterally symmetrical short step length and/or restricted hindlimb impulsion and engagement. Fifty-three (35.3%) horses had episodic lameness; only forty-five (30.0%) horses were continuously lame. The median maximum lameness grade when ridden was 2/8 (interquartile range [IQR]: 0-3; range: 0-4). Fifty-six (37.3%) horses had an ill-fitting saddle, which was considered likely to influence performance. The median RHpE scores after the interventions (2/24 [IQR: 1-3, range: 0-12]) were significantly lower than before the interventions (9/24 [IQR: 8-11, range: 2-15]) (Wilcoxon signed-rank z = 10.6, p < 0.001). There was no correlation between the RHpE score and maximum lameness grade before diagnostic anaesthesia (Spearman's rho = 0.09, p = 0.262). It was concluded that the absence of overt lameness does not preclude primary musculoskeletal pain. Gait quality and performance can be improved by diagnostic anaesthesia, with substantial reductions in RHpE scores.

Dangerous Behavior and Intractable Axial Skeletal Pain in Performance Horses: A Possible Role for Ganglioneuritis (14 Cases; 2014-2019)

Introduction: Dangerous behavior is considered an undesired trait, often attributed to poor training or bad-tempered horses. Unfortunately, horses with progressive signs of dangerous behavior are often euthanized due to concerns for rider safety and limitations in performance. However, this dangerous behavior may actually originate from chronic axial skeleton pain. This case series describes the medical histories and clinical presentations of horses presented for performance limitations and dangerous behavior judged to be related to intractable axial skeleton pain. Material and Methods: Fourteen horses that developed severe performance limitations resulting in euthanasia were included. A complete spinal examination and behavioral responses, gait and neurologic evaluations, diagnostic imaging, gross pathologic and histopathologic examinations of the axial skeleton were performed on all horses. A tentative diagnosis of the affected spinal region was formulated using medical records, owner and trainer complaints, and antemortem examination findings. The selected spinal regions were further examined with gross and histopathologic evaluations of the associated osseous, soft tissue and neural tissues. Results: Ten horses showed severe behavioral responses during the myofascial and mobilization examinations. Based on an aggregate evaluation, the cervicothoracic and lumbosacral regions were the most common regions believed to be the primary area of concern. All horses had moderate to severe ganglionitis present at multiple vertebral levels. Subdural and epidural hemorrhage or hematomas were a common finding (71%) in the cervicothoracic and lumbosacral regions. Discussion: In this case series, neuropathic (i.e., structural) pain was judged to be the underlying cause of dangerous behavior. The dorsal root ganglia (DRG) serve an important role in relaying peripheral sensory information to the central nervous system and ganglionitis has been associated with neuropathic pain syndromes. This series highlights the need for more in-depth understanding of pain behavior and its clinical presentation and progression in chronic or severely affected horses. Limitations of the study are the lack of age-matched control DRG and the incomplete collection of DRG from every vertebral level of interest.

Application of a Ridden Horse Pain Ethogram and Its Relationship with Gait in a Convenience Sample of 60 Riding Horses

A Ridden Horse Pain Ethogram (RHpE) comprising 24 behaviours has been developed to facilitate the identification of musculoskeletal pain. The aim was to further test the RHpE by its application to a convenience sample (n = 60) of sports horses and riding school horses in regular work and assumed by their owners to be working comfortably. All horses performed a purpose-designed dressage-type test of 8.5 min duration in walk, trot and canter, with their normal rider. The RHpE was applied retrospectively to video recordings acquired in a standardised fashion. Seventy-three percent of horses were lame (≤ grade 2/8) on one or more limbs; 47% had gait abnormalities in canter. Ridden Horse Pain Ethogram scores ranged from 3 to 16/24 (median 9); rider skill score ranged from 2.5 to 8/10 (median 4.75). The effect of horse age, breed, sex, work-discipline, epaxial muscle hypertonicity or pain, an ill-fitting saddle, rider skill score, the presence of lameness or gait abnormalities in canter on the RHpE score was assessed using Poisson regression. Two variables were retained in the final multivariable analysis, rider skill score as a continuous variable (p < 0.001), and lameness (p = 0.008). A RHpE score ≥8 was a good indicator of the presence of musculoskeletal pain.

Thoracolumbar movement in sound horses trotting in straight lines in hand and on the lunge and the relationship with hind limb symmetry or asymmetry

Equine movement symmetry is changed when turning, which may induce alterations in thoracolumbosacral kinematics; however, this has not previously been investigated. Our objectives were to document thoracolumbar movement in subjectively sound horses comparing straight lines with circles on both reins and to relate these observations to the objectively determined symmetry/asymmetry of hindlimb gait. Fourteen non-lame horses were assessed prospectively in a non-random, cross-sectional survey. The horses were trotted in straight lines and lunged on both reins and inertial sensor data collected at landmarks: withers, T13 and T18, L3, tubera sacrale, and left and right tubera coxae. Data were processed using published methods; angular motion range of motion (ROM; flexion-extension, axial rotation, lateral bending) and translational ROM (dorsoventral and lateral) and symmetry within each stride were assessed. The dorsoventral movement of the back exhibited a sinusoidal pattern with two oscillations per stride. Circles induced greater asymmetry in dorsoventral movement within each stride (mean ± standard deviation, up to 9 ± 6%) compared with straight lines (up to 6 ± 6%). The greatest amplitude of dorsoventral movement (119 ± 14 mm in straight lines vs. 126 ± 20 mm in circles) occurred at T13. Circles induced greater flexion-extension ROM (>1.3°; P = 0.002), lateral bending (>16°; P <0.001), and lateral motion (>16 mm; P = 0.002) compared with straight lines. Circles induced a movement pattern similar to an inside hindlimb lameness, which was significantly associated with the circle-induced greater asymmetry of dorsoventral movement of the thoracolumbar region (P = 0.03). Moving in a circle induces measurable changes in thoracolumbar movement compared with moving in straight lines, associated with alterations in the hindlimb gait.

Body lean angle in sound dressage horses in-hand, on the lunge and ridden

Animals can minimise the risk of falling by leaning into a curve. The aims of this study were: (1) to quantify the difference between observed (measured by an inertial measurement unit, IMU) and predicted body lean angle (calculated as a cyclist when turning) in horses; and (2) to compare circles versus straight lines ridden versus in-hand and trot with canter, and investigate the influence of age, rein and ridden work quality in trot (Fédération Equestre Internationale grading scale 1-10) in horses. Thirteen non-lame horses were assessed prospectively in a non-random, cross-sectional survey. The horses were trotted in straight lines, lunged and ridden on both reins. A global positioning system-aided IMU attached to the skin over the tuber sacrale quantified body lean and recorded the velocity and the radius, which were used to calculate predicted lean. Horses ≤ 6 years of age leant more than predicted (mean ± standard deviation 2.9 ± 2.6°) and more than horses ≥ 7 years old (0.4 ± 3°) (P = 0.01). Horses that scored ≥ 7 in ridden work quality leant less than predicted (-1.1 ± 2.7°) and less than horses which scored ≤ 6 in ridden work quality (2.4 ± 1.5°) (P = 0.02). There were no significant differences between trot and canter, either on the lunge or ridden (P = 0.3), or between left and right reins (P = 0.2). Asymmetry of body lean between reins may be abnormal and may be helpful for recognition of lameness.