The effect of induced forelimb lameness on thoracolumbar kinematics during treadmill locomotion

Review of the clinical diagnosis of sacroiliac dysfunction in horses - Challenges and limitations

Sacroiliac dysfunction (SID) is a condition seen in horses associated with poor performance that affects hind limb gait and impulsion. The condition comprises pain and dysfunction but there lacks clarity around the aetiopathogenesis and whether SID encompasses abnormal joint pathology, abnormal joint movement, abnormal regional biomechanical function, joint laxity and pain, or various combinations of these that may vary over time. Clinical assessment remains challenging for equine clinicians due to the deep location of the sacroiliac joint (SIJ) and surrounding structures which limits access for palpation, diagnostic imaging and joint-specific injection. There is no recognised single reference standard diagnostic test for SID. Clinical diagnosis has been based on ruling out other causes of hind limb lameness, along with combinations of ultrasonography, scintigraphy and periarticular anaesthesia of the SIJ. Recent studies have highlighted the lack of specificity of injections targeting the SIJ, with significant dispersal of injectate into surrounding structures including around the lumbosacral joint (LSJ). Advanced imaging modalities such as computed tomography offers promise for assessment of the structure and pathology of the SIJ and surrounding bony structures. However, there is a need to improve the understanding of the significance of anatomic variation of the sacroiliac region structures, with recent studies reporting detailed anatomic variation in groups of horses with and without SID. There are also limitations around functional assessment of the joint which is still largely reliant on a thorough clinical examination. This review aims to present an update on clinical approaches to the diagnosis of horses with SID, and to consider the challenges and limitations.

Integrin α10β1-Selected Mesenchymal Stem Cells Reduce Pain and Cartilage Degradation and Increase Immunomodulation in an Equine Osteoarthritis Model

OBJECTIVE

Integrin α10β1-selected mesenchymal stem cells (integrin α10-MSCs) have previously shown potential in treating cartilage damage and osteoarthritis (OA) in vitro and in animal models in vivo. The aim of this study was to further investigate disease-modifying effects of integrin α10-MSCs.

DESIGN

OA was surgically induced in 17 horses. Eighteen days after surgery, horses received 2 × 107 integrin α10-MSCs intra-articularly or were left untreated. Lameness and response to carpal flexion was assessed weekly along with synovial fluid (SF) analysis. On day 52 after treatment, horses were euthanized, and carpi were evaluated by computed tomography (CT), MRI, histology, and for macroscopic pathology and integrin α10-MSCs were traced in the joint tissues.

RESULTS

Lameness and response to carpal flexion significantly improved over time following integrin α10-MSC treatment. Treated horses had milder macroscopic cartilage pathology and lower cartilage histology scores than the untreated group. Prostaglandin E2 and interleukin-10 increased in the SF after integrin α10-MSC injection. Integrin α10-MSCs were found in SF from treated horses up to day 17 after treatment, and in the articular cartilage and subchondral bone from 5 of 8 treated horses after euthanasia at 52 days after treatment. The integrin α10-MSC injection did not cause joint flare.

CONCLUSION

This study demonstrates that intra-articular (IA) injection of integrin α10-MSCs appears to be safe, alleviate pathological changes in the joint, and improve joint function in an equine post-traumatic osteoarthritis (PTOA) model. The results suggest that integrin α10-MSCs hold promise as a disease-modifying osteoarthritis drug (DMOAD).

Adaptations in equine axial movement and muscle activity occur during induced fore- and hindlimb lameness: A kinematic and electromyographic evaluation during in-hand trot

BACKGROUND

The inter-relationship between equine thoracolumbar motion and muscle activation during normal locomotion and lameness is poorly understood.

OBJECTIVE

To compare thoracolumbar and pelvic kinematics and longissimus dorsi (longissimus) activity of trotting horses between baseline and induced forelimb (iFL) and hindlimb (iHL) lameness.

STUDY DESIGN

Controlled experimental cross-over study.

METHODS

Three-dimensional kinematic data from the thoracolumbar vertebrae and pelvis, and bilateral surface electromyography (sEMG) data from longissimus at T14 and L1, were collected synchronously from clinically nonlame horses (n = 8) trotting overground during a baseline evaluation, and during iFL and iHL conditions (2-3/5 AAEP), induced on separate days using a lameness model (modified horseshoe). Motion asymmetry parameters, maximal thoracolumbar flexion/extension and lateral bending angles, and pelvis range of motion (ROM) were calculated from kinematic data. Normalised average rectified value (ARV) and muscle activation onset, offset and activity duration were calculated from sEMG signals. Mixed model analysis and statistical parametric mapping compared discrete and continuous variables between conditions (α = 0.05).

RESULTS

Asymmetry parameters reflected the degree of iFL and iHL. Maximal thoracolumbar flexion and pelvis pitch ROM increased significantly following iFL and iHL. During iHL, peak lateral bending increased towards the nonlame side (NLS) and decreased towards the lame side (LS). Longissimus ARV significantly increased bilaterally at T14 and L1 for iHL, but only at LS L1 for iFL. Longissimus activation was significantly delayed on the NLS and precipitated on the LS during iHL, but these clear phasic shifts were not observed in iFL.

MAIN LIMITATIONS

Findings should be confirmed in clinical cases.

CONCLUSIONS

Distinctive, significant adaptations in thoracolumbar and pelvic motion and underlying longissimus activity occur during iFL and iHL and are detectable using combined motion capture and sEMG. For iFL, these adaptations occur primarily in a cranio-caudal direction, whereas for iHL, lateral bending and axial rotation are also involved.

Influence of Chronic Lameness on Thoracolumbar Musculus Multifidus Structure in the Horse

The clinical relationship between equine limb lameness and secondary back dysfunction is largely unknown. Proper function of the spine is critical to maintain the integrity of the kinetic chain and attenuate forces from the appendicular skeleton. The musculus multifidus (m. multifidus) is the primary muscle providing spinal intersegmental stabilization and a functional relationship between m. multifidus hypertrophy and equine postural stability has been established. The relationship between equine thoracolumbar m. multifidus cross-sectional area (CSA) and limb lameness is unknown. The objective was to evaluate ultrasonographic changes in thoracolumbar m. multifidus CSA in horses with chronic single limb lameness, compared with sound horses. We hypothesized that the CSA of m. multifidus, ipsilateral to the lame limb would be smaller than the contralateral side, and within the sound group there would be no difference between sides. Thirty-six horses were enrolled, with twelve horses per group: sound, forelimb lame, and hindlimb lame. M. multifidus CSA was measured ultrasonographically at multiple spinal levels and compared between groups, spinal levels, and sides. M. multifidus CSA at the spinal level T18 was significantly larger than at all other measured levels, regardless of group (P≤.05). CSA at all levels was significantly larger in sound horses than the forelimb lame group, regardless of side (P= 0.002). This is the first study to evaluate the impact of chronic lameness on the axial skeleton and showed a decrease in m. multifidus CSA with forelimb lameness. These results support that axial skeletal adaptation occurs in response to naturally occurring chronic lameness.

The Effects of the EquiAmiTM Training Aid on the Kinematics of the Horse at the Walk and Trot In-Hand

The EquiAmi Training Aid (ETA) is a popular training and rehabilitation tool, however knowledge about its effect on the equine gait is lacking. Understanding of its effects on equine kinematics, and the clinical relevance of these effects is vital to promote optimal use of training aids within training and rehabilitation programmes. Therefore, this study aimed to determine how the ETA influences horses' gait kinematics at walk and trot. Eight horses walked and trotted in-hand with and without the ETA. Optical motion capture was used to measure forelimb and hindlimb pro- and retraction angles, withers-croup angle, and stride length. Separate repeated-measures ANOVAs in each gait were used to assess the differences between gait kinematics and stride length variability with and without the ETA. The ETA did not significantly influence the horses' kinematics in walk or trot, however, individual differences in the effect of the ETA on the horses' angular and linear kinematics were found, with variation between gaits within the same horse observed. The ETA does not have the same effect on every horse, and its effect can vary within the same horse between gaits. Therefore, the individual characteristics and needs of the horse must be considered when applying training aids.

Differential rotational movement and symmetry values of the thoracolumbosacral region in high-level dressage horses when trotting

High-level dressage horses regularly perform advanced movements, requiring coordination and force transmission between front and hind limbs across the thoracolumbosacral region. This study aimed at quantifying kinematic differences in dressage horses when ridden in sitting trot-i.e. with additional load applied in the thoracolumbar region-compared with trotting in-hand. Inertial sensors were glued on to the midline of the thoracic (T) and lumbar (L) spine at T5, T13, T18, L3 and middle of the left and right tubera sacrale of ten elite dressage horses (Mean±SD), age 11±1 years, height 1.70±0.10m and body mass 600±24kg; first trotted in-hand, then ridden in sitting trot on an arena surface by four Grand Prix dressage riders. Straight-line motion cycles were analysed using a general linear model (random factor: horse; fixed factor: exercise condition; covariate: stride time, Bonferroni post hoc correction: P<0.05). Differential roll, pitch and yaw angles between adjacent sensors were calculated. In sitting trot, compared to trotting in-hand, there was increased pitch (mean±S.D), (in-hand, 3.9 (0.5°, sitting trot 6.3 (0.3°, P = <0.0001), roll (in-hand, 7.7 (1.1°, sitting trot 11.6 (0.9°, P = 0.003) and heading values (in-hand, 4.2 (0.8), sitting trot 9.5 (0.6°, P = <0.0001) in the caudal thoracic and lumbar region (T18-L3) and a decrease in heading values (in-hand, 7.1 (0.5°, sitting trot 5.2 (0.3°, P = 0.01) in the cranial thoracic region (T5-T13). Kinematics of the caudal thoracic and lumbar spine are influenced by the rider when in sitting trot, whilst lateral bending is reduced in the cranial thoracic region. This biomechanical difference with the addition of a rider, emphasises the importance of observing horses during ridden exercise, when assessing them as part of a loss of performance assessment.

A Systematic Approach to Comparing Thermal Activity of the Thoracic Region and Saddle Pressure Distribution beneath the Saddle in a Group of Non-Lame Sports Horses

Simple Summary

Thermography is a non-invasive method for measuring surface temperatures. Due to its ease of use, it may be a convenient way of identifying hypo/hyperthermic areas under a saddle that may be related to saddle pressures. A thermal camera quantified temperatures at specific locations (left/right) of the thoracic region at three-time points; a Pliance (Novel) pressure mat determined the mean/peak saddle pressures (kPa) during a period of exercise. Differences between saddle widths in the cranial/caudal mean and peak saddle pressures were found. The maximum thermal temperatures increased post lunge and post ridden compared to the baseline. No difference between post lunge and post ridden exercise were found. The thermal activity does not appear to be representative of increased saddle pressure values. The sole use of thermal imaging for saddle fitting should be applied with caution.

Abstract

Thermography is a non-invasive method for measuring surface temperatures and may be a convenient way of identifying hypo/hyperthermic areas under a saddle that may be related to saddle pressures. A thermal camera quantified minimum/maximum/mean temperatures at specific locations (left/right) of the thoracic region at three-time points: (1) baseline; (2) post lunging; (3) post ridden exercise in eight non-lame sports horses ridden by the same rider. A Pliance (Novel) pressure mat determined the mean/peak saddle pressures (kPa) in the cranial and caudal regions. General linear mixed models with the horse as the random factor investigated the time point (fixed factor: baseline; lunge; ridden) and saddle fit (fixed factor: correct; wide; narrow) on thermal parameters with Bonferroni post hoc comparison. The saddle pressure data (grouped: saddle width) were assessed with an ANOVA and Tukey post hoc comparison (p ≤ 0.05). Differences between the saddle widths in the cranial/caudal mean (p = 0.05) and peak saddle pressures (p = 0.01) were found. The maximum temperatures increased post lunge (p ≤ 0.0001) and post ridden (p ≤ 0.0001) compared to the baseline. No difference between post lunge and post ridden exercise (all p ≥ 0.51) was found. The thermal activity does not appear to be representative of increased saddle pressure values. The sole use of thermal imaging for saddle fitting should be applied with caution.

The Effect of a Physiotherapy Intervention on Thoracolumbar Posture in Horses

Dynamic mobilisation exercises (DME) are often used as part of a physiotherapy rehabilitation programme. Whilst immediate kinematic effects have been measured, the change in posture is anecdotally reported to have a longer duration. This study aimed to test the reliability of a simple objective measurement method, suitable for use in clinical practice, and to objectively measure equine thoracolumbar posture, before and after DME. A single investigator took triplicate measurements of the sagittal thoracolumbar shape using a flexicurve ruler (FCR) then triplicate measurements of the thoracolumbar shape using an adapted FCR (aFCR) in 37 horses. Subsequently, the thoracolumbar shape of 12 horses was measured using the aFCR before random allocation into two groups. Six horses acted as a control group and six horses underwent a series of DME, which included cervical flexion and lateral flexion baited stretches. Measurements were repeated prior to DME, at thirty minutes, one hour and at twenty-four hours after DME to assess thoracolumbar posture. The aFCR ruler had excellent intra-rater reliability compared to a standard FCR (aFCR: p = 0.146; intraclass correlation coefficient (ICC) 0.971; FCR: p = 0.0001; ICC 0.979). Significant increases in flexion occurred in the thoracolumbar region at 30 min (p = 0.027) and one hour (p = 0.046) after DME, but not at 24 h (p > 0.05) with no significant differences in the control group (p > 0.05) between baseline and subsequent times. The results suggest DME create a short-term postural change, determined by using an aFCR, which supports their use as part of a veterinary physiotherapy rehabilitation programme.

Functional Electrical Stimulation (FES) and the Effect on Equine Multifidi Asymmetry

Asymmetry of the multifidi has been correlated with scoliosis and back pain in humans and has been investigated as a factor in equine back pain as well. The purpose of this study was to determine if FES would affect the symmetry of equine thoracolumbar multifidi when compared to controls. Twelve horses received 24 FES treatments bilaterally over the thoracolumbar region for 8 weeks. Twelve additional control horses received no FES treatments. Ultrasonographic measurements of the cross-sectional area (CSA) of the multifidi of the treatment horses at seven thoracolumbar levels were compared to determine the change in left and right asymmetry post-FES. The same measurements during the same period were also taken in the control group. All measurements were blinded for evaluation. Statistical significance was assessed utilizing two-sided, matched-pairs t-tests, and Welch's (unequal variances) t-test (alpha = 0.05). Multiple comparisons were accounted for using the Sidak correction. A significant improvement in multifidi asymmetry was observed, post-FES, at all seven thoracolumbar levels, with no evidence of asymmetry improvement in the control group. The difference between mean improvements of the treatment and control groups was statistically significant (P < .001). FES significantly improved the symmetry of equine multifidi, and evidence was provided for the effectiveness of FES at each of seven thoracolumbar levels. The improvement in symmetry appeared to result from increases, decreases, and maintenance of the CSA of the left and right multifidi in various combinations. The FES protocol used in this study has the potential to improve spinal function and assist in reducing back pain in horses.

Use of Physical Self-Experience for Teaching Lameness Evaluation: Short-Term Effects on Lameness Evaluation of Horses with Mild Forelimb Lameness by Novice Veterinary Students

Lameness evaluation (LE) is an important veterinary skill, but it can be a challenging task to teach. Acoustic and visual input in conjunction with acting are the three major learning channels for acquiring new information. Acting (e.g., physical self-experience) has not been reported as a didactic tool for LE; therefore, we investigated two physical self-experience techniques, imitation of lameness during LE instruction and head nod during LE. Undergraduate veterinary students (N = 78) who had not yet received any instructions for LE underwent standard instruction for LE, followed by instructions to head nod, instructions to imitate lameness, or neither. Students' subjective LE skills were then tested against those of senior clinicians on two horses that were either sound or mildly forelimb lame. In more than 80%, there was agreement on the presence or absence of lameness independent of instruction, and we found no significant evaluation differences between didactic strategies. Specific instructions for head nodding did not significantly influence the quality of LE, possibly because head nodding was widespread even when no specific instructions had been given. Veterinary students who had been taught to imitate lameness without instructions to head nod were consistently closest to the assessment of the senior clinicians, and in walk these students were significantly better at LE than students additionally instructed to head nod. This finding indicates that imitation of lameness, but not necessarily head nodding, may be beneficial for understanding body movement such as mild equine forelimb lameness.

Relationship Between Postural Stability and Paraspinal Muscle Adaptation in Lame Horses Undergoing Rehabilitation

Postural stability maintains balance, protects the spinal column, and allows accurate responses to destabilizing forces. The musculus multifidus (m. multifidus) is the major postural muscle located adjacent to the vertebrae along the length of the spinal column. Increased cross-sectional area (CSA) of the m. multifidus has been demonstrated in horses after a rehabilitation strengthening exercise program; however, correlation with functional postural stability has not been shown. The objective of the present study is to evaluate the relationship of the thoracolumbar m. multifidus CSA and measures of postural sway performance in lame horses undergoing rehabilitation exercises in clinical cases. Seven client-owned horses admitted to the equine rehabilitation service were included in the study. M. multifidus CSA was measured via ultrasonography at the start of a rehabilitation program (initial evaluation) and after 12 weeks of rehabilitation exercises (final evaluation). Postural sway data were also measured at initial and final evaluation. A significant increase in m. multifidus CSA was seen from initial to final evaluation. A moderate to strong correlation was present between m. multifidus CSA and postural sway variables. These results suggest that there is an association between postural stability and m. multifidus hypertrophy in lame horses undergoing individualized rehabilitation programs. However, more research is needed to provide a definitive answer on the nature of this relationship. Ideally, specific performance tests would better define and examine the relationship in which to guide clinicians in rehabilitation protocol development.

Range of motion and between-measurement variation of spinal kinematics in sound horses at trot on the straight line and on the lunge

Clinical assessment of spinal motion in horses is part of many routine clinical exams but remains highly subjective. A prerequisite for the quantification of spinal motion is the assessment of the expected normal range of motion and variability of back kinematics. The aim of this study was to objectively quantify spinal kinematics and between -measurement, -surface and -day variation in owner-sound horses. In an observational study, twelve owner-sound horses were trotted 12 times on four different paths (hard/soft straight line, soft lunge left and right). Measurements were divided over three days, with five repetitions on day one and two, and two repetitions on day three (recheck) which occurred 28-55 days later. Optical motion capture was used to collect kinematic data. Elements of the outcome were: 1) Ranges of Motion (ROM) with confidence intervals per path and surface, 2) a variability model to calculate between-measurement variation and test the effect of time, surface and path, 3) intraclass correlation coefficients (ICC) to determine repeatability. ROM was lowest on the hard straight line. Cervical lateral bending was doubled on the left compared to the right lunge. Mean variation for the flexion-extension and lateral bending of the whole back were 0.8 and 1 degrees. Pelvic motion showed a variation of 1.0 (pitch), 0.7 (yaw) and 1.3 (roll) degrees. For these five parameters, a tendency for more variation on the hard surface and reduced variation with increased repetitions was observed. More variation was seen on the recheck (p<0.001). ICC values for pelvic rotations were between 0.76 and 0.93, for the whole back flexion-extension and lateral bending between 0.51 and 0.91. Between-horse variation was substantially higher than within-horse variation. In conclusion, ROM and variation in spinal biomechanics are horse-specific and small, necessitating individual analysis and making subjective and objective clinical assessment of spinal kinematics challenging.

Long-term prognosis for return to athletic function after interspinous ligament desmotomy for treatment of impinging and overriding dorsal spinous processes in horses: 71 cases (2012-2017)

OBJECTIVE

To determine the long-term return to performance of horses with impinging and/or overriding dorsal spinous processes (ORDSP) treated with interspinous ligament desmotomy (ISLD) and to determine the prognostic value of radiographic and scintigraphic grades.

STUDY DESIGN

Retrospective study.

ANIMALS

Seventy-one horses with ORDSP treated with ISLD.

METHODS

Medical records were reviewed for signalment, physical examination, gait evaluation, and number of interspinous spaces treated. Preoperative radiographic and scintigraphic images were evaluated with grading scales. Follow-up was obtained with a telephone questionnaire. Prognostic value of the number of affected interspinous spaces, radiographic grading, and scintigraphic grading was tested by using a χ² test.

RESULTS

A median follow-up of 35 months (range, 8-64) was available for 56 horses. Fifty-one of 56 (91.1%) horses returned to some level of performance, with 27 of 51 (52.9%) horses achieving equivalent or higher level of performance. Achieving a lower level of performance was attributed to recurrent back pain in nine of 24 (37.5%) horses and to unassociated lameness in nine of 24 (37.5%) horses. Owners of 44 of 56 (78.6%) horses were satisfied with the postoperative performance level, and owners of 46 of 56 (82.1%) horses would recommend the procedure. None of the variables tested influenced the return to performance.

CONCLUSION

Interspinous ligament desmotomy allowed horses with ORDSP to return to some level of performance, although fewer returned to an equivalent or higher level of performance than had previously been reported.

CLINICAL SIGNIFICANCE

Interspinous ligament desmotomy allows affected horses to return to some level of performance, regardless of the severity of radiographic and scintigraphic findings.

Three-Dimensional Kinematic Motion Analysis of Shivers in Horses: A Pilot Study

Our aim was to assess three-dimensional kinematic motion analysis as an objective diagnostic tool for the characterization of the movement disorder of Shivers in horses. Kinematic parameters were measured in three horses with Shivers and were compared with a control group of four normal horses. Multiple parameter differences were found in the horses with Shivers at the walk, during backing, and when asked to pick up their hindlimbs. Most significant changes were a wider hindlimb stance of 0.39 ± 0.15 m and increased abduction angle of 48.7 ± 7.52° and hoof elevation (0.77 ± 0.08 m left and 0.94 ± 0.11 m right) when the horses were asked to pick up their hindlimbs. Control horses could back easily in a straight line and with symmetrical hoof separation and could maintain their center of weight when picking up their hindlimbs. In contrast, the horses with Shivers had difficulty backing straight, were slower, with a shorter stride and asymmetric hoof separation. They could not maintain their center of balance when picking up their hindlimbs. The findings of this pilot study advance the understanding of the movement disorder of Shivers and could be used as outcome measures to evaluate treatment modalities.

Clinical investigation of back disorders in horses: A retrospective study (2002-2017)

Background and Aim:

Back disorder is an ailment that often affects athletic and riding horses. Despite the rapidly growing equine athletic and equestrian activities, there is no documentation on the nature of equine back disorder (EBD) in Malaysian horses. The purpose of this study was to characterize EBD cases presented to University Veterinary Hospital, Universiti Putra Malaysia, between 2002 and 2017.

Materials and Methods:

The compilation of data was based on signalment, case history, duration of clinical signs, anatomical location of the pain, method of diagnosis, type of EBD, treatment, and outcome. The diagnosis of EBD was based on a history of poor performance, clinical examination findings, radiography, and, where applicable, necropsy.

Results:

A total of 181 diagnosed cases of EBDs were identified. The age of horses ranged from 5 to 22 years. The EBD cases were more prevalent in male than female horses and predominantly in geldings (60.77%). Thoroughbred, Arab, Polo pony, and Warmblood also recorded the most EBD cases among breeds. The discipline of horses tended to influence the development of EBDs, with patrolling horses recording the highest frequency. Most EBD cases were of the primary type (92.27%), with the main causes being soft-tissue lesions (57.48%), vertebral lesions (18.56%), tack-associated problems (16.77%), and neurological lesions (7.19%). The common treatments employed were administration of nonsteroidal anti-inflammatory agents, 1 to 3-month rest, warm and cold compression therapy, massage therapy, exercise adjustment, as well as correction of ill-saddle fit.

Conclusion:

Most EBDs in this study were associated with soft-tissue lesions. Among vertebral lesions, kissing spines were the most common cause of EBDs in horses in Malaysia.

Sagittal plane fore hoof unevenness is associated with fore and hindlimb asymmetrical force vectors in the sagittal and frontal planes

Asymmetry in forelimb dorsal hoof wall angles, termed unevenness, is associated with forelimb gait asymmetries, but compensatory mechanisms and out of plane ground reaction forces (GRFs) due to unevenness have yet to be documented. The aim of this study was therefore to investigate the effects of fore hoof unevenness on contralateral fore and hind limb force vectors patterns, in both sagittal and frontal planes. A group of n = 34 riding horses were classified into four groups: hoof angle difference of more than 1.5 degrees (UNEVEN; n = 27), including higher left fore (HIGH-LF; n = 12), higher right fore (HIGH-RF; n = 15), and hoof angle difference of less than 1.5 degrees (EVEN; n = 7). Three dimensional ground reaction forces GRFs were collected during trotting. GRF summary vectors representing the magnitude (VecMag) and angular direction (VecAng) of the entire stance phase in the sagittal and the frontal plane were calculated. The effects of unevenness on GRF production were explored using linear regression, repeated measures ANOVA and statistical parametric mapping (SPM) with significance at (P<0.05). In all uneven groups, increasing unevenness affected sagittal VecAng values in the forelimbs, with more propulsive GRF in the high hoof. In the HIGH-RF group, medial GRFs were also found in the high RF hoof compared to lateral GRFs in the low LF hoof (RF VecAng: 0.97±1.64 (deg); LF VecAng: -0.64±1.19 (deg); P<0.05). In both HIGH groups, compensatory associations to increasing unevenness were only found in the RH, but also a significantly greater lateral VecAng was found in the LH (P<0.05) compared to the RH limb. No significant differences (P>0.05) were found between hindlimb pairs in the EVEN group. Unbalanced sagittal and increased frontal plane GRFs in uneven horses suggest that they have greater locomotory challenges, as the equine musculoskeletal system is not constructed to withstand movement and loading in the frontal plane as effectively as it is in the sagittal plane.

Two Multicenter Surveys on Equine Back-Pain 10 Years a Part

Despite back-pain being a common cause of poor performance in sport horses, a tailored diagnostic workflow and a consolidated therapeutic approach are currently lacking in equine medicine. The aim of the study was to assess the evolution in the veterinarian approach to diagnose and treat back-pain over a 10 years period. To investigate this topic, two surveys were addressed to equine veterinarians working in practice throughout Europe 10 years apart (2006 and 2016). The answers were organized in an Excel dataset and analyzed. There were 47 respondents in 2006 and 168 in 2016, from 8 European Countries. The main reasons for examining horses with back-pain were poor performance (76%), behavioral issues (68%), and lameness (50%). When assessing back pain, 97% of respondents applied careful digital pressure over paravertebral muscles, 90% of them used digital back mobilization, and 69% was detecting areas of localized heat. The use of diagnostic analgesia to confirm the source of pain was rarely employed. Radiography and ultrasonography were the most frequent diagnostic imaging modalities used to investigate the causes of back-pain in both surveys. Obtaining a definitive diagnosis in horses with back-pain is considered challenging due to the reduced accessibility of the area and the variability in the pain manifestations. Corticosteroids injections were used for local treatments by 80% of respondents in 2006 and 92% in 2016. Recently, ultrasonography has been extensively used during the injections of the vertebral articular facets and sacroiliac joints region. The use of complementary therapies was restricted to a low percentage of respondents in the first survey (20%) but it increased over the decade. In 2016, a wider percentage of respondents considered osteopathy (40%), kinesiotherapy (29%), and acupuncture (22%) when treating back disorders compared to 2006. The structural differences of the two surveys did not enable a direct data comparison. Based on the results of this surveys, however, veterinarians should be sensitized to the back-pain problems and seek to integrate findings from clinical research studies in their daily practice.

Alterations in body lean angle in lame horses before and after diagnostic analgesia in straight lines in hand and on the lunge

Altered body lean has been subjectively observed during lungeing in lame horses. The objectives were to quantify the influence of lameness on body lean in trot on the lunge and to investigate the influence of improvement in lameness on the differences in body lean between reins. Thirteen lame horses were trotted in straight lines and lunged on a 10m-diameter circle on both reins before and after lameness was subjectively substantially improved by diagnostic analgesia. A global position system-aided inertial measurement unit attached to the tubera sacrale quantified body lean. Differences between reins in body lean before and after diagnostic analgesia were calculated and means were determined. Five and eight horses had unilateral and bilateral hindlimb lameness, respectively. Two of five horses with unilateral and three of eight horses with bilateral lameness leaned more on the rein with the lame or lamer hindlimb on the inside of the circle (difference between reins 5-8°). Two of five horses with unilateral and two of eight horses with bilateral lameness leaned more on the rein with the lame or lamer hindlimb on the outside of the circle (4-10°). Four horses, one with unilateral and three with bilateral lameness, had only 1° difference in body lean angle between left and right reins. When lameness was improved by diagnostic analgesia, the body lean changed significantly towards similar leaning on left and right reins (mean angle changed from 8.8° to 10.0° (P=0.03) on one rein and 13.4° to 10.8° (P=0.002) on the other rein). It was concluded that body lean becomes more symmetrical between reins after improvement in lameness using diagnostic analgesia.

Alterations in thoracolumbosacral movement when pain causing lameness has been improved by diagnostic analgesia

Lameness, thoracolumbosacral pain and reduced range of motion (ROM) often coexist; better understanding of their relationship is needed. The objectives were to determine if thoracolumbosacral movement of horses changes when pain causing lameness is improved by diagnostic analgesia. We hypothesised that reduction of lameness will increase ROM of the thoracolumbosacral region. Thirteen horses with different types of hind limb lameness were trotted in straight lines and lunged on a 10m diameter circle on left and right reins before and after lameness was subjectively substantially improved by diagnostic analgesia. Inertial sensor data were collected from the withers, thirteenth (T13) and eighteenth thoracic (T18) vertebrae, third lumbar (L3) vertebra, tubera sacrale (TS), left and right tubera coxae. ROM of flexion-extension, axial rotation, lateral bending, dorsoventral, lateral-lateral motion and vertical movement symmetry were quantified at each thoracolumbar site. Hiphike difference (HHD), maximum difference (MaxDiff) and minimum difference (MinDiff) for the pelvic sensors were measured. Percentage changes for before and after diagnostic analgesia were calculated; mean±standard deviation (SD) or median [interquartile range] were determined. Associations between the change in pelvic versus thoracolumbar movement symmetry after each local analgesic technique were tested. After resolution of lameness, HHD decreased by 7% [68%] (P=0.006). The MinDiff decreased significantly by 33% [61%] (P=0.01), 45±13% (P=0.005) and 52±23% (P=0.04), for TS, L3 and T18, respectively. There was significantly increased ROM in flexion-extension at T13, in axial rotation at T13, T18, L3 and in lateral-lateral ROM at L3. Thoracolumbosacral asymmetry and reduced ROM associated with lameness were both altered immediately by improvement in lameness using diagnostic analgesia.

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.

Saddle fit and management: An investigation of the association with equine thoracolumbar asymmetries, horse and rider health

REASONS FOR PERFORMING STUDY

No previous studies have investigated interrelationships between saddle fit/management, equine thoracolumbar asymmetries, rider and horse health.

OBJECTIVES

To assess associations between data obtained by clinical assessment and those provided by riders via a questionnaire.

STUDY DESIGN

Clinical assessment of a convenience sample of horses and riders compared with a Web-based questionnaire survey (n = 205).

METHODS

Horse thoracolumbar asymmetries at predetermined sites, the presence of lameness (in hand and/or ridden), saddle slip, saddle fit/management and rider straightness were assessed. Kappa statistics were used to assess the relationship between categorical clinical data and questionnaire data from riders. Spearman's correlation was used to investigate associations between outcomes from clinical assessment (horse, saddle and rider data) and information provided by riders.

RESULTS

There was a 40.5% (205 of 506) questionnaire response rate. Thirty horses (14.6%) had saddle slip, which was significantly associated with hindlimb lameness or gait abnormalities (P<0.001), but only 2 riders had considered a link between saddle slip and lameness. Rider back pain was common (38.5%) and associated with ill-fitting saddles (P = 0.03) and either a quadrupedally reduced cranial phase of the step or a stiff, stilted canter (P = 0.006). Well-fitted saddles were associated with frequent saddle fit checks (P = 0.004). Minor thoracolumbar asymmetries (P = 0.04) were negatively associated with ill-fitting saddles and positively associated with rider skill level (P = 0.001).

CONCLUSIONS

The interaction between the horse, saddle and rider is complex. Ill-fitting saddles and a stiff, stilted canter or quadrupedally reduced cranial phase of the step are associated with rider back pain. Equine back pain and minor thoracolumbar asymmetries are associated with ill-fitting saddles. Saddle fit should be checked more often than once yearly to lower the number of ill-fitting saddles. Riders, trainers and other professionals involved in equine care and performance need better education to recognise ill-fitting saddles, lameness, saddle slip and rider crookedness.

Inertial sensors for assessment of back movement in horses during locomotion over ground

REASONS FOR PERFORMING STUDY

Assessing back movement is an important part of clinical examination in the horse and objective assessment tools allow for evaluating success of treatment.

OBJECTIVES

Accuracy and consistency of inertial sensor measurements for quantification of back movement and movement symmetry during over ground locomotion were assessed; sensor measurements were compared to optical motion capture (mocap) and consistency of measurements focusing on movement symmetry was measured.

METHODS

Six nonlame horses were trotted in hand with synchronised mocap and inertial sensor data collection (landmarks: T6, T10, T13, L1 and S3). Inertial sensor data were processed using published methods and symmetry of dorsoventral displacement was assessed based on energy ratio, a Fourier based symmetry measure. Limits of agreement were calculated and visualised to compare mocap and sensor data. Consistency of sensor measurements was assessed using Pearson correlation coefficients and linear regression to investigate the effect of speed on movement symmetry.

RESULTS

Dorsoventral and mediolateral sensor displacement was observed to lie within ± 4-5 mm (± 2 s.d., 9-28% of movement amplitude) and energy ratio to lie within ± 0.03 of mocap data. High levels of correlation were found between strides and trials (0.86-1.0) for each horse and each sensor and variability of symmetry was lowest for T13 followed by T10, T6, L1 and S3 with no significant effect of speed at T6, T10 and T13.

CONCLUSIONS

Inertial sensor displacement and symmetry data showed acceptable accuracy and good levels of consistency for back movement. The small mediolateral movement amplitude means that changes of <25% in mediolateral amplitude (also unlikely to be detected by visual assessment) may go undetected. New sensor generations with improved sensor sensitivity and ease of use of equipment indicate good potential for use in a field situation.

Dynamic mobilisation exercises increase cross sectional area of musculus multifidus

REASON FOR PERFORMING STUDY

In human subjects with back pain, the deep spinal stabiliser m. multifidus is inhibited ipsilaterally leading to atrophy, asymmetry and intervertebral instability. Specific physiotherapeutic exercises are required to reactivate m. multifidus. This study assesses the effect of dynamic mobilisation exercises on size and symmetry of m. multifidus in the equine caudal thoracic and lumbar spine.

HYPOTHESES

Regular performance of dynamic mobilisation exercises over a period of 3 months increases cross sectional area (CSA) and left-right symmetry of m. multifidus muscles in the caudal thoracic and lumbar spine.

METHODS

Eight horses performed dynamic mobilisation exercises (3 cervical flexions, one cervical extension and 3 lateral bending exercises to the left and right sides) with 5 repetitions/exercise/day on 5 days/week for 3 months during which time they were not ridden. Left and right m. multifidus CSA was measured ultrasonographically at 6 levels from T10 to L5 at the start (initial evaluation) and end (final evaluation) of the 3 month study. Changes in CSA of the right and left m. multifidus muscles and symmetry of m. multifidus CSA on the right and left sides between the 2 evaluations were sought using analysis of variance (P<0.05).

RESULTS

Between the initial evaluation and final evaluation m. multifidus CSA increased significantly at all 6 spinal levels on both right and left sides. Asymmetries in m. multifidus CSA between the right and left sides decreased between the initial and final evaluations.

CONCLUSIONS

Hypertrophy of multifidus occurred over a 3 month period during which dynamic mobilisation exercises were the only exercise performed.

POTENTIAL RELEVANCE

Dynamic mobilisation exercises maybe a useful rehabilitative technique for horses in which m. multifidus has atrophied in response to back pain.

Hindlimb response to tactile stimulation of the pastern and coronet

REASONS FOR PERFORMING STUDY

Lightweight tactile stimulators attached to the hind pasterns increase the height of the hind hoof flight arc but details of the induced changes in swing phase kinematics and kinetics have not been investigated.

HYPOTHESES

Stimulators on the hind pasterns are associated with increased hindlimb joint flexions and increased positive work performed by the hip and tarsal musculature.

MATERIALS AND METHODS

Nine nonlame horses trotted 4 times with and without 55 g tactile stimulators loosely attached around the hind pasterns. Height of the flight arc and peak flexion angles of the hindlimb joints were measured and net positive and negative work performed across each joint during the swing phase were calculated using inverse dynamics analysis and compared across paired conditions.

RESULTS

Speed and stride duration did not change but stimulators were associated with a reduction in hind stance duration. The flight arc was higher with stimulators due to increased flexions of the stifle, tarsal, metatarsophalangeal and distal interphalangeal joints. Positive work increased in the tarsal musculature, but not in the hip musculature, and negative work increased across the stifle, metatarsophalangeal and distal interphalangeal joints.

POTENTIAL RELEVANCE

The effects of tactile stimulation of the hind pasterns on joint motion and muscle activation may be used in physiotherapy and rehabilitation to restore or increase flexion of the hindlimb joints with the exception of the hip joint. The ability to stimulate concentric activity of the tarsal musculature may have therapeutic applications in conditions such as toe dragging.

The effect of rising and sitting trot on back movements and head-neck position of the horse

REASON FOR PERFORMING STUDY

During trot, the rider can either rise from the saddle during every stride or remain seated. Rising trot is used frequently because it is widely assumed that it decreases the loading of the equine back. This has, however, not been demonstrated in an objective study.

OBJECTIVE

To determine the effects of rising and sitting trot on the movements of the horse.

HYPOTHESIS

Sitting trot has more extending effect on the horse's back than rising trot and also results in a higher head and neck position.

METHODS

Twelve horses and one rider were used. Kinematic data were captured at trot during over ground locomotion under 3 conditions: unloaded, rising trot and sitting trot. Back movements were calculated using a previously described method with a correction for trunk position. Head-neck position was xpressed as extension and flexion of C1, C3 and C6, and vertical displacement of C1 and the bit.

RESULTS

Sitting trot had an overall extending effect on the back of horses when compared to the unloaded situation. In rising trot: the maximal flexion of the back was similar to the unloaded situation, while the maximal extension was similar to sitting trot; lateral bending of the back was larger than during the unloaded situation and sitting trot; and the horses held their heads lower than in the other conditions. The angle of C6 was more flexed in rising than in sitting trot.

CONCLUSIONS AND CLINICAL RELEVANCE

The back movement during rising trot showed characteristics of both sitting trot and the unloaded condition. As the same maximal extension of the back is reached during rising and sitting trot, there is no reason to believe that rising trot was less challenging for the back.