Medical management of human athletes is a billion dollar a year industry and there are some aspects that are similar to the equine industry.
Medical management of human athletes is a billion dollar a year industry and there are some aspects that are similar to the equine industry. For instance, the NFL combine is really no different than the pre-purchase scenario that we deal with commonly. In the human field there is full time management of diagnosis, treatment, and most importantly strength maintenance of the individual. This scenario can also be used in the equine athlete with the particular goals of: 1. Understanding the use of the horse which can influence its longevity, common areas of damage and the urgency to reach a certain point in its career; 2. Identify the weaknesses and potential weaknesses of each individual, which can be done in a pre-purchase examination; 3. Understand the goals of the trainer, owner and handler; and 4. Monitor the individual both during the season and off season. These goals need to be taken into consideration when managing the equine athlete.
Long term goals in each discipline vary significantly. For instance, in sport horses there is generally a need for long term use and the animals are often trained and used slowly. Trainers and owners will tend to back off if problems develop and performance for breeding is usually not the goal. However in western performance horse's, futurity and derby schedules often dictate aggressive training and showing schedules with a limited long term career and with the focus on performance for breeding future. With this in mind the definition of soundness can often be interpreted differently. Soundness is often defined as a lack of movement dysfunction. However with most athletes including humans some will consider soundness to be movement that does not influence performance with the understanding that it is unlikely to make any athlete completely devoid of movement dysfunction. Therefore most would consider the goal of management for these athletes to be functionally sound. In order to achieve this there must be reduction in primary and compensatory pain and maintenance of fitness.
The difficulty in managing the equine athlete is determined by several factors. First is the experience of the horse, the trainer and the rider. Good horseman can often pick up problems early, but on the downside they can also compensate for problems often making it difficult to find a subtle issue. An example of this is in the dressage field where riders often subtly compensate for potential problems in the horse. The experience of the horse also dictates ease of management as some of the better performers need less aggressive training and consequently can work mostly to maintain condition. The experience is also influenced by the veterinarian. Those that are most effective have a thorough knowledge of the field of competition as various horses commonly undergo various disease processes. For instance racehorses undergo a completely different type of joint disease process than western performance horses, or sport horses. Consequently the ability to detect this early so as to effectively treat it can be influenced. The ability of the horse to stay fit also influences ease of management. Unfortunately this can be influenced by geography and climate as those horses in warmer climates can typically be exercised more during the winter months. In addition the geographic area can often dictate the show schedule which can also influence how a horse is brought back to training. The show schedule can also influence a horse's condition. During the show season there is often limited turn out and consequently limited conditioning work due to the constraints of the show. Unfortunately the human schedule also influences conditioning based on how often the horse can be ridden. It is my opinion that complete rest can be detrimental especially to some older horses and that even compete turn out is often not enough. The "heart" of the horse can also influence ease of management. That is defined here as the ability to train or perform in the face of physical and psychological adversity and pain. This is a double edged sword since a horse that is considered to have a lot of heart can train through minor aches and pains but may delay the onset of noticeable lameness. In summary all these factors must be taken into consideration when managing an equine athlete.
Following is the basic routine that we try to follow in our practice. During the start of the competition year which is usually in the spring we perform a baseline examination and discuss the plan with the owner or trainer. There is often some early season pain which rest brings on itself, and we may or may not treat the problems at that time. We do try to get a basic understanding of the shoeing and this time period often requires frequent monitoring by the veterinarian. During the early season once the horse is back into some level of conditioning, we often treat the horses. The summer and the fall are difficult times to frequently monitor these animals due to show schedules and traveling. It is also a time when fatigue injuries such as tendonitis and desmitis commonly occur and we often find ourselves in constant communication with the trainers and veterinarians at the shows. Any conditions that develop are diagnosed and treated aggressively. This is also a time when difficult decisions need to be made. In general our aim is to effectively treat various problems with the understanding that we will not return the horse to immediate athletic use if there is any possibility that it could result in further damage especially a catastrophic condition. In the off season supplements and some medications are often continued such as Legend and Adequan, and the winter show schedule is determined and conditioning changed accordingly. Some people recommend pulling shoes however there are some horses that due to various reasons cannot go without shoes. Our recommendation is often to maintain those horses in consistent low level work with no sudden changes that could bring on a disease process.
We feel that conditioning is essential to maintaining longevity of an equine athlete. We often times recommend trail riding, hills, poles, jogging and even underwater treadmill therapy in order to maintain condition. In addition chiropractic, acupuncture, massage and magnetic therapy are often used to help treat secondary problems.
The management of the equine athlete always starts with a pre-purchase examination. Although we feel we are most effective for our clients by performing those examinations ourselves, this can often times not be done. We typically network with veterinarians in various parts of the country and the world that we are familiar with and examination findings and radiographs are often sent to us for consultation. Although this networking can be effectively done in the States, the differing perspectives on diagnostic findings between the US and Europe can make it difficult. We are fairly adamant with our clients that specific radiographic images must be taken in order to be most effective in helping them to decide whether or not to buy a horse. However it is often times difficult to convince other veterinarians to take theses images and take them using a method that is useful to the consulting veterinarian. These limitations should be discussed with the owner and trainer, and the veterinarian performing the exam. We consistently recommend an endoscopic examination of the upper airway, and CBC, diagnostic panel and a drug screen.
In summary, for those clients who wish to have aggressive management of their equine athletes we develop a proactive routine that will maximize our effectiveness. Examples of various horses will be included in this discussion.