Connectivity: Tendon & Ligament Injuries in the Horse, Part 3

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Part 3 of 3

To read part 1 click here.

by Jessie Bengoa,
This article is sponsored by Platinum Performance®

Article originally appeared here: https://www.platinumperformance.com/articles/connectivity

 

From injury prediction and prevention to treatment and rehabilitation, leading veterinarians are advancing the science of maintaining and healing tendons and ligaments in the horse.

Featuring Veterinarians Dr. Lisa Fortier, Dr. Carter Judy, Dr. Jackie Hill and Dr. Santiago Demierre

A Preventative Approach

Though diagnostic imaging, surgical capabilities and rehabilitation have all improved greatly over the last two decades, veterinarians’ primary goal is to proactively prevent soft tissue injuries rather than reactively treating them. Dr. Demierre sees primarily high-level sport horses and believes in a simple but profoundly effective strategy in preventing injury. “There are four critical points I focus on,” he says. “First is proper conditioning and not working a horse to the point of fatigue. This often brings negative consequences. Second is optimum nutrition. Horses, especially athletes, need a complete and balanced diet according to their discipline and workload. Third is proper footing, avoiding working horses on ground that is too soft or too hard. Lastly, I encourage riders and grooms to use their hands and learn how to palpate the legs as part of their daily routine.” While the approach may sound surprisingly simple, veterinarians see a significant amount of cases that have sustained a preventable soft tissue injury. A whole-horse approach is imperative to shaping more durable athletes that are well prepared for their workload and have the tools necessary for greater longevity and sustained performance. Several key factors can make the difference between a high-performing, healthy animal, and a horse prone to injury. Managing a horse’s level of inflammation through diet and simple, targeted supplementation is an integral piece of the care plan, as well as monitoring body condition to maintain an ideal weight for the horse’s health rather than the discipline’s desired aesthetic. In addition, conditioning the horse appropriately for their level of performance is imperative. “It’s so important for training to be personalized and consistent and to realize that we can’t keep horses in a stall all week, then expect them to go out on a 20-mile trail ride on the weekend without injury,” says Dr. Hill. “I am a big fan of horses being turned out and having active rest periods as opposed to constantly being in a stall.” Conditioning horses correctly can help ensure that their muscles are adequately prepared for both their training and showing workload. This attention to detail also helps to avoid the fatigue that can often leave horses at a greater risk for injury.

While many riders think of conditioning as applying to their competitive horses, in fact, the process starts with foals and should remain a mainstay throughout a horse’s life and performance career. This is of particular importance as young horses are started and brought up through the ranks of training and competition. “Many horses are started very young and are trained more aggressively than their body is able to handle at that point in their life,” says Dr. Hill. With horses not reaching skeletal maturity until the age of five, these young athletes are often overstressed and left vulnerable to injury. Dr. Demierre insists it starts with the foal, and that nutrition is the first step in the conditioning process. “Provide the foal with proper nutrition, especially during the first two years of life when musculoskeletal development is at its apogee,” he advises. “It’s important not to rush things and give the horse time at every step of the training process, especially during the first two years of work under saddle.”

The world of therapeutic nutrition has seen substantial advancements in recent decades. A whole-horse approach is imperative to shaping more durable athletes that are well prepared for their workload and have the tools necessary for greater longevity and sustained performance. Dr. Natalie Zdimal, above, talks with Platinum Performance® client Kristen Hiller.

“I absolutely think it plays a role in the healing stage of injuries, but more so, the best use for therapeutic nutrition is in the preventative stage.”
— Dr. Jackie Hill, A Boarded Surgeon at Littleton Equine Medical Center in Colorado

The Impact of Therapeutic Nutrients

The world of therapeutic nutrition has seen substantial advancements in recent decades, giving veterinarians and riders a tool to impact not only the healing process post-injury but to help prevent soft tissue injuries by targeting the inflammatory process and, more specifically, joints, tendons and ligaments locally. “As veterinarians, we can sometimes get caught up in the big picture and forget that we could get our patients recovering faster if we didn’t leave out the nutritional side of things,” says Dr. Hill. “I absolutely think it plays a role in the healing stage of injuries, but more so, the best use for therapeutic nutrition is in the preventative stage.” True prevention comes with approaching tendon and ligament health by way of the horse as a whole and appreciating that a horse in an unchecked state of inflammation will be more prone to injury and disease. “Inflammation is subtle at a microscopic level. When we don’t realize that, we’re missing all of those early inflammatory stages until we get to the point of ‘Oh no, we already have disease,’ ” points out Dr. Fortier. “By the time the horse has a limp or pain on palpation, you’re already well into the disease process — you’re not just dealing with inflammation anymore. If you are not on some type of preventive, then you’re probably at a greater risk for tendon and joint injury.”

Convincing research is ever-evolving, showing that omega-3 fatty acids are a weapon in the armory of tools used to fight inflammation. The horse relies entirely on its diet to obtain the necessary omega-3 fatty acids it requires. Where the horse was once a roaming grazer, consuming ample omega-3s from grasses, various foliage, flowers and barks, equine athletes today are significantly more confined and fed one to three daily meals instead. With domestication, the horse’s diet also transformed from pasture grasses to a mix of hays, grains and concentrates. Hays are grown today on largely mineral-depleted soil and lack the vital omega-3s and crucial antioxidants that help keep a horse’s systemic level of inflammation at a healthy level. Past that, grains and processed concentrates can deliver a high peroxide level due to the high-heat, high-moisture and high-pressure environment necessary to produce most pelleted feeds. By returning to a more natural diet of high-quality forage, supported by simple and targeted nutrient formulas, equine athletes are returning to what their bodies were designed to process and use most efficiently. “Omega-3 fatty acids are the most convincing across the board, not just related to soft tissue injury but to cellular aging in general,” says Dr. Fortier. “There is clear evidence that omega-3 fatty acids are excellent for the benefit of the whole horse. I recommend Platinum Performance ® CJ because it has the omega-3s and antioxidants in there as well as the ingredients that support the joints and soft tissue. I’m an orthopedist, so of course those specific ingredients are what I need, but I choose it because of its combinational approach.”

It’s that combinational approach that allows veterinarians and riders the ability to target joints and soft tissue while concurrently providing the horse with the core omega-3 fatty acids and antioxidants that are imperative for overall health and performance. In addition to those core nutrients, vitamins and minerals, there are key therapeutics that target joints, tendons, ligaments and cartilage specifically. ASU, or avocado/soy unsaponifiables, are derived from the lipid portion of avocados and soy, and have been shown to help support cartilage synthesis and aid the body’s natural ability to fight articular cartilage breakdown. Hyaluronic acid, known as HA, is a non-sulfated glycosaminoglycan that is naturally found in connective, epithelial and neural tissues. HA is a major component of synovial fluid, which surrounds joints and aids in reducing friction between articular cartilage that can occur during movement. Certain oral hyaluronic acid sources have been shown to be highly bioavailable, or absorbable, and are an excellent tool to help support joints and soft tissue. Other beneficial ingredients are cetyl- myristoleate, which helps the body to naturally decrease inflammatory proteins while supporting chondrocyte production, as well as MSM, or methylsulfonylmethane, which provides a bioavailable sulfur source that is a key component in most glycosaminoglycans, cartilage, tendons and ligaments. Another key component to supporting post-injury soft tissue healing is incorporating silicon into the horse’s regimen. One of the most abundant elements on earth, silicon is required for the formation of tendons, ligaments, cartilage and bone. Research has shown that bioavailable sources of silicon, such as the zeolite in Osteon®, support soft tissues as well as proper bone formation and calcification.

Supporting the horse as a whole while also targeting joints and soft tissue is a critical one-two punch in both prevention and recovery. “I recommend Platinum Performance® CJ for the vitamins, minerals, omega-3 fatty acids and antioxidants but most importantly for the ASU component. During the recovery period, I think it is important that the body has all the nutrients available to try to get that joint back to a healthy state as soon as possible,” says Dr. Hill of her post-surgical recommendation. “The vitamins and minerals play a bigger role in the healing process than we realize. Providing the proper nutrition like the omega-3 fatty acids and targeting that inflammation can only be beneficial for healing and the whole horse in general.”

“My greatest pleasure is spending my time in close contact with these magnificent animals.”
— Dr. Santiago Demierre, Palm Beach Equine Clinic in South Florida

The Future is Predictive

The understanding and ability to both prevent and treat soft tissue injuries may have taken significant leaps of late, but perhaps the most substantial discoveries are still ahead of us. Veterinarians and researchers are focused on developing more targeted therapies to further improve the prognosis for tendon and ligament injuries. But, what if practitioners were able to see those injuries coming before they occurred? It turns out, they can. The science of predictive medicine, while seeming otherworldly, is actually happening now. Tools such as predictive biomarkers are being developed with the mission to give veterinarians clear and measurable indicators to predict which horses are most likely to sustain specific injuries or suffer from certain diseases. “Biomarkers could be the way of the future in terms of what leads to more personalized medicine,” says Dr. Fortier excitedly. In addition to their ability to essentially predict injury, biomarkers could allow practitioners to tailor a more personalized approach to treatment by having an inside look at what therapies will have a greater chance of success with each individual patient. “The question is how do we find out what is going to work? If we have a biomarker, then you can see that, yes, this works for this horse and, no, this doesn’t. If you have a biomarker for joint degeneration and we put PRP into the joint together with recommending therapeutic nutrition, we can see if we are going in the right direction and changing the course of the disease.” Dr. Demierre shares this enthusiasm for the potential impact that predictive medicine could have on reshaping the way veterinarians and human physicians practice medicine. “Simply put, this is a way of finding markers of a certain disease or injury in the patient before the disease or injury becomes clinical,” he says. “There are different stages in the pathogenesis of a disease with the clinical manifestation of that disease being the end stage. The idea of this new area of research is to focus on those preclinical markers in order to prevent the clinical manifestation of the disease from ever occurring. This will likely be a powerful tool.”

Though further research lies ahead to solidify this emerging science, biomarkers appear to be setting the stage for a new frontier in medicine. No longer will we take general steps to prevent injury and disease, we could instead be armed with specifics unique to each patient. The potential is vast and just years from now we could see a dramatic decrease in sports-related injuries, disease occurrence and one-size-fits-all therapies. The future is predictive, it’s personalized and hopefully, it’ll be here within the not-too-distant future.

Redefining Limits

The research and in-practice work that has been done in the realm of soft tissue injuries has truly reshaped a vital aspect of veterinary medicine and equestrian sport. Just two decades ago, a horse’s chance of returning to work after a tendon or ligament injury was just 20 percent. Today, with tools such as advanced diagnostic imaging, surgery, veterinary-directed rehabilitation, regenerative medicine and therapeutic nutrition, that number has climbed as high as 80 percent. To the veterinarians whose lives are dedicated to treating equine athletes, it’s not simply the achievements of modern medicine that have them celebrating this shift. It all comes back to the love of the horse and their ability to help change the trajectory of their patients’ futures. “My greatest pleasure is spending my time in close contact with these magnificent animals,” says Dr. Demierre sincerely. “Personally, the best feeling is when I see the results of all of my efforts paying off and we have a successful outcome.” It’s that same motivation that keeps Dr. Hill and her friend, colleague and mentor, Dr. Fortier, firmly pointed toward further improvements in their craft. “I have loved horses as long as I can remember,” says Dr. Fortier. “In the end, it’s all about them,” agrees Dr. Hill. “It’s about getting some little girl’s horse working again or just having the chance to improve the quality of a horse’s life. We love the science, yes, but we do this because we love the horses and we want to see the best for them.”

From the left to right: Dr. Lisa Fortier, a boarded surgeon and highly respected researcher at the Cornell College of Veterinary Medicine (photo by Scott E. Palmer, VMD); Dr. Carter Judy, a boarded surgeon at Alamo Pintado Equine Medical Center in California, who is widely recognized as a world leader in reading and interpreting MRI results in the horse; Dr. Santiago Demierre, an Argentine-born veterinarian who sees a significant amount of soft tissue injury cases in practice at Palm Beach Equine Clinic in South Florida; and Dr. Jackie Hill, a boarded surgeon at Littleton Equine Medical Center in Colorado.

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