The art of sporthorse medicine

Courtesy Audrey Pavia/Shutterstock_New Africa Equine medicine is a niche requiring an often very different type of practice from small animal and even exotics. Within equine medicine, there is an even more focused niche: sporthorse medicine. Sporthorse medicine involves specializing in treating equine patients that often compete at the highest levels of international sports such as jumping, dressage, and cross-country. Unlike treating a backyard equine companion, sporthorse medicine requires an understanding of the equine athlete and the different health and soundness issues they face due to their occupation. “All horses, regardless of their discipline or use, need to have a solid health foundation, but sporthorses differ in that they have to be physically fit to perform like a professional athlete,” says Ross T. Russell, DVM, of Russell Equine Sports Medicine in Wesley Chapel, Fla. “These equine athletes have specialized dietary needs, are under strict exercise regimens, and commonly travel long distances to show or compete in stressful settings. Problem-solving these unique health and lameness issues encompasses the veterinary aspect of sporthorse medicine.” Jillian Mills, DVM, Dipl., ACVSMR, owner of Presidio Equine Sports Medicine & Rehabilitation in Encinitas, Calif., notes the structure of a sporthorse practice is probably the biggest difference between those practicing conventional equine veterinary medicine and sporthorse medicine. “An ambulatory general practice usually functions on set hours, Monday through Friday, and has a practitioner on-call during week nights and weekends,” she says. “As a sporthorse practitioner, my schedule is incredibly variable. We travel with our regional show circuits and provide on-site care throughout the year. During the show season, we often provide services Tuesday through Sunday, if not seven days a week. This is very common amongst many of my colleagues, especially in the hunter/jumper industry.” Sporthorse veterinarians frequently evaluate horses for endocrine dysfunction and metabolic disorders. Courtesy Audrey Pavia/Shutterstock_Powerlightss Common issues Sporthorse practitioners tend to see a lot of the same issues in their equine patients as a result of the challenges posed by competing at the highest levels. “The most common problems I come across in sporthorse practice are related to neuromusculoskeletal dysfunction and performance-related issues,” Dr. Mills says. “It’s important to be familiar with the discipline in which your patient competes. More often than not, the presenting complaint is unrelated to soundness. When you have an astute rider, there is often a discussion of what the horse is doing under-saddle. For example, the horse might be consistently jumping toward one of the standards, landing on a certain lead, or always landing on the cross.” Lameness issues are one of the more common problems seen by sporthorse veterinarians. (Above: Courtesy Audrey Pavia/Shutterstock_135pixels. Below: Courtesy Audrey Pavia/Shutterstock_Jaromir Chalabala) Mills adds these complaints are often related to musculoskeletal discomfort, but sorting through the subtleties of those complaints are what helps you determine the issue the horse may be having. “Deciphering a performance issue is both a science and an art, regardless of what anyone might tell you,” she says. L. Cory Branscomb, DVM, with Pine Bush Equine Services in Pine Bush, N.Y., points out common issues in sporthorses depend greatly on their breed, build, and discipline, while complaints and perceptions of the riders will vary in different disciplines. “Almost all sporthorses require joint injections several times per year, particularly in the coffin joints and the hocks,” she says. “Diseases of the axial skeleton are of particular concern for performance riders asking for increased collection and propulsion from their horse. It is not uncommon to have injuries to a horse’s suspensory ligament, ranging from mild to more severe, as the horse’s workload increases.” In addition to lameness issues, Dr. Russell also sees problems that are a result of general stress on the horse. “Some of the most common issues I see with sporthorses from a health perspective are gastric and colonic ulcers, upper respiratory malfunction; and disease, pneumonia or pleurisy from long distance travel,” he says. Mills adds sporthorse practice is often overlooked as being a subset of equine veterinary medicine that requires a “whole horse” approach. “Performance issues are not always musculoskeletal, and we frequently find ourselves evaluating the horse for endocrine dysfunction and metabolic disorders, such as PPID [Pituitary pars intermedia dysfunction] and EMS [equine metabolic syndrome], gastrointestinal issues, such as gastric ulceration and dental discomfort, as well as addressing issues with tack and proprioceptive awareness by implementing core exercises and physiotherapy techniques,” she says. Treating sporthorses Horses that are on rigorous show and competition schedules have typically been a challenge to treat. Prohibited medications and long layups have posed difficulties for both veterinarians and horse owners. However, with the advance of technology, this is becoming less of an issue. “We are utilizing more treatments now that focus on stimulating the horse to heal itself,” Russell says. “Regenerative therapies utilizing IRAP [Interleukin-1 Receptor Antagonist Protein], PRP [Platelet Rich Plasma] and stem cells have become common use. I am a big proponent of chiropractic medicine and the benefit horses receive from being adjusted. Shockwave treatment has also become very popular due to its ability to speed up the healing process. Magnawave/PEMF [Pulsed Electromagnetic Field], laser therapy and massage are good adjunct treatments for some injuries.” Dr. Branscomb agrees, noting that with advancing technology in equine sports medicine, drug withdrawal times required for competition are not as much of an issue. “Treatments like chiropractic, shockwave therapy, laser therapy, and acupuncture do not require medications to be given to most horses, so there is no concern of drug testing,” she says. “The use of orthobiologics, such as PRP, IRAP, ProStride, and Alpha2 Macroglobulin (A2M), allows for joint therapy without concern of positive drug tests.” Branscomb adds each sport has rules about how close to competition these therapies are allowed to be performed. From exams to surgery, horses performing at the highest levels of competition are treated by niche specialist sporthorse veterinarians. Courtesy Audrey Pavia/Shutterstock_Thomas Koch “The best way to avoid competition rules, however, is to focus on prevention so treatments can be planned around competitions and training,” she says. While long layups are still a common prescription for certain lameness issues, the number of educated clients in the sporthorse world makes it easier for vets to prescribe this remedy. “No client likes to hear their horse has to be out of training for a period of time, but they all understand it’s not worth the risk of maybe a minor issue becoming potentially a career-ending issue for a horse,” Russell says. “Owners and trainers are invested emotionally and financially in these equine athletes, and take great care of them. They usually spend most of their time fretting about their horse getting sick or injured, so the last thing they want to do is jeopardize the horse’s health in any way.” Mills notes whether or not prescribing a long layup is challenging for the veterinarian, it is completely dependent on the client. “Most sporthorse operations and their horses are managed by a team of individuals, including the owner, the client’s trainer, assistant trainer, and barn manager,” she says. “Some horse owners are hands-on, and want to be involved in their horse’s care. These clients are easy. They are often the ones who have the horse’s best interest at heart and recognize that layup can sometimes be a necessary part of the treatment plan.” According to Mills, problems can arise when the owner is not involved, and diagnostic recommendations and treatment options are often filtered through the horse’s trainer. “Most trainers recognize when a horse has a significant injury, such as a tendon or ligament tear,” she says. “These individuals are generally understanding if you conclude prolonged controlled exercise is essential for the horse’s rehabilitation plan. The difficulty arises when a trainer views a horse’s layup time as a detriment to his or her ‘bottom-line.’ When a trainer has a horse that is laid-up, they may not be earning full training fees, and in some instances, they may not even be receiving board if the horse was referred to a rehabilitation center for treatment.” Mills says in most cases, these individuals have already sent up some red flags and raised concerns. “For example, a trainer may want you to omit certain details regarding the horse’s evaluation and treatment, or exclude an owner from the discussion and decision-making process all together,” she says. “My all-time favorite is when the trainer requests all invoices be sent to them directly for them to pass along to their clients, and they request the invoice be provided separate of the document containing the patient’s medical notes.” Courtesy Audrey Pavia/Shutterstock_DuxX. Why sporthorses? Equine veterinarians opt for specializing in sporthorses for a number of different reasons, but stay with it because of the rewards. “I was fortunate to grow up in a horse racing family, and have worked with athletic horses since I was young,” says Russell. “I’ve always been into sports and I am very competitive, so it’s basically a perfect fit for me. The hours are long and the job is demanding, but it’s a very rewarding job that's taken me all over the world. I can’t imagine doing anything else.” Mills’ interest in sporthorse practice started well before veterinary school, when she was a specialty imaging technician for University of California at Davis. “As a technician, I performed CT, MRI and nuclear scintigraphic exams on large and small animal patients,” she says. “A lot of our equine patients were referred for diagnostic imaging due to musculoskeletal abnormalities, which prompted my interest in functional anatomy.” Mills says she has always enjoyed complicated performance cases that are a diagnostic challenge. “I completed a residency in sports medicine and rehabilitation, which gave me the opportunity to travel, work on impressive equine athletes, and practice both challenging and rewarding medicine,” she says. “I appreciated all of the elements that sporthorse practice had to offer during my residency, so I elected to open my own sporthorse practice after becoming board certified in equine sports medicine and rehabilitation.” For Branscomb, sporthorse medicine is just interesting. “I enjoy helping clients reach their goals with their horses, and helping horses achieve their full potential,” she says. “The nice thing about sporthorse medicine is that it is not just about the horse’s legs or joints, but the whole health of the horse. In this way, I can practice standard medicine plus what interests me.” Audrey Pavia is an award-winning freelance writer who specializes in pet and veterinary topics. She lives in Southern California with a menagerie of dogs, cats, and horses.

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The art of sporthorse medicine

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