LEADING UK veterinary surgeon Dr Sue Dyson gave an informative lecture last Saturday at the CAFRE Greenmount Campus in Co Antrim. The lecture was titled ‘Lameness problems in the horse – Let’s get down to the detail’ and was organised by the British Horse Society.

The day provided CPD points for coaches with the British Horse Society, Horse Sport Ireland and the Irish Pony Club. Dyson was one of two speakers. Dr Esther Skelly-Smith, who worked under Dyson at the Animal Health Trust in Newmarket, gave a presentation on equine rehabilitation.

Dyson was very enthusiastic throughout the day and was keen educate as many people as possible on how best to determine lameness. She emphasised that low grade lameness does not mean the horse can never be ridden again and reminded everyone of the importance of treating each horse as an individual.

Over 60 people attended the event. Throughout the day Dyson maintained a very matter-of-fact way of looking cases and was quick to admit that certain reoccuring problems are partly due to the failure of some veterinary surgeons.

Both Dyson and Skelly-Smith encouraged all horse owners, riders and trainers to take a comprehensive approach to accessing horses for lameness.

DETERMINING LAMENESS

The opening session of the day was on how to determine if a horse is lame and, if so, on which limb(s) are they lame.

Dyson focused on developing to ability to look at a horse and determine possible lameness. She emphasised that it is very important to take things slowly and to take every factor into account.

It is difficult to make a visual examination for lameness objective. In order to counter this Dyson applies a scale when she is examining a horse. The scale ranges from zero to eight. Zero indicates that the horse is sound, while eight indicates that horse is unable to bear any weight on that limb.

Dyson uses a very comprehensive examine when trying to detect lameness. She assesses the horse in walk and trot in straight lines and on circles. In the majority of cases circles extenuate lameness on the inside limb, but that can also show lameness on the outside limb.

When the horse is being assessed in hand Dyson makes sure to listen to the stride to see if she can hear any irregularities, she also looks at the horse going away from her and coming back towards her as well as from the side.

The assessment should take place on different surfaces but not on concrete or tarmac. According to Dyson: “I don’t like lungeing on concrete or tarmac for safety reasons, the horse can easily slip and hurt itself. Many big moving horses will instinctively protect itself on slippery surfaces.”

Dyson discussed how when she is assessing a horse in-hand they are led off a bit rather than just in a headcollar. She explained that they do this for safety reasons and to be more likely to keep the horse under control. She did note that the downside of using a bit is that the horse is more inclined to lean towards the handler.

Dyson added: “If the handler can keep the rein as lose as they dare I think it’s the safest.” She also uses ridden examination to detect lameness.

Dr Esther Skelly-Smith and Dr Sue Dyson with representatives from the British Horse Society at the lecture in Greenmount Campus last Saturday (Photo BHS)

VIDEO FOOTAGE

Attending a lecture on lameness without seeing any horses was different from what you would expect, but Dyson used video footage throughout the day which encouraged engagement and participation.

The videos showed lameness on each of the limbs and a variety of assessments for each lameness. Slow motion footage helped show the lameness clearly. Some of the videos also included different flexion tests.

The videos also showed how the type of horse can impact on the assessment. For instance, one of the clips showed a hairy cob type. Dyson said: “Cob types are harder to detect lameness, clipping the hair off the limbs is normally advised in order to progress with the investigation of lameness.

“With ponies and small horses you have a more rapid step frequency both front and hind limb lameness can be more difficult to diagnose,” she added.

Some of the footage included horses being lunged in order to detect lameness. Lungeing often shows up a disparity depending on which direction the horse is going. Dyson said: “In a reasonably trained horse there should not be a vast difference in how they lunge on each rain.”

Lungeing allows the veterinary surgeon to access the horse without the weight of a rider and have a direct comparison to each rein. Lungeing also allows for the assessment to be in walk, trot and sometimes canter. Lameness is not always obvious in canter, but it can be. Canter can help detect problems which Dyson believes reflect musculoskeletal pain.

The footage included a horse who suffered from ataxia (commonly known as being a ‘wobbler’.) Dyson explained how ataxia can coexist with lameness. It is not always obvious to the naked eye but can often be seen when the horse is decelerating. Dyson said to watch downwards transitions carefully. She described the transitions as: “Bouncy deceleration from trot to walk.”

Ataxia occurs due to spinal cord compression. Low grade cases can respond to treatment. Surgical techniques are available but they may only make small improvements to ataxia.

TRAINING AND PERFORMANCE PROBLEMS

Dyson once again used case examples to illustrate how training and performance problems may reflect lameness. This part of the lecture highlighted why she is so keen to use ridden examinations to determine lameness.

She used video footage of the riders at the veterinary practice riding the horses. She also showed some videos and photographs of the horses with their own riders. The footage included clips of the horses before and after initial treatment.

Initial treatment usually consisted of nerve blocking the area in pain. In all of the videos there was a clear improvement in how the horses was going and rideablity after initial treatment.

The ridden examination included 10 metre circles in trot. Dyson believes these are one of the best tests for lameness and, similar to lunging, they allow the assessor to get a clear comparison between each rein.

Dyson also emphasised that it is very important to remember every horse is an individual. “Some horses react to pain by going more slowly, some horses react by trying to accelerate.”

Saddle slipping is another possible indication of lameness. To observe if saddle slipping is occurring you must watch the horse from behind.

Changing the saddle can help hugely. 60% of the horses Dyson has to examine have a saddle which compromises the horse’s performance.

https://soundcloud.com/the-irish-field/bhs-lecture-audio-dr-sue-dyson

COMBINED APPROACH

Dr Esther Skelly-Smith followed on very well from where her mentor left off. Skelly-Smith uses a version of integrated medicine combining traditional and complementary therapies. Her work also focuses on equine rehabilitation.

Box rest is one of the most commonly prescribed treatments for horses suffering from lameness. Skelly-Smith went through some of the pros and cons of the box rest.

Firstly, she noted that box rest helps to reduce the force and strain on the injury. However, she added the quality and quantity depend on the injury, the horse and the owner.

There is very little research behind box rest and it requires a high level of husbandry. Once again everyone in attendance were reminded that every horse and injury must be treated individually.

Skelly-Smith discussed how in some cases functional exercises can be more useful than immobilisation and help to improve muscle and joint movement and reduce pain.

Box rest can also be very mentally tough on horses. Certain injuries, such as fractures, do require immobilisation.

ALTERNATIVE OPTIONS

Skelly-Smith is not only a veterinary surgeon and equine dentist but she is also a trained veterinary chiropractor and acupuncturist. She combines these different means of treatment and pain management in order to formulate the best possible rehabilitation for each horse.

Veterinary chiropractic is a manual therapy which is used to prevent and treat and wide range of health and performance problems. It can also be used to maintain or restore normal function of the spine and nervous system to optimise health and well-being.

Skelly-Smith finds veterinary chiropractic is most effective after injury, before backing a young horse and in pregnant mares. She also recommends regular check-ups for all young and ridden horses.

Veterinary acupuncture is an effective means of pain control according to Skelly-Smith. Unlike some of the other forms alternative treatment which have very little evidence behind them there is significant evidence from human acupuncture.

Acupuncture works in conjunction with the fast and slow pain fibres. It stimulates the fast pain fibres cause a release of endorphins.

Anyone in the audience who may have doubted the treatment most likely changed their mind after Skelly-Smith showed a video of her doing acupuncture on a chicken who sat down and completely relaxed when the needle was inserted because of the release of endorphins.

THERAPEUTIC EXERCISE

Therapeutic exercise is the common foundation to must rehabilitation programmes and consists of a controlled or targeted exercise programme. It promotes a gradual return to cardiovascular exercise.

Swimming and using a water treadmill have some benefits but there is limited scientific evidence.

Skelly-Smith went through a number of stretches horse owners and riders can do at home. This once again gave a very hands-on feeling to the lecture.

Both Skelly-Smith and Dyson emphasised the important of exercising horses in a variety of different environments and surfaces.

Skelly-Smith touched on using thermal therapy to help reduce swelling and pain. She added that correct equine dental care should be used as part of the rehabilitation process.

The British Horse Society would like to thank Dr Dyson and Dr Skelly-Smith for sharing their knowledge. A special thanks also goes to the event sponsors Bluegrass, IMV imaging, Lintbells and Dechra without whom the event would not have been possible.

There will be further coverage from on this event, in Horse Sense, in the coming weeks.