Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry...

71
IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner Rood and Riddle Equine Hospital Training and the Musculoskeletal System

Transcript of Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry...

Page 1: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

IV

Training and the Musculoskeletal System

Dr Larry Bramlage SurgeonPartner

Rood and Riddle Equine Hospital

Training and the Musculoskeletal System

Lameness A Sign or a Disease

LR Bramlage DVM MS

Sometimes Most times All the time

bull Trainers regard lameness as ldquotherdquo problem as it prevents performance

bull Ideally lameness would be regarded as a ldquosignrdquo of the problem that needs attention

bull Understanding and prevention is always way better than treatment

What is lameness

bull The shifting of weight from one limb to another

bull What causes lameness pain (there are a few mechanical lameness)

bull What causes pain inflammation ndash Tumor ndash Calor ndash Dolor ndash Rubor

What causes inflammation bull Trauma bull Neoplasia bull Immune responses bull Degeneration bull Metabolic Disorders

bull For practical purposes in the racehorse = trauma ndash Almost all fractures in

the race horse are stress fractures

ndash What are stress fractures Fractures caused my multiple sub-maximal loads (cyclic stress)

Repetitive Cyclic Stress to the Skeleton is the primary cause of

lameness in the Racehorse

Relationship Am J Vet Res 1996 Nov57(11)1549-55 High-speed exercise history and catastrophic racing fracture in thoroughbreds Estberg L Stover SM Gardner IA Drake CM Johnson B Ardans A

Load Stress = Magnitude X Frequency

bull Why donrsquot all bones eventually fail

bull Because the horse repairs them

bull But there is a limit on the rate of repair and training can overwhelm the system

Am J Vet Res 1996 Nov57(11)1549-55

Results

hellipA horse that had accumulated a total of 35 furlongs of race and timed-work distance in 2 months compared with a horse with 25 furlongs accumulated had an estimated 39-fold increase in risk for racing-related FSI (95 confidence interval = 21 71)hellip

All horses get the same diseases but the level of performance and

the extreme ability of Thoroughbred racehorses magnifies skeletal effects

Why do racehorses have so much trouble with their musculo-

skeletal system bull Wonderful cardio-vascular system bull The musculo-skeletal system is the system that

ndash Requires the most training ndash Sustains the most wear and tear

Why does the skeleton require so

much training

bull The skeleton has to be literally molded into a performance skeleton

bull How do you do this ndash Selective breeding and

exercise (skeletal modeling) bull Adaptive training (skeletal modeling and

re-modeling) Skeletal remodeling is

work specific

bull 36 cycles day bull Bone trains to the level

of work not the amount bull Not true of

cardiovascular system

How many loads are required to train

bone

bull Additional cycles become detrimental to bone

bull We gallop too much and donrsquot vary gaits enough

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

The highest load 36 cycles day guide the bone response

bull A little better than a furlong bull The rest is trauma bull Lots of implications for

training ndash Galloping a horse lots of

miles doesnrsquot strengthen the bone it weakens it

ndash One furlong should be a little faster than the rest

Wolffrsquos Law bull ldquoBone is laid down where strength is needed and

removed where strength is unnecessaryrdquo bull Horses carry this to the extreme

How Bone trains

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

overl

Racing

Overload results in micro-fracture generation

Over repair results In hypertrophy

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 2: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Lameness A Sign or a Disease

LR Bramlage DVM MS

Sometimes Most times All the time

bull Trainers regard lameness as ldquotherdquo problem as it prevents performance

bull Ideally lameness would be regarded as a ldquosignrdquo of the problem that needs attention

bull Understanding and prevention is always way better than treatment

What is lameness

bull The shifting of weight from one limb to another

bull What causes lameness pain (there are a few mechanical lameness)

bull What causes pain inflammation ndash Tumor ndash Calor ndash Dolor ndash Rubor

What causes inflammation bull Trauma bull Neoplasia bull Immune responses bull Degeneration bull Metabolic Disorders

bull For practical purposes in the racehorse = trauma ndash Almost all fractures in

the race horse are stress fractures

ndash What are stress fractures Fractures caused my multiple sub-maximal loads (cyclic stress)

Repetitive Cyclic Stress to the Skeleton is the primary cause of

lameness in the Racehorse

Relationship Am J Vet Res 1996 Nov57(11)1549-55 High-speed exercise history and catastrophic racing fracture in thoroughbreds Estberg L Stover SM Gardner IA Drake CM Johnson B Ardans A

Load Stress = Magnitude X Frequency

bull Why donrsquot all bones eventually fail

bull Because the horse repairs them

bull But there is a limit on the rate of repair and training can overwhelm the system

Am J Vet Res 1996 Nov57(11)1549-55

Results

hellipA horse that had accumulated a total of 35 furlongs of race and timed-work distance in 2 months compared with a horse with 25 furlongs accumulated had an estimated 39-fold increase in risk for racing-related FSI (95 confidence interval = 21 71)hellip

All horses get the same diseases but the level of performance and

the extreme ability of Thoroughbred racehorses magnifies skeletal effects

Why do racehorses have so much trouble with their musculo-

skeletal system bull Wonderful cardio-vascular system bull The musculo-skeletal system is the system that

ndash Requires the most training ndash Sustains the most wear and tear

Why does the skeleton require so

much training

bull The skeleton has to be literally molded into a performance skeleton

bull How do you do this ndash Selective breeding and

exercise (skeletal modeling) bull Adaptive training (skeletal modeling and

re-modeling) Skeletal remodeling is

work specific

bull 36 cycles day bull Bone trains to the level

of work not the amount bull Not true of

cardiovascular system

How many loads are required to train

bone

bull Additional cycles become detrimental to bone

bull We gallop too much and donrsquot vary gaits enough

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

The highest load 36 cycles day guide the bone response

bull A little better than a furlong bull The rest is trauma bull Lots of implications for

training ndash Galloping a horse lots of

miles doesnrsquot strengthen the bone it weakens it

ndash One furlong should be a little faster than the rest

Wolffrsquos Law bull ldquoBone is laid down where strength is needed and

removed where strength is unnecessaryrdquo bull Horses carry this to the extreme

How Bone trains

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

overl

Racing

Overload results in micro-fracture generation

Over repair results In hypertrophy

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 3: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Sometimes Most times All the time

bull Trainers regard lameness as ldquotherdquo problem as it prevents performance

bull Ideally lameness would be regarded as a ldquosignrdquo of the problem that needs attention

bull Understanding and prevention is always way better than treatment

What is lameness

bull The shifting of weight from one limb to another

bull What causes lameness pain (there are a few mechanical lameness)

bull What causes pain inflammation ndash Tumor ndash Calor ndash Dolor ndash Rubor

What causes inflammation bull Trauma bull Neoplasia bull Immune responses bull Degeneration bull Metabolic Disorders

bull For practical purposes in the racehorse = trauma ndash Almost all fractures in

the race horse are stress fractures

ndash What are stress fractures Fractures caused my multiple sub-maximal loads (cyclic stress)

Repetitive Cyclic Stress to the Skeleton is the primary cause of

lameness in the Racehorse

Relationship Am J Vet Res 1996 Nov57(11)1549-55 High-speed exercise history and catastrophic racing fracture in thoroughbreds Estberg L Stover SM Gardner IA Drake CM Johnson B Ardans A

Load Stress = Magnitude X Frequency

bull Why donrsquot all bones eventually fail

bull Because the horse repairs them

bull But there is a limit on the rate of repair and training can overwhelm the system

Am J Vet Res 1996 Nov57(11)1549-55

Results

hellipA horse that had accumulated a total of 35 furlongs of race and timed-work distance in 2 months compared with a horse with 25 furlongs accumulated had an estimated 39-fold increase in risk for racing-related FSI (95 confidence interval = 21 71)hellip

All horses get the same diseases but the level of performance and

the extreme ability of Thoroughbred racehorses magnifies skeletal effects

Why do racehorses have so much trouble with their musculo-

skeletal system bull Wonderful cardio-vascular system bull The musculo-skeletal system is the system that

ndash Requires the most training ndash Sustains the most wear and tear

Why does the skeleton require so

much training

bull The skeleton has to be literally molded into a performance skeleton

bull How do you do this ndash Selective breeding and

exercise (skeletal modeling) bull Adaptive training (skeletal modeling and

re-modeling) Skeletal remodeling is

work specific

bull 36 cycles day bull Bone trains to the level

of work not the amount bull Not true of

cardiovascular system

How many loads are required to train

bone

bull Additional cycles become detrimental to bone

bull We gallop too much and donrsquot vary gaits enough

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

The highest load 36 cycles day guide the bone response

bull A little better than a furlong bull The rest is trauma bull Lots of implications for

training ndash Galloping a horse lots of

miles doesnrsquot strengthen the bone it weakens it

ndash One furlong should be a little faster than the rest

Wolffrsquos Law bull ldquoBone is laid down where strength is needed and

removed where strength is unnecessaryrdquo bull Horses carry this to the extreme

How Bone trains

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

overl

Racing

Overload results in micro-fracture generation

Over repair results In hypertrophy

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 4: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

What is lameness

bull The shifting of weight from one limb to another

bull What causes lameness pain (there are a few mechanical lameness)

bull What causes pain inflammation ndash Tumor ndash Calor ndash Dolor ndash Rubor

What causes inflammation bull Trauma bull Neoplasia bull Immune responses bull Degeneration bull Metabolic Disorders

bull For practical purposes in the racehorse = trauma ndash Almost all fractures in

the race horse are stress fractures

ndash What are stress fractures Fractures caused my multiple sub-maximal loads (cyclic stress)

Repetitive Cyclic Stress to the Skeleton is the primary cause of

lameness in the Racehorse

Relationship Am J Vet Res 1996 Nov57(11)1549-55 High-speed exercise history and catastrophic racing fracture in thoroughbreds Estberg L Stover SM Gardner IA Drake CM Johnson B Ardans A

Load Stress = Magnitude X Frequency

bull Why donrsquot all bones eventually fail

bull Because the horse repairs them

bull But there is a limit on the rate of repair and training can overwhelm the system

Am J Vet Res 1996 Nov57(11)1549-55

Results

hellipA horse that had accumulated a total of 35 furlongs of race and timed-work distance in 2 months compared with a horse with 25 furlongs accumulated had an estimated 39-fold increase in risk for racing-related FSI (95 confidence interval = 21 71)hellip

All horses get the same diseases but the level of performance and

the extreme ability of Thoroughbred racehorses magnifies skeletal effects

Why do racehorses have so much trouble with their musculo-

skeletal system bull Wonderful cardio-vascular system bull The musculo-skeletal system is the system that

ndash Requires the most training ndash Sustains the most wear and tear

Why does the skeleton require so

much training

bull The skeleton has to be literally molded into a performance skeleton

bull How do you do this ndash Selective breeding and

exercise (skeletal modeling) bull Adaptive training (skeletal modeling and

re-modeling) Skeletal remodeling is

work specific

bull 36 cycles day bull Bone trains to the level

of work not the amount bull Not true of

cardiovascular system

How many loads are required to train

bone

bull Additional cycles become detrimental to bone

bull We gallop too much and donrsquot vary gaits enough

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

The highest load 36 cycles day guide the bone response

bull A little better than a furlong bull The rest is trauma bull Lots of implications for

training ndash Galloping a horse lots of

miles doesnrsquot strengthen the bone it weakens it

ndash One furlong should be a little faster than the rest

Wolffrsquos Law bull ldquoBone is laid down where strength is needed and

removed where strength is unnecessaryrdquo bull Horses carry this to the extreme

How Bone trains

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

overl

Racing

Overload results in micro-fracture generation

Over repair results In hypertrophy

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 5: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

What causes inflammation bull Trauma bull Neoplasia bull Immune responses bull Degeneration bull Metabolic Disorders

bull For practical purposes in the racehorse = trauma ndash Almost all fractures in

the race horse are stress fractures

ndash What are stress fractures Fractures caused my multiple sub-maximal loads (cyclic stress)

Repetitive Cyclic Stress to the Skeleton is the primary cause of

lameness in the Racehorse

Relationship Am J Vet Res 1996 Nov57(11)1549-55 High-speed exercise history and catastrophic racing fracture in thoroughbreds Estberg L Stover SM Gardner IA Drake CM Johnson B Ardans A

Load Stress = Magnitude X Frequency

bull Why donrsquot all bones eventually fail

bull Because the horse repairs them

bull But there is a limit on the rate of repair and training can overwhelm the system

Am J Vet Res 1996 Nov57(11)1549-55

Results

hellipA horse that had accumulated a total of 35 furlongs of race and timed-work distance in 2 months compared with a horse with 25 furlongs accumulated had an estimated 39-fold increase in risk for racing-related FSI (95 confidence interval = 21 71)hellip

All horses get the same diseases but the level of performance and

the extreme ability of Thoroughbred racehorses magnifies skeletal effects

Why do racehorses have so much trouble with their musculo-

skeletal system bull Wonderful cardio-vascular system bull The musculo-skeletal system is the system that

ndash Requires the most training ndash Sustains the most wear and tear

Why does the skeleton require so

much training

bull The skeleton has to be literally molded into a performance skeleton

bull How do you do this ndash Selective breeding and

exercise (skeletal modeling) bull Adaptive training (skeletal modeling and

re-modeling) Skeletal remodeling is

work specific

bull 36 cycles day bull Bone trains to the level

of work not the amount bull Not true of

cardiovascular system

How many loads are required to train

bone

bull Additional cycles become detrimental to bone

bull We gallop too much and donrsquot vary gaits enough

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

The highest load 36 cycles day guide the bone response

bull A little better than a furlong bull The rest is trauma bull Lots of implications for

training ndash Galloping a horse lots of

miles doesnrsquot strengthen the bone it weakens it

ndash One furlong should be a little faster than the rest

Wolffrsquos Law bull ldquoBone is laid down where strength is needed and

removed where strength is unnecessaryrdquo bull Horses carry this to the extreme

How Bone trains

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

overl

Racing

Overload results in micro-fracture generation

Over repair results In hypertrophy

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 6: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Repetitive Cyclic Stress to the Skeleton is the primary cause of

lameness in the Racehorse

Relationship Am J Vet Res 1996 Nov57(11)1549-55 High-speed exercise history and catastrophic racing fracture in thoroughbreds Estberg L Stover SM Gardner IA Drake CM Johnson B Ardans A

Load Stress = Magnitude X Frequency

bull Why donrsquot all bones eventually fail

bull Because the horse repairs them

bull But there is a limit on the rate of repair and training can overwhelm the system

Am J Vet Res 1996 Nov57(11)1549-55

Results

hellipA horse that had accumulated a total of 35 furlongs of race and timed-work distance in 2 months compared with a horse with 25 furlongs accumulated had an estimated 39-fold increase in risk for racing-related FSI (95 confidence interval = 21 71)hellip

All horses get the same diseases but the level of performance and

the extreme ability of Thoroughbred racehorses magnifies skeletal effects

Why do racehorses have so much trouble with their musculo-

skeletal system bull Wonderful cardio-vascular system bull The musculo-skeletal system is the system that

ndash Requires the most training ndash Sustains the most wear and tear

Why does the skeleton require so

much training

bull The skeleton has to be literally molded into a performance skeleton

bull How do you do this ndash Selective breeding and

exercise (skeletal modeling) bull Adaptive training (skeletal modeling and

re-modeling) Skeletal remodeling is

work specific

bull 36 cycles day bull Bone trains to the level

of work not the amount bull Not true of

cardiovascular system

How many loads are required to train

bone

bull Additional cycles become detrimental to bone

bull We gallop too much and donrsquot vary gaits enough

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

The highest load 36 cycles day guide the bone response

bull A little better than a furlong bull The rest is trauma bull Lots of implications for

training ndash Galloping a horse lots of

miles doesnrsquot strengthen the bone it weakens it

ndash One furlong should be a little faster than the rest

Wolffrsquos Law bull ldquoBone is laid down where strength is needed and

removed where strength is unnecessaryrdquo bull Horses carry this to the extreme

How Bone trains

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

overl

Racing

Overload results in micro-fracture generation

Over repair results In hypertrophy

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 7: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Load Stress = Magnitude X Frequency

bull Why donrsquot all bones eventually fail

bull Because the horse repairs them

bull But there is a limit on the rate of repair and training can overwhelm the system

Am J Vet Res 1996 Nov57(11)1549-55

Results

hellipA horse that had accumulated a total of 35 furlongs of race and timed-work distance in 2 months compared with a horse with 25 furlongs accumulated had an estimated 39-fold increase in risk for racing-related FSI (95 confidence interval = 21 71)hellip

All horses get the same diseases but the level of performance and

the extreme ability of Thoroughbred racehorses magnifies skeletal effects

Why do racehorses have so much trouble with their musculo-

skeletal system bull Wonderful cardio-vascular system bull The musculo-skeletal system is the system that

ndash Requires the most training ndash Sustains the most wear and tear

Why does the skeleton require so

much training

bull The skeleton has to be literally molded into a performance skeleton

bull How do you do this ndash Selective breeding and

exercise (skeletal modeling) bull Adaptive training (skeletal modeling and

re-modeling) Skeletal remodeling is

work specific

bull 36 cycles day bull Bone trains to the level

of work not the amount bull Not true of

cardiovascular system

How many loads are required to train

bone

bull Additional cycles become detrimental to bone

bull We gallop too much and donrsquot vary gaits enough

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

The highest load 36 cycles day guide the bone response

bull A little better than a furlong bull The rest is trauma bull Lots of implications for

training ndash Galloping a horse lots of

miles doesnrsquot strengthen the bone it weakens it

ndash One furlong should be a little faster than the rest

Wolffrsquos Law bull ldquoBone is laid down where strength is needed and

removed where strength is unnecessaryrdquo bull Horses carry this to the extreme

How Bone trains

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

overl

Racing

Overload results in micro-fracture generation

Over repair results In hypertrophy

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 8: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

All horses get the same diseases but the level of performance and

the extreme ability of Thoroughbred racehorses magnifies skeletal effects

Why do racehorses have so much trouble with their musculo-

skeletal system bull Wonderful cardio-vascular system bull The musculo-skeletal system is the system that

ndash Requires the most training ndash Sustains the most wear and tear

Why does the skeleton require so

much training

bull The skeleton has to be literally molded into a performance skeleton

bull How do you do this ndash Selective breeding and

exercise (skeletal modeling) bull Adaptive training (skeletal modeling and

re-modeling) Skeletal remodeling is

work specific

bull 36 cycles day bull Bone trains to the level

of work not the amount bull Not true of

cardiovascular system

How many loads are required to train

bone

bull Additional cycles become detrimental to bone

bull We gallop too much and donrsquot vary gaits enough

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

The highest load 36 cycles day guide the bone response

bull A little better than a furlong bull The rest is trauma bull Lots of implications for

training ndash Galloping a horse lots of

miles doesnrsquot strengthen the bone it weakens it

ndash One furlong should be a little faster than the rest

Wolffrsquos Law bull ldquoBone is laid down where strength is needed and

removed where strength is unnecessaryrdquo bull Horses carry this to the extreme

How Bone trains

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

overl

Racing

Overload results in micro-fracture generation

Over repair results In hypertrophy

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 9: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Why do racehorses have so much trouble with their musculo-

skeletal system bull Wonderful cardio-vascular system bull The musculo-skeletal system is the system that

ndash Requires the most training ndash Sustains the most wear and tear

Why does the skeleton require so

much training

bull The skeleton has to be literally molded into a performance skeleton

bull How do you do this ndash Selective breeding and

exercise (skeletal modeling) bull Adaptive training (skeletal modeling and

re-modeling) Skeletal remodeling is

work specific

bull 36 cycles day bull Bone trains to the level

of work not the amount bull Not true of

cardiovascular system

How many loads are required to train

bone

bull Additional cycles become detrimental to bone

bull We gallop too much and donrsquot vary gaits enough

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

The highest load 36 cycles day guide the bone response

bull A little better than a furlong bull The rest is trauma bull Lots of implications for

training ndash Galloping a horse lots of

miles doesnrsquot strengthen the bone it weakens it

ndash One furlong should be a little faster than the rest

Wolffrsquos Law bull ldquoBone is laid down where strength is needed and

removed where strength is unnecessaryrdquo bull Horses carry this to the extreme

How Bone trains

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

overl

Racing

Overload results in micro-fracture generation

Over repair results In hypertrophy

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 10: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Why does the skeleton require so

much training

bull The skeleton has to be literally molded into a performance skeleton

bull How do you do this ndash Selective breeding and

exercise (skeletal modeling) bull Adaptive training (skeletal modeling and

re-modeling) Skeletal remodeling is

work specific

bull 36 cycles day bull Bone trains to the level

of work not the amount bull Not true of

cardiovascular system

How many loads are required to train

bone

bull Additional cycles become detrimental to bone

bull We gallop too much and donrsquot vary gaits enough

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

The highest load 36 cycles day guide the bone response

bull A little better than a furlong bull The rest is trauma bull Lots of implications for

training ndash Galloping a horse lots of

miles doesnrsquot strengthen the bone it weakens it

ndash One furlong should be a little faster than the rest

Wolffrsquos Law bull ldquoBone is laid down where strength is needed and

removed where strength is unnecessaryrdquo bull Horses carry this to the extreme

How Bone trains

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

overl

Racing

Overload results in micro-fracture generation

Over repair results In hypertrophy

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 11: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

bull 36 cycles day bull Bone trains to the level

of work not the amount bull Not true of

cardiovascular system

How many loads are required to train

bone

bull Additional cycles become detrimental to bone

bull We gallop too much and donrsquot vary gaits enough

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

The highest load 36 cycles day guide the bone response

bull A little better than a furlong bull The rest is trauma bull Lots of implications for

training ndash Galloping a horse lots of

miles doesnrsquot strengthen the bone it weakens it

ndash One furlong should be a little faster than the rest

Wolffrsquos Law bull ldquoBone is laid down where strength is needed and

removed where strength is unnecessaryrdquo bull Horses carry this to the extreme

How Bone trains

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

overl

Racing

Overload results in micro-fracture generation

Over repair results In hypertrophy

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 12: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

The highest load 36 cycles day guide the bone response

bull A little better than a furlong bull The rest is trauma bull Lots of implications for

training ndash Galloping a horse lots of

miles doesnrsquot strengthen the bone it weakens it

ndash One furlong should be a little faster than the rest

Wolffrsquos Law bull ldquoBone is laid down where strength is needed and

removed where strength is unnecessaryrdquo bull Horses carry this to the extreme

How Bone trains

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

overl

Racing

Overload results in micro-fracture generation

Over repair results In hypertrophy

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 13: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Wolffrsquos Law bull ldquoBone is laid down where strength is needed and

removed where strength is unnecessaryrdquo bull Horses carry this to the extreme

How Bone trains

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

overl

Racing

Overload results in micro-fracture generation

Over repair results In hypertrophy

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 14: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

How Bone trains

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

overl

Racing

Overload results in micro-fracture generation

Over repair results In hypertrophy

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 15: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

How bone responds

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair

Over repair Over repair

overload

overload

overload

overload

overl

overloa

overload

Change the material

Change the shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 16: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Horses are not born with racehorse skeletons they are made by training

Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

Caudal Tibia almost doubles in thickness

Other sites must similarly adapt

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 17: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

bull Dorsal cannon bone hypertrophies to twice itrsquos yearling diameter

bull Caudal Tibia almost doubles in thickness

bull Other sites must similarly adapt

bull Usually it does both increase its density and change its shape

Adaptation necessary to accommodate to the high stress of repetitive cyclic load

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 18: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Over repair

Over repair

Over repair

Over repair Over repair o

verloa

overload

overload

overload

overload

overload

Failure of Bone occurs in the absence of adequate repair

overl

FailureFracture

How Bone trains

Overload results in micro-fracture generation

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 19: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 20: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

How Bone Maintains

repair repair repair repair repair overload

overload

overload

overload

Racing

Overload results in micro-fracture generation

bull High speed furlongs result in bone damage that must be healed

bull Biologic systems remain plastic never gain elastic status

overload

In Reality Am J Vet Res 1996 Nov57(11)1549-55

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 21: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Individuals Vary

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 22: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Exceptions

bull Edwin Moses bull Serenarsquos Song

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 23: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Usain Bolt

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 24: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Adaptation is work specific

bull You can alter the balance by altering input ndash Different surfaces

bull Variety is good ndash distances ndash speeds

bull Exclusivity is bad ndash Different surfaces at

the same track ndash Vs changing tracks

Regulation of bone formation by applied dynamic loads CT Rubin and LE Lanyon The Journal of Bone and Joint Surgery Vol 66 Issue 3 397-402

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 25: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Have we altered the raw material

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 26: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Are we moving the breed

bull It is an unconscious choice

bull We are selecting for the wrong type horse

bull We have made the average height 3rdquo taller in 100 years

bull Are we selecting for unsoundness by not rewarding longevity

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 27: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

The event driven mentality selects our stallions and therefore drives our

evolutionary selection bull The Triple Crown bull The Breeders Cup bull The Weekend Stakes

bull Formerly ldquoHome-

bredsrdquo were generally rewarded for longevity and stamina

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 28: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Which quality do we desire most in a stallion

Early brilliance (genetic ability) or Career stamina (ability to withstand

training)

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 29: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 30: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

How do you make a successful stallion

bull Early career brilliance bull Early success in the breeding

shed

bull If we donrsquot select for longevity in our breeding programs why do we expect it

bull Lack of longevity is not wrong but we should realize why it is happening

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 31: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

This makes the trainers job harder

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 32: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Performance Ability = Natural ability x Training

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 33: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Performance Ability = Natural ability x Training

Some former time

Horses had less Natural ability Speed

But they were more durable and could stand more training

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 34: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Performance Ability = Natural ability x Training

Currently

They have more speed But you canrsquot train them as hard or they get injured

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 35: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Increased time between races (especially quality horses)

bull They are healing bull Current efforts are

more stressful ndash Horses are trained

harder ndash Horses are more

mobile ndash Horses donrsquot dominate

a local division any more

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 36: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Wolffrsquos Law bull Joint surfaces such as the distal cannon bone canrsquot

change their size because they are within the joint bull They must change their structure

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 37: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Cumulative Stress Induced Bone Injury and eventually stress fractures cause

insidious lameness and eventually fracture bull All bones are

vulnerable bull The distal cannon

bone is ldquohighlyrdquo vulnerable because it canrsquot change its shape it is part of the fetlock joint

bull Training fatigue bull ldquoTrack sourrdquo

bull Suddenly wonrsquot load

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 38: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Diseases of the McIIIMtIII Articualtion Inflammation of the distal cannon bone

bull Inflammation of the distal cannon bone ndash Perhaps the single

most important lameness of the racing Thoroughbred

ndash Also occurs in the racing Standardbred

ndash Also occurs in high level performance horses

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 39: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid

Articulation

bull Is a consequence of the major adaptation required of the skeleton for high level work ndash Distal cannon bone

edema bull Reining bull Cutting bull Eventing bull Jumping

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 40: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Palmar McIIIPlantar McIII ndash Sesamoid Articulation

Inflammation of the distal cannon bone

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 41: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Inflammation of the distal cannon bone

bull The problem starts as bruising then branches into many pathologic conditions of clinical importance

Bruising

Condylar fracture

Para-sagittal

PalmarPlantar articular

Palmar articular degeneration

Palmar articular flattening

Base sesamoid fracture

Performance limiting lameness

Other injuries due to

asymmetry

Tendon and suspensory

ligament injury

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 42: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

bull Many contributing factors ndash Equine Anatomy ndash Shoeing Practices ndash Track surfaces ndash Training methods ndash Intrinsic individual

biomechanics ndash Management practices ndash Abused medication ndash Many more

Inflammation of the distal cannon bone

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 43: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Palmar Distal Cannon Bone Inflammation Forelimb vs Hindlimb

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 44: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

bull Fractures are more common on the lateral condyle

bull Degeneration and flattening are more common on the medial condyle

Forelimb

Hindlimb

L

L

M

M

Inflammation of the distal cannon bone

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 45: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Distal Cannon Bone Inflammation How Should You Diagnose It

bull History bull Characteristic

Lameness bull Nuclear Scintigraphy bull Pain on Flexion bull Radiography bull MRI bull Diagnostic Local

Anesthesia

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 46: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Flexed D-P is invaluable

Variations different horses

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 47: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Variations same horse

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 48: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Palmar distal cannon bone

P-I McIII

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 49: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Palmar distal cannon bone

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 50: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull The bonersquos ability to respond with the way we manage horses is slowed

bull Damage just accumulates faster than the horse can respond

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 51: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Diseases of the McIIIMtIII Articualtion Palmar McIIIPlantar McIII ndash Sesamoid Articulation Inflammation of the distal cannon bone

bull How do we treat it

bull Encourage normal bone remodeling ndash Nothing

compares to paddock turnout

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 52: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Inflammation of the distal cannon bone

The key is to stop the horse before the inflammation becomes degeneration (begins to change the shape of the bone)

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 53: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

ndash Prognosis

Journal of the American Veterinary Medical Association May 15 2011 Vol 238 No 10 Pages 1316-1322

doi 102460javma238101316 Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses 55 cases (2000ndash2009) Travis M Tull DVM DACVS L R Bramlage DVM MS DACVS Rood and Riddle Equine Hospital 2150 Georgetown Rd Lexington KY 40580

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 54: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

After 2-3 months in the paddock

Results Mean age was 32 yearshellipNinety-five percent (5255) of horses

with CSBI raced after injuryhellip There was no significant difference in post-injury total earnings

compared with total earnings before injuryhellip Median time to first start after injury was 194 dayshellip

Previous studies that used various combinations of restricted activity and medication had 40 to 60 return to racing

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 55: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Man-made predilection to distal cannon bone injury

bull Short periods of high intensity exercise with prolonged periods of stall rest

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 56: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Normal distal limb circulation most effective at its evolutionary optimum

bull Horses are grazing animals ndash No venous valves in their limbs ndash They depend on motion for the return portion of circulation ndash As natural grazers they spend hours eating a few bites then

walk a few steps then repeat helliphellip

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 57: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Bone circulation is Limited Low pressure Medullary to periosteum in diaphysis

bull Restricted exercise tends to cause stagnation of circulation ndash Stocking up ndash Increased incidence

of remodeling diseases

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 58: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism

with our management practices

bull High stress exercise bull Cool out and stand for

hours

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 59: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 60: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Man-made predilection to distal cannon bone injury

bull Shoeing appliances

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 61: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 62: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Man-made predilection to distal cannon bone injury

bull Effects of angle changes

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 63: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Man-made predilection to distal cannon bone injury

bull Effect of surface

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 64: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 65: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Increased braking Increased ldquoplow downrdquo

Fatal injuries are 95 fetlock injuries

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 66: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Man-made predilection to distal cannon bone injury

bull Effect of shoeing

Things that affect the plow bullHeight of toe grab bullStiffness of surface bullLength of slide

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 67: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

So when a horse is lame it is a sign that something is going on

bull Not all lameness is related to bone but the dangerous ones are

bull The ones that are are dynamic

bull Just because radiographs are negative doesnrsquot mean they will not change

bull Many most joint inflammation problems have bone components in the racehorse

bull The most painful problem is often not the most important problem

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 68: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal

Cautions bull When you start

accumulating lots of high speed furlongs in short periods of time the skeleton gets behind

bull Few horses can stay in high level training continuously

bull Be aware of the bonersquos role in causing joint inflammation

bull Recurrent lameness is often the secondary problem look for the root cause

bull Lameness especially multiple site lameness is a big cause of decreasing performance

bull Attitude changes are very important

  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71
Page 69: Training and the Musculoskeletal System · IV Training and the Musculoskeletal System Dr. Larry Bramlage Surgeon/Partner . Rood and Riddle Equine Hospital . Training and the Musculoskeletal
  • Training and the Musculoskeletal System
  • Lameness A Sign or a Disease
  • SometimesMost timesAll the time
  • What is lameness
  • What causes inflammation
  • Repetitive Cyclic Stress to the Skeleton is the primary cause of lameness in the Racehorse
  • Load Stress = Magnitude X Frequency
  • All horses get the same diseases but the level of performance and the extreme ability of Thoroughbred racehorses magnifies skeletal effects
  • Why do racehorses have so much trouble with their musculo-skeletal system
  • Why does the skeleton require so much training
  • How many loads are required to train bone
  • The highest load 36 cycles day guide the bone response
  • Wolffrsquos Law
  • How Bone trains
  • How bone responds
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • Adaptation necessary to accommodate to the high stress of repetitive cyclic load
  • How Bone trains
  • How Bone Maintains
  • How Bone Maintains
  • Individuals Vary
  • Exceptions
  • Usain Bolt
  • Adaptation is work specific
  • Slide Number 25
  • Slide Number 26
  • Slide Number 27
  • Are we moving the breed
  • The event driven mentality selects our stallions and therefore drives our evolutionary selection
  • Which quality do we desire most in a stallion
  • How do you make a successful stallion
  • How do you make a successful stallion
  • This makes the trainers job harder
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Performance Ability = Natural ability x Training
  • Increased time between races (especially quality horses)
  • Wolffrsquos Law
  • Cumulative Stress Induced Bone Injury and eventually stress fractures cause insidious lameness and eventually fracture
  • Diseases of the McIIIMtIII ArticualtionInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid Articulation
  • Palmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • Palmar Distal Cannon Bone InflammationForelimb vs Hindlimb
  • Inflammation of the distal cannon bone
  • Distal Cannon Bone InflammationHow Should You Diagnose It
  • Slide Number 48
  • Slide Number 49
  • Palmar distal cannon bone
  • Palmar distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Diseases of the McIIIMtIII ArticualtionPalmar McIIIPlantar McIII ndash Sesamoid ArticulationInflammation of the distal cannon bone
  • Inflammation of the distal cannon bone
  • After 2-3 months in the paddock
  • Man-made predilection to distal cannon bone injury
  • Normal distal limb circulation most effective at its evolutionary optimum
  • Bone circulation isLimitedLow pressureMedullary to periosteum in diaphysis
  • One of the reasons we have so many bone remodeling diseases is that we impede the natural response mechanism with our management practices
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • Man-made predilection to distal cannon bone injury
  • So when a horse is lame it is a sign that something is going on
  • Cautions
  • Slide Number 71

Football Training: Speed Testing and Training Considerations

Football Training: Speed Testing and Training Considerations

Neurologic and Musculoskeletal Imaging Studies Pediatric MSK radiology2

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makalah Musculoskeletal

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Specialist in orthopaedic surgery and musculoskeletal … · Specialist in orthopaedic surgery and musculoskeletal traumatology Postgraduate Curriculum applicable from January 1st

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Imaging Techniques and Fundamental Observations for the Musculoskeletal System Dr. Muhammad Bin Zulfiqar

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Predictors of depression- and musculoskeletal disorder ...

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CEDERA MUSCULOSKELETAL

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S2K-Leitlinie „Einsatz von Exoskeletten im beruflichen ...€¦ · Keywords: Assistive device, prevention, musculoskeletal complaints, musculoskeletal disorders, musculoskeletal

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THE MUSCULOSKELETAL SYSTEM - ANATOManatom.in.ua/wp-content/uploads/MUSCULOSKELETAL-SYSTEM-ana… · musculoskeletal system ... •Breathing. •Storage of calcium and phosphate in

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