Equine Gait Analysis & Rehab

11/07/2022

This post should be read through to the end. Full of really useful information if you use boots or wraps on your horse. I personally have never bandaged or booted but still found it fascinating to read the reasons why this was a good decision on my part.

Boots and bandages - are we harming our horses as we try to protect them?

Bandaging and booting our horses is becoming more and more popular, especially with the popularity of matchy matchy sets. But are we doing more harm than good? Most people will have come across the articles in magazines and comments from vets saying they are, and yet still they become more and more popular. Why is that? Why do riders still cover their horses in thick fleece bandages or fluffy boots despite the dangers? Tradition I suppose. Wanting to fit in. Or just habit, some will feel like they haven’t finished tacking up if they haven’t put the boots on.

I know this isn’t about dentistry (for which I apologise) but I am a vet first and foremost, and as a dressage rider I am asked why I don’t use bandages all the time. I’ve written about this several times now and no one pays attention, so rather than stating facts and quoting research, I’d like to take you through my journey of discovery, please bear with me. Facts and papers are at the end.

Rewind 12 years and I was in my final year at vet school. Prior to and during vet school I had a horse and we did dressage. I had planned to ODE but this horse pulled every tendon and ligament known to vet kind. He spent more time out of work than in. Each time I would up my game with the latest boots/bandages on the market. From fluffy boots to wraps to sports fetlock boots, fleece bandages to gamgee and cotton to the half fleece/half elastic bandages. I learnt new techniques for better support, figure of 8 bandaging to cradle the fetlock etc etc. I’d been there and done it. My collection was extensive.

Right at the end of vet school I had my rotations. I chose Equine lameness as one of my options. During in this I very vividly remember a wet lab with Dr Renate Weller where she had a skinned horses leg (showing all of the tendons and ligaments) in a machine that mimicked the pressures a horse applies to their limbs. She took us through walk, trot, canter and gallop, loading this leg so we could see the inside workings of the horses leg without the skin. It was fascinating I can tell you, and I very clearly remember thinking about my horse and wondering how on earth we are suppose to support this limb when it undergoes these incredible forces! Half a ton of animal pushing down a tiny spindle of a leg held by tendons barely thicker than my thumb. Craziness!

Fast forward just a few short months and I was a fully qualified vet in the big wide world. I attended my first BEVA Congress and during the break I wandered around the stalls looking at the latest inventions and technologies companies bring to these gatherings. Here I came across a company with the Equestride Boot which caught my eye. Now if you haven’t seen this boot, it’s wonderful and I’ve since used it a few times in rehabbing very severe tendon and ligament injuries with great success. The boot is a carbon fibre boot that stops the fetlock dropping, which stops the tendons and ligaments being fully loaded while they heal. This boot is super strong. You couldn’t ride a horse in it as it is limiting the range of motion so much, but they can move about easily enough at the lower settings to rehab etc. The guy on the stand (I’m afraid I can’t remember his name) showed me their research and in the straight talking Irish way explained the stupidity of expecting a thin piece of material to support a horse. And of course it can’t! Literally no bandage or boot (short of this very expensive carbon fibre rehab boot) is capable of reducing the amount the fetlock drops. Thinking back to Dr Weller’s demonstration, I could very clearly see how ridiculous I had been to ever believe a scrap of material could do anything to reduce or support that pressure.

But the boots/bandages don’t actually cause any harm do they? Surely it’s ok to use them on the off chance they might help and if we look good in the meantime, great! Well, not long after this, research started appearing that got me very worried about my bandage collection. Heat. Anyone that uses bandages and boots will not be surprised to see sweat marks under their bandages/boots after they’ve been removed. They trap a lot of heat. The horses body and legs generate a lot of heat when working. The tendons/ligaments in the leg, along with an increased blood flow generate ALOT of heat. Fleece bandages/boots in particular, hold this heat in the horses leg. Very few boots and virtually no bandages (especially if you use a pad under) allow the legs to breath adequately. This heat is easily enough to kill tendon/ligament cells. Each tendon/ligament is made of thousands and thousands of cells all lined up end on end and side by side in long thin spindles. They stretch and return to their original shape and size like an elastic band, absorbing and redistributing the pressures applied from further up the leg and from the ground impact below. All of these cells must work together as one to do this effectively.

Just a little side step here to explain how tendons/ligaments heal. A tendon/ligament cell can not be replaced like for like. They always heal with scar tissue. This is why reinjury is so much more likely if a tendon/ligament is blown. The fibrous scar tissue doesn’t stretch, it isn’t capable of stretching or absorbing the impact of a horses movement. It will always be a weak spot. In a full blown sprain/strain the whole (or most) of the tendon has been damaged. But this heat injury might just kill a few cells at a time. Those few cells are replaced by fibrous scar tissue, then next time a few more etc etc. Like a rubber band degrading over time the tendon/ligament loses its elasticity and eventually goes snap. Then you’ve fully blown a tendon/ligament. The injury didn’t start to happen at that moment, but that was the final straw. The damage adds up over time, each time thermal necrosis (vet word for cell death) occurs.

So if using boots/bandages can not offer any sort of support, and using them generates heat that slowly damages the tendons/ligaments until they give way. Why use them? Protection. This is the only reason to use boots. To stop the horse brushing, injuring themselves catching a pole or over cross country. But for goodness sake make sure your boots are breathable! If the horse is sweaty under the boot but not above or below, the boot is not breathable enough. And don’t use fleece bandages just because you like the colour. These fleece bandages are the worst at holding heat in the leg, way above the threshold for thermal necrosis to the cells of the tendons and ligaments. If your horse doesn’t need protection, don’t use boots. I haven’t for the last 12 years and *touch wood* I haven’t had a single tendon/ligament injury in any of my horses. I will never go back to boots or especially bandages now. I don’t use them for schooling, lunging, jumping, travelling, turnout, stable, in fact I don’t use them at all. Ever. But I don’t hunt or XC.

I hope you have found my story useful and can make informed decisions on boots and bandaging going forward.

For more information on the Equestride boot and their research into support offered by boots and bandages, visit http://www.equestride.com/ and https://www.equinetendon.com/services/equestride/

The horses leg under the compression machine at the Irish Equine rehabilitation and fitness centre https://fb.watch/cmVMt6-iOJ/ (I highly recommend you watch this incredible video. It clearly shows the amount of force the leg goes through and demonstrates the real purpose of boots)

Other relevant papers-
https://equimanagement.com/.amp/articles/horse-skin-temperature-under-boots-after-exercise
https://pdfs.semanticscholar.org/8f15/0ea480edca142260d01f419f80d2e7e7fb29.pdf
http://www.asbweb.org/conferences/1990s/1998/59/index.html

Edit 1 - I am getting asked about stable wraps very frequently. This post is about riding, the tendons and blood flow create heat which is trapped by bandages/boots during exercise. This doesn’t occur in the stable stood still. If the horse has a strain/sprain resulting in inflammation, then there is an increase in blood flow and there is heat being created. In this situation you should not be bandaging. But if it’s cold and an old horse needs stable wraps to keep the joints warm and improve sluggish blood flow (filled legs) you can use the heat trapping to your advantage. But you need to be careful in summer.

Edit 2 - the other thing I’m being asked about is compression. Compression DOES NOT control inflammation. The inflammation still occurs, but the swelling can not escape the bandages and the increase in internal pressure reduces blood flow, causing ischemic damage. Like laminitis within the hoof. The hoof capsule prevents swelling so the inflammation expands inwards and cuts off the blood supply. This is why laminitis is so painful and difficult to treat. Compression is only useful in the case of leaky vessels, for example reduced blood pressure, reduced movement so the blood isn’t being pumped backup the legs, or osmotic imbalances eg low protein with diarrhoea. In these situations, compression of the legs can encourage blood to return to the vessels and continue circulating.

26/05/2022

Worth reading. I don't feed beet pulp but I have done so in the past. I had no particular reason for dropping it; I simply moved my horses onto a more natural diet. There are some interesting points made.

BEET PULP - TOXIC OR BENEFICIAL?

Beet pulp has found its place in the equine world, marketed as the fibre rich, safe-for-all-feed. I personally have not fed Beet, it must be near close to 10 years now even with a strong movement really advocating its use.

I initially read an article by an equine health healer back then which really tweaked my inner alarm bells, and to this day, I’ve not fed it since. For the life of me, I really wish I had printed that article out but the basis of it was the mention of the GMO and chemical spray factors and the fact horses retained water.

HHIO does not recommend beet and over the years any particular tricky case I have come across, beet was recommended to be removed. Now, I am not bagging beet, nor wanting to create a hotly contested debate. This is from my own personal experiences and that of my own horse herd. They never particularly liked beet and I tend to listen to my horses, well at least I try too! There are many people who do use beet and swear by it, and that’s great! This is for those of you who do use Beet and are experiencing issues with your horse – the anecdotal evidence suggests loose stools, digestive upsets or hind end weakness.

I recently stumbled across another article (I printed it out this time!!) and wanted to share this particular insert.

“Lon Leiws DVM-Feeding and Nutrition care of the Horse 1982 states quoted:

Excess amounts of oxalates (form of salt) may be present in these plants-halogeteon, greasewood, BEETS, dock, rhubarb-(Beets =product beet pulp) - If the horse consistently eats these plants over a LONG extended period of time, calcium deficiency will result. Insoluble oxalate crystals will deposit in the kidneys resulting in kidney damage - Could be the reason for the water molecules trying to flush the kidneys? Beet pulp originates from sugar industry. It is an insoluble fibre, meaning that it does not interact with the body. It rushes through the intestines taking with it whatever supplements have been given. Simply put, it cannot be digested. It takes four molecules of water for the body to process beet pulp-adding water weight, and making the horse appear heavier. Once beet pulp is removed from the diet, the horse loses weight quickly, leading the owner to believe that the horse needs the beet pulp.

Like many other crops, sugar beets are treated with an extensive array of herbicides to limit weeds and grasses in the fields. The herbicides are absorbed by the beets. Nothing removes the chemicals from the pulp. In addition, growers top the beet plants with a chemical defoliant to kill back the tops before harvest. These chemicals also end up by-product beet pulp.

Dr. Eleanor Kellon, DMV, says that beet pulp is safe; it is washed with water to remove the solvents. However, the water only removes what is on the outside. The soaking process removes the sugar from the outside, but not the chemicals. Toxins are stored in the pulp not the juice.

There are case studies cited that often, if the horse is unable to digest the beet pulp. Their hind-ends "shut down" and become weak. The common complaint being, "my horse has a weak hind-end."”

Now, I am not a vet and clearly there are differing opinions in the vet world as to whether beet is a beneficial equine feed, or not. At the end of the day each horse is an individual and it is our duty as horse owners to keep an open mind and observe our horses for inconsistencies/issues. For me personally the high level of chemical use in beet is a red flag, however to put it in perspective - chemical use across the board in all aspects of equine and human feeds is prevalent!! Food for thought.

If your horse is on beet pulp and is experiencing unresolved issues, I do recommend to remove beet pulp for a period of time, whilst not changing anything else and observe changes, if any. The horse, as always is the best one to ask. Listen and they will show you.

14/09/2021

This video shows footage of a "Sox" a young warmblood mare that suffered from ECVM. The footage is a MUST SEE because many people would not see a seriously ...

20/08/2021

An important read on several levels. Listen very carefully to your horse.

The horse in the picture looks well, doesn't he........ or does he?

I'm currently decompressing after another intensive, full horse, 3 day dissection with the internationally renowned Sharon May-Davis and her team Zefanja Vermeulen, Tina Fitzgibbon and Thirza Hendriks, organised with incredible efficiency by Lindsay Holder of Whole Horse Health.

Dissecting horse is not new to me - in fact it's a slight obsession! Why?
❗ Because as a rider, I used to spend most of my time trying to work out how to make the horse straighter, more athletic, jump cleanly, better.
❗ Because as a student Animal Physiotherapist, I pored over anatomy books, trying to remember muscle attachments, function, innervation.
❗ Because as an Animal Physiotherapist, I spend my life trying to work out the correlation between the horse's behaviour, movement, history and impact of owner/rider/management/equipment in order to make the correct decisions to improve the quality of life of the horse in front of me.
❗ Because EVERY horse's quality of life can be improved, whether that be by easing a ni**le, adjusting the exercise routine, or referring to a vet to investigate a suspected more serious problem.

This time was different. The horse was on the table was one that I have known well for 6 years. Teddy was bought as a hunter. He was already seriously compromised and only lasted 2 seasons with the new owner before being retired due to unsoundness. In the vet's words: "his body wouldn't cope with the amount of steroid needed to keep him comfortable". That's him in the picture, on summer holidays 4 years ago, just before he was retired.

I spent a lot of time just trying to keep him comfortable to do his job. We discovered that he had serious kissing spine and ringbone and sidebone in one forefoot. Other problems were evident, although not diagnosed, and he was retired. Recently it became evident that he was deteriorating and becoming very uncomfortable, so the decision was made to relieve him of his pain. His owner was kind enough to agree to allow us to investigate in the only way that truly exposes all the problems held within the body.

Teddy had numerous physical issues - this is a brief summary:
❌ On one side of his mouth, he had 7 upper and lower molars. The upper back one was horribly overgrown and eroding the opposing tooth. Horses should have 6 molars on each arcade. His mouth had been checked regularly by both EDT and vets - no-one had picked it up. With 6 molars on the other side, this already sets him up for asymmetry throughout his body, even if the overgrown one had been addressed
❌ Misalignment of C6 vertebrae and evidence of osteoarthritis and bony changes of the cervical vertebrae
❌ Joint erosion and inflammation of EVERY limb joint that was opened up
❌ Ruptured muscles, partial ruptures of tendons and ligaments
❌ Fused overlapping (lipping) of 4th and 5th lumbar vertebrae bilaterally
❌ Significant pelvic asymmetry
❌ Sub-chondral bone cysts
❌ Ruptured hip ligaments - in the words of the very experienced lead dissector - the worst hip joints she's ever seen

The majority, if not all of these problems were there before the latest owner bought him, yet he continued to do his job with good nature and willingness.

I have retained his head, neck and pelvis, which will be cleaned and investigated thoroughly for asymmetries and bony changes.

It is through investigating like this that we truly become aware of the painful and performance-limiting conditions that our horses can carry, while trying to do all we ask of them. It is what opens our eyes to recognising dysfunctional movement patterns and recommending further diagnostic tests. It is a sharp reminder to never ignore abnormal behaviour, gait or posture.

Thank you Teddy, for being so good natured despite everything and helping us to understand why you couldn't be comfortable.

Teddy was 15, retired at 12. The average age of horses competing at the Olympics - at the top of their game - this year was 15. It looks like he was born with some asymmetries that were always going to limit his ability, but it is also apparent that he had suffered trauma at some point, and also been subjected to very poor management and riding, that had exacerbated his injuries.

Our horses welfare is our responsibility.

05/07/2021

Think about this before you start breeding.

Dr Karin Leibbrandt asks if as responsible owners, riders and breeders we are paying too high a price for spectacular horses.