IN-DEPTH: PREVENTATIVE MEDICINE: BEING PROACTIVE IN PRACTICE Specific training strategies for each discipline are
beyond the scope of this presentation, but there is evidence that bones, cartilage, and the surrounding soft tissues respond (favorably or unfavorably) to the forces applied to them. Therefore, incorporating dynamic mobility exercises and core strengthening maneuvers to equine athletes’ daily routines can help build supporting musculature and stave off injury, fa- tigue, andmisuse of joints. Core strengthening is con- sidered a progression of dynamic mobilization.4 Studies on the effects of specific dynamicmobilization exercises have focused on axial and core musculature and have demonstrated not only hypertrophy of the multifidus muscle but also improved symmetry in muscle size.5 Gymnastic exercises including backing up, tight turns around barrels, and walking over raised poles performed 3 days per week were shown to significantly increase stride and tracking lengths.6 Ground poles and cavaletti gymnastic exercises increase joint flexion.7 Joint mobility is substantially increased following heating.8 An adequate warm-up period and/or application of heat in the form of wraps and blankets prior to stretching can improve the elas- ticityjointcapsulesand tendonsaswellasmuscles.8 Although further research is needed, since symmetri- cal conformation and posture is important in the even application of forces across joint spaces, it is reasona- ble to assume that a routine of dynamic mobilization and gymnastic exercises could help prevent or miti- gate degenerative joint disease in the distal limb by improving posture andmotion. Often the terminology used in integrative treat-
ment modalities to describe disturbances is confusing and leads to misunderstandings between different types of practitioners. Chiropractors speak of “luxa- tions” that seem anatomically impossible, and acu- puncturists describe energy blockages that may not be detected in Western examinations. In physiother- apy or physical therapy, a “functional diagnosis” results froma static and dynamic functional assessment rather than a pathoanatomic diagnosis veterinarians are trained to provide.9 Acupuncture, myofascial release, spinal manipulation, joint mobilization, and other bodywork have been purported to improve joint and overall health. There are no studies specifically support- ing their effectiveness in preventing distal limb osteoar- thritis in horses, but some reviews have shown improvement in human chronic knee pain following acupuncture.10 Thesemodalities are thought to bemost effective in early recognition of abnormalities. For example, a traditional Chinese veterinary medicine diagnosis may be made prior to any clinical signs of osteoarthritis being present from a Western veteri- nary medicine perspective. However, this is difficult to investigate in blinded controlled studies, so objec- tive data is lacking. Acupuncture often takes several sessions to achieve effect, which gives the practitioner the additional benefit of repeated intense observation. This allows practitioners to recognize and address areas ofweakness rather than waiting for overt injury.
Incorporating objective assessments of motion and
physical condition into examinations and medical records can help monitor individual cases and recog- nize pathology earlier as well as describe response to treatments more accurately and precisely for discus- sion with other professionals. Meticulous recording of weight tape and goniometry measurements, videos and stationary photos, performance statistics fromcom- petition and training, and objective gait analysis equip- ment will help analyze response to treatments and manipulations. Goniometry, the measurement of joint angles, has been validated in horses11–13 and is a simple and inexpensive way to measure and monitor joint range of motion. Bergh et al. demonstrated good inter- and intraobserver reliability of measurements of the range of motion of the carpus and fetlock in sound horses. Both universal and digital goniometers were precise and repeatable, but findings suggested “that the same type of goniometer should be used in subsequent measures of thesamehorse”12with the type of goniome- ter being recorded in themedical records along with the measurements. Reliable systemic biomarker tests are not yet currently available to screen for early stages of joint inflammation. Some intriguing work has investi- gated urinary excretion of glycosaminoglycans (GAGs) in athletic versus sedentary horses and those with evi- dence of osteoarthritis in one or more joints,14 but assays are not commercially available, and complete understanding of the relation of urinary GAGs to carti- lagemetabolismrequiresmore research.
3. Oral Supplements
In a 2018 survey of owners and trainers in Ireland, Murray et al. found that joint supplements were the most used type of oral supplement, andmore respond- ents sought advice from feed merchants than from veterinarians.15 Veterinary advice is too often bypassed in the selection of oral joint health supple- ments. Veterinarians need to be prepared to discuss relevant available data, proposed mechanisms of action, and possible contraindicationswith clients. Most oral joint supplements are intended to act
through one or both of two mechanisms: as building block substrates for articular cartilage (proanabolic effect) and as anti-inflammatory modulators (antica- tabolic effect). Articular cartilage is composed of a dense extracellular matrix of water, type 2 collagen, and proteoglycans.16 Glucosamine is an amino mono- saccharide that is the main component of GAGs including chondroitin sulfate, keratin sulfate, and heparan sulfate. The negatively charged GAGs in turn bond to protein backbones to formproteoglycans. Aggrecan molecules, produced by chondrocytes, have the charged bottle brush structure of proteoglycan molecules (lending cartilage its resistance to compres- sion) bonded to a hyaluronan backbone. Hyaluronan is produced by both chondrocytes and synoviocytes for incorporation into the cartilage extracellular matrix and synovial fluid, respectively. However, it is believed that its demonstrated beneficial effects on
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