Promoting Longevity in Performance Horses
A comprehensive look at supporting soundness to help sport horses perform into the years ahead
By Lucile Vigouroux, MSc
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Photo: Adobe Stock
W
hy do some horses compete at top levels year after year, never missing a beat, while others seem to spend more time rehabbing from injuries and ultimately retiring when they should be in their prime? Increasing the longevity of a performance horse’s career isn’t just about luck; it’s a matter of strategic care, training, and management. In this feature we’ll explore the myriad factors that can cut a sport horse’s career short, with a special focus on the connective tissue you should protect at all costs—joint cartilage.
Photo: Adobe Stock
A Recipe for Lifelong Soundness in Horses
What Makes or Breaks a Horse’s Athletic Career?
There isn’t one magic bullet that can guarantee a long, productive athletic career for your horse. Many factors—some within our control, others not—stress your horse’s musculoskeletal system and, over time, increase his chances of sustaining both soft tissue injuries and joint damage. Experts agree that mitigating the stressors on your horse’s body over time, as it accumulates wear and tear, is the best way to promote long-term soundness and performance.
This brings us to our second category of contributing stressors to lameness in horses: extrinsic factors. Whether or not your horse was blessed by genetics and good conformation, these aspects of his care and management can make or break his athletic career.
Beau Whitaker, DVM, CERP,
is a partner at Brazos Valley Equine Hospitals in Salado, Texas, where he has established a busy lameness and sports medicine clientele since joining the practice in 2007. Whitaker graduated from Texas A&M University College of Veterinary Medicine in 2005. Upon graduation he completed an internship at Arizona Equine Hospital before working as a veterinarian at the 6666 Ranch, in Guthrie, Texas. Whitaker received his CERP (certified equine rehabilitation practitioner) in 2014 from the University of Tennessee.
General and Preventive Care
“Good husbandry practices are the foundation of maintaining longevity in performance horses,” says Whitaker. “A long career is dependent on a long life. Provide species-appropriate care and work with your veterinary team to keep your horse at a healthy weight and current on vaccines, deworming, and dental care. Various types of bodywork can also benefit your horse’s musculoskeletal system, helping reduce his risk of acquiring overuse or compensatory injuries.”
Hoof Care
You know the saying: No hoof, no horse. Ensuring your horse receives regular hoof care (typically every four to eight weeks) by a qualified professional from the start can spare him from needing corrective farriery down the road. A horse needs a balanced hoof for correct biomechanics and lasting soundness. To illustrate this point, note that every excess centimeter of toe length increases the force on the horse’s flexor tendons by 110 pounds.2
Nutrition
Training
MacKinnon and other experts agree that inappropriate training regimens are a leading cause of equine athletes’ premature breakdown. This includes providing insufficient rest and recovery time between athletic events. “Be aware of your horse’s limitations and gradually build his fitness level to where he is physically capable and comfortable doing the job you’re expecting of him,” she cautions.
Kim MacKinnon, DVM,
is an associate veterinarian at Miller & Associates, based in Westchester County, New York. Upon graduation from the Atlantic Veterinary College, in Prince Edward Island, Canada, she completed an internship at an equine sports medicine practice in Calgary, Alberta, where she continued to practice as an associate veterinarian before moving to New York. Equine lameness is one of MacKinnon’s top clinical interests.
Rehabilitation
“Bringing a horse back into work too soon and too quickly following an injury can lead to further breakdown of affected structures,” continues MacKinnon. Rehabilitation is not the time to skip steps or rush the process. After time off, even the healthy, noninjured tissues in your horse’s musculoskeletal system—from the bones to the tendons—need progressive, gradual loading to readjust to the stress of training.
Footing
The surfaces on which your horse exercises matter. Excessively hard, unforgiving footing adds concussion to joints and bones, whereas footing that’s too deep strains soft tissues. “Bad footing is directly related to soft tissue and bone injuries,” says MacKinnon.
Most Common Musculoskeletal Causes of Lameness, Poor Performance, or Premature Retirement in Horses, According to Research:
- Joint problems, bone fractures, sore shins, and tendon and ligament injuries in Thoroughbred racehorses (Wilsher et al., 2010, Parkin et al., 2006, Shrestha et al., 2021, Sousa et al. 2016).
- Superficial digital flexor tendon (SDFT) and suspensory ligament injuries in eventing horses, with soft tissue damage accounting for 45% of all injuries (Singer et al., 2008, Murray et al., 2010).
- Forelimb flexor tendon injuries in elite show jumpers (Murray et al., 2010).
- Suspensory ligament injuries in dressage horses (Rogers et al., 2012), specifically affecting the hind limbs (Murray et al., 2010).
- Hoof bruising, navicular disease, and low-grade degenerative joint disease (DJD) of the fetlock, coffin, and hock joints in both dressage horses and show jumpers (Dyson, 2002).
- Data on Western horse injury rates is limited, with one study identifying the knee and stifle joints as common sources of pain (Johnson et al., 2020).
The Importance of Keeping Joints Healthy
In this article we’re paying special attention to the horse’s joints for good reason: They can be very unforgiving. “Bone can break and mend itself as strong as ever before, and tendons and ligaments can tear and then repair themselves—to some degree, at least, often with some limitations,” says Whitaker. “Cartilage loss, on the other hand, is permanent.”
Because arthritis can’t be reversed, affected horses need lifelong management. What starts as synovitis (inflammation of the synovium, which lines the joint capsule) can snowball into osteoarthritis (OA). A whole-joint disease, OA causes damage beyond the joint capsule, affecting the subchondral bone—which lies beneath and supports the cartilage of the joint surfaces—and the ligaments connecting bones. In short, untreated joint inflammation poses a significant threat to the future of your athletic horse’s career.
The Crucial Role of Cartilage in Equine Biomechanics
Hyaline cartilage is the smooth, glassy cartilage found inside joint capsules. It plays two vital roles:
- It provides a smooth, gliding surface for joint movement, reducing friction and allowing fluid motion between bones.
- It cushions and absorbs shock, distributing mechanical forces across the joint.
What Happens Inside an Inflamed Joint Capsule?
Joint pain and inflammation are the nemesis of countless ridden horses, forcing them to step down to easier jobs or retire entirely. Researchers conducting one 20-year-old survey estimated that up to 60% of equine lameness is caused by OA.3
The daily wear and tear of training creates minor inflammation inside the horse’s joint capsule. Hyaluronic acid (HA), the joint’s natural viscous (sticky) lubricant, provides cushioning inside the joint and binds to the inflammatory enzymes, preventing them from damaging cartilage.4 When inflammation persists and worsens, HA can become depleted faster than chondrocytes (cartilage cells) are able to replenish it.
“This dwindling supply of HA in synovitis is a strong contributor to some of the devastating effects we see over time with joint inflammation,” explains Whitaker. “OA-affected chondrocytes produce less HA, so there is a ‘chicken or egg’ analogy here.” He describes a vicious cycle where osteoarthritis results in less HA, and less HA perpetuates osteoarthritis. “The synovial fluid loses its viscosity and becomes waterlike, which compromises its ability to lubricate the joint and reduce friction. On the outside you might notice puffy effusion over your horse’s joints—this is the accumulation of watery synovial fluid. With synovitis, the synovial capsule swells, and researchers hypothesize that this puts pressure on nociceptors, sending a pain signal to the brain that manifests as lameness.”5
Synovitis involves multiple inflammatory substances—enzymes, cytokines, prostaglandins, and free radicals—that perpetuate an inflammatory cascade inside the joint capsule. Without pharmaceutical intervention these substances can damage cartilage irreversibly. For this reason veterinarians emphasize the importance of keeping joints healthy, lubricated, and pain-free before the inflammatory process turns into a destructive loop.
Arthritis Develops Because of:
Photo: Practical Horseman/Steve Heath
Preventing and Treating Joint Injuries in Horses
Now that we’ve established the irreparable properties of arthritis, let’s focus on proactively keeping our horses’ joints gliding smoothly. By combining sound training and management practices with evolving joint therapies, you can do a lot to make your horse’s joints last longer.
Preventing Joint Damage in Horses: Why Early Diagnosis and Action Matter
Starting with the basics, experts recommend keeping your veterinarian regularly involved throughout your horse’s career, even in the absence of problems. “Routine soundness evaluations to catch potential concerns early are essential,” says MacKinnon. During a lameness examination your veterinarian will perform flexion tests on your horse, manually stressing his joints and watching for a pain response when he jogs off immediately afterward. Depending on the findings, the practitioner might recommend further diagnostic imaging and/or intra-articular therapy (i.e., joint injections).
“Getting baseline diagnostics serves as a benchmark to track the progression of potential future orthopedic and soft tissue injuries.”
-Dr. Kim MacKinnon
“Even when there is nothing wrong with your horse’s soundness, getting baseline diagnostics serves as a benchmark to track the progression of potential future orthopedic and soft tissue injuries,” MacKinnon explains. “This allows us to get ahead of problems and treat them proactively before the disease process or injury worsens.”
Veterinarians are more frequently turning to ultrasonography to diagnose joint problems. Ultrasound shows changes in the synovium earlier than radiographs do. This paradigm shift allows practitioners to care for synovitis cases sooner and more proactively, potentially improving the outcomes.
In practice, stopping OA in its tracks means treating the joint at the appropriate time and with the appropriate products. “I often hear from clients, ‘I don’t want to start injecting my horse because once you start, you have to keep injecting them (for life),’” says Whitaker. While this reasoning comes from an admirable desire to do what’s best for the horse long-term, he adds, it can produce the opposite effect and negatively impact the animal’s career longevity.
“The problem with that line of thinking is that the horse will continue to be in pain, and the inflammatory process is allowed to progress unchecked,” he explains. “This can lead to a less manageable condition than if we had intervened early on. A small fire is much easier to put out than a blazing inferno.”
It’s the progressive and degenerative nature of joint damage that makes early intervention so crucial. “Once we have joint inflammation, the conditions for progression to osteoarthritis are being set,” cautions Whitaker. “Directly interfering, with the use of joint injections, not only helps to get the horse out of pain but can also prolong the health span of his athletic career.”
Another well-intentioned, but potentially risky, habit some horse owners have is spacing out joint injections as much as possible, even when their horse shows clinical signs of joint pain and lameness. “Waiting too long between intra-articular therapy to try and stretch the life of the injections can be equally detrimental,” says Whitaker, who has seen horses overdue for joint injections start to regress in performance. “They will overload other areas to compensate for their painful joints, setting them up for injury. I agree with owners that injecting a horse every few months with corticosteroids is not ideal, but we now have safer and longer-acting alternatives that are changing how we manage OA.” Let’s look at treatment options when it comes to maintaining your horse’s joint health.
Corticosteroids
Hyaluronic Acid
As noted earlier, HA is an organic substance naturally found in joints. HA is considered viscoelastic because it has both viscous and elastic (rebounding) characteristics under stress, and, again, the horse needs sufficient levels of it for proper joint lubrication. Veterinarians have options when it comes to administering HA; they can give it systemically as an intravenous injection or combine it with a corticosteroid—or other therapy—and inject it directly into the joint.
Polysulfated glycosaminoglycan (PSGAG)
Glycosaminoglycans are naturally occurring molecules that maintain the integrity of joint cartilage and synovial fluid. The principal glycosaminoglycan present in equine medicine’s most widely used PSGAG drug is chondroitin sulfate.8 Just like HA, PSGAG can be administered intravenously or intra-articularly, though it is labeled for intramuscular use.
Oral Joint Supplements
Researchers report that oral joint supplements are the most common types of nutritional supplements fed to horses9 despite limited evidence backing up their benefits. For an oral joint supplement to work, its key ingredients need to travel successfully to the joints rather than being absorbed in the horse’s digestive system. That’s easier said than done. Glucosamine is a popular type of joint supplement fed to horses, yet scientists have reported its oral bioavailability is very low.10 Current research on the effectiveness of oral consumption of nutraceuticals for joint health is either lacking or inconclusive.11
Regenerative Medicine
Advances in regenerative medicine have brought safer, more technologically advanced alternatives to corticosteroids for long-term OA management. Regenerative therapies are disease-modifying agents, meaning they can alter the course of a condition by targeting its underlying process, unlike the traditional corticosteroid joint injections, which are only symptom-modifying agents.
Orthobiologics have become a popular branch of regenerative medicine, with a recent survey showing a significant increase in autologous conditioned serum (ACS) use between 2009 and 2019.6 The term ACS refers to processing the horse’s own blood to concentrate and extract specific healing agents that are injected into the joint.
Whitaker says that two of the most popular examples of ACS in equine medicine are:
- Interleukin-1 receptor antagonist protein (IRAP). As explained by Scott Hopper, DVM, Dipl. ACVS, of Rood & Riddle Equine Hospital in Lexington, Kentucky, joint trauma results in the release of inflammatory mediators including the cytokine interleukin-1 (IL-1). This can lead to a negative spiral of cartilage and joint damage that results in joint inflammation and lameness. Scientists developed IRAP to counteract IL-1 that is produced in the traumatized joint and to slow the progression of OA. It works by preventing IL-1 binding to the IL-1 receptors in the joint and, therefore, blocking damage caused by IL-1.12
- Platelet-rich plasma (PRP). Platelets are blood cells that veterinarians can obtain, concentrate, and extract for use in joint healing. Researchers suggest that the growth factors and proteins found in high platelet concentrations could enhance the biological processes associated with tissue repair and regeneration.13 Veterinarians use PRP in both soft tissue and joint therapies.
Polyacrylamide hydrogels (PAAGs) also belong to the regenerative medicine family. Let’s take a closer look at this technology.
Maintaining and Restoring Horses’ Joint Health with PAAGs
“One of the most exciting advancements in joint therapy is a type of viscoelastic therapy called polyacrylamide hydrogels,” says Whitaker, who is currently studying this technology as it relates to equine soundness.
In the context of orthopedics, veterinarians use synthetic PAAGs—which absorb and retain water—to reestablish healthy lubrication and cushioning when inflammation has depleted HA inside the joint.
Veterinarians use PAAGs to address joint disease of varying severity, and this therapy can serve as a first-line treatment rather than being reserved for last-ditch efforts in crippled horses.
Whitaker has investigated viscoelastic therapy through both research and clinical use. He says the obvious advantage he’s seen from PAAG therapy has been long-acting relief of clinical signs. “We often get one to two years between injections depending on the severity of the joint disease,” he says. “Another benefit is 2.5% PAAG’s ability to alter the synovium in a way that can slow or halt the progression of joint degradation if used early in the disease process.”
He recounts several cases of horses with advanced joint disease that have stayed sound and in work with the use of these products when nothing else helped. “They have literally extended the lives of some of my patients,” he says.
In ongoing research Whitaker and others are looking at the optimal uses and combinations of PAAGs with other joint therapies. “PAAGs are effective as a stand-alone treatment, but there are also instances where combining them with corticosteroids or regenerative therapy can make sense, whether that be at the same time or several weeks apart,” he says.
To learn more about the use of viscoelastic therapy in equine orthopedics, check out these resources on TheHorse.com:
Take-Home Message
When you take care of things, they last. Maximizing the longevity of your sport horse’s career involves strategically maintaining his musculoskeletal system throughout his life. By prioritizing preventative care, providing the right therapies at the right time, and having realistic expectations for your horse’s athletic abilities, you’re boosting your chances of building a partnership that stands the test of time.
Editor’s Note: Dr. Beau Whitaker serves on the Contura Vet advisory board.
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3 Caron JP, Genovese RL. Principles and practices of joint disease treatment. Ed. Ross MW, Dyson SJ. Diagnosis and management of lameness in the horse. Philadelphia: Elsevier, 2003;746–764.
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7 Hauser RA. The Deterioration of Articular Cartilage in Osteoarthritis by Corticosteroid Injections. Journal of Prolotherapy. 2009; 1(2):107–123.
8 McIlwraith W. (2010, April 6–7) Management of Joint Disease in the Sport Horse [Paper presentation]. 17th Kentucky Equine Research Nutrition Conference, Lexington, Kentucky, United States.
9 Oke SL, McIlwraith CW. Review of the Economic Impact of Osteoarthritis and Oral Joint-Health Supplements in Horses. Proceedings of the American Association of Equine Practitioners. 2010;56:12-16.
10 Meulyzer M, Vachon P, Beaudry F, Vinardell T, Richard H, Beauchamp G, Laverty S. Comparison of pharmacokinetics of glucosamine and synovial fluid levels following administration of glucosamine sulphate or glucosamine hydrochloride. Osteoarthritis and Cartilage. 2008;16(9):973-979.
11 Neil KM, Orth MW, Coussens PM, Chan PS, Caron JP. Effect of Glucosamine and Chondroitin Sulphate on Mediators of Osteoarthritis. Proceedings of the American Association of Equine Practitioners. 2006;52:572-573.
12 Hopper, S. Regenerative Medicine—Understanding IRAP, PRP and Stem Cell Therapies. 2014.
13 Arnoczky SP, Delos D, Rodeo SA. What Is Platelet-Rich Plasma? Operative Techniques in Sports Medicine. 2011;19(3):142-148.
Credits
Lucile Vigouroux, MSc,
is a New-York-based freelance author with a passion for equine health and veterinary care. She holds a master’s degree in equine performance, health, and welfare from Nottingham Trent University, in the U.K., and an equine veterinary assistant certification from AAEVT. Vigouroux also runs a small equine PEMF therapy business.
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