Managing Injuries (was: Interval Training Darar)

["guest@endurance.net" <guest@endurance.net>]

k s swigart katswig@earthlink.net

Heather said:

> Latest news is I'm going to back off training for a few days. Did a 1 and
> a half hour trail ride Tues and Wed am there was some swelling & heat in
> his left front fetlock. Trotted him up & he wasn't quite level. The
> swelling is wind-puff type swelling. Don't know if this is from the sprints
> Sun or the hard ground Tues or a combo of both.
> ...
> Will keep him walking thru to middle of next week and take him to be 
> scanned next Fri (couldn't get an appointment before then) so I can make a 
> decision about the 90kms ride on 02/04 but I don't feel too positive about 
> it right now.  Don't want to jeopardise the ride in UK in May.

And then Tom said:

> No need to scan as yet. No need to keep walking, either, unless the horse
> is lame.  I'd keep up daily trotting--long enough to cut a sweat and avoid
> tying up. Don't use any anti-inflammatories--we want to see the problem
> staring us in the face.

I am not so sure that I agree with this, and it certainly isn’t advice I 
would give to somebody without having seen the horse AND knowing a whole lot 
more about the horse.  

There is little doubt in my mind that the horse has sustained an injury to 
the left fore.  The cause of the injury, the extent of the injury and the 
appropriate treatment protocol (including the best course of physical 
therapy) is unclear to me--and it would remain unclear until I had a 
diagnosis of the injury.  What I do know, is you can't count on observed 
lameness to tell you the extent of and injury and its appropriate treatment.  
And in a situation where there is inflammation (that's what "swelling and 
heat" means to me), I ain't so sure but that anti-inflammatories (whether 
they be drugs or cold therapy) might actually be the best treatment option.  
However, most anti-inflammatories do have an analgesic effect as well...even 
just using ice; so if you are using observed lameness as a key to how to 
proceed, then you don't want analgesics covering up the horse's pain 
response.  And a certain amount of inflammation can actually promote healing.

From what has been stated here on Ridecamp, this injury could be anything as 
simple as a minor stretching of the tendon sheath to something as serious as 
a full blown suspensory tear or even a mild fracture of a sesamoid (seems 
that the injury is most likely in/around the fetlock).  In my experience, the 
degree of lameness the horse shows from the injury is more a function of a) 
the observer :), and b) how stoic the horse is about pain than it is of the 
seriousness of the injury.  I think Heather reported that the horse is a 
seasoned endurance horse with no pulls for lameness, which could be and 
indication that the horse is quite stoical about pain.

Whatever, the case may be, if it were my horse, I would cease being concerned 
about the horse's interval training/conditioning program and concern myself 
with treating the injury.  So _I_ wouldn't be trotting the horse (but then I 
have never had a problem with horse's tying up after putting them back to 
work after a layoff so doing anything to prevent that would be low on my list 
of priorities).  A certain amount of "injury" is necessary to the building 
process (it is called micro damage); however, it is my understanding that 
"micro damage" is generally sub-clinical; and this injury is not sub-
clinical, so I am not sure it falls into that category.  And whatever the 
extent of the injury even in the case of micro damage, the horse needs a full 
"recovery" period before going back to work (if the damage is "micro" enough, 
that full recovery can be completed in a day or two).

So, if money were no object (and I couldn't diagnose the injury any other 
way, which presumably Heather can't or she wouldn't have made the 
appointment), I would indeed have the horse's leg scanned with ultrasound 
(and I am considering ponying up myself to actually purchase one of these 
machines myself so that I can avoid the cost and hassle of having the vet out 
to do it).

But...and here is the reason I am posting this...I am curious as to what 
everybody else's protocols are in diagnosing injuries and establishing 
protocols for how to treat them.  I am fully aware that there are some 
injuries that heal faster with prudent work (in fact, I think most of them 
do), but how do we determine prudent work; and how do we balance this against 
the greater risk of additional injury to and already compromised system (as 
an example, many broken bones in humans heal much better and faster if they 
are not fully immobilized or put in a hard cast--however, the threat of 
additional injury is greater if you don't cast it, so if you aren't going to 
put your broken leg in a hard cast to keep it from sustaining additional 
injury while it is vulnerable, you have to be really careful not to do 
something stupid).

I ask this because it has been a niggling question in my mind since Darolyn 
Butler's account of her trip to Dubai in January where she said:

> Slowest loop was 3rd quarter... he had shown a tiny bit off in vet check,
> vet didn't see it, but Grace Ramsey did, so we iced like crazy, then didn't
> push that loop.  Decided later that he had bumped his old splint bump & he
> was just ow-ing a bit. 

And it made me wonder why it was decided, with clinical signs of an injury, 
to administer an analgesic and anti-inflammatory (that's what ice is) and 
continue with the race.  As I said, it just made me wonder how we decide how 
and when to treat our horses' injuries.  I don't have enough information 
about why these decisions were made in this instance, and I would be 
interested in hearing how other people make decisions in the face of signs of 
injury.

I ask this because, I am rapidly becoming convinced that the best way to have 
a horse with a long and successful endurance career is to properly manage and 
minimize any and all injuries...and I am still trying to figure out the best 
way to do this.

kat
Orange County, Calif.

p.s.  In a completely unrelated matter and merely as a matter of personal 
curiosity, I have a question for Heather, "how do you and your horse get from 
France to a ride in the UK?"