It would be impossible to count the number of articles that have been published and how many lectures have been delivered on the subject of lameness. Early on the morning of November 22nd, equine lameness specialist Dr. Mark Revenaugh, DVM of Northwest Equine Performance, spoke to a group of eager dressage enthusiasts at the annual USDF Region Six Mini-Convention. Dr. Revenaugh introduced himself and his veterinary background before launching into a detailed lecture on a common subject from a unique perspective. His three-hour dialogue covered everything from the common causes of performance problems, warning signs associated with potential issues, and new therapies to help your horse before a major problem develops.

Dr. Revenaugh hails from a horse-oriented family. His mother and his sister both train in dressage and his wife is an accomplished dressage rider as well. Dr. Revenaugh rode until he formed Northwest Equine Performance in 2002. He moved to Portland, Oregon from B.W. Furlong & Associates, a highly regarded equine clinic near Gladstone, New Jersey. Currently located in Mulino, Oregon, Northwest Equine Performance is home to both Dr. Revenaugh and his associate, Dr. Susan Emerson. Their practice focuses exclusively on lameness and atypical performance problems including stomach ulcers, saddle fit, hoof problems and neurological issues. As Dr. Revenaugh emphasized in his lecture, Northwest Equine Performance tries to combine a large dose of “common sense, practical horsemanship” with state-of the-art diagnostic imaging and therapeutic technologies.

By the time most horses get to Dr. Revenaugh, the damage has been done. While he covered a vast array of details regarding diagnosing and treating lameness, Dr. Revenaugh repeatedly returned to the responsibility riders and trainers undertake when they work with horses. He believes that the tools and instincts that horsepeople use when they are attentive while working with horses can play a critical part in preventing lameness. He encouraged the group to watch their horses’ behavior so the horses can communicate with us better, “…if we’re ready to listen.” In that spirit, Dr. Revenaugh walked the group through the process of diagnosing a lame horse, working backward to specific moments and behaviors that riders and trainers can use to ‘hear’ what their horses are trying to tell them.

“The best treatment for lameness is learning to recognize it early!,” says Revenaugh. Once you have a problem, experience, prudence, and therapy will get you back in the saddle. In training, the old adage of “no strain, no gain” is generally true within reason. A horse is like any other athlete; consistent, progressive, and dynamic training creates elite athletes who are able to perform at high levels over long periods of time. Revenaugh also emphasized the importance of the warming up and cooling down phase of the daily ride. Like a gymnast, a horse must be highly coordinated, strong, and flexible in order to execute demanding movements with perfect timing and the ease that comes from being physically well-prepared. “Most of the injuries I see come from a lack of timing and coordination; the wrong move at the wrong moment,” explained Revenaugh. Another frequent cause of injury stems from the kind low level trauma associated with repetitive motion on the joints, bones, tendons, and ligaments. Like the smoldering ashes of a fire, these structures become progressively compromised—yet frequently go unnoticed until they are full blown cases of lameness. A rider must always consider how much strain goes beyond a reasonable amount, based on the feedback they receive from their mounts.

What may begin as a simple resistance can often turn into a more significant performance problem or gait abnormality. Successful therapy relies on an accurate diagnosis. The linchpin of this issue: know thy horse! Too often, horse owners don’t know what the ‘normal’ physiology and behavior patterns of their horses are on a day-to-day basis. Learning to pay attention to signals before one is actually dealing with lameness is a valuable skill to develop.

One of the most commonly overlooked signs of a potential problem in the making is if a horse is struggling with a new movement or exercise. Consider examining the reason behind any reluctance, fighting, stopping or other more distinctly violent behavior. Your horse may be unable to perform with ease because it is not yet strong enough or its physique does not support the desired action. Perhaps the horse is confused or, worst case, injured. In this situation, Revenaugh suggests backing off, reconsidering your approach, or enlisting the help of your vet. In some cases, ‘active rest’ like tack walking, hacking out, or longing, can rest your horse’s body and refresh their mind while keeping them active enough to return to work easily. If there is a distinct change in your horse’s attitude towards work or it just ‘feels funny’, this can be the beginning of a developing issue. Diagnosing and treating a developing injury properly can often help you avoid situations that might exacerbate lameness and/or avoid lameness altogether.

You can help your vet most in this process by providing a detailed history on the horse. Revenaugh advised his audience to assume as little as possible when answering questions and include even seemingly inconsequential information when outlining the answers. He suggested some critical questions to include when gathering information:

• When did the problem originate?
• Is this a new problem?
• Did any significant changes precede the development of this problem?
• Has it gotten worse or did something happen?
• Does your horse have a decreased range of motion anywhere?
• Does your horse have any unusual swelling, heat or sensitive areas that were not previously sensitive? • • Does this change before or after work?
• What treatments have you tried before the vet arrived to examine the horse? (Icing, liniments, sweats, wraps, hand-walking etc.)
• Has your horse’s musculature or weight changed suddenly in any way?
• Is there any atrophy?
• Does the problem present itself under specific circumstances?
• Is your horse unusually stiff or lazy going to one specific direction. If yes, does this change on the longe or under saddle?
• Does it get better or worse with time off?
• Does it get better or worse after being worked?

A detailed history can make a significant difference in the type of exam your horse receives and how much you end up paying during any one veterinary visit. A vet will look for gait abnormalities under several different circumstances; on a straight line and on a circle, on both soft and hard surfaces. In some cases, the problem is so subtle that it’s only recognizable to the rider when the horse is under tack.

It is important for riders to learn effective ways to communicate what they feel, to help the vet understand the significance of the irregularity. Flexion tests and nerve blocking can be used to isolate areas where the horse might be uncomfortable. A useful tool to use under your vet’s specific instructions is a short trial of an NSAID (Non-Steroidal Anti-Inflammatory Drug), like Phenylbutazone or Firocoxib. If the horse improves or does not improve, this is a valuable indicator for your vet, either way. These basic tests are often useful for pinpointing discomfort that may lead to lameness later on. Learning to see lameness is an acquired skill, if not an art. By the same token, a head nod or the discordant sound of a lame horse on hard footing can be enough to help the layperson know when to call a vet.

Once a lameness or gait abnormality has been diagnosed, finding the most appropriate therapy can make a significant difference in your horse’s future. In the last 10 years, there has been a boom in new technology, therapy, and medicine, to aid in recovery. While traditional methods of ultrasound and x-ray continue to be used, technology now allows vets to see x-rays at the time they’re taken, and both x-ray and ultrasounds can be viewed in high definition—leading to more precise diagnoses.

Therapies like shockwave, Platelet Rich Plasma Therapy (PRP), and Interleukin-1 Receptor Antagonist Protein Therapy (IRAP) have been proven to dramatically enhance the rate of healing in bone and soft tissues—in some cases helping tissues to heal stronger than if they had been given the traditional “tincture of time” of stall rest with restricted movement. Stem cells, A-cells and prolotherapy can also be used to help restore tendons and ligaments to health. Lastly, drugs like Tildren can be used to treat multiple sites of osteoarthritis simultaneously through systematic administration.

On the prophylactic side of therapy, there are also the more commonly used Adequan and Legend which aid in maintaining joint health both prior and following the development of arthritis in the joints. More information about these therapies can be found at www.equinepi.com

Where do lameness and gait abnormalities come from? Frequently, problems develop out of fundamental imbalance and weaknesses that refer pain throughout the body and eventually culminate in a specific injury. There are many potential causes of more subtle injuries that go beyond the most straightforward strains, sprains, and tearing of the tendons or ligaments. For example, abrupt changes in your horse’s training program can make a horse muscle sore, enough so that their gait is disrupted. Changes in footing, particularly deep footing, can cause great strain on tendons and ligaments in addition to muscle fatigue. (This is much like walking in deep sand on the beach or through deep snow.) Slick footing beneath a firm layer of footing is also particularly dangerous, as the horse may feel confident in the placement of its hooves, only to be deceived, resulting in a slip or fall and a consequent loss of confidence. Worst case, this can result in injury.

Ulcers are a misunderstood or overlooked source of gait alteration. Ulcers can prompt a wide range of behavior and gait issues. Symptoms include sore backs, kicking out, bad attitudes and poor coat quality. While having your horse ‘scoped’ is the best way to determine whether or not he has ulcers, a week long trial run on Gastrogaard is a safe alternative to be explored under your vet’s supervision. Travel can cause stress, which irritates ulcers—ulcer medication may be helpful if administered pre-, during, and post travel. The constant balancing of riding in a trailer is tiring for a horse and can result in stiffness, muscle soreness, or lameness. Some have even equated an hour in the trailer with one hour of walking. This is compounded by the dehydration that often accompanies a long trailer ride. Can you imagine what your horse must feel like after an eight hour trailer ride or more?!

While never stepping outside of his range of expertise, Dr. Revenaugh explained that poorly fitting tack is a problem he and many vets often encounter. Tack should be considered when exploring gait and performance problems. From his prospective, the most important thing to consider in relation to tack is that horses change, both by improving and getting stronger and by losing muscle tone and fitness. The horse’s tack will need to change correspondingly with the changes his body makes. Proper fitting tack will invite change, as the horse experiences greater freedom in its body, which will develop in turn. This may be more frequent, depending on your horse’s rate of development, particularly with young horses and advanced horses.

Bitting and dentistry are also very important. A poorly fitting bit can pinch and rub, causing the horse to resent the bridle and the rider. Teeth that have not been well cared for can cause sores and significant pain, which often result in odd neck carriage or even deeper behavioral issues. Poor saddle fit and a lack of dental maintenance often manifest themselves as back and neck problems, which ultimately trickle down to cause gait abnormalities.

Neck problems can be divided into two categories: those accompanied by neurological deficits and those without. Neurological issues can be assessed by a series of tests performed on the ground. Neurological discrepancies can come from arthritis in the neck, disc injuries, pinched nerves, and spinal cord compression. Neck problems without neurological problems can stem from the stress caused by many things, including forced movement and repeated trauma. Neck problems are most apparent when using diagnostic imaging tools like ultrasound, x-ray, and MRI’s. The most useful tool, according to Revenaugh, is the bone scan for its unique ability to find bone inflammation when lameness is difficult to diagnose. It has much higher sensitivity than x-rays.

These are all useful tools for examining the issues associated with the low back and the sacropelvic region, as well. Injuries in this area, while less likely due to the strength of the ligaments, are particularly important to address as the spinal column and pelvic limbs are the most significant players in that region and are responsible for the propulsion of the horse.

Some gait-altering issues are more fundamental, such as poorly shod or unbalanced hooves. Often it’s as simple as looking at your horse’s hooves from the side and from directly in front to ensure that the angles are similar and that the hooves are level. Beyond their basic appearance, this is an area where horse owners struggle to evaluate the appropriateness of the shoeing or trimming their horse receives. Revenaugh encourages horse owners to ask questions of their farriers and their vets. Both are often happy to help teach owners about this crucial subject.

Even more fundamental are poor nutrition and/or fitness levels. The most common complaint from vets: horses are too fat. Extra weight makes horses less agile and puts additional weight on tendons and ligaments, making them more prone to injury. The peril of fat horses often lies in the proximity of their owners. Changes that sneak up subtly when horses are seen by the same eyes every day. While the scale is the ultimate tool for measuring weight, most of us don’t have access to one. However, weight tapes, the body weight equation, and the Henneke body condition scoring system all work well. Weight tapes can be found at your local tack or feed store. If you don’t have a weight tape you can use a regular measuring tape with the equation “heart girth x body length, divided by 330” to compute your horse’s weight.

The Henneke method rates horses’ appearances on a score of 1 to 9, with ‘1’ being emaciated and ‘9’ being extremely fat. The scale evaluates six major parts of the horse; neck; withers, the shoulder area; ribs, loins, and the tailhead area. A score between ‘4’ and ‘7’ is acceptable. A ‘5’ on the Henneke scale is ideal and defined by a level back where the ribs cannot be visually distinguished, but can be easily felt. The fat around the tailhead should be slightly spongy. The withers should appear rounded over spinous processes and the shoulders and neck blend smoothly into body. The Henneke scale is widely used and readily available on the internet.

Revenaugh emphasized the importance of ensuring that the rider/trainer’s skills and training methods are appropriate and correct. Performance problems can be challenging to deal with and not all are physical issues. As many great equestrians have lectured before him, Revenaugh emphasized the importance of ‘the basics’, regardless of discipline, in order to develop the correct muscle groups, neuro-muscular function, and to build confidence and a positive attitude toward work. Consistent communication of the rider’s expectations both under saddle and on the ground is the key to proper development. Certain training methods come and go, but the traditional and systematic methods never go out of style and are readily available in paperback form. The core values of the most prominent training methods are universal.

Allowing proper time for the muscles, tendons, and ligaments to warm up is the most important and most frequently overlooked part of training a horse. Next is the patience and time taken in developing a horse physically and mentally. Too often, talented young horses are allowed to perform at levels that their aptitude allows, but their conditioning does not. This affects their longevity as competition horses, especially at the higher levels—and they often are injured due to their fundamental weakness and lack of basic training.

The levels that have been created by our national federations and international federations are there for a reason. Revenaugh encouraged riders to take a closer look at what’s required at each level in order to better understand the proper development of the horse. When these principles are neglected, the resulting injuries are often magnified by inappropriate rehabilitation and maintenance post injury. During pre-, post-, and intra- lameness, many people who do harm are often unaware of their damaging actions. This is why it is of vital importance to put ego aside when considering the sources of discomfort for your horse. Each and every one of these factors is enough to make these gentle and willing animals act in whatever way directs our attention toward the problem. The end result is unhappy riders on horses with performance issues.

Three hours passed like a blur and for those of us taking notes, we could barely write fast enough to capture every piece of information. To have a good training program, to know your horse, to learn to identify problems, to know the most current therapies, and to manage gait abnormalities in the long term through preventative care is to ensure a sound and healthy horse over the course of its life. Dr. Revenaugh ended his already profound lecture with a simple statement, “The ultimate goal is to make our horses comfortable and strong enough to do the work we ask with ease.” That’s something we can all take back to the barn!

Jessica Rattner was a member of the gold medal team at the 2001 AHSA/Cosequin Junior Dressage Team Championships and an Individual Bronze Medalist at the 2001 North American Junior Dressage Championships. She also received the 2003 Dressage Foundation Scholarship for the Advanced Young Rider Training and Education Program and is the former president of the USDF Youth Executive Board. A student of the late Dietrich von Hopffgarten, “O” judge Anne Gribbons and two-time Olympian Lendon Gray, Jessica is currently the resident trainer at DevonWood Equestrian Centre in Sherwood, Oregon (www.devonwoodec.com).