Page 6 - Equine Matters Spring 2013

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POOR PERFORMANCE
Lameness
and back
pain as causes of
poor performance
Veterinary Surgeon
Chris Lehrbach
XLVets Equine Practice
Chapelfield Veterinary
Partnership
Chris Lehrbach BVMS MVM CertES(Orth) MRCVS
Chapelfield Veterinary Partnership
Just as beauty is in the eye of the beholder, poor performance is in the eye
of the performer or rider; it is different for every rider and dependent on the
individual pursuit. Many animals suffer from poor performance, which can
be caused by a range of medical problems, including cardio-vascular
disease, neurological problems and orthopaedic injury. Poor performance
can also be confused with a limit in the ability of the horse and/or rider.
Clinical signs
Lameness and back pain are intimately
associated and surprisingly common problems
in the performance horse. Despite being
a common cause of poor performance,
lameness is rarely the complaint, often
because it may be mild and involve multiple
limbs. Back pain is quite often suspected
because of bad behaviour when tacked up
or ridden such as bucking, rearing or head
shaking. Physical signs are often subtle, but
poor back and hind end muscling might
be evident. Many patients have several
problems, probably accumulating over time,
which are initially tolerated. Eventually the
increasing soreness results in the appearance
of clinical signs.
Diagnostic investigations
Unfortunately, by the time the veterinary
surgeon is called to assess a suspected poor
performance, the patient has often been
showing signs for quite a while and may
have already been treated. Qualified equine
physiotherapists (ACPAT members) are,
in the author's opinion, one of the few
para-professionals who are capable of
undertaking a meaningful assessment of
a case of poor performance prior to a
veterinary examination.
In terms of veterinary orthopaedic (muscle and
bone) investigations of poor performance, the
initial assessment can be undertaken at home
or at the clinic, depending on the facilities
available. The aim of the initial assessment is
to gauge whether or not a problem is likely
to exist, rather than to actually make a
diagnosis. Detailed history taking may seem
onerous, but is enormously beneficial to the
veterinary surgeon. Even if an owner feels
that a particular area of the body is causing
the problem, it is essential that a thorough
physical examination is undertaken. Many
patients have multiple sites of pain and if the
investigation is focussed on the most obvious
sign, then other significant problems will be
missed. Following the physical examination,
the patient may then undergo any or all of
the following:
Each stage of the examination can provide
important information, but with subtle problems,
ridden assessment of behavioural components
can be extremely useful (Figure 1).
Further investigations vary in their complexity
and can include: nerve blocks, radiography,
ultrasonography, bone scan, MRI and CT. The
decision on which is appropriate depends
on the facilities available, the vet's judgement,
the owner's preferences and the budget. It
is important that owners are aware of the
options and their associated costs, which can
be considerable. There are frequently several
ways of reaching the same conclusion.
Figure 1
- Ridden assessment of a patient with
poor performance may be the only means of
seeing the abnormal behaviour
walk/trot in hand on a firm surface;
flexion testing;
lunge exercise on a firm/soft surface;
ridden exercise.
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EQUINE MATTERS