Maintenance for the Upper Levels

[Carried_Away]

I’m curious what the COTH hive is doing maintenance-wise for their Prelim+ horses. There are a lot of new things available since the last time I had an upper level horse, and although I’m working with a great vet I don’t want to under or overdo it.

My horse is 9 this year and started going Prelim as a late 6yo. Understandably he’s starting to show a bit of wear and tear, so I want to do everything possible to keep him comfortable and happy in his job.

Please share what “normal” maintenance looks like for your horses, what seems to work well and what you’d skip going forward.

[RAyers]

I’ll bite!

Nothing. Peanut lives out in a pasture. Out side of competition, I want him to get sore and develop inflammation. That is the ONLY way new tissue is developed and how damaged tissue is reorganized. This way when he does compete, his biology and physiology is better equipped to handle added stresses or an injury. He does get massage though.

I think the best thing ever to keeping my old advanced guy (Shiver) sound was a lot of road hacks and not really doing much to keep him from being sore. He ran OI at 18 and retired.

Yes, injections, regular vet exams, consistent quality showing are all part of it.

At a competition, anything goes. Peanut has a acupressure mat, gets wrapped and hoof packed, at least a half a package of peppermints over the course of competing.

Now I admit that I am old and grew up in a different era. At the same time, I believe in EVIDENCE based medicine. Things like icing have been show to be detrimental to healing outside of the acute phase. Things like lasers, PEMF, etc. have not been shown in any prospective or actual biologic mechanism study to work. So I rely on my vets, trainers, and experience and skip most non-prescription modern things that supposedly help soundness.

[Demerara_Stables]

Specifically for lasers, there is research that shows they work: https://thehorse.com/1116544/the-power-of-equine-laser-therapy/

[Virginia_Horse_Mom]

Have you tried it with your horse?

[Jealoushe]

Just anecdotally, I borrowed my friends Magnawave and used it on my
old broken leg when I suddenly developed a lot of pain and swelling. I haven’t had issues with this break (it’s 7 years old) and I have several plates and pins. It swelled for the first time since breaking it and was incredibly painful for a week.

I PEMFd it for ten minutes a day for week. Swelling and pain completely gone. I’m
convinced it works now lol

[Demerara_Stables]

Yes, I own one and have used it on ligament injuries, lacerations with infection, and most commonly use it on tight/sore muscles and general pain.

I’ve also used it on myself on a tight/sore neck and it’s worked great. Probably a 80% reduction in pain.

[Virginia_Horse_Mom]

Interesting. Did you take a course or get specialized training in terms of using it? Did you work in coordination with a vet when treating ligament injuries?

[Demerara_Stables]

When a horse in my barn had a ligament injury, my vet recommended that I buy it to speed the healing. She wrote a program complete with settings and times and number of times a week.

There was a very comprehensive guide provided when I bought mine, and for the lacerations/muscle soreness/pain, I followed the instructions in the guide. It basically lists an “ailment” and then says what settings to use and for how long.

[RAyers]

This is an example of how poor quality vet research is. The numbers of horses used is so low that there is no statistical power nor is there sufficient biologic mechanism testing. In medical research this is equivalent to “low quality” research akin to case studies and no indicative of large scale effect. Additionally, retrospective studies are notoriously inaccurate due to inconsistent patient reporting and measurement protocols. For example, my smallest patient population for a retrospective study (infection of orthopedic implants) is 600 patients to measure spine level and sex differences. And that is only for a single center.

These studies cited are simply saying, there may be something.

If one looks at the large scale research on laser treatments, e.g. meta-analyses of thousands of patients, there is no evidence of effect.

[HeartsDesireEventing]

First off, work closely with a good vet you trust.

I always did a pre-season performance exam, so the vet had eyes on the horse for a soundness exam, became familiar with his responses to flexions, etc. and we could address any issues early. I will say Rusty competed Prelim and CCI for several years before ever needing injections - I am definitely not one to inject unless the horse actually needs it. For him, that was prepping for his second CCI long format, when we did inject his hocks and coffin joints. We moved up to Prelim when he was 11, and he continued competing upper level including running Intermediate at 16.

Day-to-day, lots of hacking, especially up and down hills. Turnout as much as possible. Icing after every jump school or gallop. Pentosan every two weeks, and a Legend round once or twice a year. He also got Legend the day before cross country when he was competing. Liniment baths and epsom salt soaks in the summer after rides, and a Back on Track sheet in the winter. PEMF every 2-3 weeks, depending on how intense his schedule was at the time (this really helps his SI). I keep him on a high dose MSM feed-through joint supplement (for him, this makes a big difference and I can tell when he’s on it vs not), as well as a hoof supplement and a GI supplement. He gets UlcerRx when he travels. Alfalfa hay, and high quality feed to help keep weight on. He stays on a regular 5-week schedule with a good farrier.

I’ve done chiro and acupuncture with him, although not on a regular schedule, just as needed. I also now have a bodyworker who does him semi-regularly, which I think is helpful and something I probably could have added sooner - I started working with her when he was coming off extended stall rest for a tendon injury and was quite tight.

[Carried_Away]

Thank you for sharing, that all makes sense and I 100% agree with allowing them to get sore/inflamed to make them stronger over time.

I am specifically interested in injections - how often are you all injecting and with what? I have always been pretty conservative about injections, but with the new biologics that are available (although $$$) I’m wondering if people are choosing to inject more frequently than what used to be the “norm”.

I’ve also heard of Osphos making a huge difference in hoof/coffin sore horses, how does that fit into people’s maintenance, if at all?

[Demerara_Stables]

Not an UL eventer, but PRP lasts a little over a year on my 21 year old horse, for what it’s worth.

[Libby2563]

This Equiratings podcast episode had some interesting info about joint injections: https://podcasts.apple.com/us/podcast/equiratings-eventing-podcast/id1163693349?i=1000645543344. I also don’t like to inject unless there’s an actual need but have been wondering how the biologics fit in with that. Curious to hear others’ thoughts on this thread. The previous owner of my Prelim horse before me used to do IRAP of hocks and stifles on each horse annually.

[RAyers]

Osphos and Tilden destroy bone quality due to hypermineralization. This has been proven many times in human studies and is why many oral and craniofacial surgeons will not operate on patients on bisphosphonates. They have been shown to act as pain killers though through a metabolic pathway associated with bone so that may be why horses feel better.

Most vets I know will not use these on their horses.

[Virginia_Horse_Mom]

@RAyers

Osphos and Tilden destroy bone quality due to hypermineralization. This has been proven many times in human studies and is why many oral and craniofacial surgeons will not operate on patients on bisphosphonates.

Osteonecrosis of the jaw is a serious risk for people taking Zometa. But… the risk is somewhat dose dependent.

[LadyB]

Oh I love this thread. @RAyers I love your way of working! I am similar.

I am not an UL rider, contested Prelim for a few years on my current 21 year old. I’ve had him since he was 3, he’s an OTTB, second career. I am of the same mindset, although he is not out 24/7 but from 6am-8pm in the summer and 8am-5pm in the winter.

He jumps once a week, if that, not so much anymore as he’s quite seasoned and knows his job. More about keeping him supple and keeping the muscle built. He still goes out at Training level and seems to have no issues with recovery. We do a lot more hacking and easier rides, and less hard rides because of his age, I want him to last a few more years to have fun. He gets a joint supplement daily, and hocks are injected yearly. He also has Kissing Spine, which is maintained by Massage every 3 months and rarely Chiro because he absolutely despises it, also very hard to find good ones in my area.

With very little set backs his whole life, after any jump school he is wrapped with alochol, and any xc schooling he is iced (as long as I remember the boots!) and poultice every. single. time. He has great looking legs

The biggest set backs we’ve ever had were farriers, because they are also few and far between for good ones, many have caused me more issues. Very frustrating.

[RAyers]

Actually it is for any bisphosphonate. We found that in the 1990 with ibandronate, pamidronate, and others. This is why entities such as NASA will never treat astronauts with them even though we know anybody in orbit will lose a large amount of bone.

[Virginia_Horse_Mom]

Understood. I personally only have knowledge or experience with Zometa risks. But it makes sense it’s all of these drugs.

With Zometa, it was explained to me that the jawbone takes up more of the meds than other bones in the body, hence complications being seen so frequently with the jaw. I’m curious about equine anatomy, and if it’s known that different bones take up the meds at different rates.

[RAyers]

It is most likely given the biology and physiology of equine bone is equivalent to human. Bisphosphonates target any calcium ion in the body (hence why there is a risk of colic when administering these drugs). We saw the same side effects in humans as well.

The reason we found issues in the jaw is because we operate on the craniofacial complex regularly. Not so much in horses.

However, I do wonder if we will see femoral neck and trochanter fractures never seen before? We see that in women who have extended treatments with these drugs.

[Bonnie2]

Injections only if there is an issue. What to use depends on location and nature of the problem. Some of the new biologics can be amazingly helpful. And sometimes a little steroid is all that’s needed. If you have a “footy” horse, since you asked about Osphos, you probably will need repeated injections. Be sure to plan them carefully around your event schedule. And scratch if the ground is hard! Always worth having the vet do a soundness exam 8 or 10 weeks out from a “goal” event to pick up on little issues and leave time to address them. I also put my horses on a longe line at least once a week (having already taught them to longe politely) to watch for changes in their way of going. You may not be able to diagnose what’s going on but if you see something different that’s a warning bell. Good luck and have fun!