Lame horse? The problem may be in the back

Ten to fifteen percent of equine lameness problems can be traced to problems in the back, according to Dr. Rob van Wessum, sport horse lameness clinician at the McPhail Equine Performance Center. “If we did more research, I wouldn’t be surprised to find that the percentage is actually higher,” he says. And yet, very few veterinarians are equipped to comprehensively diagnose and treat these problems.

Van Wessum is using advanced technology at the McPhail Equine Performance Center in some new and creative ways, and when combined with his experience as a rider, trainer, and judge, the end result is dramatic. Horses that were headed for retirement are now competing successfully.

Van Wessum spends two to three hours with each patient and sometimes a full day. “I really get to know a horse before I treat it,” he says. Having horses come to him is an advantage too. “I see every horse under circumstances that are more or less the same – the same tests, same floor, same arena, etc. As those external variables are constant, it’s easier to pinpoint more spots on the spine that are painful.”

Van Wessum also uses several types of imaging. One of them, fluoroscopy, allows for real-time imaging and the ability to freely position the x-ray field during examination. As such, it is a powerful tool for checking mobility of the spine and for pinpointing structures to be radiographed.

His creativity really comes to the fore in his use of Doppler ultrasound. Most veterinarians are familiar with the use of Doppler ultrasound in cardiology, but van Wessum is using it to get information about the soft tissues in joints.

“Doppler is great for seeing blood vessel activity. It helps for getting information about the stage of soft-tissue inflammation. For example, you can see if inflammation is active or if it’s old,” van Wessum explains. “You can also get information about the synovial membrane, the quality of the synovial fluid, and the quality of the cartilage.”

Additionally, van Wessum uses a bone scan (scintigraphy) to pinpoint structures and see skeletal structures from several angles and to distinguish between inflammation of soft tissue and inflammation of bone.

This combination of technologies and the use made of them are unusual, according to van Wessum, and allow him to treat back problems more accurately.

When necessary, treatment consists of joint injections or surgery and is followed with a tailor-made rehabilitation program that is designed to increase range of motion and speed of motion gradually.

“We proceed in a very controlled way,” says van Wessum. “I see the horse every two months and part of the visit includes an ultrasound to see if there is inflammation. If so, we can adapt by increasing the range of motion but not the speed of motion, or some other combination.”

Client compliance is essential for the rehabilitation to work, he adds, and education is a big part of that.

“We show clients anatomical models and videos of how horses move and give thorough explanations during the clinical exam. If they understand why we are prescribing certain rehabilitation techniques, they can, and do, become really committed partners in the rehabilitation process.”

Some trainers are bringing in their horses annually or biannually for consultations on training. “We evaluate which parts of the body are at risk and suggest adaptations to training so that the trainer can fortify other structures to prevent a horse from becoming lame,” he says.

One such trainer, Anne Stahl, has a stable with 16 FEI (Federation Equestre International) horses, which range from lower level to Grand Prix competitors. Van Wessum has seen most of them, she says, some for problems she already knew about and some for preventive visits.

“One of my horses was not fond of his work,” she says. “He would do it, but with a lot of resistance and with his ears pinned back. He didn’t show any overt signs of lameness though.”

It turned out the horse had acute inflammation in the back in the lumbar sacral region.

“Van Wessum doesn’t go for the quick fix,” she says. In this case, he recommended two months of rest that included nothing more than just walking on a hard surface. After that, he and Stahl worked on slowly introducing some dressage exercises designed to develop muscles that support the horse’s spine.

“It’s hard to wait for those two months,” she says. “But after that and with the rehab, this horse is now more comfortable than he’s ever been and a far better athlete than before. It’s been a year since I first took the horse in, and he no longer has any restrictions in what he can do. Every move now is forward and supple, and where he was formerly reluctant to do his work, he’s now delighted. All of the horses that Dr. van Wessum has treated for me have gone through the same transformation.”