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Evidence based decision making in endurance Equine Limb Injury - PowerPoint PPT Presentation

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Evidence based decision making in endurance Equine Limb Injury Prevention Program Professor Chris Whitton Summary Evidence based decision making Types of evidence Outcomes Modifiable risk factors Speed Mandatory

  1. Evidence based decision making in endurance Equine Limb Injury Prevention Program Professor Chris Whitton

  2. Summary Evidence based decision making • Types of evidence • Outcomes • Modifiable risk factors − Speed − Mandatory rest periods Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  3. Introduction Two key processes in catastrophic injuries 1. The accumulation of damage Most modifiable • Bone material fatigue with 2. The response of bone regulation • Bone adaptation • Bone repair Trainer education Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  4. Evidence 1. Epidemiology • Identification of risk factors 2. Bone properties • Fatigue properties • Bone biology 3. Data from other disciplines • TB racing Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  5. Evidence Epidemiology • Excellent screening method • Identify risk factors − Modifiable − Non-modifiable • May not be causative Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  6. Evidence Bone injury and biological data • Often simplified • May not include full complexity of process • Can identify causative factors Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  7. Bone fatigue •Fatigue life 100 − No. of cycles to 90 failure 80 Load MPa Faster 70 60 50 100 10'000 1'000'000 Fewer strides Cycles to failure Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  8. Bone fatigue Racehorse • High loads − Failure with relatively few cycles of load − Short fatigue life Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  9. Racehorse Bone fatigue • Damage may be observed as microcracks 2mm • Commonly observed in highly loaded areas Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  10. Racehorse Bone fatigue • Microcracks accumulate and grow into fractures Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  11. Racehorse Bone fatigue • Microcracks accumulate and grow into fractures Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  12. Bone fatigue Racehorse • Fractures may progress to catastrophic failure Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  13. Soft tissue • Similar process • Cyclic loading causes fibre damage Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  14. Outcomes Elimination for lameness • Common – easier to get good data Catastrophic injury • Rare – adequate data more challenging Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  15. Outcomes Lame Fatality Fatality Cause Cause Lame Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  16. Outcomes Fatality Cyclical Bone loading injury Lame Soft tissue injury Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  17. Outcomes Fatality Cyclical Bone loading injury Lame Soft tissue injury Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  18. Outcomes Fatality Cyclical Bone loading injury Lame Soft tissue injury Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  19. Types of injury Catastrophic fracture • Incomplete fractures propagate to complete fractures Non fatal bone injuries • Subchondral bone injuries Cyclic • Chip fractures loading • Osteoarthritis Soft tissue injuries • Suspensory ligament • Tendon injury Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  20. Suspensory ligament injury • May be ligament only • May be ligament and bone − MC3 at origin − Sesamoids distally Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  21. Suspensory ligament injury • Sustains high loads at midstance − 660kg at canter (27 km/h) − 1200kg at gallop (48 km/h) Force N/kg From Harrison et al. 2010 Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  22. Suspensory ligament injury • Risk factors − Older horses, longer careers (Reardon 2012; Perkins 2005; Lam 2007) − Racing frequency – both too little and too many (Perkins 2005, Reardon 2010, Hill 2001) − Distance – increased in last month but lower cumulative distance over time − Pre-existing injury (Cohen 1999, Hill 2001, Lam 2007, Reardon 2012) Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  23. Suspensory ligament injury • Risk factors − Very similar to those identified for fractures − Biased towards older horses Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  24. Injury prevention • Reduce cyclic loading − Epidemiology and bone biology indicate risk is not linear Damage accumulation Adaptation Risk Work load Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  25. Elimination for lameness Risk factors • Interval between rides • Speed Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  26. Risk factors Increasing intervals between rides (MRPs) • Reduces number of rides • Bone repair ‒ Allow more time ‒ Increases rate Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  27. Intervals between rides • Fewer rides – less fatigue MRP 19 days 1 2 3 4 5 6 7 8 MRP 26 days 1 2 3 4 5 6 6 months Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  28. Intervals between rides • Fewer rides – less fatigue MRP 19 days 1 2 3 4 5 MRP 26 days 3 1 2 4 6 months Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  29. Intervals between rides • Greater time for repair • Some increase in repair rates 120 100 80 Km/day 60 40 20 0 120 100 80 Km/day 60 40 20 0 Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  30. Intervals between rides Potential risks • Loss of bone adaptation 120 100 80 Km/day 60 40 20 0 120 100 80 Km/day 60 40 20 0 Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  31. Intervals between rides Potential risks • Loss of bone adaptation Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  32. Intervals between rides Potential risks • Loss of bone adaptation Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  33. Risk factors Speed From Witte et al. 2006 • Direct relationship between speed and loads in limb Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  34. Risk factors Speed • Direct relationship between speed and loads in limb Fetlock joint loads Walk (4 km/h) 0.8 tonnes Trot (13 km/h) 2.3 tonnes Canter (27 km/h) 2.6 tonnes Gallop (48 km/h) 4.0 tonnes Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  35. Bone fatigue •Fatigue life 100 − No. of cycles to 90 failure 80 Load MPa Faster 70 60 50 100 10'000 1'000'000 Fewer strides Cycles to failure Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  36. Accumulated bone fatigue Modelling of bone fatigue • Stride length v speed (Witte et al. 2006) y = 0.10x + 1.27 • Load v speed (Harrison et al. 2014, Harrison et al. unpublished) y = 1.57x + 18.57 • Load v fatigue life (Martig et al. 2014) y = 134.2- log 10 x Speed and distance Fatigue life Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  37. Accumulated bone fatigue Loop speed 120km ride (all regions) • Slow – 11.0 km/h • Mean – 18.6 km/h 4.5 • Fast – 26.2 km/h 4 3.5 3 Slow 2.5 % fatigue 2 Mean life/loop 1.5 Fast 1 0.5 0 Loop 1 Loop 2 Loop 3 Loop 4 Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  38. Accumulated bone fatigue Mean speed 7 6 5 % fatigue 4 All life/ride 3 Group 7 2 1 0 80 km 120 km 160 km Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  39. Accumulated bone fatigue Fastest 2.5% of horses 35 30 25 % fatigue 20 life/ride All 15 Group 7 10 5 0 80 km 120 km 160 km Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  40. Accumulated bone fatigue Reduce speed of fastest horses in 120 km rides • (28.2-29.5 km/h) 20% 37% 35 reduction reduction 30 25 20 % fatigue life/ride 15 10 5 0 no change minus 1 minus 2 km/h km/h Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

  41. Accumulated bone fatigue • Function of speed and distance − 120 km rides accumulate most bone fatigue − Small reductions in speed have large effects for fast rides/horses Equine Limb Injury Prevention Program Equine Limb Injury Prevention Program

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