"You want to do what to my horse? Oh, I don't believe in joint injections. My grand prix jumper competed until he was 23-years-old and never needed his joints injected."
I'll go ahead and say it. Although I shouldn't judge, my mind starts going in all directions at such a bold statement. I can't help but think, that horse must have been a freak of nature to have felt that good for so long at such an upper level of competition. Or... I wonder how lame that horse was while it was competing at age 23? Or... She must of had great success with other less invasive treatments.. Or... So the horse wasn't injected, but how many pain medications did it receive at the shows?
I listen to something along these lines almost every day. I am an equine veterinarian that focuses in sports medicine. This controversial topic is not an easy nor a simple discussion with my clients.
So, are they good or bad?
If you are an equine competitor, no doubt you have had a horse injected or know another that has. Most would agree that joint injections among the equestrian horse show community have become somewhat "trendy." They've also received a bad reputation. Some would consider the use of this treatment last minute or at the event as a gain in advantage over another competitor with a less "souped up" horse. And in this case, I would agree, joint injections... very bad.
More commonly, you hear the story of the horse that had a joint injected with corticosteroids every 2 months just so it could continue showing... yes, very bad.
The use of this modality to mask pain when a more severe underlying pathology exists forces the horse to use itself harder when otherwise the horse might guard this area and thereby protect itself from further injury.
Comparatively, a competitor that schedules routine veterinary visits to evaluate soundness, rule out injury versus inflammation, and utilizes joint injections prior to an event in this manner... very good.
A horse doesn't have to be "head bobbing" lame to warrant routine soundness checks throughout the year. You would be surprised how many horse owners do not contribute performance issues to subtle lameness. More often it's not that they don't recognize it, it's that they mis-label the condition. I know several horse owners that won't acknowledge that their horse is lame unless it is head bobbing or unable to bear weight in one limb. Instead they describe a horse that is "stiff" or are unwilling to perform certain maneuvers. Let me be blunt, whatever words you want to use to describe it, these issues are in fact a form of lameness.
Routine visits allow the veterinarian to recognize slight lameness and subtle decreases in performance. I encourage owners to seek out a veterinarian with special focus in equine sports medicine or specific interest in the performance horse. Systematically, the veterinarian creates a road map for future treatments. Whether you decide to treat that day or not, the area of concern can be monitored throughout the horse's career. And specifically in respect to joint injections, decreasing significant inflammation early on may decrease the risk of a more catastrophic injury later down the road.
Another point to consider is the medicine used for a joint injection. Not all joint injections are created equal. The rumors surrounding corticosteroid use and its deleterious effects on a joint has caused exceptional alarm. Although study has shown that frequent and inappropriate use of methylprednisolone acetate, a corticosteroid, in a joint may adversely affect cartilage (Colorado State University), alternatively triamcinolone acetate, a different type of corticosteroid, might be chondroprotective (CSU Orthopaedic Research Laboratory).
Moreover, joint injections can be performed using regenerative medicine instead. IRAP (interleukin-1 receptor antagonist protein) has become a popular choice. IRAP manipulates the body's biological mechanisms to stimulate healing by counteracting the destructive effects of inflammatory proteins such as Interleukin-1 (IL-1) within the joint thereby halting the progression of joint disease.
It is obvious that any joint injection poses a risk of joint infection or flare. As with any invasive veterinary service, this is a risk an owner must take. Competent preparation, care in sterility, and proper handling decrease this risk significantly. Many practitioners, including myself, include antibiotics with the other medications used.
In my professional opinion, I do not believe that the incidence of risk is so unacceptable to completely dismiss treatment by joint injection completely from a list of options. Although there are a multitude of alternative ways to treat joint inflammation, frankly, for some horses, joint injection has been the only treatment that has made a significant change in comfort.
In summary, I believe that the benefits of joint injections, used in good judgement, outweigh their bad reputation and low incidence of harmful effects. In conjunction with frequent routine veterinary assessment, proper conditioning, and training, they may help reduce injuries, enhance performance, and essentially create more sustainable equine athletes.
Equine Sport Solutions (ESS) is a veterinary practice that promotes the pursuit of excellence in the equestrian sport by providing expertise in the general care, athletic support, and the restoration of normal form and function after musculoskeletal injury in the performance horse. We customize treatment, conditioning, or rehabilitative programs that fits both the needs of the horse and rider. We strive to always offer the most innovative, state-of-the-art, and progressive diagnostics/treatments available.
You may obtain more information about Dr. Factor and her practice, Equine Sport Solutions, through her website.
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