Melanie Cole, MS (Host): Board-certified specialists in equine sports medicine and rehabilitation practicing at the University of Florida College of Veterinary Medicine at World Equestrian Center: Ocala offer a variety of ways to enhance performance in elite equine athletes through state-of-the-art diagnostics combined with novel and traditional therapies.

Melanie Cole, MS: Welcome to UF Vet Med Voice with the University of Florida College of Veterinary Medicine. I'm Melanie Cole. And joining me, we have a panel today with Dr. Ali Morton. She's a Clinical Professor and Medical Director at the UF Veterinary Hospital at World Equestrian Center in the Department of Large Animal Clinical Sciences at the UF College of Veterinary Medicine, and she's board-certified by the American College of Veterinary Surgeons and the American College of Veterinary Sports Medicine and Rehabilitation; and Dr. Robin Bell, he's a clinical professor at the UF Veterinary Hospital at World Equestrian Center, Department of Large Animal Clinical Sciences at the UF College of Veterinary Medicine. And they're here to talk to us about optimizing performance in the elite equine athlete.

Doctors, thank you so much for joining us today. What a cool topic we've got. And Dr. Bell, I'd really like to start with you. Just tell us about the UF Veterinary Hospital at World Equestrian Center. Tell us about this premier equestrian venue.

Robin Bell, BV.SC: Thanks, Melanie. It's such an honor to be invited to speak at this podcast. We're really excited to be part of your show. So, the hospital here is newly built. It's over 40,000 square feet and it sits at the very top of the World Equestrian Center, which in my opinion is probably one of the best equestrian facilities in the world. We have over 3,000 horses here during the peak of the season.

Our hospital is frankly fantastic. We have an amazing array of equipment here. And Dr. Morton and I were chatting about this before, I'm pretty sure we're the only place in, I think, the world that has all these standing advanced imaging modalities under the one roof. And that really helps us in these high-performance horses to get to the bottom of what's causing their problems.

But that's not the only thing we have here. On the backside of that, we have a huge rehabilitation suite. Again, I do work for the Australian Olympic team. And I've been all over the world with those horses, and I have never seen a facility that has this caliber of equipment in one place. Having the two underwater treadmills, a salt room, we've got a whole room with a vibration plate, a solarium, it's just amazing. And we are fully equipped with all the other equipment that you'd expect to have at a high-quality veterinary hospital.

Melanie Cole, MS: That's so cool. That is really just an amazing center you just described, Dr. Bell. So Dr. Morton, why don't you tell us about your expertise in this unique area and the team approach? What kinds of expertise and expert clinicians all work together with all this cool equipment in this amazing center?

Alison Morton, DVM: Yes. Thank you, Melanie. And actually, thank you so much for inviting us to participate in this interview. Like Dr. Bell said, we are super fortunate to have all the things we do and just along with the facilities, our team is similar. We have a combination of three sports medicine board-certified veterinarians. And in addition, two of our sports medicine, myself and Dr. Bell are board-certified in surgery. So, we bring a little bit different perspective to one of our other sports medicine board-certified veterinarians, Dr. Jennifer Taintor, who is also board-certified in internal medicine, and so she has another perspective. So, we really can completely look at our equine athletes and give you a really well-rounded perspective on the problems that these horses face, or even just how we can best kind of optimize the performance for those horses.

In addition, we have on our faculty a board-certified equine diagnostic imaging or radiologist, Dr. Erin Porter. And we also consult with another board-certified equine radiologist. So, our diagnostic imaging capacity is well served by experts in these areas. So that, combined with we have an amazing support staff and these facilities, we feel like we have an advantage over just about any other facility certainly in our country. And so, we are super fortunate. We work really well together and are so happy to serve the clientele that we are able to in this wonderful venue here at the World Equestrian Center.

Melanie Cole, MS: Well, it certainly sounds just exactly like you say. I mean, that's world class. And Dr. Morton, sticking with you for a minute, what are some of the common injuries or health concerns that affect elite equine athletes? What do you see most often?

Alison Morton, DVM: That's a great question, Melanie. And we see a lot of different things, and that can be like you, who works in exercise physiology in people, depending on the discipline. And the predominant discipline that we do see during the season is our English sport horse. And so, we do see these horses tend to be in their middle age, but you know, some of them are younger and some of them are older. But we do see a lot of musculoskeletal injuries, a lot of osteoarthritis. And so, we may be treating horses that just have arthritis, but we do see quite a lot of soft tissue injuries and those tend to be tendon and ligament injuries in the lower leg of horses. And so, we may be treating injuries like suspensory ligament injuries or tendon injuries, the superficial and deep digital flexor tendon injuries. But we can see a myriad of lot of different things. We are seeing more and more disease of the cervical facets or neck vertebrae and in the back. And with the advent of these newer diagnostic imaging modalities, we're able to go and place these horses in a CT and do a CT scan of almost the entire horse now, which until a few years ago was not a capability that we could actually perform. But now, these advanced imaging modalities, we can do a lot of this standing and for the parts that we can't do standing, we can place the horse under general anesthesia and get almost the entire horse.

So, there's probably not one particular injury that we see more frequently than the other, other than the disease of the foot that we see in most all horses. But in our English sport horses, we see a lot of variable diseases and a lot of times in a lot of different combinations. So, a horse may have some foot lameness that is very common in all types of horses, but they may also be suffering from some neck pain or some muscle pain in their low backs, and it really does take a team and people with a lot of experience to address all of those different concerns and make sure we're not ignoring one of these parts to kind of go with the kind of typical traditional, "Oh, the horse has got a sore foot, so we need to address that" and then, not pay attention to all the other parts of the horse that may be bothering them to get these elite athletes back to the show arena.

Melanie Cole, MS: You make a great point too, Dr. Morton, and we've learned so much more in humans and in animals about how it's all connected. And you just made that point. Now, Dr. Bell, what are some of the key factors to consider when you're designing training programs for elite equine athletes to optimize their performance? And while you're telling us that, are you seeing a higher performance from these athletes? Are they faster, stronger than maybe 20 years ago? And if so, to what are we attributing that to?

Robin Bell, BV.SC: Very good question. I'll start with the second part first. It's very hard to judge whether we're seeing an improvement in performance compared to 20 years ago because the sports, with the exception of I guess racing, have changed a lot, they've evolved. We're working on different surfaces where the jumps tend to be different. In eventing, that whole sport has totally and absolutely changed. So, you know, they've taken out the steeplechase phase at the Olympics. They've taken out the roads and tracks. They've made the cross country much, much safer for both riders and horses, but that does make it a little bit softer. And what they've done with that is they've made the times a lot harder to get. So, it's hard to compare.

For me personally, I think we are seeing less of certain sorts of injuries, so we see a lot less breakdown injuries in our jumpers and our cross country horses, but I think we're seeing a little bit more of the suspensory ligament injuries on these newer surfaces. So, I think things just change around a little bit.

And to answer to your first question, how do I go about maximizing these horses' performance? Well, I think we need to make sure that the horse is as free of lameness and problems as possible. So, with all my elite horses, I try to see them at least twice a year, maybe more frequently if they're a little bit older. And what we'll do is a complete exam as well as trotting them up for lameness and then probably follow up with diagnostics from there if we see something that's changed and then tailor some specific treatments to whatever we're finding.

The other thing I really like to do with these horses is have them on supplements that are purported, and some of them have more evidence behind them than others that help to prevent arthritis and other clinical problems.

Alison Morton, DVM: And if I can just add a couple things to that as well too, I think, Dr. Bell talks about those couple times a year exams, I think those are really important for us to do for our performance horses. And along that, having a training program that is not always just about training them for the performance in their arena, that is a cross-training program that designs a strengthening program that is for what they don't always do. And so, I think when we are athletes, we tend to do what we do really well and develop strength for what we do well. But then when we go to do something that we don't normally do, we're weaker in that and that's where some of the musculature and the flexibility and things that are not as inherent to our sport, those need to be developed as well too.

And just like human athletes, when you're a sprint runner, you don't have much endurance. But if you get fatigued because you're running more frequently in your performance during your competitions, you need to have some endurance training and vice versa, those endurance athletes may need to do some sprinting to be able to develop some of that, speed work and agility work, that when they get into a situation, that they may need that to get out of a situation that might cause them an injury, they have that depth within their kind of tools to be able to perform well. And I think that's the same with our equine athletes. And so, that's something that we do with our kind of our rehab facilities that we have here.

And we struggle for a better term than rehab, and I haven't come up with one better than kind of conditioning, but it's not really kind of conditioning or training. There's a better term out there that we need to develop, but that kind of training that we can do to make sure that they're really well developed and rounded in their condition and can go out there and be prepared for something that they're unexpected.

Melanie Cole, MS: Well then, Dr. Morton, along those lines, as you're doing performance evaluations for lameness, neurologic, respiratory, gastrointestinal, cardiac, any of these kinds of conditions, and you really mentioned this team approach in multidisciplinary care, can you, depending on your findings during any examination, speak about some of the treatment modalities for some of these injuries? As you were mentioning, hydrotherapy and the underwater treadmill, and I mean, you've got all of this amazing equipment, tell us a little bit about how it all works and some of the treatments that you've found that really work well.

Alison Morton, DVM: Sure, Melanie. And I'll ask Dr. Bell to comment too, because one of the modalities we've been using more frequently, he has probably a little bit more experience with. But we use probably the underwater treadmill and we have one that is at kind of a traditional temperature, 74 degrees Fahrenheit, it can be used for conditioning and/or injury rehabilitation.

But we also have a cold water that is just above kind of freezing, that these horses can go into and has the benefits of the cold water as well as the hydrotherapy. And that really provides two things. It provides some kind of buoyancy that if you have a horse that has an injury that's in the lower limb, you can kind of decrease the amount of stress or strain that's placed on that tendon. And also, with the cold water, if you're putting them there that you also have those kind of effects of the cold therapy, but also you can increase the resistance that they go through as you increase the amount of water that they're moving through too. So, this is really great for kind of conditioning and depending on what type of injuries you're doing.

Robin Bell, BV.SC: I'll probably jump in there, because as you alluded, Dr. Morton, I do think one of the strengths of what we can offer here for these elite athletes is a change or a break in their daily training environment. Because, as Dr. Morton alluded, we often get sort of stuck. I call it stuck in the arena, whether that be doing dressage or show jumping. And all of our training tends to be around there, and especially somewhere here like Ocala, which is a lovely place to live, but it's very, very flat. So, often, I'll suggest my clients go and do hill work, but the underwater treadmills allow us to introduce some change and some different work for these horses in their daily training environment. And so, it also allows, which is unless you're doing carriage driving, allows us to work these horses in a straight line for a long period of time. Whereas we struggle a little bit with our show jumpers and our dressage horses, because you can only keep them going straight for so long. And I think it really helps to build up their core strength and their muscles and we can vary the height of the water as Dr. Morton mentioned. And so if I'm wanting to try and condition these horses, one time when they come through, we'll put them all the way up to the stifle so they really have to work. Or for a change in the way they're using themselves, I'll probably put the water up to about their fetlocks, so that they're doing the high stepping motion through the water. So, I've found it a really valuable addition and we have a number of Grand Prix show jumpers and actually Grand Prix dressage horses that use this facility and these treadmills as often as two or three times a week.

Alison Morton, DVM: And certainly some of the other modalities, one of the ones that you talked about, some of the different diseases that we can treat for these performance horses, and we get stuck on musculoskeletal disease, which is a very common, probably the most common, performance-limiting problems that we see. But respiratory disease and cardiac disease is also something that is performance-limiting in a lot of these horses. And respiratory disease, especially lower airway disease, can be something that can limit these horses as well. And we have a newer therapy that's a dry salt therapy that is a room that's got a low humidity and then basically pumps in this ultra fine sodium chloride or table salt particles in, and they breathe this in and provides a couple things. If they have some inflammation, it quells some of that inflammation as well as if they have some low-grade infection, it has some antimicrobial effects, and a lot of other things that are not super well understood now. But there's some evidence from research in people that have had lower airway disease, whether that's asthma or some of the other airway diseases like COPD or pneumonia and things like that, that treat it very well and also has some benefits like here in Florida, especially as we approach the summertime, some of the skin disease that they can encounter, which is not necessarily always performance-limiting, but can be debilitating in some conditions. And also, you know, just kind of a pain in the rear end for some of these horses that are sensitive to some of the different skin conditions that are especially prevalent in florida.

Robin Bell, BV.SC: Yeah. And I just have to jump in there too. I personally can attest to the salt room. I've really struggled over here with allergic bronchitis, with all the different allergens, having come straight from a much drier environment in Australia. And so, I can often be seen holding the first Halotherapy Horse of the Day, and I can really feel the difference in my breathing having sat in that salt room for 20 odd minutes. It's balanced a bit because I'm actually allergic to horses. So, it's a bit of a two-edged sword. But it is a really good therapy that we have available here.

Melanie Cole, MS: And Dr. Bell, you know, when in the world of sports medicine and when we're talking about elite athletes, we're always talking about burnout and overuse injuries and the mental aspect that goes into being an elite athlete. How do you balance the horse's physical and mental wellbeing while pushing them to perform at their highest level and working on any injuries and modalities and all these cool things you just discussed with us? Tell us a little bit about how you work on that mental wellbeing.

Robin Bell, BV.SC: As part of my work with the Australian Equestrian Team, we work closely with the Australian Institute of Sport, which is one of the top elite sport institutes in the world and probably the sole reason that Australia wins so many per capita Olympic medals. And what we found with work that they did is that actually what we often think of as overuse injuries are actually under training. And the reason they find that is that when the time that athletes injure themselves the most is coming into camp. And so, what we do in any of our disciplines actually, whether that be equestrian or swimming or running, is before major championships, the whole team will get together in camp for really intensive training. And it's when they step that training up, those athletes are often not prepared for that, and that's when they'll have injuries. So, a lot of it is managing what we call their daily training environment, what they're doing on a day to day basis.

We're lucky in that horses don't have to do this sport. They have to want to do it at this level and they have to love doing it. And as soon as they don't love doing it, then they stop doing it. And so, we find it a lot easier, I think, than our human coaches for more conventional disciplines is that the horses tell us when they need a break. They'll start having rails. They may not be doing as well in their dressage tests. And so, all we have to do to fix that is give them a little break and it's as quick as two or three weeks out in the paddock eating grass or whatever they like. They tend to come back really well from that.

Alison Morton, DVM: Yeah, I totally agree. I think that horses are not inherently mean, right? Once in a while, just like people, you get a bad horse. But for the most part, horses don't behave poorly. And when they start behaving poorly, they're telling you something. Either something is hurting them or they're having a bad time and responding to that appropriately through whatever type of enrichment, whether that's time off or a different environment when they're going on the circuit,. They may only ever be in a stall and they need to go out and be pasture horses and providing them simple things as turnout when they're at a show venue can be really, really enriching for them, you know, great enrichment for them and making sure you provide that and keep their routine as normal as possible. And I think that we forget about that when they're showing, that they are horses and they need to do that normal horse activity. The more they can be a normal horse, the more that they kind of love their life. And I think that's a really important thing for horse owners and trainers to remember.

Melanie Cole, MS: I'm so glad you both brought that up, because it is really different than in the elite athlete human world where we tend to push ourselves or, you know, that sort of thing breaks down. But I'd like to give you each a chance for a final thought here. So, Dr. Bell, I'd like you to speak about any role, alternative therapies, acupuncture, chiropractic. You mentioned nutrition earlier and supplements. I'd like you to speak to that for a minute and just tell us where that fits into the picture to optimize that performance.

Robin Bell, BV.SC: Yeah. And that's a really good question as well. And for me, I think of our management of these elite athletes in the whole. And so, that means you need a good team around you from every aspect. And not one person can bring all those skills to bear, which is what Dr. Morton was alluding to, which I love here, is that we have such a strong team here, each with individual strengths and frankly weaknesses, but that compliment each other really well.

And so, for me, you mentioned chiropractic. I think that me as a surgeon, I often get a little bit too orthopedic focused and not focused enough on the soft tissues as I should be, the muscles. And so, I think having a very good body workup. I also really like good qualified chiropractic practitioners. And that's where we're lucky enough that Dr. Taintor, not only being an internist, as well as sports medicine boarded, she's also qualified in chiropractic.

And the final thing I'll address is acupuncture, which I absolutely love. And I think having a good acupuncturist as well, it's on my list to do, but my wife's going to kill me if I go and do any more training. So, I think I'll leave it to other people. But acupuncture I think has a lot to offer these horses, especially because we can use it legally within competition and really help those horses out.

Melanie Cole, MS: Dr. Morton, last word to you. As we're speaking about optimizing that performance in the elite equine athlete, what would you like the key message to be? What would you like other providers to take away from the specialists that you are at the UF Veterinary Hospital at World Equestrian Center, and really the specialized expertise that you provide there?

Alison Morton, DVM: Oh, thanks, Melanie. I think that the message I would like to get out there is that we are quite available and we are not the only people on that team. The team comes from everybody that's involved with that horse, it comes from the rider. It comes from the trainer. It comes from the veterinarians that work with that horse day in, day out. And so, there are a lot of good veterinarians that are not here at our hospital, but work with those horses at the horse show at home and know those horses frankly better than we do. We see them for a very short period of time, maybe even only on a day or two for the horses that come in for the horse show and we're helping those veterinarians and those clients out for that horse. And so, they are as equally as important and have different expertise than we do, and it really is a team approach to get that elite athlete to do the best that they can do and help that client to optimize the performance in their horse.

Melanie Cole, MS: What an interesting episode this was. So informative and really a fun issue to talk about because what you both do is just so cool and so important. And thank you so much for joining us today. And for more information about the UF College of Veterinary Medicine, please visit vetmed.ufl.edu/ufachievers. And to listen to more podcasts from our experts, you can visit vetmed.ufl.edu.

And that concludes today's episode of UF Vet Med Voice brought to you by the University of Florida College of Veterinary Medicine, advancing animal, human and environmental health. I'm Melanie Cole. Thanks so much for joining us today.