The effect of induced forelimb lameness on thoracolumbar kinematics during treadmill locomotion

REASONS FOR PERFORMING STUDY: Lameness has often been suggested to result in altered movement of the back, but there are no detailed studies describing such a relationship in quantitative terms. OBJECTIVES: To quantify the effect of induced subtle forelimb lameness on thoracolumbar kinematics in the horse. METHODS: Kinematics of 6 riding horses was measured at walk and at trot on a treadmill before and after the induction of reversible forelimb lameness grade 2 (AAEP scale 1-5). Ground reaction forces (GRF) for individual limbs were calculated from kinematics. RESULTS: The horses significantly unloaded the painful limb by 11.5% at trot, while unloading at walk was not significant. The overall flexion-extension range of back motion decreased on average by 0.2 degrees at walk and increased by 3.3 degrees at trot (P<0.05). Changes in angular motion patterns of vertebral joints were noted only at trot, with an increase in flexion of 0.9 degrees at T10 (i.e. angle between T6, T10 and T13) during the stance phase of the sound diagonal and an increase in extension of the thoracolumbar area during stance of the lame diagonal (0.7degrees at T13, 0.8 degres at T17, 0.5 degres at L1, 0.4 degrees at L3 and 0.3 degrees at L5) (P<0.05). Lameness further caused a lateral bending of the cranial thoracic vertebral column towards the lame side (1.3 degrees at T10 and 0.9 degrees at T13) (P<0.05) during stance of the lame diagonal. CONCLUSIONS: Both range of motion and vertebral angular motion patterns are affected by subtle forelimb lameness. At walk, the effect is minimal, at trot the horses increased the vertebral range of motion and changed the pattern of thoracolumbar motion in the sagittal and horizontal planes, presumably in an attempt to move the centre of gravity away from the lame side and reduce the force on the affected limb. POTENTIAL RELEVANCE: Subtle forelimb lameness affects thoracolumbar kinematics. Future studies should aim at elucidating whether the altered movement patterns lead to back and/or neck dysfunction in the case of chronic lameness.     

Evaluation of discriminant analysis based on dorsoventral symmetry indices to quantify hindlimb lameness during over ground locomotion in the horse

Reasons for performing study: Advances in gait analysis techniques have led to assessment tools that can aid in detecting and quantifying lameness; here, bilateral tuberà coxae and pelvic movement during over ground locomotion are compared in order to investigate a practical method to assess hindlimb lameness in the horse. Objectives: To evaluate which parameters from anatomical landmarks on trunk and proximal hindlimbs are the best indicators of degree and side of hindlimb lameness. Methods: Fifteen horses (age 11–23 years, 6 nonlame and 9 unilaterally hindlimb lame horses 1/10 to 2/10 lame) were fitted with 4 inertial sensors: tuber sacrale, left and right tubera coxae and withers; 889 strides were collected from 6 trot trials per horse. Horses were assessed for lameness by a qualified equine orthopaedic surgeon from videos. Vertical displacement data for each sensor were used to calculate symmetry indices as well as published Fourier analysis based parameters. Linear discriminant analysis was used to determine the most discriminative parameters for 2 scenarios: grading of severity of lameness and identification of the affected limb. Results: Pelvic energy ratio gave the best indication for the degree of lameness. Directional symmetry index of the tubera coxae sensors yielded the highest discriminative power for identification of the lame limb. Conclusions and potential relevance: A good indication of the degree of hindlimb lameness can be obtained from vertical displacement data of the pelvic midline, collected from inertial sensors during over ground locomotion. The trunk mounted inertial sensor system allows for a time efficient collection of a representative database from horses with differing grade and site of lameness in a clinical setting. This is crucial for future work on a robust definition of the best parameters for lameness classification under practical conditions.     

Back kinematics of healthy trotting horses during treadmill versus over ground locomotion

Reasons for performing study: Treadmill locomotion is frequently used for training of sport horses, for diagnostic purposes and for research. Identification of the possible biomechanical differences and similarities between the back movement during treadmill (T) and over ground (O) locomotion is essential for the correct interpretation of research results. Objectives: To compare the kinematics of the thoracolumbar vertebral column in treadmill and over ground locomotion in healthy horses. Methods: Six sound Dutch Warmblood horses trotted on a T and O during 10 s at their own preferred velocity (mean ± s.d. 3.6 ± 0.3 m/s T and 3.6 ± 0.1 m/s O), which was the same in both conditions. Kinematics of the vertebral column was captured by infrared cameras using reflective skin markers attached over the spinous processes of selected vertebrae and other locations. Flexion‐extension and lateral bending range of motion (ROM), angular motion pattern (AMP) and intravertebral pattern symmetry (IVPS) of 5 vertebral angles (T6‐T10‐T13, T10‐T13‐T17, T13‐T17‐L1, T17‐L1‐L3 and L1‐L3‐l5) were calculated. Neck angle, linear and temporal stride parameters and protraction‐retraction angles of the limbs were also calculated. Results: The vertical ROM (flexion‐extension) was similar in both conditions, but the horizontal ROM (lateral bending) of the lumbar angles T17‐L1‐L3 and L1‐L3‐L5 was less during T locomotion (mean ± s.d. difference of 1.8 ± 0.6 and 1.7 ± 0.9°, respectively, P>0.05). During O locomotion, the symmetry pattern of the lumbar vertebral angles was diminished from 0.9 to 0.7 (1 = 100% symmetry) indicating increased irregularity of the movement (P>0.05). No differences were found in the basic linear and temporal stride parameters and neck angle. Potential relevance: Vertebral kinematics during treadmill locomotion is not identical to over ground locomotion, but the differences are minor. During treadmill locomotion lumbar motion is less, and caution should be therefore taken when interpreting lumbar kinematics.     

The effect of different head and neck positions on the caudal back and hindlimb kinematics in the elite dressage horse at trot

Reasons for performing study: Dressage involves training of the horse with the head and neck placed in a position defined by the rider. The best position for dressage training is currently under debate among riders and trainers, but there are few scientific data available to confirm or disprove the different views. Objective: To evaluate the kinematic effects of different head and neck positions (HNPs) in elite dressage horses ridden at trot. Methods: Seven high‐level dressage horses were subjected to kinetic and kinematic measurements when ridden on a treadmill with the head and neck in 5 different positions. Results: Compared to free trot on loose reins the HNP desired for collected trot at dressage competitions increased T6 vertical excursion, increased sacral flexion and decreased limb retraction after lift‐off. Further increasing head or head and neck flexion caused few additional changes while an extremely elevated neck position increased hindlimb flexion and lumbar back extension during stance, increased hindlimb flexion during swing and further increased trunk vertical excursion. Conclusions: The movements of the horse are significantly different when ridden on loose reins compared to the position used in collected trot. The exact degree of neck flexion is, however, not consistently correlated to the movements of the horse's limbs and trunk at collected trot. An extremely elevated neck position can produce some effects commonly associated with increased degree of collection, but the increased back extension observed with this position may place the horse at risk of injury if ridden in this position for a prolonged period. Potential relevance: Head and neck positions influence significantly the kinematics of the ridden horse. It is important for riders and trainers to be aware of these effects in dressage training.     

Evidence of the development of ‘domain‐restricted’ expertise in the recognition of asymmetric motion characteristics of hindlimb lameness in the horse

Reasons for performing study: Visual assessment of horses' movements is subjective, affected by bias and dependent on the level of experience of the assessor. However, to date there are no data available on the ability of the human visual system to recognise (a)symmetry in moving objects. Objectives: To investigate, using visual lameness assessment, the limits of human perception and the ability of experienced and nonexperienced individuals to detect asymmetry in 2 moving objects simulating hindlimb lameness in the horse. Methods: Twelve experienced individuals (equine and small animal clinicians), and 24 nonexperienced individuals (undergraduate veterinary students) were presented with computer simulations showing 2 ‘tuber coxae markers’ created using data from both lame and nonperceptibly lame horses, as well as artificial data based on a sine wave. Individuals were asked to classify as symmetrical or asymmetrical, and then rank based on the grade of perceived asymmetry. Repeatability and learning effect were evaluated by repeating the tests on a subset of subjects. Results: The threshold for detection of movement asymmetry was found to be approximately 25% difference in amplitude between the 2 moving objects for all individuals. There was no significant difference between experienced and nonexperienced individuals in the ability to detect asymmetry in the simulations based on artificial data. However, the percentage of correct answers was higher for experienced compared to nonexperienced individuals for simulations based on data from real lame horses. Conclusions: There was a significant difference between experienced and nonexperienced individuals in the ability to identify asymmetric movement based on the pattern seen in a lame horse, as opposed to an artificial pattern for which all individuals showed similar performance. Potential relevance: The study provides the basis for the development of computer simulations that could aid in training veterinarians in the diagnosis of lameness and, even, the objective assessment of expertise in this field.     

Compensatory load redistribution of horses with induced weightbearing hindlimb lameness trotting on a treadmill

REASONS FOR PERFORMING STUDY: The compensatory mechanisms of horses with weightbearing hindlimb lameness are still not fully understood. HYPOTHESIS: That weightbearing, unilateral hindlimb lameness would not only alter stride characteristics to diminish structural stress in the affected limb but also induce compensatory load adjustments in the other supporting limbs. OBJECTIVE: To document the load and time shifting mechanisms of horses with unilateral weightbearing hindlimb lameness. METHODS: Reversible lameness was induced in 8 clinically sound horses by applying a solar pressure model. Three degrees of lameness (subtle, mild and moderate) were induced and compared with the nonlame (sound) control measurement. Vertical ground reaction forces were recorded for all 4 limbs simultaneously on an instrumented treadmill. RESULTS: Compared to the sound situation, moderate hindlimb hoof lameness induced a decrease in stride duration (-3.3%) and stride impulse (-3.1%). Diagonal impulse decreased selectively in the lame diagonal stance (-7.7%). Within the diagonal limb pair, vertical impulse was shifted to the forelimb during the lame diagonal stance (+6.5%) and to the hindlimb during the sound diagonal stance (+3.2%). Peak vertical force and vertical impulse decreased in the lame limb (-15%), but only vertical impulse increased in the contralateral hindlimb (+5.7%). Stance duration was prolonged in both hindlimbs (+2.5%). Suspension duration was reduced to a greater extent after push-off of the lame diagonal limb pair (-21%) than after the sound diagonal limb pair (-9.2%). CONCLUSIONS: Four compensatory mechanisms could be identified that served to reduce structural stress, i.e. peak vertical force on the affected limb: 1) reduction of the total vertical impulse per stride; 2) diagonal impulse decreased selectively in the lame diagonal; 3) impulse was shifted within the lame diagonal to the forelimb and in the sound diagonal to the hindlimb; and 4) the rate of loading and peak forces were reduced by prolonging the stance duration. POTENTIAL RELEVANCE: Load shifting mechanisms are not only effective in diminishing peak forces in the affected limb, but also suppress compensatory overload in other limbs. Selected force and time parameters allow the unequivocal identification of the lame limb. Future studies have to examine how far these compensatory mechanisms may be generalised for other defined orthopaedic problems in the hindlimb.     

Comparison of visual lameness scores to gait asymmetry in racing Thoroughbreds during trot in-hand

Regular monitoring of movement asymmetry with inertial measurement units (IMUs) to aid in the diagnosis of the underlying cause of a lameness is feasible. Normal ranges for specific groups of horses may be required, with consideration of expert veterinary opinions for both asymmetry screening and lameness assessment. The aim of this study was to determine movement asymmetry values compared with expert lameness scores to enable screening for lameness in Thoroughbreds in race training. IMU gait assessment during in-hand trot-up was performed in 25 racehorses undergoing routine gait analysis or lameness examination at the Singapore Turf Club. Video recordings were graded numerically (0–5) for lameness by six experienced racehorse veterinarians. Inter-observer agreement and consistency were determined. Median lameness scores were used to calculate sensitivity and specificity for head, withers and pelvic movement asymmetry. Guideline values for aligning movement asymmetry values with expert opinions about forelimb and hindlimb lameness were determined from receiver operating characteristics (ROC). Inter-observer agreement was poor to fair, inter-observer consistency was good (intraclass correlation coefficient: 0.667 for forelimbs and 0.617 for hindlimbs). ROCs indicated higher discriminative power for hindlimb lameness using pelvic asymmetry (90% sensitivity, 93% specificity) compared with forelimb lameness using head asymmetry (69% sensitivity, 89% specificity) or withers asymmetry (44% sensitivity, 89% specificity). When compared to expert lameness scores from videos of a limited number of Thoroughbred racehorses, preliminary guideline values for movement asymmetry screening for forelimb lameness (>|14.5 mm|) and hindlimb lameness (>|7.5 mm|) are higher than previously reported clinical thresholds of >|7 mm| for head movement and >|4 mm| for pelvic movement asymmetry.