Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Elevating Equine Performance: The Role of Water Treadmills in Training and Recovery
Dr. Claudia Fraschetto provides groundbreaking insight on how water treadmills can revolutionize your horse's regimen. Prepare to have your understanding of equine biomechanics enhanced as Claudia walks us through the interplay between water depth, treadmill speed, and their collective impact on a horse's musculoskeletal system. We traverse the complexities of trunk vertical displacement during trotting and why it's critical for designing tailored rehabilitation and conditioning programs.
Join us for a thought-provoking session that merges science with practical applications in the equine world. Claudia, with her surgical precision and passion for equine welfare, shares her expertise on the multifaceted benefits of water treadmill use—from mitigating limb impact to augmenting neuromuscular function. Our discussion extends beyond theory into the realm of clinical practice, where Claudia guides us through the nuances of individualized water treadmill protocols, general indications, and contraindications, ensuring veterinarians and horse trainers are equipped with the necessary tools to elevate the health and performance of their equine athletes.
AJVR article: https://doi.org/10.2460/ajvr.23.10.0236
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You're listening to Veterinary Vertex, a podcast of the APMA journals. In this episode, we chat about water depth and speed for horses treading on a water treadmill with our guest, Claudia Frachato.
Speaker 2:Hi, thank you very much for inviting me.
Speaker 1:Claudia, your AJVR article discusses how water depth and speed may have an opposite effect on the trunk. Vertical displacement in horses treading on a water treadmill. Please share with our listeners the background on this study.
Speaker 2:Yes, of course. So this is the first published study with a biomechanical analysis of horses treading on a water treadmill at different conditions of water depth and speed. And while we carry out this study it's a quite long story but I will try to briefly explain that. Probably everybody knows this, but for the past 15 years has been a growing interest in the water treadmill, which is today a very popular training or habilitation modality for horses, and we know that the locomotion of horses is different when moving in water compared to overground. This is because there are additional forces acting on the musculoskeletal system due to the presence of water, like the buoyancy that reduces the body weight and the drag force that opposes to the forward movement of the horse and so increases the workload needed for moving in water. And basically we can influence these forces by selecting the water depth and the belt speed. So it's possible to design different protocols depending on the individual horse condition and on the desired effects. But this is also why the choice of the appropriate protocol is a common concern among veterinarians and professionals, because there are a lot of possibilities. Fortunately, the scientific research on this area has also grown considerably and thanks to that today we have first guidelines for using the water treadmill and also a consensus statement published in 2021. A nice picture on the use of the water treadmill in equine practice was also mostly in European countries. It was also given by an international survey made in the UK in 2018. That was interesting because highlighted that indeed, the protocol used in practice are variable and so the indications for using this modality.
Speaker 2:But generally the work is the gate most used, especially for rehab, but also trotting on a water treadmill is possible, and clinicians or trainers mainly use this exercise to improve the fitness and condition of horses. However, looking at the literature, we can see that most of the studies published on the water treadmill are realized in horses walking at slow speed, usually from 2 to 3 km per hour, so it's lower speed than the speed actually used in practice, and there are approximately 10 studies that analyze the locomotion of the horses at the walk on a water treadmill, but only two preliminary studies that analyze the trot underwater. So it's clear that there is a lack of objective data about horses trotting in water, and the first question we had when designing our research was why the trot has not been studied so far. So we had several explanations to that. Our first reason was that the water treadmill is usually considered for a rehab program, and a rehabilitation program usually starts at the walk, so there is more focus on this gate. A second reason was that, in general, kinematic studies with skin markers are considered the gold standard for gate analysis, but it's difficult to use this method by moving in water at high speed. Fortunately, other technologies like waterproof accelerometers are now available and they are easier to use. For that, another reason was that not all the water treadmills can reach trotting speeds. And finally, the consensus statement published in 2021, the clinicians working on this area stated that trotting in water doesn't give additional benefits to the horse and may overuse the machine. So, based on their experience, there is no reason to recommend this type of exercise. And, of course, these considerations are important to consider.
Speaker 2:But in our opinion, it was still interesting to have more scientific and objective data to know what the positive and negative effects are related to this, and especially because trotting in water is not rarely used to train horses.
Speaker 2:For example, in some countries, like here in Normandy in France, trotting on the beach is commonly integrated in training programs and can be considered quite a similar situation to water treadmills. So trotting in water deserves more attention and this is why our study. So we used the six sound standard retorses and accelerometers placed on the back and pelvis to measure the dorsal ventral movement of a trunk While the horses were trotting at three different water depths. So we used low water level at the mecanobone and intermediate one at the mid radius, and the highest water level was at the shoulder and true trotting speeds at 3.5 mps was the slow trot and 5 mps was the faster trot. And this is only a part of a big project. So we started with the analysis of the trunk movement, but there are a lot of things that we can still do. For example, we also placed accelerometers on the limbs of the same horses. So I hope that we will also conclude this part very soon.
Speaker 1:Thank you. So now we know a bit more about the study. What were some of the important findings from this study?
Speaker 2:Yeah, and I think that the important findings, to remember that the trunk, the dorsal ventral movement of the trot, can be modified by selecting the water depth and the belt speed. So it's important to consider both parameters and that they have mainly opposite effects. Because by increasing the water depth from dry to an intermediate water level I mean up to the radius the dorsal ventral movement of the trunk increases compared to trotting on the dry treadmill, while for this same condition, if we increase the trotting speed, the vertical displacement decreases. And this is true until the horse has the abdomen not completely underwater, because when the water is too high and at the level of the shoulder, this dorsal ventral movement decreases even if we increase the trotting speed. And to better understand these findings and the effect of the water depth, we have to imagine that the trunk of a horse moves regularly up and down like a sinusoid during the stanza ventrin phases, and so this movement is mainly passive at trot and related to the displacement of the abdominal mass. So if the horse is almost completely underwater, this movement is mainly limited. Instead, when the water level is not too high, the horse can step over the water and this vertical movement will increase. And so the trunk vertical displacement and about the effect of the trotting speed.
Speaker 2:We know that from previous studies the horse is trotting on a dry treadmill and at increasing speed that the activity of muscles stabilizing the spine, like the longissimus dorsi and viratus abdominis muscles, increases linearly with the speed, always a trot, so limiting this vertical displacement of the spine. So this can explain also the results in our study, even in horses trotting in water. And the second important finding was that the main variations of this dorsal ventral movement, depending on the water depth and speed, will happen at the Toracolumbar junction and this was not previously analyzed but unfortunately in this study we can say if the increase or decrease in the trunk movement is also associated to more flexion or extension of each spinal segment. That we analyzed Because we only measured the displacement in centimeter from the acceleration in the dorsal ventral axis. But hopefully the measurement of the spinal range of motion with accelerometers has been recently validated in our institution in horses trotting over ground, so it will be possible to measure also underwater in a second study.
Speaker 3:Thank you, Claudia. It's really difficult to put hard data behind these sorts of studies, so I appreciate it. You just spoke on some of the really interesting findings in your manuscript, but what was really surprising to you?
Speaker 2:It's a good point. I was not surprised about the main findings on the study because we expected such results, mostly by experience in using the water treatment and based also on previous tests we were done by the same research team. But it was also the first time we put the horses trotting on a water treatment with such high water I mean until the shoulder and at such high speed, because 5 mps correspond to 18 km per hour, so it's quite fast. And I was surprised about the tolerance of horses in doing that, because they were able to trot without panicking and keeping a regular gait during the protocol. So I was surprised that we didn't have a lot of variability in our data during this condition, as I expected.
Speaker 2:But I think that we used horses with a very good behaviour. They were trotter horses and maybe with dressage horses, for example, it would be different and the horses were used during exercise in water, on the treadmill or in the swimming pool. So this helped us in doing this protocol. However, I have to say that it was not always comfortable for them to trot in high water because there were a lot of waves in the treadmill and the horses tended to elevate their head to avoid the contact with the water. So they tended to sometimes to keep the neck overextended, and this should be considered because it can be uncomfortable, especially in horses with cervical pathologies, for example, or with kisses pines in the craniotoracic region.
Speaker 3:Yeah, that'll make sense. It's always nice when you get less variability in clinical data than you expected. What sparked your interest in your research? Interest in treadmill water treadmill for horses.
Speaker 2:I have always considered water treadmill a very interesting modality because it has several applications in rehabilitation or training programmes for horses and also other animals, like dogs, for example.
Speaker 2:So it's particularly useful for veterinarians doing mostly sport, medicine or rehabilitation.
Speaker 2:And the water treadmill is useful because it offers a way to exercise a horse in a straight line on a firm surface and with the additional benefits of water, for example in reducing the body weight and the ground direction forces on the distal limb or in stimulating the proprioception neuromuscular function, or it can be used to improve the range of motion and the muscular activity of some muscle groups, for example.
Speaker 2:So it's a very interesting modality. And in a water treadmill there is also more controlled environment compared to swimming pools, for example, because we can control the end, adapt the water level and speed and eventually stop the session if there is a good problem. It's also easily available in various centres. And finally, it's a very practical tool in research because, as we can select the parameters, we can do standardised protocols and we can also analyse the locomotion over several strides. So I was very happy to have such a research project on these interesting topics and I think that we have to continue to work on this area, to be more confident on its use, especially on clinical cases, because there are very few studies until now on the use of a water treadmill in horses with specific pathologies. So we have still a lot of things to do.
Speaker 3:Yeah, thank you. As an equine surgeon interested in rehab, of course I love this manuscript, yeah, and we're very pleased that you chose to share it with AJBR. Why did you choose to?
Speaker 1:submit your manuscript to AJBR.
Speaker 2:We wanted to publish in AJBR because, as I said, the Water Treatment is a very popular topic in the equine field and, more in general, in animal physiotherapy. So we wanted to realize a good quality manuscript with a good impact and to diffuse it worldwide. And this was also a first publication on horses trotting on a water treatment. So we cared particularly on the success of the manuscript and I'm very proud that it's now published in such a prestigious journal. And finally, we were also surprised about your reactivity in the review compared to Adard Journal and we really appreciated that.
Speaker 1:Well, thank you. We strive for a fast and fair review process for our authors and we're just really happy again that you share this manuscript with us and to those who are joining us on the podcast. We're currently talking about water treadmill use for horses with our guest, claudia. So, claudia, how did your advanced training prepare you to write this manuscript?
Speaker 2:I think that to carry out studies like this, it's important to have a solid basis in equine biomechanics, gait analysis and, of course, physiotherapy.
Speaker 2:So in doing my training in sport medicine, I could focus on these topics.
Speaker 2:During the last three years and when I started my residency program at the CIRAL, I had also a great opportunity to have a rehabilitation center in the facility with a water treadmill, so I was also exposed to some clinical cases that helped me in doing my research.
Speaker 2:And, of course, this study would not have been possible without at team work, because I was lucky to have technicians and students helping me with the horses during the data collection, or to have a medical engineer working with me with the sensors in doing the gait analysis and to be under supervision of expert clinicians. So, honestly, it was not always simple because I had a lot of work and a lot of data to analyze. But I've learned a lot in doing this study, especially thanks to my supervisors, because they always taught me to work on the study and on the manuscript step by step, so to focus on the basis first and before doing sophisticated things, and to be as clear and simple as possible. So it has been a very learning process for me, and I think that the manuscript is a nice representation of that, because we record some fundamental concepts about the biomechanics of trot, but in water and with a simple and, I think, well designed study. So I'm very grateful about that.
Speaker 1:That's excellent. This next set of questions is really important for our listeners. The first one is going to relate to the veterinarian. What is one piece of information the veterinarian should know before discussing water treadmills for horses with a client?
Speaker 2:Yeah, that's a good point. I think that veterinarians should be aware about the general indication and contraindications in using the water treadmill, because it's very popular in the equine field that there is also a risk of inappropriate use. For example, possible contraindications are they're using the acute inflammatory phase of tendons or joint injuries or the presence of wounds or skin problems like dermatitis. That is the most common adverse effect also after water treadmills sessions or the presence of respiratory, gastrointestinal disease or severe ataxia and ambulatory problems. An indication can be multiple, as I said, and for a lot of musculoskeletal injuries, and they depend mostly on the water depth and the speed used. So veterinarians can refer to a large number of studies published on this topic to have an idea about the best protocol to use. But even if we need references based on standardised protocols, I think that for clinical cases it's never the application of our recipe.
Speaker 2:We have to adapt the protocol based on the individual horse. So for me it's very important to do an initial assessment of the horse before starting a protocol. We have to assess, for example, the gait. We have to look for underlined pathologies and assess the horse behaviour. This is an important starting point to assess if the horse is progressing or worsening with the water treadmills, and after that we have to assess the horse periodically during the protocol and eventually adapt the water depth and the speed. So, even if it takes time, for me it's important that veterinarians should attend the session when possible and to look at the horse movement and behaviour to adapt the session as the best.
Speaker 1:And on the other side of the relationship, when we're thinking about the client, what's one thing the client should know to consider around water treadmills for horses.
Speaker 2:Yeah, I think that, on the other hand, the clients should always ask the veterinarian to assess the horse before starting a protocol to know if there is any contraindication for using a water treadmill or any underlying pathologies that can be potentially worsened by the exercising water and with an appropriate water level or speed. So a client should prefer training or rehabilitation centres with a qualified vet monitoring the horse during the session, but I am aware that it's not always possible. So, if not, it's important to monitor the horse for signs of fatigue, for example during the session, and it will be a horse not moving straight on the treadmill or with a tendency to stumbling, or with a decreased protraction of the forelimb or decreased engagement of the hindlimb, and in this case the speed and the water depth should be decreased or the session stopped. And the same is for the posture, as I said. If the head is too elevated, for example, the best is to decrease the water depth.
Speaker 3:Thank you, claudia. It's really again super that you're putting some clear science behind what's really important in our rehab. As we wind down the interview, we'd like to end with a little bit of a personal question and we'd like to ask you what is the first concert you attended?
Speaker 2:Very nice question. It was 15 years ago, I think? Yes, because it was in 2009 and I was in Italy and I took a last time ticket for Coldplay. So it was the time of Viva la Vida, the famous album, and I remember that it was so beautiful and I was so attached to being here, but I was crying during the concert during a lot of songs, so it was very, very, very beautiful.
Speaker 1:Yeah, I'd love to see Coldplay. I heard that there might be that much more time before they're not going to be touring anymore, so, yeah, I'm very happy to see you guys see them. That's awesome. And just thank you again, claudia, for being here today and for also sharing your manuscript with AJVR.
Speaker 2:Thank you. It was a great opportunity for me. Thank you.
Speaker 1:And to our listeners. You can read Claudia's article on our journal's website. I am Sarah Wright with Lisa40A. We want to thank each of you for joining us on this episode of the Veterinary Vertex Podcast. We love sharing cutting-edge veterinary research with you and we want to hear from you. Be sure to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
