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Regenerate

Regenerative technique for horses to aid the body repair injuries old or new where gait and sports performance are adversely compromised.

With Marc's high-powered analogue ultrasound it is possible to look 40 cm into the body with good detail for approx 25cm - sufficient to image the major muscle groups and spot tears with great detail.

Once a tear has been identified it can be injected under guidance with the ultrasound to ensure the regenerative cocktail is correctly introduced.

All Chronic Lameness Starts High Up

This title is a rather unconventional and controversial statement, yet there are historical reasons as to why the common perception is that lameness starts in the foot or low down on a leg.

Firstly, it would appear to make sense that the structure that is in contact with the ground is getting all the abuse and likely to fail. There is some truth in this reasoning, however the foot has evolved to take the punishment of running on hard ground. Nature saw to it that those who had poor feet and couldn't run as fast were eaten first!! The hoof mechanism that acts as assistance to blood circulation also cushions the concussive forces when the foot lands. The hardness of the hoof tends to direct forces higher up rather than into the foot. The frog, digital cushion and tendon arrangements also cushion the landing and the fetlock drops which acts as the horse's suspension system. Shoeing horses interfere's with some of these adaptations and directs concussive forces higher up the leg too.

Secondly, lameness investigation using nerve blocks, ultrasound and X-rays are easier to perform on the lower leg and foot which means these areas are investigated first and anything that's not perfect is likely to get the blame and halt higher investigations.

Regardless of these factors, muscle is more prone to tears and strains than bone and harder connective tissue that makes up ligaments and tendons. The weakest point is where muscle joins tendon which attaches muscle to bone. Ligaments join bone to bone and again the weakest point is at the attachment although injuries such as stretches, tears and ruptures can occur within the body of the ligament too.

All too frequently the joint itself is blamed for lameness ignoring the possibility that it could be damage to the muscles that are involved in joint movement and/or stabilisation. Muscles are recognised as the structures that are most prone to injury in human athletics but are largely ignored in horses because injuries are difficult to identify with the type of equipment that most vets carry in cars. Unfortunately, once joints are identified as the culprit they are all too frequently injected with steroids. Steroids preparations also include collagenases ie enzymes that break down collagen. Collagen is the main structural protein in ligaments, tendons and cartilage and will be damaged in these soft-tissue injuries and must be repaired in order to return the proper structure and function. Although injected with the best intention, steroids are contra-indicated in these situations as they suppress repair.

Muscle tears don't necessarily result in overt lameness. It is possible to have gait anomalies and muscle weakeness without the horse actually being perceived as lame. For example a show-jumper with a tear in the gluteal muscle will have a functional deficit on this side (ie will be weaker) so will tend to drift to the same side because the stronger gluteal without functional deficit will push off more strongly. In Dressage horses, those with muscle tears will frequently find it difficult to stabilise the stifle and struggle to sit for more advanced movements and/or lateral work and in transitions.

In all treatment options set out below, Stem Cell nutrition in the form of StemEquine will significantly help the repair process.

What happens when muscle tears?

Damaged muscles leak tissue fluid that contains cytokines and other markers that signal to circulating Stem Cells to migrate along the concentration gradient to source and make good any damage. This process happens every day as small micro-tears are common and a part of what stimulates muscles to get bigger and stronger as the body attempts to resist further injury. It is a part of normal body maintenance.

With micro-tears and small tears up to a certain size, this innate healing response is sufficient for the body to repair itself without any intervention provided the rest days in the training programme are recognised as being as important as the active days.

With larger muscle tears the same process takes place, however the Stem Cells will seal the tissue fluid leakage around the edge of the tear first. If the torn muscle is sealed before the Stem Cells have filled in the whole tear space then there is no further tissue fluid leakage and no more signalling for the Stem Cells. The repair process stops but leaves a structural and functional hole in the muscle.

When this happens, external intervention is required to stimulate the healing process to restart and complete the unfinished job of repairing the muscle. There are a number of options, some better and/or faster than others.

Stem Cell Therapy

Stem Cells were hailed as the Holy Grail of healing when they were first identified and studied and still have that potential. However it is not quite as straight forward as was first thought and although Stem Cell Therapy is offered by a number of MsRCVS there are good reasons why it has largely been put on hold within human medicine.

Stem Cells are pre-programmed to differentiate into certain cells and tissue and it is currently impossible to identify which Stem Cells in the bone marrow and circulation are going to become which tissue in advance. When bone marrow is harvested to collect Stem Cells with a view to repairing a tendon, ligament or muscle tear etc the proportion of relevant Stem Cells appropriate for the damaged tissue type within the total number of Stem Cells collected is very small. However, when introduced into a lesion the introduced Stem Cells are stimulated according to the leaking signalling molecules to differentiate into the damaged tissue type. The lesion heals and everything appears to be good and it looks like Stem Cells have fulfilled their original promise.

However, with no further leakage of the signalling molecules that direct the Stem Cell division into a certain tissue, the original pre-programmed cell type override kicks in. Cells start to divide and become the tissue type they were originally intended to be. This results in the wrong tissue in the wrong situation which forces the body to respond against these cells which creates renewed weakness in the original site of injury which predisposes it to another lesion at that site.

Until Stem Cells can be identified according to future tissue type at harvest they remain a less than satisfactory technique.

A better Alternative

There is a better and safer alternative to Stem Cell Therapy that does not require surgery to harvest Stem Cells yet can encourage the body to completely regenerate the correct tissue type for the injury without introducing the the wrong cells into the injury site.

Using very powerful analogue ultrasound imaging it is possible to look deep into large muscle groups at certain risk areas and identify tears. This imaging work is done alongside Roger by Belgium's top Professor for Soft Tissue Sports Injury, Marc van Cleynenbreugel. Once imaged, Roger can diagnose the injured area(s) so that treatment can start.

A special formula that includes the horse's own plasma, signalling chemicals and certain nutrients to help the body heal the tear takes the process one step back before Stem Cells. It is injected under ultrasound imaging guidance directly into the tear. In this way, the correct innate Stem Cells are stimulated to migrate from the blood circulation again into the lesion site and continue where they previously left off when the tear was sealed. The muscle/ligament/tendon heals with the correct tissue type and no risk of the wrong tissue developing in the lesion in future. Tears are checked and monitored every 4-6 weeks to ensure that healing is progressing as it should and to ensure it is safe to increase exercise as and when.

Using this technique, tears that were never going to repair on their own can be made as good as new! It can take 3-6 mths+ to fully fill in a tear depending on size. The repair is helped by carefully controlled exercise according to a very specific regime. Once the tear has been replaced with new tissue it then needs to strengthen as the level of work increases as with normal fitness work post injury.

For high performance horses that can go out and win the cost of repeat treatment, it is possible for horses to return to competition before the tear has fully healed, however they require more of the special formula which is expensive. Repair will take a similar length of time but is significantly more expensive depending on how many repeat injections of formula are required and goes against Roger's and Marc's ideal recommendations to give the horse time off for injuries to heal properly first.

Scenar and Cosmodic treatment can help stimulate muscle tear injuries to repair but have to first unseal the tear and stimulate the Stem Cells to revisit the injured area. This process is therefore a longer process. Without the imaging it is reliant on Roger's interpretation of the biofeedback between the horse and the device to try to identify at what point the lesion is filled in. The upside is that it is cheaper but still takes months of intermittent treatment sessions to heal.

For more info on Scenar see here ...