Bramlage: Activity, not stall rest, helps heal some injuries

LEXINGTON, Ky. - Bone and musculoskeletal problems in North American Thoroughbreds are exacerbated by the near-universal practice of keeping racehorses in stalls, according to Dr. Larry Bramlage, one of the most well-known orthopedic specialists in the equine world.

Bramlage, speaking informally for an hour at Wednesday’s Safety and Welfare of the Racehorse Summit at the Keeneland sales pavilion in Lexington, said that a horse’s natural tendency to move constantly while grazing improves its blood circulation and leads to stronger bone. But most North American horses based at racetracks generally spend as much as 23 hours in a stall, where movement is limited, leading to weaker bone, Bramlage said.

The problem is most acute for horses that are suffering from minor bone injuries in the lower legs, Bramlage said. If the horses were turned out in a pasture, the natural impact on the bone and the stresses of supporting the weight from the movement would lead to faster and better healing.

"A lot of the problems we have with the skeletal system and the bone is that we make them stand still for so long," Bramlage said.

Bramlage’s talk touched on several subjects dealing with bone growth and remodeling, his speciality. Bramlage, who is a surgeon and a partner in the Rood and Riddle Equine Clinic outside Lexington, has frequently been a guest speaker at the summit, and his remarks have often touched on ideas that many horsemen and laypeople consider counterintuitive, such as the widespread belief that “stall rest” can heal minor injuries in the lower extremities.

“It drives me crazy to hear a trainer say we’re going to give the horse stall rest and walk him under tack in the shedrow,” Bramlage said. “The horse needs to get out to pasture and move around as much as possible. Bone is very dynamic. It’s laid down where it’s needed and taken away where it’s not.”

Bramlage began his talk by reiterating that horses that train and race at 2 have stronger musculoskeletal systems than those that do not, citing the extensive bone remodeling that occurs at that time of a horse’s development. Nevertheless, and despite lower fatality rates for horses that run at 2, many people believe the opposite to be true, especially among the animal-welfare community.

Bramlage also said that he believed that horses suffered lower rates of catastrophic injuries on artificial surfaces when compared to dirt or turf because the artificial surfaces are more consistent, although he cautioned that he does not have data to back the theory up. Although Bramlage cited longstanding research that has consistently shown that most catastrophic injuries occur at the sites of pre-existing conditions, he also said that the “bad step has to be part of it.”

During a presentation later in the day on post-mortem programs, the “myth of the bad step” was brought up several times, with two of the panelists explicitly citing the research also mentioned by Bramlage. The research, which is most prominently connected with Dr. Sue Stover at the University of California-Davis, has long been used by the veterinary community to cast doubt on explanations that breakdowns are random events, which Megan Ramono, a veterinarian for the Kentucky Horse Racing Commission who was on the post-mortem panel, called a “good thing.”

“To me, that means there are opportunities for intervention,” such as radiographs to identify pre-existing lesions that would inform trainers about the need to give a horse an extended layoff, Romano said.

“We need to take care of our horses,” Romano said. “They take care of us.”