The Support Value of Wrapping: original research sought

I'd really like to get the recent scientific data on wrapping. Not really interested in people's opinions as I'm a horsewoman and already have my own, right?

I've heard lots of mention of studies demonstrating that wraps do not provide tendon support, but I've never been given an actual reference. I've even heard pretty specific stuff, like <1% improvement in support. I would love to read something on the actual lode borne by the tendons during such-and-such activity and the lode difference with wraps/boots/etc. Other stuff I've heard is reduction in concussion or increase in heat and therefore cell death. If anyone has the research available to them, I'd love to know how concussion is reduced and to what extent. I'd also like to know more about the "slow cooking the tendons" thing. What temp to the cells begin to die and what would be the "danger zone", eg working in 80 degree temps for an hour (a lesson) or only 15min (a x-country run)?

Background: I've heard this from respected vets and pros and have repeated it, but w/o being able to offer specific references I feel it comes across as just another opinion rather than information about evidence-based equine management. For all I know, we have all been referencing a study done with six Dutch Warmbloods 10yrs ago by students in Provence :) and while interesting, I find those to be only mildly convincing.

Also just curious: I've also heard basically the opposite regarding heat from respected professionals recommending Back on Track wraps and saddle pads. Even bell boots? Please explain.

PS the only professional reference on wrapping in the context on could find was this: http://www.aaep.org/health_articles_view.php?id=44 from the AAEP which states:

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"Leg bandages are beneficial for several reasons:

- Provide support for tendons and ligaments during strenuous workouts
- Prevent or reduces swelling (edema) after exercise, injury or during stall rest
- Protect legs from concussion and impact
- Shield leg wounds from contamination and aid in healing."
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There are a number of citations on PubMed that are not difficult to search. But the studies are sparse, and not too many of them draw compelling conclusions. Most are looking at different things, as well, making any sort of blanket statement difficult. But there's a modest number of things that are out there for the seeker. :) Try words like "horse" "tendon" "bandage" "support" "ligament" etc.

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Originally Posted by HillnDale

I'd really like to get the recent scientific data on wrapping. Not really interested in people's opinions as I'm a horsewoman and already have my own, right?

I've heard lots of mention of studies demonstrating that wraps do not provide tendon support, but I've never been given an actual reference. I've even heard pretty specific stuff, like <1% improvement in support. I would love to read something on the actual lode borne by the tendons during such-and-such activity and the lode difference with wraps/boots/etc. Other stuff I've heard is reduction in concussion or increase in heat and therefore cell death. If anyone has the research available to them, I'd love to know how concussion is reduced and to what extent. I'd also like to know more about the "slow cooking the tendons" thing. What temp to the cells begin to die and what would be the "danger zone", eg working in 80 degree temps for an hour (a lesson) or only 15min (a x-country run)?

Background: I've heard this from respected vets and pros and have repeated it, but w/o being able to offer specific references I feel it comes across as just another opinion rather than information about evidence-based equine management. For all I know, we have all been referencing a study done with six Dutch Warmbloods 10yrs ago by students in Provence :) and while interesting, I find those to be only mildly convincing.

Also just curious: I've also heard basically the opposite regarding heat from respected professionals recommending Back on Track wraps and saddle pads. Even bell boots? Please explain.

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I just want to say that I think this is a really important question, and something that I've thought quite a bit about myself.

I've had almost no success finding actual studies (not news articles about studies, but actual peer reviewed articles) that are conclusive on this subject. This makes me very uneasy, because I think if the science is actually conclusive, then it should be easy to prove.

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Originally Posted by c'est moi

I've had almost no success finding actual studies (not news articles about studies, but actual peer reviewed articles) that are conclusive on this subject. This makes me very uneasy, because I think if the science is actually conclusive, then it should be easy to prove.

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The beauty - and for some, the frustration - of science is that it's rarely conclusive - you have to be ready and willing to look again and rethink something as soon as new data become available.

That said, I'm not where I can get at my files right now, but IRRC the most useful studies were performed at Cornell and (I think - it's been many years now) at Ohio State. And there's a fellow at Colorado State - he's with the Equine Orthopaedic Research Center - whose name I cannot recall, but I believe he's published something on the subject of tendon support. I will think of his name as soon as I send this, of course.

You are SO RIGHT to be looking for actual studies and research reports. ANY studies need to be looked at carefully - veterinary ones as well as (human) medical ones - because more often than not, the articles that purport to be about those studies bear little or no relation to the studies themselves, their purpose, their results, and the researchers' conclusions. Then you need to look at who sponsored the research and who will profit from a certain set of conclusions (bearing in mind that in academia, "profit" doesn't necessarily mean "cash in hand," but can mean "will receive funding for next research project").

If you can manage to get your hands on the raw data, it's often very revealing, and makes very worthwhile reading.

AHA. I remembered his name: Frisbie! (Or possibly Frisbee?) IRRC he is both a DVM and a PhD, and a very well-spoken man.

When I hear wraps, I think standing wraps. I don't know anyone who advocates riding in standing wraps. Boots and such are a different story but aren't wrapping in my book.

Well, I found something via Google Scholar. Sponsored by a boot manufacturer, no less:

http://onlinelibrary.wiley.com/doi/10.2746/042516402776250423/abstract

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In vitro evaluation of nonrigid support systems for the equine metacarpophalangeal joint

ABSTRACT:
Metacarpophalangeal (MCP) joint extension is primarily resisted by the digital flexortendons and suspensory ligament. A variety of external support techniques are used to protect these supporting structures from or after injury by resisting MCP joint extension, although not all are effective and/or practical for use in an exercising horse. In this study, 7 forelimbs were loaded in vitro to determine the effect of a simple gamgee bandage, a 3-layered bandage with and without a contoured palmar splint, a neoprene exercise boot, and an innovative carbon fibre composite exercise boot (Dalmar tendon support boot). There was no significant resistance to MCP joint extension by the gamgee or neoprene exercise boot. The 3-layered bandage had a significant (P < 0.01) supporting effect at MCP angles of ≥245°, and when combined with the contoured splint at angles of ≥230°. The Dalmartendon support boot resisted MCP extension at angles of ≥245° (settings 1 and 2) and ≥225° (setting 3). These data demonstrate that the contoured splint and the Dalmar tendon support boot (which is also easily fitted for use during exercise) are useful for the management of tendon/ligament injury and during rehabilitation.

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I downloaded the full article (yay free library access through work!). The "3-layered bandage" they refer to is described as a modified Robert Jones bandage. Another important note: the testing was performed on cadaver limbs.

Oh, here's another one (the full article can be viewed for free - click on "Full Text"):
http://www.j-evs.com/article/S0737-0...231-0/fulltext

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Evaluation of shock attenuation in the forelimb of horses wearing boots and wraps

Abstract:
High frequency, high amplitude shock waves, believed to contribute to detrimental joint and bone changes, are generated each time the hoof strikes the ground. The purpose of the present study was to compare the shock attenuating capability of athletic support boots and traditional cotton wraps (polo wraps). Accelerometers were attached to the hoof and third metacarpus of five horses. Peak deceleration and asymptotic frequencies were measured at two speeds (3.5 mls, trot, and 6. 0 mls, gallop) under the following conditions: control (no boots or wraps), cotton wraps, and two athletic support boots. Leg supports did not reduce shock in the third metacarpus. In fact, support boots increased the asymptotic frequency measured in the third metacarpus. This result could be explained if the leg supports were acting to stiffen the limb, thereby increasing the spring constant of the leg support-limb system.

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One more:

http://www.sciencedirect.com/science...66636294901481

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Influence of bandage material on pressure distribution under the bandage on the distal forelimb of the galloping horse

Bandaging of thoroughbred race horses is very common. Bandaging is used for prevention of abrasion and support purposes. The support function of different bandage materials and bandage configurations has been quantified in the literature by in-vitro energy absorption studies. How far the measured energy absorption is significant from a physiological point of view and to what force underneath a bandage it translates during galloping is unknown. The purpose of this study was to investigate the influence of bandaging and the influence of bandage material on the kinematics of the forelimb of the galloping horse and to compare the pressure distribution underneath bandages of different materials. The results of the kinematic part of the study are reported elsewhere (Kobluk et al., unpublished). Seven mature thoroughbred race horses were investigated with six different bandages during standing (before and after a trial) and during galloping in an unfatigued and a fatigued condition on a high-speed treadmill. Pressure distribution was collected from a capacitive 21-sensors measurement mat placed underneath the bandage on top of the fetlock joint at a sampling frequency of 100 Hz. The results indicate that the pressures and forces underneath the bandage are high (up to 14.4 N cm⁻², 290 N respectively) and that they increase from unfatigued to fatigued galloping as quantified by heart rate. The behaviour of the investigated bandages showed significant differences between them. Some bandages exhibited forces and pressures that might restrict the blood flow.

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Nerdy Scientist, over and out :D

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Originally Posted by Pasde2

The beauty - and for some, the frustration - of science is that it's rarely conclusive - you have to be ready and willing to look again and rethink something as soon as new data become available.

That said, I'm not where I can get at my files right now, but IRRC the most useful studies were performed at Cornell and (I think - it's been many years now) at Ohio State. And there's a fellow at Colorado State - he's with the Equine Orthopaedic Research Center - whose name I cannot recall, but I believe he's published something on the subject of tendon support. I will think of his name as soon as I send this, of course.

You are SO RIGHT to be looking for actual studies and research reports. ANY studies need to be looked at carefully - veterinary ones as well as (human) medical ones - because more often than not, the articles that purport to be about those studies bear little or no relation to the studies themselves, their purpose, their results, and the researchers' conclusions. Then you need to look at who sponsored the research and who will profit from a certain set of conclusions (bearing in mind that in academia, "profit" doesn't necessarily mean "cash in hand," but can mean "will receive funding for next research project").

If you can manage to get your hands on the raw data, it's often very revealing, and makes very worthwhile reading.

AHA. I remembered his name: Frisbie! (Or possibly Frisbee?) IRRC he is both a DVM and a PhD, and a very well-spoken man.

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Perhaps conclusive was the wrong word to use. I realize that it is very unlikely that I would find a study (or jackpot, a series of studies) that would actually "prove" anything beyond a reasonable doubt. But among us scientific lay-people, there are many tightly held beliefs about horse care/treatment, some of which appear to be supported "real" science, most of which have no scientific basis. As others have noted, I feel uncomfortable when I realize that my understanding of a particular issue is based on a vague sense of "scientific inquiry" and not actual research.

And thanks for the info!

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there are many tightly held beliefs about horse care/treatment, some of which appear to be supported "real" science, most of which have no scientific basis

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This is true in a lot of spheres. Especially those where there is a long tradition of "this is the right way to do it" dating back centuries, with characters in play who place inordinate value on the warm and fuzzy aspects of tradition. :) I'm not saying it's a good thing or a bad thing, just a human nature thing!

There's certainly a place for conventional wisdom, but for those who are happiest when there is solid evidence to back up decision-making, it is often very frustrating. We are still left with the wisdom of making up our minds with "best available evidence" even when best is more like "minimal to none". There isn't ample proof to support every decision we make . . . and that would be kind of dull, anyway. ;)

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Originally Posted by deltawave

This is true in a lot of spheres. Especially those where there is a long tradition of "this is the right way to do it" dating back centuries, with characters in play who place inordinate value on the warm and fuzzy aspects of tradition. :) I'm not saying it's a good thing or a bad thing, just a human nature thing!

There's certainly a place for conventional wisdom, but for those who are happiest when there is solid evidence to back up decision-making, it is often very frustrating. We are still left with the wisdom of making up our minds with "best available evidence" even when best is more like "minimal to none". There isn't ample proof to support every decision we make . . . and that would be kind of dull, anyway. ;)

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You're of course right that conventional wisdom has its place in almost every corner of society, and I certainly don't expect everyone to back up every single opinion or preference with a slew of scientific data. But back to the OP's original point, I do get worried when I see people making claims about different products/horse-care preferences that they think are based on scientific research, but in fact would crumble under serious scrutiny. Just look at what a mess the equine (and human) supplement world is in at the moment.

With that in mind, there are plenty of products, training methods, general preferences, etc. that I use that I am quite well aware that I am only using because *I* think they work, not because I have any hard data to back me up. But I think the fact that I realize I am only using anecdotal evidence (in this case, my own) to justify my actions is an important contrast from many who, as someone on this board said, "think the plural of anecdote is data."

This problem is of course not limited to the horse-world, but that doesn't mean equestrians should pretend they have science on their side when they really don't. And personally, I would love to see some serious studies on the effects of leg wrapping on our horses, because I hear a lot of claims coming from all sides of the debate. However, I do realize that good research is expensive and time-consuming, so I'm not holding my breath.

I think you'll find that a fairly decent majority of people on COTH are fairly evidence-based in their thinking, while maintaining a sense of reasonable-ness when it comes to trying things. This is a pretty savvy bunch. With just enough of a presence of the granola types to keep it lively! :D

Much of the "clinically proven!" statements that get tossed out here are pounced on immediately, a majority of which are generated in the marketing department rather than the R&D department of the various products and supplements with which we are bombarded daily. Which is laid bare in rapid fashion by vultures like myself and others. :p

Can one of you smart people translate those studies for me? It sounds like from my layman's reading that instead of disspating shock, they actually measured an increase in the reverberations in one of the bones studied? So not only would polos provide no protection or support, they may actually interfere with the horse's God-given shock absorption systems?

Suits me fine. I hate wrapping and unwrapping polos, and have only ever found them useful to keep a horse with white legs cleaner before entering a show ring with sticky footing.

yeah- those studies say that wrapping is possibly detrimental- restricts blood flow to a bad level, and increases shock, probably by restricting mobility of the joints.

another way to try to apply science is to look at the scientific rationale behind it- does the mechanism of action make any sense in light of what else is known about the topic? Some people call this the "laugh test".
the idea that wrapping "supports" tendons/ligaments doesn't pass the "laugh test" for me. I can't think of any way applying a wrap could possibly provide "support" to a ligament or tendon.
A wrap could provide protection from external injuries, sure, that's easy to imagine happening. But not support.

The way I read what's been posted so far is that wraps of various kinds can protect the legs from abrasions (and in some used that might be a valuable thing). That's the proven function. In some cases they might cause issues. A couple of devices did, in fact, show some benefits.

G.

Remember that abstracts contain only very distilled information and quite a bit of editorializing/conclusion-drawing. An abstract is meant to give you the bare-bones summary. In order to answer any sort of meaty questions, one has to dig into the whole thing. Which is incredibly tedious in most cases. Leaning too heavily on the last couple of sentences of an abstract gives you a lot more of the authors' bias in condensed form than is probably needed. ;) Especially with this type of research, the authors are trying to generate more topics for study, more support (no pun intended) for their project, more funding, more publishing, and more subjects. There is a bit of gamesmanship in writing a good abstract, and since those are what is generally available on literature searches, well, a cleverly-written and compelling one can make a lot more of an impression than a comparatively dry and tedious one.

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Originally Posted by Absolut Equestrian

Oh, here's another one (the full article can be viewed for free - click on "Full Text"):
http://www.j-evs.com/article/S0737-0...231-0/fulltext

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I don't have much time, but I took a look at the data on this one. I think this is a stretch at the claims they made. The raw data numbers they showed in Hertz for what they are calling "asymptotic frequency," which from my understanding in their article is what they are attributing to impact, is completely equal throughout (excerpt):

Trot, Day 1 (the first number is control, the second and so on is Boot 1, boot 2, polo)
Hoof 243 ± 118a, 204 ± 77a, 243 ± 132a, 203 ± 95a
Metacarpus 108 ± 17a, 134 ± 5b, 125 ± 19ab, 115 ± 7a


When they normalized the numbers, they appear to show MAYBE a slight increase from no boots to boots/wraps:
Gait Control Boot 1 Boot 2 Polo Wraps
Trot 0.512 ± 0.193a 0.690 ± 0.135b 0.636 ± 0.187b 0.644 ± 0.184b
Left Lead Gallop 0.407 ± 0.120a 0.507 ± 0.102a 0.505 ± 0.047a 0.624 ± 0.197a
Right Lead Gallop 0.431 ± 0.094a 0.632 ± 0.114a 0.663 ± 0.044a 0.909 ± 0.480a


To me, given the standard deviation, that is not really that impressive. The other thing that leaves me with questions is the fact that they put the recording devices on the hoof. Now, I understand that makes sense to record impact. My question is, how do we measure tendon support (or lack thereof)?

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My question is, how do we measure tendon support (or lack thereof)?

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I think the only way to directly measure forces to the tendons is in a cadaver study. In living animals you have to use "proxy" measures.
The tendon connects the bone to the muscle. When the muscle contracts, it pulls very hard on the tendon, which then pulls the bone into the desired position. The only way the external wrap could affect the forces applied to the tendon is if the wrap affected the motion of a joint- if the wrap goes around the joint and prevents it from flexing fully, then the joint bends less, and less force will be applied to the tendon; or perhaps more force will be applied as the horse pulls harder against the restricting wrap trying to flex the joint properly? it's hard to say for sure. You could measure range of motion of the joints by say, imaging the horse in motion, slowing the images, and measuring how the wraps restrict mobility vs. when unwrapped.
Of course, even if restricting mobility reduces stress on the tendon it is probably not very beneficial to the horse- you try wrapping your joints up such that you can't bend them, and I suspect you will be more prone to injure yourself vs. when not wrapped.
So the real outcome to consider is probably "injuries", not any proxy measure. If you wrap 500 horses and ride them, what is the injury rate vs. 500 similar unwrapped horses put through the same exercises?