Wednesday, May. 22, 2024

What Can We Do To Prevent Steeplechase Injuries?

The author would like to see more pre-race veterinary inspections, fewer drugs and greater rider and trainer responsibility.

In 2009 the need for injury recognition was thrust into prominence in the Thoroughbred racing world. The year started with the publication of Jack Squires’ Headless Horsemen, saw the Saturday morning veterinary scratch of the Kentucky Derby favorite, and ended with the cancellation of Australian steeplechasing in Victoria.

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The author would like to see more pre-race veterinary inspections, fewer drugs and greater rider and trainer responsibility.

In 2009 the need for injury recognition was thrust into prominence in the Thoroughbred racing world. The year started with the publication of Jack Squires’ Headless Horsemen, saw the Saturday morning veterinary scratch of the Kentucky Derby favorite, and ended with the cancellation of Australian steeplechasing in Victoria.

Squires’ book had a byline that read “A Tale of Chemical Colts, Subprime Agents and the Last Kentucky Derby on Steroids.” This catchy line surely does not call for business as usual. For even the casual observer, the vet scratch of Pioneer Of The Nile should emphasize that someone in racing is serious about injury prevention. To the best of my knowledge, the favorite in the Derby has never been subjected to a vet scratch the morning of the race.

In Victoria, a three-year trial period in which the sport’s leaders were unable to arrive at a solution to an injury rate at least four times that of flat racing has ended. The ban has been lifted, but the threat remains. At the heart of all the previous events is the question of how we perceive and encourage injury prevention.

To admit that we have an injury problem is the first step. In his bestseller, What The Dog Saw, Malcolm Gladwell explores the philosophical differences between puzzles and mysteries. In short, a puzzle is a problem that can be solved by the addition of data, whilst a mystery is a problem that overwhelms the observer with too much data. By that token, the capture of Osama bin Laden could depend only on finding one informant to rat on the whereabouts of the most wanted man on earth. It is the kind of problem that can be solved by energy and persistence.

In contrast, the solution to a mystery involves qualities of wisdom, experience and judgment. Gladwell cites the Enron collapse as a problem that remained unsolved until the collapse of the corporation, because of the mountain of distracting data that surrounded the ill-fated company. If we are to control steeplechase injuries, we must view them as a mystery that will require the attention of the whole organization from top to bottom.

The standard scientific approach to medical problems involves data and transparency. In the absence of these two factors, we will not be able to move beyond a subjective analysis of any problem.

We know that steeplechasing starts at a disadvantage. Referring to Dr. Susan Stover et al’s research in California, published, among other places, in the American Journal of Veterinary Research, there was an increased risk of fatality in older geldings running a distance of ground. In steeplechasing we add amateur and semi-professional riders and a most important factor, jumps. We have some advantages over flat racing in that the spring and perhaps fall courses tend toward softer going, and the longer distances, sometimes over hills, and are run at a slower pace. Also, our organization is small and should be more nimble than the governing bodies of
flat racing.

What does the data tell us besides a disturbing trend in fatalities? All race meets do not have equal safety records. For instance, over the past 13 years, the Middleburg Spring (Va.) has had a fatality rate of 1.5/1,000, which is equal to Santa Anita’s (Calif.) artificial surface rate and far superior to the National Steeplechase Association average for 2009. If Middleburg Spring is way under the average, then someone else must be way over the average.

Unlike the self-assessments of automobile drivers, we cannot all be “above average.” If the difference is ground moisture and low course compaction, then that would explain why the Virginia Gold Cup, Foxfield (Va.) and Middleburg all have lower fatality rates in the spring as opposed to the fall. The data show that a high number of injuries are related to jumping incidents. What can we do to minimize falls? What role do pre-existing injuries play?

What’s Wrong With This Picture?

In my private practice, if a trainer mentions that a horse is not jumping well, I assume until shown otherwise that there is a pain issue, and generally that approach is fruitful at least 80 percent of the time. If we assume that the most common cause of jumping errors is pain or low-level lameness, then that would support rigorous pre-race inspections. The other obvious suspects would be fatigue, jockey error and bad racing luck.

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Concerning pre-existing injuries, consider this: in my private purchase exam practice, in which serviceably sound horses are presented for sale, 40 percent of the last 400 horses presented had a gradable lameness. At least 50 percent of these lame horses were ulti-mately sold, therefore they would be considered “serviceable.”

How many horses take lame steps in the steeplechase pre-race jog ups? The answer is quite a few, but only a tiny fraction (7/1,000 at NSA meets in 2009) was, in fact, scratched. If the fatality rate in American steeplechasing is approaching that of Victoria, and the scratch rate is going down, what is wrong with this picture?

It’s legitimate to question whether pre-race inspections can actually prevent catastrophic breakdowns. But we should not allow “the perfect to be the enemy of the good,” as Jerome Groopman explains in How Doctors Think. We surely can identify some of the obvious pre-existing musculo-skeletal injuries as well as some lameness.

Recognizing lameness is a skill acquired over years, often decades, of clinical work subsequent to years of post-graduate education. In an era when diagnostic medicine is dominated by capital intensive but cumbersome technology such as the MRI, veterinarians still have to depend on their hands and eyes alone to examine 60 to 70 horses in the space of two hours. Just as the skilled professional race rider does not have to look back to know that a competitor is near, there is an intuitive aspect to lameness observation.

If we grade lameness on a scale of 1 to 10 where a grade 4/10 will get by a hunter judge, I make my cut-off point at Grade 4.2. Why? Because that grade of lameness starts to become apparent to the general public. That is not to say a horse with a Grade 3/10 lameness would not bear out with a vengeance or jump over three panels, but we have to make a decision to stand some place.

Inevitably some of the decisions to scratch will be judgment calls. This is just as the baseball umpire must call balls and strikes when the ball is two inches in or out. By the way, when calling balls and strikes, a baseball umpire cannot be subject to appeal and neither should veterinarians who put a lot on the line to make a definitive decision. As the baseball umpires say: “we are not the game.” Like umpires, examining veterinarians uphold the integrity of the contest.

The trainers must decide whether a marginal lameness is worthy of closer veterinary evaluation or more training. Jockeys must decide just how much adversity they can countenance in any one horse. What about horses whose lameness is more noticeable at the walk than at the trot? Stover found that horses with non-displaced humeral fractures were lamer at the walk than the jog. What about horses that are lame in both front limbs or both hind limbs? What about horses that warm up out of a lameness but only by 50 percent?

Could not the trainers make their own decision not to run as in the days of Mikey Smithwick or Burling Cocks? Well yes, of course, but the question is will they? Knowledge of human nature would suggest otherwise.

Consider the following psychological study described in Super Freakonomics in which a free coffee machine was placed in an office. Directly above the coffee pot was hung a portrait of flowers. The participants in the trial were asked to voluntarily donate to the coffee fund, if they availed themselves of the java. Compliance was poor. Next the portrait of the flowers was changed to a pair of eyes. Donations increased by threefold.

Coming To Terms

We started to do veterinary inspections at Virginia steeplechase meets in the spring of 1996. There were no scratches. However, by Virginia Fall, in October, conditions had changed to necessitate the veterinarian scratching five horses for various infirmities on one weekend. There was some weeping and gnashing of teeth, but everyone understood that there was a new standard in place and it would be prudent to comply.

We had no more five-scratch days after that. Indeed that number is close to the total scratches for 2009.

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How many scratches are enough? It is best to do that which needs to be done, but a scratch at a meet would be sufficient incentive to keep everyone’s attention. That number would be approximately four to five times the current level. Unfortunately, the cram-down approach does have its limitations. The all-stick-and-no-carrot strategy will incite resentment and ultimately be counterproductive if over-enforced.

Gerald Wilde’s Risk Homeostasis Theory cites an example of a safety study undertaken by a taxicab company in Munich, Germany. Half of its cabs were equipped with antilock disc brakes, which were technically far superior to the older braking system. Surreptitious safety records were kept for three years. Interestingly the safety record of the new cabs was no different from the old taxis. What could explain this counterintuitive result? The drivers of the taxis with the advanced safety devices drove faster, often on the wrong side of the road, and tail-gated more often. Thus, the drivers negated the safety potential of the newer brakes because of a false sense of security. Economists would say that the subjects “consumed” rather than “saved” the benefit.

American steeplechasing will have to come to terms with the limited tools for injury prevention in a sport that exists precisely because of the risks that it poses. In 2009 there were at least five meets sanctioned by the NSA that saw fit to run their programs without benefit of either pre-veterinary inspections or data collection. Some of these meets ran with six-figure purse schedules. Absence of data collection and pre-race veterinary inspections suggests that money is more important than the safety of the participants, especially the horses. Steeplechasing can ill afford to create that impression, whether it is true or not.

What should steeplechasing do to be proactive on behalf of injury prevention? We must recognize that a mystery has no simple diagnosis or solution. Next be assured that the easiest thing to do when faced with a complex problem is nothing. Every effort should be made to achieve transparency from top to bottom, from weight overages to drug violations and surely collection of factual data.

Trainers and jockeys should be encouraged to make judgments in the face of injuries that reflect the long-run careers of horses in their charge. Drug policy should be transparent, and the emphasis should be on less medication rather than more, especially for race day administration. Nothing can sow more confusion for injury recognition than the inappropriate use of drugs.

Ultimately everyone must consider the question of how much risk is acceptable. There is no such thing as zero risk. Even driving to the races involves the chance of an accident. From that point there is a large gap to the risk of playing Russian roulette.

Risk homeostasis theory means that real progress in safety can be negated, and the loss is probably guaranteed, if negative re-enforcement is the sole method of injury containment. Therefore, a reward system should be considered to re-enforce constructive behavior.

When the seasoned jockeys take it upon themselves to advise their less-experienced competitors on the nuances of safe riding, they should be rewarded. Trainers should be encouraged to scratch their own horses rather than testing the veterinary examiners’ tolerance for lameness. Those responsible for course maintenance should seek an average course compactibility of 95 to 115 lbs/in2, which is the soft side of a course rated “good.” Dangerous fences should be moved, modified, or eliminated if necessary. The stewards should administer swift, sure, but not necessarily harsh penalties for infractions.

All the possible elements related to racing safety must reinforce each other. Just because, on one day, we escape unscathed while tolerating unsafe procedures as “acceptable risk” does not mean that the danger no longer exists.  

William H. McCormick had stints at the University of Virginia (’69), the University of Pennsylvania (’73) and the Delaware Equine Clinic, with some great times foxhunting, playing polo and amateur race riding along the way. Currently he is an equine practitioner along with Cleanth Toledano DVM at the Middleburg Equine Clinic (Va.). He has written 10 referred articles on the application of Chinese medicine to equine practice as well as co-authoring a paper on steeplechase injuries in Virginia, 1996-2000. “My father, James P. McCormick, taught me the principles of racing injury prevention and survival in the horse business long ago,” he said. “I just did not realize it at the time.”

In The Forum, horsemen are invited to express their views and offer constructive criticism on any topic relevant to working with and enjoying horses. The opinions express by the writers are entirely their own and not necessarily those of The Chronicle of the Horse.

If you enjoyed this article and would like to read more like it, consider subscribing. “What Can We Do To Prevent Steeplechase Injuries? ran in the March 26, 2010 issue. Check out the table of contents to see what great stories are in the magazine this week.

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