Regardless of which combination of rehabilitation techniques you and your veterinarian ultimately select to manage injuries, generally your goal is to facilitate return to performance. This requires working closely with your horses rehab team to know which modality to use at what point during the recovery process.
To garner the most benefit from rehabilitation, the first step is to pinpoint the underlying injury, says Fortier. Only once a firm diagnosis has been achieved can a rehabilitation plan be mapped out.
When to use which rehabilitation technique depends on the exact nature of the injury, whether the goal at that point is pain reduction, restoring range of motion, contributing to tissue healing, and/or strengthening healing tissues. Even the veterinarians experience with biologics greatly impacts how each horse is treated.
As excited as you might be about the prospect of having stem cell technology at your fingertips, know that its not a magic bullet. Researchers recently reviewed the plights associated with obtaining, processing, transporting, and administering stem cells to horses so you can get the maximum bang for your buck (Barrachina et al., 2018). Here are some of the many factors your veterinarian considers when planning your horses biologic needs:
MSC therapy is expensive. To use autologous stem cells, which are collected from your horse, processed, and used to treat his own injury, your veterinarian must sedate the horse and collect and process bone marrow (or fat) according to rigid guidelines using specialized equipment and laboratories. The cost of the equipment, supplies, and time adds up.
The process of using bone-marrow-derived autologous stem cells is time-consuming. This method requires several weeks of culture to acquire a sufficient number of stem cells for administration. It is possible, however, to inject a subset of concentrated bone marrow cells immediately after collecting the marrow, while the remainder of the sample is sent for culture. Further, veterinarians can use PRP in the interim so the horse is at least receiving some form of biologic therapy while awaiting the delivery of the cultured cells.
Another way to circumvent delayed treatment times is to use allogeneic stem cells. These are stem cells collected from a different horse ready to inject into the patient. The main concern with allogeneic stem cell usage, our sources say, is that the patients immune system will view them as nonself, similar to bacteria and viruses, and attack and destroy them. However, many horses with underlying medical conditions, such as pituitary pars intermedia dysfunction (equine Cushings disease), equine metabolic syndrome, or insulin dysregulation, cannot use their own stem cells because those cells arent considered healthy. Thus, veterinarians must rely on allogeneic cells instead (e.g., for managing laminitis).
As Barrachina et al. noted in their review of stem cell pros and cons, Although MSCs may be a promising treatment for equine musculoskeletal injuries, it is important to highlight that their actual therapeutic potential still remains unclear and that there are still several gaps in the knowledge to be investigated.
For example, some veterinarians use combinations of stem cells, PRP, and other rehabilitation modalities. Because of this wide array of treatment plans and because equine veterinarians implement and adapt their own protocols to best help each patient, collecting clear data and creating a recipe book for biologic therapy is challenging to say the least.
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