EQUESTRIAN sports place strains on horses that all too often lead to poor performance.

Whether it's a bad dressage test, poles down show jumping or a run out cross country, the consequences are as frustrating to those competing at riding club level as they are aspiring Olympic riders.

Equine sports medicine describes activities that ensure the health and soundness of horses, thereby contributing to competitive success. Together with vets, it involves farriers, nutritionists and saddlers, as well as massage, chiropractic, osteopathic and physiotherapists.

Horses with riders on the lottery-funded World Class Performance programme are subject to intense and frequent scrutiny. 'No stone is left unturned', with the programme primed to prevent problems or pick them up before they become an issue. It was essential to our success at London 2012.

While most of us do not have access to such support, we can access some of the developments – the Fairfax Performance Girth being a prime example – and adopt many of the principals. So, what can we do to ensure that our horses stay healthy and sound during the summer competitive season?

First we need to get the basics of nutrition, worming and shoeing right, along with ensuring that saddles and tack fit correctly.

The emergence of polysaccharide storage myopathy and equine metabolic syndrome has caused us to re-evaluate the foods that competitive horses are fed. Now, instead of simply adding carbohydrates such as oats to provide energy, research has shown that increasing levels of fat and fibre is a better way to feed for performance.

Diets rich in fat and fibre can also help reduce the threat of gastric ulcers, which are a concern in horses stressed by training, travel or competition and a frequent cause of poor performance. Feeding multiple small meals throughout the day helps too by providing a more natural dietary intake.We are fortunate in that many horse food manufacturers have specialist nutritionists who will provide dietary advice free of charge. Guidance on worming is also free from your vet!

Poor foot conformation, especially when combined with over-due or inappropriate shoeing, and badly fitting saddles are frequent causes of lameness and back pain. Money spent with the farrier – even if he comes every 4-5 weeks – and having saddles checked every six months is never wasted. Costs of treating lameness, including remedial shoeing, and fixing back problems are invariably substantially greater.

As well as these fundamentals, attention should also focus on specific dental, orthopaedic or back conditions that affect individual horses. This is best done by periodic veterinary inspection and a programme of medical treatment and physical therapy.

Lameness problems that affect horses at lower levels of competition tend to mirror those suffered by pleasure horses and ponies. Common causes of forelimb pain include hoof imbalance, bruising or navicular syndrome and degenerative joint disease of the fetlock, pastern and coffin joints. Hind limb lameness is usually associated with degenerative disease of the small hock joints. Other conditions emerge in horses competing at higher levels, notably affecting suspensory ligaments, back and sacroiliac joints. These are often subtle and it is not unusual for several conditions to exist concurrently. These problems often reflect accumulation of repetitive subclinical injuries – rather than sudden damage – and result from strains placed on limbs and axial skeleton by athletic demands of high level sport. Inconsistent work patterns and poor footing can also contribute.

Early or low grade injuries may not always be obvious, even to experienced riders, even though they have a large impact on performance. Riders are also capable of 'hiding' subtle lameness – sometimes unintentionally – by changing their balance or contact.

Veterinary inspection involves trotting the horse in hand on a firm surface, in both a straight line and on a circle, performing flexion tests, and seeing the horse lunged and ridden. As well as observing the limbs and back, it is important to look at the horse's attitude and demeanour, and listen to the rhythm of the gaits.

Resentment to palpation of the back muscles, together with reluctance to flex the back and engage the hind limbs, suggests back pain. Sacroiliac problems are more difficult to diagnose: pain may be apparent on rectal examination and some horses resent swaying on the affected limb.

Suspensory injuries may be associated with swelling, especially if the branches are affected, or pain on pressing the body of the ligament between the splints bones just below the knee or hock. Damage to hind limb suspensory ligaments is often associated with a positive flexion test, meaning that it can be confused with hock osteoarthritis.

Nerve blocks and other diagnostic tests such as scintigraphy, as well as conventional radiography and ultrasound examination, may be required. Newer digital technologies such as the Lameness LocatorTM and Pliance®-S saddle testing system are also helping evaluation of poor performance.

A treatment plan should then be administered and programme of maintenance mapped out. This may include a change in shoeing, specific physical manipulations or alternative therapies such as acupuncture, in addition to medications.

Periodic treatment of diseased joints with steroid anti-inflammatories and, or, hyaluronic acid is one way in which soundness can be preserved. Intravenous injection of hyaluronic acid or intramuscular injection of polysulphated glycosaminoglycan (Adequan®), especially prior to or during intense periods of competition, may also help suppress joint inflammation.

There are many reasons for poor performance. It may be costly but so are entry fees, diesel and stabling – not to mention disappointment – when things don't go well!