Musculoskeletal diseases cannot be optimally prevented or treated without understanding the origins of the specific diseases; namely, why they happen and the pathophysiology behind them. As an example, catastrophic injury is a major problem in the equine athlete and, consequently a major problem in the equine athletic industry. Dr. Chris Kawcak, in his Ph.D. work with Drs. Bob Norrdin, Sue James, and Wayne McIlwraith first demonstrated that these severe fractures and injuries start as microdamage and microfractures in the subchondral bone. It is important to understand bone and its response to repetitive stress and the origins of subchondral bone disease. Further, we need to understand the mechanisms of pain, hypersensitivity to ongoing pain and the neurological pathways associated with the pain response. Much work in this area, including the use of imaging and fluid biomarkers to detect early microdamage has continued under the leadership of Drs. Kawcak, Frisbie and McIlwraith, and is continuing into the next generation with Drs. Brad Nelson and Holly Stewart.
2a. Musculoskeletal pain pathways
Pain has very complex pathways starting from the periphery and progressing up to the spinal cord and on to the brain. Understanding these pathways gives insight into how and where to intercede to better control and treat pain.
2b. Biomechanics/ sensory input
Sensitivity response to repetitive impact and the biomechanics of how a horse changes or alters the response to repetitive motion will offer insight into motion, recognition of pain and physical response to pain. This area offers initial understanding of complex physiology of what our equine athletes undergo with motion.
2c. Repetitive stress response
With any repetitive motion to muscle, bone, cartilage, and tendons/ligaments there is a physiological response. Sometimes it makes our athletes stronger but often, if not controlled or applied too quickly or too strongly, tissues can and will breakdown. Understanding the response and how to control it so that tissues only become stronger (and not breakdown) will lead to less injury to our patients.
2d. Cell markers
There are cell responses in the origins of musculoskeletal disease and understanding these responses at the cellular and molecular level will translate to being able to detect disease through the study of biomarkers (in Focus 3, “Improve the Detection of Musculoskeletal Disease”). The biology and pathophysiology of cell responses are crucial to our understanding of the pathogenesis of disease.
2e. Dorsal root ganglion (DRG)
When pain is recognized by the central nervous system it is actually “processed” in the dorsal root ganglions (DRGs) within the central nervous system. Understanding how pain responses are processed and how ongoing pain translates to increased sensitivity to pain is important to breaking the pain cycle.
Recent publications about investigating the origins of musculoskeletal disease.