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Topic:Musculoskeletal System

The musculoskeletal system in horses encompasses the bones, muscles, tendons, ligaments, and joints that facilitate movement and provide structural support. This system is essential for locomotion, athletic performance, and overall health in equine species. The equine skeleton consists of approximately 205 bones, which are connected by joints and supported by a network of muscles and connective tissues. Tendons connect muscles to bones, while ligaments link bones to other bones, contributing to joint stability. The musculoskeletal system is subject to various conditions, including injuries, degenerative diseases, and developmental disorders, which can impact a horse's mobility and performance. This page compiles peer-reviewed research studies and scholarly articles that explore the anatomy, physiology, pathology, and treatment of musculoskeletal conditions in horses.
Kinematic Analysis During Straight Line Free Swimming in Horses: Part 2 – Hindlimbs.
Frontiers in veterinary science    January 31, 2022   Volume 8 761500 doi: 10.3389/fvets.2021.761500
Santosuosso E, Leguillette R, Vinardell T, Filho S, Massie S, McCrae P, Johnson S, Rolian C, David F.Swimming is used for rehabilitation and conditioning purposes in equine sports medicine. We described the swimming kinematics of the equine forelimbs in Part 1. The aim of Part 2 is to assess stifle, tarsus, and hind fetlock joints kinematics in swimming horses. The objectives were 1- to calculate and compare joint angles during swimming against passive mobilizations (PM), 2- to determine joints angular velocities during a swimming stride cycle. Methods: Eleven elite endurance horses were used to swim in a 100-meter straight pool. Underwater (swimming) and overground PM videos were recorded fr...
The failure mode of a mechanically loaded equine medial femoral condyle analog with a void and the impact of lag and neutral screw placement.
Veterinary surgery : VS    January 31, 2022   Volume 51, Issue 3 474-481 doi: 10.1111/vsu.13765
Moreno CR, Santschi EM, Younkin JT, Larson RL, Litsky AS.To determine the failure method of simulated equine medial femoral condyle (MFC) subchondral bone defects under compression and the influence of screw placement on failure resistance. Methods: In vitro study. Methods: Composite disks (CD) simulating the moduli of yearling bone in the MFC. Methods: Four CD conditions were tested, all with a 12.7 mm void (n = 6 per condition): intact (no void), void only, void with a 4.5 mm screw placed in neutral fashion, and void with a 4.5 mm screw placed in lag fashion. Composite disks of each condition were tested under monotonic compression to 6000...
Effects of a Bio-Electromagnetic Energy Regulation Blanket on Thoracolumbar Epaxial Muscle Pain in Horses.
Journal of equine veterinary science    January 23, 2022   Volume 111 103867 doi: 10.1016/j.jevs.2022.103867
King MR, Seabaugh KA, Frisbie DD.Back pain and inflammation of the epaxial musculature is a significant problem in all equine athletes. Treatment of back pain can be challenging and often requires a multimodal approach. In humans, bio-electromagnetic energy regulation therapy (BEMER) has been reported to be effective in pain modulation. With its increased use in people comes a similar robust application in veterinary medicine unfortunately, there is unsubstantiated evidence for this type of therapy in horses. Objectives of this study were to assess analgesic responses and biomechanical outcome variables using a bio-electromag...
Dynamic three-dimensional computed tomographic imaging facilitates evaluation of the equine cervical articular process joint in motion.
Equine veterinary journal    January 21, 2022   Volume 55, Issue 1 83-91 doi: 10.1111/evj.13560
Schulze N, Werpy N, Gernhardt J, Fritsch G, Hildebrandt T, Vanderperren K, Klopfleisch R, Ben Romdhane R, Lischer C, Ehrle A.Dynamic computed tomography (CT) imaging has been introduced in human orthopaedics and is continuing to gain popularity. With dynamic CT, video sequences of anatomical structures can be evaluated in motion. Objective: To investigate the feasibility of dynamic CT for diagnostic imaging of the equine cervical articular process joints (APJs) and to give a detailed description of the APJ movement pattern. Methods: Descriptive cadaver imaging. Methods: Cervical specimens of twelve Warmblood horses were included. A custom-made motorised testing device was used to position and manipulate the neck spe...
Genome-Wide Association Analyses of Osteochondrosis in Belgian Warmbloods Reveal Candidate Genes Associated With Chondrocyte Development.
Journal of equine veterinary science    January 21, 2022   Volume 111 103870 doi: 10.1016/j.jevs.2022.103870
Drabbe A, Janssens S, Blott S, Ducro BJ, Fontanel M, Francois L, Schurink A, Stinckens A, Lindgren G, Van Mol B, Pille F, Buys N, Velie BD.Osteochondrosis (OC) is an important skeletal disease causing profound welfare concerns in horses. Although numerous studies have explored the genetics underlying OC in various breeds, the Belgian Warmblood (BW) remains unstudied despite having a concerning prevalence of 32.0%. As a result, this study aimed to conduct genome-wide association (GWA) analyses to identify candidate variants associated with OC in BWs. To achieve this, blood samples and radiographs were collected from 407 Belgian Warmbloods registered to one of two BW studbooks (Belgisch Warmbloedpaard and Zangersheide), and genotyp...
Intralesional bone marrow and superior check desmotomy is superior to conservative treatment of equine superficial digital flexor tendonitis.
Equine veterinary journal    January 14, 2022   Volume 54, Issue 6 1047-1054 doi: 10.1111/evj.13553
Murphy DJ, Kö-Peternelj V, Aleri JW.Superficial digital flexor tendon (SDFT) injury is common in racehorses and a significant cause of lost training days and wastage in the industry. Objective: To compare the post-injury performance of Thoroughbred and Standardbred racehorses diagnosed with SDFT tendonitis treated with intralesional bone marrow and superior check desmotomy or managed conservatively and further to compare this performance with that of uninjured racehorses. Methods: Retrospective and case-controlled. Methods: Medical and race records of racehorses treated surgically or managed conservatively for SDFT tendonitis we...
Anatomical position of the palmar/plantar nerves at the metacarpal/metatarsal distal level in horses: An in vivo study by means of ultrasonography.
Anatomia, histologia, embryologia    January 9, 2022   Volume 51, Issue 2 236-243 doi: 10.1111/ahe.12782
Maia BT, Vendruscolo CDP, de Souza AF, Zoppa ALDV.The neurovascular bundle of the equine distal cannon can dynamically vary with limb position, and this can affect the performance of low 4- or 6-point block. This study aims to identify and describe the anatomical position and variations of the lateral and medial palmar/plantar nerve at the metacarpal/metatarsal distal level in horses by ultrasonography. Eight mares underwent ultrasound examination on the lateral and medial palmar/plantar sides of the metacarpus/metatarsus. Images were obtained for measurements of the cross-sectional area of the nerve, distances between the nerve and the skin ...
Effects of Internal Fluid Pressure on Stresses in Subchondral Bone Cysts of the Medial Femoral Condyle.
Annals of biomedical engineering    January 7, 2022   Volume 50, Issue 1 86-93 doi: 10.1007/s10439-021-02883-z
Norton NM, Santschi E, Fischer KJ.The etiology of subchondral bone cysts (SBCs) is not fully understood. Mechanical trauma and fluid pressure are two mechanisms believed to cause their formation and growth. The equine stifle joint provides a natural animal model for studying SBCs. Computed tomography images of an extended yearling cadaveric stifle joint were segmented using ScanIP to isolate bones and relevant soft tissues. Three model geometries were created to simulate cyst sizes of approximately 0.03 cm (C1), 0.5 cm (C2), and 1 cm (C3). A uniform pressure resulting in 3000 N force was applied at the proximal end of the fem...
The influence of the metacarpophalangeal joint angle on the transversal area and mean echogenicity of the superficial digital flexor tendon and suspensory ligament in gaited horses.
Journal of equine science    December 28, 2021   Volume 32, Issue 4 135-141 doi: 10.1294/jes.32.135
Schade J, de Souza AF, Vincensi LC, Fonteque JH.The objective of this study was to assess the influence of the metacarpophalangeal (MCP) joint angle on the transversal area (TA) and mean echogenicity (ME) of the superficial digital flexor tendon (SDFT) and suspensory ligament (SL) in gaited horses. Ultrasound images were obtained from 50 healthy adult horses of the Mangalarga Marchador (MM; n=25) and Campeiro (n=25) breeds. Static and dynamic angles of the MCP joint were measured from photographs and video recordings. Higher ME values were evinced for the SL only in the group with the smaller dynamic angles of the MCP joint in the MM horses...
Relationship between the ultrasonographic findings of suspected superficial digital flexor tendon injury and the prevalence of subsequent severe superficial digital flexor tendon injuries in Thoroughbred horses: a retrospective study.
The Journal of veterinary medical science    December 21, 2021   Volume 84, Issue 2 261-265 doi: 10.1292/jvms.21-0028
Iimori M, Tamura N, Seki K, Kasashima Y.The onset of severe injury to the superficial digital flexor tendon (SDFT) is extremely difficult to predict from slight changes in ultrasonographic findings in cases with no apparent clinical signs. This study investigated the relationship between an increased cross-sectional area (CSA) or edema in the subcutaneous tissue around the tendon and the subsequent onset of severe SDFT injury in Thoroughbred racehorses. Horses were classified into three groups based on ultrasound diagnosis (USD) findings: Group A included cases with enlarged tendons; Group B included cases with tendons of normal siz...
Comparison of Bone Mineral Content of the Equine Third Metacarpal to Total Radiographic Bone Aluminum Equivalents From Unprocessed Digital Radiographs.
Journal of equine veterinary science    December 16, 2021   Volume 110 103837 doi: 10.1016/j.jevs.2021.103837
Emmert BJ, Robison CI, Pritchard A, Nielsen BD.Digital radiographs are common for estimating bone mineral content (BMC) in horses with radiographic bone aluminum equivalents (RBAE). Processing algorithms are used to produce clearer images of digital radiographs in clinical settings, but this distorts RBAE. This study compared RBAE from digital radiographs to BMC from bone ash, and physical and digital morphology measurements. Digital radiographs were taken of six third metacarpals (MCIII) from equine cadavers with an aluminum step wedge penetrometer. A 2-cm transverse section of bone was digitally analyzed and excised from each MCIII. For ...
Multivariable Logistic Regression Models of X-Ray Thoracic Spinous Process Osseous Changes Findings and Body Measurement Factors Associated With Defined Over-riding of the Dorsal Spinous in Riding Horses.
Journal of equine veterinary science    December 16, 2021   Volume 109 103839 doi: 10.1016/j.jevs.2021.103839
Takeyama T, Sasaki N.Thoracic spinous process osseous changes in horses occur due to riding-induced back compression. This study aimed to evaluate the relationship between the findings of thoracic spinous process osseous changes on radiographic imaging and conformation based on the difference in over-riding of the dorsal spinous processes in racing horses. This study included 55 sports horses. The hardness of the back muscles (the multifidus, longissimi, and latissimi collectively) was measured, and the horses were divided into two groups: low muscle hardness (n = 16) and high muscle hardness (n = 39). We conf...
Robustness of five different visual assessment methods for the evaluation of hindlimb lameness based on tubera coxarum movement in horses at the trot on a straight line.
Equine veterinary journal    December 13, 2021   Volume 54, Issue 6 1103-1113 doi: 10.1111/evj.13531
Starke SD, May SA.The evaluation of hindlimb lameness remains a major challenge in everyday clinical practice. In the absence of clear guidelines, veterinarians use different visual assessment methods for this task whose robustness is unknown. Objective: Determination of the robustness of five visual hindlimb lameness assessment methods based on the comparison of left and right tuber coxae movement. Methods: Validated mathematical hindlimb lameness model based on experimental data from the literature. Methods: Vertical movement of left (LTC) and right (RTC) tuber coxae was simulated for the range of common hind...
Moderate-intensity training in hypoxia improves exercise performance and glycolytic capacity of skeletal muscle in horses.
Physiological reports    December 11, 2021   Volume 9, Issue 23 e15145 doi: 10.14814/phy2.15145
Mukai K, Kitaoka Y, Takahashi Y, Takahashi T, Takahashi K, Ohmura H.We investigated whether moderate-intensity training of horses in moderate hypoxia for 4 weeks elicits greater adaptations in exercise performance, aerobic capacity, and glycolytic/oxidative metabolism in skeletal muscle compared to normoxic training. In a randomized crossover study design, seven untrained Thoroughbred horses (5.9 ± 1.1 years, 508 ± 9 kg) completed 4 weeks (3 sessions/week) of two training protocols consisting of 3-min cantering at 70% of maximal oxygen consumption ( ) in hypoxia (HYP; F O  = 14.7%) and normoxia (NOR; F O  = 21.0%) with a 4-month washout period....
Myofibre Hyper-Contractility in Horses Expressing the Myosin Heavy Chain Myopathy Mutation, MYH1E321G.
Cells    December 6, 2021   Volume 10, Issue 12 3428 doi: 10.3390/cells10123428
Ochala J, Finno CJ, Valberg SJ.Myosinopathies are defined as a group of muscle disorders characterized by mutations in genes encoding myosin heavy chains. Their exact molecular and cellular mechanisms remain unclear. In the present study, we have focused our attention on a -related E321G amino acid substitution within the head region of the type IIx skeletal myosin heavy chain, associated with clinical signs of atrophy, inflammation and/or profound rhabdomyolysis, known as equine myosin heavy chain myopathy. We performed Mant-ATP chase experiments together with force measurements on isolated IIx myofibres from control horse...
Using Short Term of High Power Laser Therapy in Horse’s Tendon Injuries.
Archives of Razi Institute    November 30, 2021   Volume 76, Issue 5 1437-1444 doi: 10.22092/ari.2021.356105.1779
Jaafar SE, Al-Bayti AAH, Abdullah SI.High-power laser therapy has been used as a treatment to cure sports injuries; however, there are no controlled standardized studies on its efficacy. Moreover, high-power laser therapy has been applied for the sport horses field. This study aimed to investigate whether high-power laser therapy can cure tendon disorders and reduce the pain in tendon lesions in injured horses and also to examine the effect of laser therapy on injured horses. This retroactive experiential clinical research was performed on50 racing horses between 5 and 15 years old. They were diagnosed with neither superficial di...
Growth and Bone Development in the Horse: When Is a Horse Skeletally Mature?
Animals : an open access journal from MDPI    November 29, 2021   Volume 11, Issue 12 3402 doi: 10.3390/ani11123402
Rogers CW, Gee EK, Dittmer KE.Within the lay literature, and social media in particular, there is often debate about the age at which a horse should be started and introduced to racing or sport. To optimize the welfare and longevity of horses in racing and sport, it is important to match exercise with musculoskeletal development and the ability of the musculoskeletal system to respond to loading. The justification for not exercising horses at a certain age is often in contrast to the scientific literature and framed, with incorrect generalizations, with human growth. This review provides a relative comparison of the growth...
In vitro motions of the medial and lateral proximal sesamoid bones under mid-stance load conditions are consistent with racehorse fracture configurations.
Journal of biomechanics    November 27, 2021   Volume 130 110888 doi: 10.1016/j.jbiomech.2021.110888
Shaffer SK, Shelly K, Garcia TC, Samol MA, Hill AE, Fyhrie DP, Stover SM.Proximal sesamoid bone (PSB) fractures in racehorses are likely fatigue fractures that occur due to repetitive loads and stress remodeling. The loading circumstances that may induce damage in the PSBs are not well understood. The goal of this study was to determine in three-dimensions, PSB motions relative to the opposing metacarpal condyle during simulated mid-stance loads. Seven equine cadaveric forelimbs were axially loaded in a material testing system to simulate standing and mid-stance walk, trot, and gallop load conditions (1.8-10.5 kN). Joint angles were determined by tracking the posit...
Imaging and Gross Pathological Appearance of Changes in the Parasagittal Grooves of Thoroughbred Racehorses.
Animals : an open access journal from MDPI    November 24, 2021   Volume 11, Issue 12 3366 doi: 10.3390/ani11123366
Johnston GCA, Ahern BJ, Palmieri C, Young AC.(1) Background: Parasagittal groove (PSG) changes are often present on advanced imaging of racing Thoroughbred fetlocks and have been suggested to indicate increased fracture risk. Currently, there is limited evidence differentiating the imaging appearance of prodromal changes in horses at risk of fracture from horses with normal adaptive modelling in response to galloping. This study aims to investigate imaging and gross PSG findings in racing Thoroughbreds and the comparative utility of different imaging modalities to detect PSG changes. (2) Methods: Cadaver limbs were collected from twenty ...
Growth Factor Roles in Soft Tissue Physiology and Pathophysiology.
Advances in experimental medicine and biology    November 23, 2021   Volume 1348 139-159 doi: 10.1007/978-3-030-80614-9_6
Roberts JH, Halper J.Repair and healing of injured and diseased tendons has been traditionally fraught with apprehension and difficulties, and often led to rather unsatisfactory results. The burgeoning research field of growth factors has opened new venues for treatment of tendon disorders and injuries, and possibly for treatment of disorders of the aorta and major arteries as well. Several chapters in this volume elucidate the role of transforming growth factor β (TGFß) in pathogenesis of several heritable disorders affecting soft tissues, such as aorta, cardiac valves, and tendons and ligaments. Several member...
Sarcoplasmic Reticulum from Horse Gluteal Muscle Is Poised for Enhanced Calcium Transport.
Veterinary sciences    November 23, 2021   Volume 8, Issue 12 doi: 10.3390/vetsci8120289
Autry JM, Svensson B, Carlson SF, Chen Z, Cornea RL, Thomas DD, Valberg SJ.We have analyzed the enzymatic activity of the sarcoplasmic reticulum (SR) Ca2+-transporting ATPase (SERCA) from the horse gluteal muscle. Horses are bred for peak athletic performance yet exhibit a high incidence of exertional rhabdomyolysis, with elevated levels of cytosolic Ca2+ proposed as a correlative linkage. We recently reported an improved protocol for isolating SR vesicles from horse muscle; these horse SR vesicles contain an abundant level of SERCA and only trace-levels of sarcolipin (SLN), the inhibitory peptide subunit of SERCA in mammalian fast-twitch skeletal muscle. Here, we re...
Multimodal therapy for treatment of equine back pain: a report of 15 cases.
Brazilian journal of veterinary medicine    November 22, 2021   Volume 43 e003321 doi: 10.29374/2527-2179.bjvm003321
de Melo UP, Ferreira C.Back pain and diseases of the spine are considered significant problems in equine sports and veterinary medicine. This article reports a multimodal approach to the treatment of equine back pain using ozonized platelet rich plasma (PRP), dynamic mobilization exercises, and therapeutic shoeing in 15 horses involved in the vaquejada discipline. Fifteen American Quarter Horses of both sexes engaged in vaquejada in the state of Rio Grande do Norte, Brazil, with a mean age of 8.61 ? 1.73 years were examined at a training center for lower performance diagnostics or back pain. A complete clinical exam...
Mechanical Principles of the Equine Foot.
The Veterinary clinics of North America. Equine practice    November 17, 2021   Volume 37, Issue 3 581-618 doi: 10.1016/j.cveq.2021.09.001
Bras R, Morrison S.A healthy foot requires a well-balanced foot capable of shock absorption, traction, and normal proprioception. Radiographs and venograms are helpful in assessing health of the external and internal structures of the foot and in early diagnosis. Other techniques to assess foot mechanics include force plate and inertial sensors. When foot pathology ensues, early recognition and emergency mechanical treatment can improve prognosis and overall outcome. Sheared heels, under-run heels, and clubfeet are common problems that need to be corrected early. Successful management and results require he vete...
Fast and slow myofiber-specific expression profiles are affected by noncoding RNAs in Mongolian horses.
Comparative biochemistry and physiology. Part D, Genomics & proteomics    November 16, 2021   Volume 41 100942 doi: 10.1016/j.cbd.2021.100942
Bou T, Han H, Mongke T, Zhao R, La X, Ding W, Jia Z, Liu H, Tiemuqier A, An T, Dugarjaviin M, Bai D.The heterogeneity and plasticity of muscle fibers are essential for the athletic performance of horses, mainly at the adaption of exercises and the effect on muscle diseases. Skeletal muscle fibers can be generally distinguished by their characteristics of contraction as slow and fast type myofibers. The diversity of contractile properties and metabolism enable skeletal muscles to respond to the variable functional requirements. We investigated the muscle fiber composition and metabolic enzyme activities of splenius muscle and gluteus medius muscle from Mongolian horses. The deep RNA-seq analy...
Application of kinesiology taping to equine abdominal musculature in a tension frame for muscle facilitation increases longitudinal activity at the trot.
Equine veterinary journal    November 11, 2021   Volume 54, Issue 5 973-978 doi: 10.1111/evj.13533
Biau S, Burgaud I.Kinesiology taping (KT) has been used on human subjects for many years. More recently, KT has been used in sport horses. The physiological mechanisms involved remain unclear and its benefits are controversial. Objective: To investigate the effects of application of kinesiology taping to abdominal muscles on locomotor parameters before and after lungeing exercise in horses. Methods: Cross-over study. Methods: Eleven horses were tested twice, once with an application of KT without tension on abdominal muscles (condition 1) and once with a facilitation application of KT on abdominal muscles (cond...
Pre-race and race management impacts serum muscle enzyme activity in Australian endurance horses.
Equine veterinary journal    November 8, 2021   Volume 54, Issue 5 895-904 doi: 10.1111/evj.13519
Buckley P, Buckley DJ, Freire R, Hughes KJ.Marked increases in serum muscle enzyme activity can occur in endurance horses but the diagnostic certainty in predicting cases of myopathy is unclear. Improved understanding of horse management effects on serum muscle enzyme activity as markers of muscle health would assist interpretation of serum muscle enzyme activity and guide management to reduce myopathy risk. Objective: To investigate associations between serum muscle enzyme activity and management factors in endurance horses. Methods: Cross-sectional study. Methods: One hundred endurance horses competing in four endurance events (offer...
Factors associated with completion of Fédération Équestre Internationale endurance rides (2012-2019): Modelling success to promote welfare-oriented decisions in the equestrian sport of endurance.
Preventive veterinary medicine    November 6, 2021   Volume 198 105534 doi: 10.1016/j.prevetmed.2021.105534
Zuffa T, Bennet ED, Parkin TDH.Endurance riding is a popular equestrian sport organised at the international level by the Fédération Équestre Internationale (FEI). The sport involves prolonged exercise at speed over significant distances, which puts a substantial load on equine athletes' musculoskeletal systems and metabolism and contributes to the risk of injuries and other veterinary problems. The FEI employs a system of in-ride veterinary inspections aimed at early detection of such problems and elimination of horses unfit to continue in the ride. To date, risk factors for elimination due to irregular gait or metaboli...
Cervical Epidural Spinal Analgesia for Acute Management of Severe Unilateral Forelimb Lameness: Case Report.
Frontiers in veterinary science    November 4, 2021   Volume 8 749713 doi: 10.3389/fvets.2021.749713
Watkins AR, Hopster K, Levine D, Hurcombe SD.A 20-year-old Quarter Horse gelding was presented with severe right forelimb lameness (5/5 AAEP Lameness Scale) due to a tear of the superficial digital flexor muscle which was diagnosed via palpation of swelling and ultrasonography revealing major muscle fiber disruption and hematoma formation. When traditional systemic therapy (non-Steroidal anti-inflammatories) did not restore clinically acceptable comfort and the risk of supporting limb laminitis became a reasonable concern, a cervical epidural catheter was placed between the first and second cervical vertebrae in the standing, sedated pat...
Survival Analysis of Training Methodologies and Other Risk Factors for Musculoskeletal Injury in 2-Year-Old Thoroughbred Racehorses in Queensland, Australia.
Frontiers in veterinary science    November 2, 2021   Volume 8 698298 doi: 10.3389/fvets.2021.698298
Crawford KL, Finnane A, Greer RM, Barnes TS, Phillips CJC, Woldeyohannes SM, Bishop EL, Perkins NR, Ahern BJ.Musculoskeletal injuries remain a global problem for the Thoroughbred racing industry and there is conflicting evidence regarding the effect of age on the incidence of injuries. The ideal time to commence race training is strongly debated, with limited supporting literature. There is also conflicting evidence regarding the effect of high-speed exercise on musculoskeletal injuries. There is a strong interest in developing training and management strategies to reduce the frequency of injuries. The types of musculoskeletal injuries vary between 2-year-old and older horses, with dorsal metacarpal ...
An exploration of stakeholder perceptions to inform the development of an evidence-based classification system in para dressage.
Journal of sports sciences    November 2, 2021   Volume 40, Issue 4 459-469 doi: 10.1080/02640414.2021.1997012
St George L, Thetford C, Clayton HM, Hobbs SJ.In dressage, horse-rider combinations must demonstrate harmony whilst performing a test of gaits and movements, scored by judge(s) using predetermined criteria. The para dressage governing body is working towards compliance with the International Paralympic Committee's mandate for evidence-based classification, which requires a comprehensive understanding of key performance determinants. This study aimed to explore stakeholder perceptions surrounding the key determinants of, and impact of impairment on, para dressage performance. Semi-structured interviews with 30 para dressage stakeholders (a...
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