Plaidcast 364: Dr. Tim Worden, PhD & Dr. David Woznica by Taylor, Harris Insurance Services

Plaidcast Episode 364 Dr. Tim Worden, PhD Dr. David Woznica


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Piper speaks with Dr. Tim Worden, PhD about biometrics and show jumping performance and Dr. David Woznica about how riders can take better care of their bodies to help prevent injuries. Brought to you by Taylor, Harris Insurance Services. Listen in!


  • Host: Piper Klemm of The Plaid Horse Magazine
  • Guest: Dr. Tim Worden is a sports performance consultant, Member of the Equine High Performance Sports Group, and co-hosts the Sport Horse Podcast. He specializes in the translation of human high-performance training concepts to equestrian athletes, with a special interest in the jumping discipline. Dr. Worden has worked with numerous FEI riders to provide detailed performance analytics and guidance on training program design. Dr. Worden completed his Master’s Degree in Human Biomechanics and Neuroscience and PhD in Human Biomechanics at the University of Guelph in Ontario, Canada. In addition to his work in the equestrian community, Dr. Worden is a Business Development Manager at Inteligex Inc. and a member of the Spinal Cord Injury Clinical Research Unit at Toronto Western Hospital.
  • Guest: Dr. David Woznica is an experienced interventional spine and regenerative medicine physician, board-certified in Physical Medicine and Rehabilitation as well as Sports Medicine. Dr. David Woznica is an expert in pre-physical therapy, pain management, and musculoskeletal care. Dr. Woznica’s approach focuses on empowering athletes with the knowledge to proactively manage and prevent injuries, rather than adopting a reactive approach to pain and physical strain. 
  • Title Sponsor: Taylor, Harris Insurance Services, Taylor, Harris Insurance Services (THIS) was founded in 1987 to provide specialized insurance for all types of equine risk. THIS places their policies with the highest rated and most secure carriers, meticulously selected for reliability and prompt claims settlement. THIS is proud of their worldwide reputation for responsive and courteous service, and welcomes the opportunity to discuss your equine insurance needs and provide you with a quote.
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  • Sponsors: American Stalls, Purina Animal NutritionAmerica CryoLAURACEA, Wordley Martin, BoneKare, Show Strides Book Series, With Purpose: The Balmoral Standard and Good Boy, Eddie

This transcript was generated automatically. Its accuracy may vary.

Piper Klemm [00:01:00] This is the plaidcast. I’m Piper Klemm, publisher of the Plaid Horse magazine, and coming up today on episode 364, I talk with Doctor Tim Worden, PhD, about biometrics and show jumping performance. I then talk with Doctor David Woznica, M.D., about how riders can take better care of their bodies to prevent injuries. This episode is brought to you by Taylor Harris Insurance Services. 

Piper Klemm [00:03:25] Doctor Tim Worden is a sports performance consultant, member of the Equine High Performance Sports Group, and co-hosts the Sport Horse Podcast. He specializes in the translation of human high performance training concepts to equestrian athletes, with a special interest in the jumping discipline. Doctor Worden has worked with numerous FEI riders to provide detailed performance analytics and guidance on training program design. Doctor Worden completed his master’s degree in Human Biomechanics and Neuroscience and his PhD in Human Biomechanics at the University of Guelph in Ontario, Canada. In addition to his work in the equestrian community, Doctor Worden is a business development manager at Inteligex, Inc. and a member of the Spinal Cord Injury Clinical Research Unit at Toronto Western Hospital. You had a really interesting article come out last year about biometrics and showjumping performance. Can you tell us about that? 

Dr. Tim Worden [00:04:17] Yeah. So, it was a Canadian publication, Horse Sports. They reached out about, wanting to, I guess started that bit of dialog about some of these different metrics that we can be tracking with horses. I think that there is a lot of opportunity in this sport. And I know some of your other episodes have talked on that, talked about that as well. There’s a lot of opportunity to take what is being done in other sports, more human focused sports, and to apply that to equestrian disciplines to both improve performance as well as, improve welfare and health for the horses. 

Piper Klemm [00:04:54] It’s really interesting, like how how much has changed, but how much stays the same with the horses. And for all our technology, like how much better we are off than, you know, than a few decades ago. And you see a lot of these discussions on social media about our. Are we better off with new footing? Are we better off with new technology, or does it almost just make us more, or tempt us into overdoing it with our horses? Like, how do we start to think about balancing all these concepts? 

Dr. Tim Worden [00:05:27] Yeah, that’s a really great point. I guess a few thoughts surrounding it. I think the first one that I think everyone needs to consider is what is the ultimate goal of what we do with, sport horses or just horses in general? I think a lot of people, if they are competing, would probably say the ultimate goal is to win a gold medal. At an Olympics or to, win a World Championships or whatever. But I think that just needs to be reframed. I think that the ultimate goal really needs to be, that you have when your horse retires at the end of its career, that it could still go out in the field and be relatively active, and it can move around as it wants to. And I think this secondary goal needs to be that the horse is happy to do its job. And then if you hit goal one and goal, two, then I think you can chase performance and, you can be happy if you go and you win that gold medal. And I think I’ve talked to a few, human centered coaches and really, really good coaches like the people coaching world champions and world record holders and so on. And they always talk about you need to focus on the athlete first and making sure that you’re keeping them healthy and happy. Because if you have those two pieces in place, then everything follows. And I think just circling back to what you said, I think that that’s something that gets missed more and more in our sport now is the veterinary management improve. So we have therapies that are very, very effective on that veterinary side. So I think people are very tempted to just pursue different types of injections or therapies to get the horses back going as quick as possible. As well. We are footing where we can travel the world. We can set up these shows. You can fly horses in for a week, jump them, fly them out next week for them around the world. And again, it creates this environment where people are always on the go, go, go. The way the FEI ranking system is structured, it encourages the riders to compete as much as possible, especially the jumping disciplines. So yeah, look, I think that there is a lot out there. And then just the second point that I’ll bring up and I thought it was really insightful. It was I was talking to quite a well known jumping rider who’s had a very long career, and they were talking about, you know, 20, 30 years ago. If you think about a horse’s health as a green light, so healthy and ready to do whatever. And then there’s that orange light where, you know, some things are maybe some warning signs are starting to appear. And then you have your red light, which is obviously cannot compete. This rider was saying that 20, 30 years ago, whenever you had that orange light, the idea was just take a step back, give the horse time so you can get it back to green before going again versus today, because there’s so many therapies and so many different ways of keeping horses going, that an orange light is treated the exact same as a green light. So even if you have these small warning signs, people tend to still keep competing and competing. And so even with all of these medical advancements that have come along, these veterinary advancements, therapeutic advancements, I don’t think that, the prevalence of certain injuries has really decreased just because we tend to compete more and more still. 

Piper Klemm [00:08:40] I was just having this conversation with someone about hooves and, you know, you look at, like, the Swedish horses and stuff being barefoot, and it seems impossible in our world. So I, I always, I always ask people like, well, how is it possible for them and not possible for us? And the conversation I had the other day with someone was, exactly what you’re saying, that they’re showing so much and their schedule is so intense, and then their, their feet get smaller, and then you just put smaller shoes on them because that’s a fix this week, whereas the long term fix would be actually rehabbing the hoof. And that might take a week or two here or there. But then when you don’t do it, that adds up to this kind of catastrophic injury because their feet have gotten so much smaller because we’re just shoeing for this week instead of this month or this year or this lifetime. 

Dr. Tim Worden [00:09:27] Yeah for sure. And and it comes back to priorities, as you say. Right. I think that it really. People tend to, I think, sometimes invest in the wrong areas or it’s always investing in short term success. And like I understand it from the rider perspective as well. Right? I think it’s it’s very expensive to have a stable to have all these horses. And it’s probably very daunting to look at, just those invoices coming every week and knowing like, okay, like instead of going in and chasing prize money and chasing, publicity that I need to drive sponsorships and all those different things, like, maybe I need to take a step back. And so, like, there are for sure a lot of pressures that ultimately drive people to compete as much as they do and everything, but it. It does. It does challenge the the organism- the horse quite a bit. And it’s something where I, we, I always pose this to people I talk to. And you think about an athlete like a Usain Bolt, who is just so dominant over his career, had a relatively long career. For sure some small injuries along the way, but I’d say like nothing catastrophic for him. But would Usain Bolt have ever broken the world record, or would he have been as successful had he been trained like we train horses and probably not. Like ultimately that he needed more. He needs recovery time too. We tend not to give our horses enough of. He needed very targeted training. We tend not to do that so much in our world. And ultimately it makes you question how much athletic potential are we leaving on the table just because we’re not, prioritizing things, maybe as we should be. 

Piper Klemm [00:11:11] And I think about this like we know that they were complete outliers, but, like, back in the day, you had, you know, you had ponies jumping the Olympics, which we would never see in today’s world. And you talk about potential. We had, you know, like a pony do Land Rover, formerly Rolex. And, and you think about that level of potential, and the jumps were still huge back then and then big and wide. And, you know, I totally agree. What what potential do these horses have? On the flip side, we are seeing people horses last longer and longer and longer. And we’re seeing horses late into their teens being very successful when managed carefully. So I think there’s a lot of evidence to your point there. 

Dr. Tim Worden [00:12:00] Yeah. Completely agree. And yeah, that’s the flip side, right? Like I think there are some programs out there. Like I absolutely love following and love learning about because you see, on the flip side, like what happens when horses are managing them in a more natural type way where they’re having access to turnout. The competitions are chosen a little bit more carefully as to when, horse goes I, I’m always fascinated by those riders who can peak horses for the major championships. And sometimes you look through the competition record and it doesn’t look that impressive for most of the year. But then, like, they’re always, you know, gunning for a podium and in the race until the last day. At at championships. So yeah. And to your point a little bit about like there’s outliers. So if ponies or unconventional horse that go on to have success. I think that’s another fascinating thing, especially when. So the jumping world is what I’m most familiar with, and you have all these young horse classes and people are selecting essentially what horses are going to potentially have an FEI career when the horses three or 4 or 5 years old, kind of driving them down that road. And it does make you wonder how many horses are just missed because they never get a chance early. Just because people write them off early in life. And you think about, like so many top athletes, whether it’s like a Michael Jordan or, like they’re there’s so many like those types of people who ended peak a little bit later in life and maybe weren’t the most special early. And I think it again, relates back to a little bit of the metrics that we follow and what truly does matter for a jumping horse or dressage horse or, thoroughbred racehorse. And are we truly selecting for the best traits or are we selecting is there so much bias built up with respect to what we’re searching for? 

Piper Klemm [00:13:56] Back to what you said about Usain Bolt earlier. What would that look like? What would that kind of cross training look like for horses? Like how do you kind of define that? Or how would we know if our horses were doing it? 

Dr. Tim Worden [00:14:08] Yeah. So I guess a few things to look for. The first thing is recovery. I think right now a lot of programs they tend to view like the off days, the recovery days in the stable as a little bit like the forgotten days. It’s like the horse is just off today, so it doesn’t matter what the horse does, as long as it’s not ridden hard, it’s fine. And I think there needs to be a shift around that. I think more and more, we’re starting to appreciate that those recovery days, realistically, are probably the most important days and require the most thought a lot of times. And with respect to thought, like you have to decide whether it’s going to be active recovery. So that’s still having an athlete go out and move around, and they may still get the heart rate relatively high. They may go play some other sport, do some other sport, and then you have passive recovery, which is a bit more like just sitting on the couch. So that would just be a horse just very calmly in the pasture all day. And it really relates back to like what makes the horse happy and what allows it to relax mentally. So people need to think a lot about like, each individual horse in the barn. I think some horses do enjoy love going for trail ride. Some horses just want to be on the field all day. Some horses, they do love their, their owner, their rider, their, whatever staff member may look after them. So spending a lot of time with that staff member may be valuable for them. So for someone like Usain Bolt, recovery was for sure critical to them. And he would have had a lot more recovery built into his weekly program than, horses tend to. So if you go down to Wellington, a lot of horses do have the six day work week. And yeah, they may have some lighter days and some harder days, but usually every day, like the riders getting after the horse a little bit, you know, like they’re working on ride ability or you know, they’re working on turning or and maybe they’re popping over some small jumps. And I think we need to be very, very structured with if it is a recovery day for a horse or an easy day for a horse, their, their mind, their body really does need to recover and you can’t get after them so much. And then on the flip side, again, like jumpers, what I’m more familiar with. But if you think about what is the end goal for that sport, like the course, of course, jump clear in the first round to make it to the jump off and then it becomes a race essentially. So we need to think about having horses that can jump 16 jumps at a meter 60, round one, from different approaches and from in different combinations and different different constraints that way. But then as soon as you get into the jump off, you’ve got about eight jumps, like it really becomes a velocity game. And I think that there’s a lot that can be done. So that horses can generate these large forces at the base of the jump, but they need to be able to do that very, very quickly. And that’s something that tends not to get trained. So, all that to say, for someone like Usain Bolt, like those hard training days, they would have been very, very targeted to speed and speed, endurance and just building that ability to generate large, large forces over a very, very short period of time. And then that would have been countered with very, very easy light days so his body could recharge and regrow and. So I think that that’s something to that. There is a lot of opportunity in equestrian sports to to pursue that a little bit more and make sure that we’re being very, very structured with giving our horses time to recovery to recover from very, very intense workouts that we are going to do with them so that we make sure their bodies are ready to perform at their maximal or near maximal potential. 

Piper Klemm [00:17:54] Can you talk about, kind of the FEI constraints? I think a lot of people know and a lot of people listening also don’t know, like how FEI Barn’s work at the horse show that the horse is in a supervised area and, their comings and goings are monitored. It’s not like, you know, many USEF or national horse shows like, like my horse in Kentucky over the summer, we take him home at night for a turn out overnight and bring him back to the horse show during the day. And and the FEI constraints are very different from that, which is, you know, the, the lifeblood of, of so much of the rest of the world, especially. 

Dr. Tim Worden [00:18:35] Yeah for sure. So yeah, with regards to the FEI stabling, there are it’s not an easy, an easy world for the horses. So they of course they have to jog, just to make sure the horse is sound before they enter for stabling or the first day, if. Yeah. And then you’re. The FEI is trying to do certain things to make sure the horses in there stay healthy. So they’re checking temperatures and try to monitor those types of things just to look for early, signs of illness. But. Ultimately the FEI stabling exists so that people can’t do, anything, negative to the horses during the competition. So, like on one hand, I understand it and like, it needs to be supervised, and all those types of things. But yeah, to your point, on the other side, they are kept in a confined space. It’s a bunch of horses in a very, very small area. Until recently, they always had lights on or typically had lights on overnight. So it was harder for the horses to sleep. Like that has been changed now. So the lights are supposed to be off at night in FEI stabling, so the horses can now sleep a little bit better. But 100% like you never have access to turnout, in a FEI, except for a very, very small number of exceptions. There are only so many places where you can hand walk a horse. Typically you’re constrained to where you can ride the horse. So if you have a horse that does enjoy going for trail rides or just enjoys, you know, getting out, getting to new location just to get away from the hustle and bustle of a very active stabling area. You can’t really do that. And. And then as well. Just related to the FEI. Like they’re just to get the points that you need to get into the big shows. Like people are- it encourages people to show very, very frequently. And so now, again, especially if someone doesn’t have a huge budget, they’re having to show the same horses more frequently throughout the year. The worst that are left at home may not have access to great care, so they may get neglected a little bit just because someone may not be able to afford a huge team to be at home and monitoring the horses while the other team is on the road. So it’s all of those types of things that make FEI a very, very challenging landscape for horses. 

Piper Klemm [00:20:56] That kind of comes back to your point of it’s even more unnatural. So they probably need even more rest time from, from a week, in FEI stabling. 

Dr. Tim Worden [00:21:06] Yeah, for sure. And, I’ll be curious to see that in the future if the, the FEI and different federations take a bit more of a leadership role on, with respect to how frequently horses show while they’re in FEI. So, like, there’s no rule against doing horses three days a row, or four days a row in classes. I think, without a doubt, that speeding up the body, especially like on these more modern surfaces, which do tend to be a bit firmer, and lack, maybe as much as maybe lack, the same cushion that other surfaces have. So like the body’s for sure getting beat up in there. As a general rule of thumb, that if you think about, the way the body responds to different loading, like in a lot of cases, two days is a good window to think about between different training sessions that are similar. And I could tell you that if you look at Olympic level, like long jumpers or high jumpers or triple jumpers, if you jumped in 3 or 4 days in a row, like you would break them. There’s just no way around it. Like those athletes the force that’s going through those bodies is just so massive on takeoff and on approach. And it makes you wonder, like the data isn’t out there for horses, but it’s something I’m always thinking about. In the back of my mind is what is the threshold for horses? Because in human athletes, there’s no way they would survive the competition calendar that we have for horses. 

Piper Klemm [00:22:34] Let’s talk more about that footing. Everyone I’ve ever met in my life is a footing expert. And has many opinions on it. But we don’t have a ton of, you know, a ton of actual data. You talk to the old horsemen, and they never had, as many soft tissue injuries. A lot of stuff. I think some of that, at least a small percentage of that, is that our diagnostics are so much better, and we’re actually looking for stuff. I’m not in the camp that this stuff never happened back in the day. But it definitely has become more frequent. I definitely have. Older, older ponies do not do well on the synthetic footing and do really well on sand, but it’s hard to find places for them to horseshow on sand anymore. I think there are a lot of layers of this, but. So many people are on synthetic all the time at home. You have people who cross train on different surfaces, but then still might have some problems when they get on synthetic like how do we. How do we manage our horses the best we can. And, it kind of comes back to the FEI stabling when you’re really limited on on where you can ride, back to, you know, the Kentucky example. You can if you’re not FEI, you can just go around the field and not even be on the surfaces unless you’re showing. But, you know, that’s not the case for FEI. 

Dr. Tim Worden [00:24:08] Yeah. Really, really good question. And so I think the first thing before I dive into my perspective, I would encourage people to go and read, the FEI white paper on different footings. Like, there are a lot of just really, really talented researchers who contributed to that paper. Maybe you can include a link to that in the show notes, if possible, Piper. But it provides a really, really nice overview of surfaces and how to think about them. There are six characteristics. Things such as, you know, firmness and cushioning, responsiveness, grip, uniformity, consistency. Those are the the six parameters that, to think about for different footings. And it just provides a really nice overview. That being said, my perspective on it is that too much time on any surface, whether it’s. You know, the the best surface in the world. Too much time on any surface will eventually. Lead to some issues with your horses. I don’t think there’s any way around that. Again. Coming back to the human example, like if you look at someone like Usain Bolt, he spent most of his time running on grass. He would have been on sand a little bit, and he actually, very infrequently, probably would have been on the track with, actual race spikes. So he would have been constantly varying the, the surfaces beneath him. He would spend a lot of time just regular, running flat as well, just so that, the stimuli going through the body and the loading going through the body was always variable. Just so you never, overloading certain structures the same way consistently day in and day out, because that’s when you you get injury. About ten years ago now, maybe a bit longer. There was a really nice epidemiological study done by a Swedish group, and they tracked, I think, over 250, sport horses, I think mostly jumpers that may have been in some dressage there as well. And they looked at some of the risk factors, for injury. And then conversely, some of the protective factors to protect horses, sport horses from, from being injured. And one of the, protectors was having those horses, exercise on different surfaces. So the horses that tended to be on be exposed to more different surfaces tend. This tended to stay healthier, over the course of that study. And so that that would be my one recommendation is, if possible, to everyone listening at home, try to get on as many different surfaces as you can every week with the horses. If there’s most people probably have a sand or synthetic ring at home, so you’re going to spend a bit of time in there, but maybe you can get out and ride a little bit in the paddock, if it has. Okay footing out there, even just, going for trails through a forest, being on dirt or, crushed, gravel may be possible if you don’t, canter, gallop on that. And so just trying to expose the body to as many different variables as possible. I think some people on the flip side maybe say, was the last thing you want to do is just not expose your horse to a certain surface. So, for example, like Wellington, if you’re going to go down, compete in Wellington for a couple of weeks, and then you’ve been only riding on softer surfaces, maybe sand and like, a little bit of a softer grass for a couple weeks. Then you’re going to go to Wellington like you want to make sure there’s a bit of a runway where you prepare your horse to be exposed to a firmer surface or, less cushion for surface, if that is what you perceive Wellington to have, for example. But I think in general, trying to be on as many different surfaces as you can through the week. Gives your horse the best chance to recover between different workouts, to not have the body exposed to the same pounding day in and day out. If that makes sense. 

Piper Klemm [00:28:06] It’s super interesting. I was in Ireland last year and most of the barns we went to trotted the horses up and down, on gravely rocks, before they got going, riding. And so naturally I was like, why are you doing riding your barefoot horse over rocks? And, they explained to me that because it’s so rainy and wet there that their feet get too soft. And doing that basically hardens up their feet, and keeps their feet from getting essentially,  too wet over the course of the season there. And it, it was completely eye opening to me. Like, how much exactly what you said. It’s, it’s a runway and local factors. And what are you, you know, personally dealing with and if you’re, you know, at the desert, obviously that’s not going to be the right call. But, you know, where it rains pretty much every day of the year. That’s necessary. 

Dr. Tim Worden [00:29:03] Yeah for sure. That’s fascinating story to to hear. And and I think that’s where it’s really cool. Right. Because on one hand you have and for sure like I’m a science guys. So like my bias is always going to be going into the literature and, and seeing what’s new and exciting coming out, what studies are being done. But I think that to your point, it’s really cool when. It’s like that’s a lot of probably horsemanship passed down from generation to generation to generation and through trial and error, like they probably figured out like that, these certain types of stimuli, these workouts were protecting the horse’s feet and protecting the bodies. And it’s cool to see that, intersection right where, I think the horsemanship and like, I think that that’s something I want to just touch on really quickly is I think sometimes people perceive me to be against, with the horsemanship and that like, knowledge passed down from generation to generation. But ultimately a lot of the horsemanship is, is science in a way, too, right? Like over the years people have experimented and they figured out, you know, this is what works and this is what doesn’t. And we’ve ended up with just an incredible wealth of knowledge that, you know, the experts in the industry do have. But I think just looking at next steps and how do we continue to evolve the sport and make it so that horses can compete more frequently and at higher and higher levels? I think that’s where horsemanship just can’t stay where it is today. That’s where it needs to keep evolving and growing. 

Piper Klemm [00:30:33] And any great horse person I’ve ever met. You know, you really sit down and talk to them and they completely are a scientist. They they don’t write it down in the same way that that you and I are classically taught. But they’re analyzing data sets. They’re they’re adding in data every single day and changing their hypotheses and their conclusions with more knowledge and more information. And that’s exactly what a scientist does. 

Dr. Tim Worden [00:30:58] Exactly. Like, I think, of course, riders in our industry and trainers, if they have such long careers right away, longer than pretty much any other sports out there, and people will sometimes ask me because I have been similar to you, like very, very fortunate to talk to a lot of very, very successful riders and horse people. And I completely agree. Like, I think the one common denominator is just like a curiosity and like a true love for the horse. I think that there you can have short term success in this world if you don’t have one of those components. But yeah, it’s it’s pretty rare that I don’t get into a conversation or that I’ll get into a conversation with like a horse person who’s been very, very successful, who will, sort his own out or tune out early on. You know, if if you bring in new ideas and new concepts, I think that those people are always really engaged and just like learning about it. And ultimately they’re always looking for a bit of a competitive edge, and you never know where where that’s going to come from. 

Piper Klemm [00:32:05] You talked about biases earlier that might let us not think of or not get a horse into the right place. For sure. We have it with with people too. Our generally, our top riders have been successful at some level at a younger age as well. We don’t see, even though this is a lifelong sport and hypothetically, we should see it. We don’t really see many people crop up in their 40s for the first time and say, I’m here. I. I couldn’t help but think when you were saying that of like how much the fact that every like kind of the investment culture, both in the horse world and the real world at large really impacts that, all those biases. And because everyone’s buying a horse, thinking about reselling it, thinking about its next stage, thinking about, that part, like we have so much bias. And in that perfect vetting, we, we’ve kind of added these biases in that don’t always make sense. And then I, it also has the other side where it’s like really causing short term thinking, which goes back to your very first point of our first goal should be that the horse retires sound. And I think so many people in the chain and in the pipeline are so far from that horse retiring sound. It’s it’s hard to think in the long term when society and investment culture really has us thinking in the short term. 

Dr. Tim Worden [00:33:37] Yeah. For sure. And it’s really challenging, right? I think again, like. It’s probably gotten more and more difficult to look at the long term over the years as the sport got more and more expensive, because people have to invest so much and so early on in the process. Now that I think they’re probably always in the back of their mind, they have that escape grade where it’s like, okay, like, you know, if the horse doesn’t hit these milestones, I need to get rid of it ASAP because I can’t afford to carry it on my books anymore. But yeah, it’s just it’s created a world where, I do think people are looking for the wrong things in horses. There’s, a quote I love from the human side. A lot of coaches say it, and the quote is, if you want to guarantee that your child will not win an Olympic medal, then have that child win a youth championship medal, with the idea being that it is very, very rare that those kids who hold the youth world records and like the junior world records ever go on to have incredible success at a senior level. Just because they typically you have to beat up the body a little bit to win. And if you beat up the body to win at five, 6 or 7, then the you’re withdrawing so much in that horse’s body early on in life that you’re never going to be able to make enough deposits when you get into eight nine to ever counteract that, like you will. There will be so much damage in just like micro structural, like small damage that may not show up on a vetting, but, it’s going to have an impact later in life. And like obviously there are exceptions to that. But I think for the most part, a lot of times, so much time is spent pursuing those, the young horse championships stuff that is probably, in the long run, hurting the horse a little bit. And then as well, like you hear everyone talk about to your point, the, the x rays and, you know, it needs to be a clean x rays so that I can potentially resell it later down the line. And obviously there’s certain things on x rays that’s most likely will shorten a horse’s career or could potentially lead to a catastrophic, breakdown. You need to be mindful of that. But yeah, we we really do ride the, the horse and not, the x ray. And I just think about, like, if someone, did some imaging on, on my body, then, you know, no one. No one would touch me with a ten foot pole because, you know, my body’s been beaten up over the years, but at the same time, like, I’m able to do whatever I need to do, right now in my life. And so it’s those types of things, I think as well, like, and personality. People have a perception of what the correct personality should be for a jumper. And I think sometimes they don’t focus on the bigger picture of, yeah, this is the personality of a 5 or 6 year old horse, but it’s going to change. It’s going to grow in like an indifferent environment. That personality could be very, very different, 4 or 5 years down the line. So it’s the whole psychology of it is fascinating. And then just because, I mean jumper is the last point, I’ll touch on that, is a little bit of a pet peeve of mine, is those all those pictures of horses jumping way over the standards and, everyone gets excited about that, right? But to me personally, that just shows that, like, the horse doesn’t know where the jump is. Because there’s always a trade off between efficiency and, you know, clearance. And you go back and you look at those horses that have really long careers and they tend to be very, very smart and very efficient over their jumps. And the other point to that is that if you do want a horse to look really impressive or jump, then they just get it really deep and get to the base of the jump extend. It has to pop up anyway. So, it’s always interesting to see all those pictures of horses posted online where they’re like, find way over the standards. If you actually watch the round, that’s usually the jump. Or it can be jump or the rider missed, and then the horse had to pop way up to just get over it. So, it’s all those types of things where we’ve just been conditioned to look for a horse that’s way over the jump or something like that. But usually there’s a reason it’s doing that, doing that, and it’s not what I would select for personally. 

Piper Klemm [00:38:04] All the top horses. The really top horses understand the game at some level. And exactly what you’re saying like that. That’s more indicative of the horse not understanding or grasping what what the game is. And I think a lot of horses that are a little more, maybe plain looking and understand the game get completely undervalued by the market because it’s such a complicated thing to look for. 

Dr. Tim Worden [00:38:29] Exactly. And like just talking to a few young horse producers who produce really, really top jumpers, like they always say that. Like they were just normal to your point. You know, like there was nothing. And like obviously, again, there are exceptions, but a lot of them, like they weren’t super flashy. Like they wouldn’t say that they were like the best horse is like a 5 or 6 year old they ever sat on. But it’s just like the they went and did the job. They enjoyed doing the job and. You know, they would still pull rails like a lot of them. It’s not that they were like consistently like always going clear, clear, clear, but they were just very clever in that. Like, if they did pull a rail, like they wouldn’t do it again. Coming around to the same jump. Right. Like they learned, they seem to enjoy the, the mental side of the game and they’re just very, very good of good at getting their body in the right position on approach. So that’s. You know they can clear the jump as they need to. 

Piper Klemm [00:39:26] And I would almost make a separate argument there. And that’s the same argument I would make with the youth championships of, of people in any sport, is that I do think that. If they’re quote unquote, less special horses or less seeming special horses. At five years old, the pressure to, go too fast kind of almost isn’t there. Just like the people who, win youth championships like, all of a sudden this pressure comes out, you win the young horse championships and all these people, you know, you’re the this we want results. We want whatever. And and so they start to rush things. Those putting pressures on riders, putting pressure on putting pressure on horses. I think the more almost quality you have or the more quality you perceive you have it, it takes a higher level of self-control to go really slow and do it correctly. 

Dr. Tim Worden [00:40:17] Yeah, for sure. I think that’s a really important point. Because I think that there’s yeah, to your point, there’s so much pressure when someone starts to show talent early in life. Right? Like, and I think that’s. Yeah, it’s really well said. I don’t, I guess I don’t have much to elaborate on it for like all that to say that, like, on the human side, like, there’s so many athletes like that who are just like, normal. And they flew under the radar for so long, and then when they finally get their chance, like they haven’t been screwed up earlier in life. So you haven’t had all those different coaches and, you know, people trying to approach you and say, you need to be doing this and this. Like they were just left alone with a coach who they trusted, who did have their best interests at heart. And then you just let them chip away, chip away, chip away. And then when they actually, like, start showing the talent that they have, like, it’s on such a solid base that even when that pressure does come and it comes rapidly, they’re able to tolerate it. 

Piper Klemm [00:41:16] I don’t related to something you said earlier. It takes a lot of everything to to peak any time. But what we’re almost creating for both physically, mentally, emotionally, the horse and the rider. But yeah, this culture we’re kind of creating expect people to peak all the time. And we have this issue of every the importance of every class. Like somehow in today’s world, every class is important and everything is a can’t miss situation. And they come all the time and they come so fast. What how can we kind of back people off on that? Like what is a realistic number of times a year to peak for your horse going back to your your rest statement, like how many, how many times a year truly can we ask the horse in competition or how many competitions a year can we truly ask the horse to give it their all? 

Dr. Tim Worden [00:42:12] Yeah, that’s a good question. And, I don’t I don’t want to dodge it, but I would say we don’t really know. I, I have my own ideas, and I’ll touch on that in a minute. But you go through the human literature and especially in the 80s and the 90s, like some of those countries just published so much and they were tracking everything with their athletes. And so you end up with like all of the stat, and you can actually go through and you can become quite comfortable with how many times you can get, human athlete into peak form. And it really depends on sport. For like insurance type events. It’s a little bit longer. Do you have a little bit, of a more narrow window with how long they can be in true top, top shape? Because when they go in they do a marathon like it, just this body up so much that you can’t do two marathons in a row or anything. You get closer to the speed power sports. So they keep track and field, sprinting or weightlifting, those types of things. You can be in peak form for a little bit longer, but it’s still ultimately you’re maybe looking at. Maximum like two months in three times a year type thing, you know, and like there are certain things you can do to maybe extend or, decrease that time window, but absolute maximum would probably be like five months of the year where they could close to potential. And then in terms of truly peaking for an event again, you’re looking at, a few weeks, a year where you could actually say to your horses in or your athlete is in peak form and could potentially win, a medal or break a world record. Horses. I don’t think we we know. Just when I’m building programs and when I’m talking to riders about until we learn more differently, like I tend to work build stuff based on, like the human literature that is out there, and obviously making tweaks depending on individual horses and how they respond to certain things. I think that there are definitely some things you can do to keep them close to peak form for a little bit longer, but with respect to having a horse come out of the stable and say like, this is the best the horse has ever been, like everything came together like, that’s you know, that’s a little bit harder to, to plan for and to make happen. And then just a little bit to your point, and I think it’s a very, very valid point. I was talking to some friends about this, last week. There’s so much pressure every single day. Right? Like, I was at a competition last week, and I think it was four straight days of competition. Of FEI jumping like two rounds or two FEI classes a day. And every single class that the riders are all very serious and very much so in the zone. And just for the human athlete, forget the horse for a minute. Like for the human athlete. Like that takes an incredible drain on the body. Right? And I think like those types of things, if you think about riders who are doing that in the 3 or 4 days a week, they’re competing and they’re doing that 45 to 50 weeks a year. Like, I know there’s some superhumans out there, but I don’t think anyone’s body can really respond to that well, and then you had the your same point about the horse. Like they’re under pressure maybe 2 or 3 times a week for, you know, 20, 25 weeks of the year in some cases. And it just takes an incredible, pull. And I think that’s one thing that human athletes have been coached up very well to do is to keep it all in perspective and to make sure they find ways that the sport is still fun. And. And easy for them. And so I think it’s really, really important to be able to joke around in competition, with your athletes to make it so that, like, obviously there are those competitions where, like, nerves will be up and everything, but you can’t stay super serious and super focused, or I should say, you can’t stay super serious and super intense every single day, because you’re just going to To burn out. Like It’s just not possible. Obviously you need the focus, but you need to be able to laugh around or to joke around it, to laugh, and to take it a bit easy at times. 

Piper Klemm [00:46:27] Where can people find your podcast? If they enjoyed this, where can they listen to more? 

Dr. Tim Worden [00:46:32] Yeah. So, you can listen to, the Sport Horse podcast. It’s available on all the major podcast, players. And if you go to horse, you can also find it, through our website there. And we also have some other, learning material there. 

Piper Klemm [00:46:51] Amazing. Doctor Tim Worden, thank you for joining us on the plaidcast. 

Dr. Tim Worden [00:46:54] Thanks for having me. I hope I didn’t talk too much, but I love, I love this content. So I’ll never turn down an opportunity to, to chat. 

Piper Klemm [00:49:40] Doctor David Woznica is an experienced interventional spine and regenerative medicine physician, board certified in physical medicine and rehabilitation as well as sports medicine. Doctor David Woznica is an expert in physical therapy, pain management and musculoskeletal care. Doctor Woznica’s approach focuses on empowering athletes with the knowledge to proactively manage and prevent injuries, rather than adopting a reactive approach to pain and physical strain. Welcome to the plaidcast, doctor David Woznica. 

Dr. David Woznica [00:50:10] Oh thank you Piper, pleasure to be here. 

Piper Klemm [00:50:12] So tell us a little bit about your background in musculoskeletal care and how you became interested in helping equestrians in pain. I think one of the things you go to any equestrian thing and the the battle scars, the pain that we all carry from the sport, is very real. 

Dr. David Woznica [00:50:31] Oh, yes. Absolutely, absolutely. That’s almost universal to all sports. Right. But, you know, with equestrian sports, you have the addition of a thousands of pounds of animal. So, you know, essentially, I’m a physciatrist by background, so it’s a physical medicine and rehabilitation specialist. So I did my training at a New York Presbyterian of Columbia in Cornell, in Manhattan, and, some specialize in sports medicine with a fellowship at northwestern and then Rehab Institute of Chicago. After that, I practiced kind of, kind of for historically traditional medicine. I was at the Yale Spine Center. I was the head spine non-surgical physciatrist there, doing a lot of steroid injections for injections, etc., to help people with pain. But I saw how kind of it was a repetitive sort of a treatment, and people would eventually end up in a surgical route. So I look for something better and ended up back in Chicago, actually. And I trained in what’s called prolo therapy, proliferative therapy, under one of the greats of the field, doctor Ross Hauser, who had been trained by one of the grandfathers of the treatment technique, which was invented in the 1930s in the US. And really, you know, I’d been a personal trainer for maybe about eight years of my life and had a, undergraduate focus in exercise science as well. And so it really had been a passion of mine to make sure people can be as active and injury free to keep their activities going. So and really, once I started grasping on to regenerative medicine and prolo therapy, etc., I’ve opened up a whole new world and how people can get better and how long they can do that for. 

Piper Klemm [00:51:59] I feel like with our horses, we’ve, we’ve gone in the direction of kind of treating things as they come to being more holistic and and more preventative and, kind of that, that human range of how we approach things, is kind of following this in parallel. Can you talk a little bit about how we how we think about ourselves and that process of it’s less like waiting to get injured, I would say today? 

Dr. David Woznica [00:52:26] No, absolutely. It’s you’re trying to follow the shift from kind of sick medicine to wellness medicine. You know, sick medicine is when you treat the specific injury or your high blood pressure, etc., whereas wellness is in trying to prevent these things occurring and treating them and trying to resolve them as they come up. And, you know, in the question in sports specifically, you know, it was wellness. I see a lot of patients that have low back sick, really active dysfunction and hip dysfunction. And you can because the joints you can kind of over you can over ignore them. Right. You can work through things and people end up having these injuries kind of at a low level, just building up after years and years and years until it gets to a severe point. And what’s nice about regenerative treatments is they don’t cause any degradation to the tissue, like a steroid injection could do, or long term anti-inflammatory drug use like absolutely do. Instead, you know you’re causing the healing response. So it’s not uncommon for people, especially in their offseason when they’re kind of like, you know, maybe without pain or let’s have less competition. So you do more aggressive treatments where they’re really trying to re obtain stability to their joints and improve the health of the tendons and the ligaments to keep themselves strong in season comes. And then as season comes in, it’s, you know, in in the midst of it, a lot of treatments are focused there on kind of keeping the area as healthy as it can be until you can treat it more aggressively later. 

Piper Klemm [00:53:41] So and so in low back pain. I mean, what percentage of equestrians do you think, do you think this is affecting almost everybody? Like, how do you. 

Dr. David Woznica [00:53:51] Yeah, it’s it’s it’s a, I would say high like 70 to 80%. Okay. And you might only feel kind of things like a twinge in the outer hip or a twinge in the low back, kind of an area. But if you think of the mechanics of getting on and off of the horse and just how your your legs are positioned there, for the entire time that you’re on your kind of splaying the hip and sigriliac joint, they’re both getting a lot of, torsion activity. And on top of that, sitting just basic sitting is really like the fourth, most, aggressive position for the low back discs. Okay. So once you start to lose some spinal stability at the low back, which happens naturally, bend forward. You’re working your entire life in the forward plane. So you start to get instability happening in the low back. And then you’re sitting for a long time on an animal that’s moving and all that up and down and forward and side forces, they start transmitting abnormally through your back and start to get kind of a stiffness and ache. You know, you feel like you just kind of like want to stretch a lot or your muscles. You hang tight and occasionally get sharp twinges and pain. And like I said before, you can really work through this for a very long period of time, but then at a certain point it becomes unbearable. And really the key is to start things early before you’re getting to the unbearable point, because it’s a lot easier to treat them. 

Piper Klemm [00:55:05] We published, this book With Purpose last year. And, one of the things in the book is about how you should lead, for your horses sake, lead your horse from both sides and, you know, maybe get on and off from both sides. But so I’ve had people coming up to me all year long at the horse shows being like, oh, I started leading my horse from the right side also. And, I started doing this. And so it’s kind of been top of mind for me all year. And then everything I do in the barn, I’ve started thinking about myself also, and not just my horse of like, how many like almost repetitive use injuries we don’t need because we’re so stuck on the formality of like, always leading from the same side. But that puts a lot of pressure on, like your right arm and your right shoulder and distorts your back. Whereas, like, we almost made this up, if we led equally from both sides, we wouldn’t be having the same pressure. 

Dr. David Woznica [00:55:58] Absolutely. Sure we would really would realistically cut your load in half. Right. And didn’t come much more symmetric. But unfortunately, in life we kind of get in our traditional roles and we stick with. But you’re absolutely right. I’m glad you’re making those life changes. It’s as simple as, you know, one of the simplest things people can do if you’re doing a lot of bending forward and twisting for, you know, in the horse and taking care of things, you know, one of the simplest things you can do is simply bending backwards. You know, that’s one of my favorite therapeutic maneuvers, is just have people put their hands on their low back where it meets the back of the hip and kind of lean backwards into it’s in the chest, goes up and hold that position for a few seconds and straighten out, and you do about 10 or 15 of those and out. And even simple things like that Piper, can help get you back into alignment and position and really reduce some of these repetitive stresses. And I’d say it was well, on this. We talk a lot about that because it’s not about just getting better now, but we want to keep you better. 

Piper Klemm [00:56:48] And I think there’s so much more, emphasis now put into stuff that’s like that, that’s strength training. That’s stuff we can control that, that is preventative. You know, what other kind of exercises? I always love stuff that you can, like, do at the airport while you’re waiting. I’m always that weird person waiting at the gate doing something, something weird in line. That exercise you just mentioned is so easy. And what are some other things people can do just interspersed in their day? 

Dr. David Woznica [00:57:18] Yeah, absolutely. You know, the simple back stretch that I talked about, the standing back essentially extension that’s you know, you can be doing that 15 repetitions per hour with really no significant ill effects as long as you’re not causing yourself any pain. And then you can just get some advice and probably modify it. I’m a big proponent of stretching in line. I’m a huge calf stretch. Or if I’m at Starbucks, you know, usually my foot’s on a wall or on the on the bottom of their counter, and I’m just kind of leaning in for a stretch, so it’s not too embarrassing for myself. But still, I’m getting a little bit there. So I think calves are on a tighter things people can have, for, you know, simple exercises, you know, try to squat down as many times as you can, you know, do simple stuff like when you’re trying to get out of a chair or couch, try not to use your hands. Try to control the movements. I noticed when I was a personal trainer that I would look out the window and really see, at an age differential, people over the age of 30, roughly and below the age of 30, got into and out of their cars differently. And under the age of 30 you’re butt’s still very toned. You still have a lot of activity. You maybe you’re not set in your professional life yet, and you’re doing a lot of, you know, up and down work. So these people would kind of squat into the chair of the car and squat out of the chair of their car, whereas over 30, it’s kind of a plop and a lurch out. So really just kind of notice these habits that you’re doing. If you’re using momentum during an activity, that means you’re probably weak in some kind of muscular function, and you can avoid causing yourself damage because even though it’s not hurting while you’re doing it, every time you’re putting excess load on your ligaments and tendons instead of using the muscles, it’s going to be causing a slow onset depredation. But those standing back extensions I’m a big fan of like if you can do a subtle hip flexor stretch and I get caught, I think called out like, significant others in the past for doing these at Starbucks as well. And, you know, you just, kind of one foot in front of the other slightly and just kind of do a slight hip thrust forward to get a stretch in the front of that back, hip back position. Those are some of the best I have. 

Piper Klemm [00:59:15] There is still kind of that gap, I think, with with the all time horse people who who did not grow up with any of these things and grew up with a very high, pain threshold and then just get back in it. And how do we kind of, like, approach both of these things? Because. For us, for lack of a better term, with both human and horse. Preventative. Well, this like it’s a popular. And you don’t always like, see the results. Whereas like when there’s an injury, obviously you take care of it and it’s a whole thing. But how do we make. This kind of thing more and more appealing to people with both our humans and their horses. I think it’s kind of the same discussion. 

Dr. David Woznica [00:59:59] Yeah, I think a lot of that is the emphasis on ounce of prevention, a pound of cure. Right? I mean, if you know that you can get an extra 10 or 20 years of activity, if you take care of yourself and you set that as a goal, it’s going to really reframe how you approach life and how you approach your self-care. You know, especially, you know, older generations are very, you know, tough in the tooth and they will tear through everything. And it’s a really impressive characteristic, but you end up having some trouble with that. But again, I really think it’s all mindset, right? Hyper mindset is everything in life, whether you’re going through tough times or trying to push yourself to another activity level. The. The way I would like to think about it is I don’t want to be doing what I’m doing now. Only now I want to be doing what I’m doing now for the rest of my life, or hopefully be doing even more. And I think once you establish that mindset, you know, really change things and help people become more tune in their bodies, right? If you’re paying attention to things, if you’re if you notice that something’s sticking around, like you have this little ache that’s kind of around for like six weeks, it might or 12 weeks, it might not even be significant. But obviously there’s something in your body that’s not healing. And although you can ignore it, that’s not the best choice for you. So it’s but we also want to balance this between over separation on issues. Right. You never want to be too caught up in your own syndromes. And that’s why it’s important to talk to a specialist that’s, you know, well versed in conditions of musculoskeletal care like we are at last, wellness. But if you get those opinions, you really can see, like, okay, is this something I need to worry about now? So it’s not something so much that needs to be treated all the time, but it should be checked frequently, especially if you’re a very active person. 

Piper Klemm [01:01:40] And it’s that balance that makes all of this so hard because, you know, it’s so absolutes are so easy. That’s why we love. Always do more, never do this, you know. But yeah, the balance is is a really challenging, challenging part of this. You know, when when are you pushing yourself the right amount to, you know, for your own career and for your own business? And, you know, when is it so are and when is it a problem? The 6 to 12 weeks. So when you’re in pain, like, feels like a, a really long time. When should people start to get worried? When is it time to, like, really start thinking about things? 

Dr. David Woznica [01:02:17] I would say that the 6 to 10 week mark. Right. Most injuries will be resolving about three months in. But if they’re not, then you should pay more attention to them. And like I said, Piper, it might not be a significant injury. You know, you might be getting up in the morning. Your back hurts on the right side for like 30 or 40 minutes. But it’s a new thing. And that’s still going on three months later. And like I said, you know, hips and sake really act dysfunction dysfunctions very common in the question of sports. And one of the things about the hip is it’s really good at hiding issues, you know, so if you have an insult to the hip, it has such a great range of motion that, you know, maybe say you’re 18 years old and you’re walking straight and someone happen to look down, you might see at rest your feet are roughly pointing forwards, right? But then you kind of accumulate some hip irritations, and 20 years later, you know, you might be living without general hip pain, but if you look down, the feet might be splayed outwards now a little bit like you’ve actually suddenly changed the way your body is moving to avoid the irritations that would occur if you walked with your feet forward. Now. So because every position that you turn out, the foot changes the angle at the hip. So if you’re starting to build up spurs or starting in your labrum, it’s going to remove that irritation for you so you don’t feel it anymore. Which is great except it’s still a progressive issue. So that’s one of the main things. So if you’re having something that’s happening for more than ten weeks, even if it’s kind of low onset, you know, 2 to 3 out of ten in discomfort, you should have it checked out. So the smartest things to do. 

Piper Klemm [01:03:43] So tell us about your, your clinic and your office. Like, how does that work for equestrians to come in and. 

Dr. David Woznica [01:03:52] Yeah. So, you know, it’s actually I have, clinics in Chicago and here in Wellington, and typically I run on the weekends because people are typically busy during the week. And as a result, you know, it gets pretty busy. And what happens in the clinic is you come in, you get evaluated. Typically an ultrasound evaluation is done as well to see what else is going on there. Do you have any frank terrors or any further progressive injury that I need to treat more aggressively? And most people get treated the same day, and this could be anything from riders to owners to, you know, caregivers, etc., and the downtime for the procedures. Only a few days, really. I’m just asking you to rest for about 3 to 4 days. There are some more aggressive procedure that I do, maybe potentially bone marrow stem cells or fat liposuction, stem cells, these sort of things for more advanced conditions where I’ll ask you to be resting longer. And that’s something I would typically do out of a season if you’re a competitive athlete or competitive equestrian rider. And that’s it’s pretty simple. So you just you get treated the same day and you rest for a few days. We’re in contact throughout that. And additionally we do actually for correct instances, treat at people’s homes if they have a good set up. I bring all my equipment there. And you do things as simple as dextrose based prolo therapy to as complex as the like aspirates or bone marrow aspirates and very commonly uses platelet rich plasma PRP. And that’s done to with a simple blood draw. You collect some blood, you concentrate it really well, and then you inject that to the areas that you’re trying to strengthen. So a lot of these procedures are done same day with local anesthesia and the main restrictions afterwards I advise no lotions, no bathtubs or swimming for 48 hours. So you don’t want to get any infections and try to avoid anti-inflammatory drug use by things like advil or aleve, because people think of inflammation as a negative thing. Piper. But really what we try to teach it was wellness. Is that the only time you’ve healed without inflammation is when you were a baby in your mother’s belly. Every time after that, you actually require inflammation in the short term to cause a healing response. And a lot of these tissues that I treat as a prolo therapist are ligaments or tendons. And these tissues are white or semi black in color. So the tissue is white. It’s telling you it’s not really getting a good blood supply. So part of the job is to cause a little inflammation, get some blood supply to the area. And that inflammation will activate the local resident stem cells that every tissue has to start rebuilding things. And then we’ll also collect stem cells in the circulation that get attracted to the inflammation and some hard to treat tissues. You have to jump to things like the platelet rich plasma a little bit early, because you know that the blood supply will not last for too long at that level. So you really need to add something and more growth factors. But all procedures essentially are done same day and with fast recovery afterwards. 

Piper Klemm [01:06:35] It’s so interesting how our yeah, the human side of this is kind of mirroring the horse side of things. 

Dr. David Woznica [01:06:40] Oh yeah. Oh yeah. Oh yeah. 

Piper Klemm [01:06:43] And even just things hearing you say that, thinking about how, like, just the perception of ice and icing things has changed, you know. 

Dr. David Woznica [01:06:51] We’re throwing that out the window. Yeah. 

Piper Klemm [01:06:53] Absolutely. And that’s like fairly recent, I would say, over how long it was used for. 

Dr. David Woznica [01:06:59] No, absolutely. I mean, I always tell people, you know, if you’re in, you know, game six of the World Series and you have to play in game seven, you’re probably going to use ice, right? Because you need that anti-inflammatories because, you know, it’s everything’s on the line. You’re going to try to do that and get the pain under control, the swelling under control. And you you know, the. That’s not a healing, that you’re actually inhibiting your healing, but you’re also giving your pain. And at that critical moment, that might be the right thing to do. But as soon as that moment is over, you need to switch. So I’m a big proponent of electric heating pads. You know, it’s nice to be in Florida because we generally warm all the time, right? But, even, you know, in things like beds, you know, if your low back has been bothering or if you’ve been treated a pro therapy for your low back, I typically advise applying heat in the form of a low to medium setting, an electric heating pad, applying it to the area even while you sleep, and just get some low level heat to that area that’s going to speed the metabolism. Get more blood supply to the area. And that’s really how you get the healing out of it. But yeah, it’s it’s amazing how, how the the rice method of the rest ice compression elevation. And then anti-inflammatories have been pretty much a mainstay for decades now. But we’re finally making the shift, thankfully. 

Piper Klemm [01:08:06] So if you get started on prolo therapy, is that something you kind of continue to do for a long time, or can you. Are there some things that you can do once or twice or like what’s kind of the that that same day fix versus like the maintenance plan? How does all that look work. 

Dr. David Woznica [01:08:24] So essentially, you know, prolo therapies and all the stem cell stuff, the PRP stuff, it’s essentially the opposite of things like a cortisone injection. Right. So you get a cortisone injection, it makes you feel better. But it’s really it actually causes more death of those tissues. So if you’re loading those tissues, putting more weight on them, you won’t feel the pain. But the cortisone itself makes and makes the cells die. And then you have this condition where you’re putting extra force on a tissue that’s already healthy, and you have a drug there that’s going to make it. The cells die easier. So it’s a downhill road now with pro therapies, regenerative treatments. You’re actually starting healing phase. And the first thing I talk about is inflammation. And that progresses and overlaps with something called proliferation. So that’s a pro and pro therapy. That’s where the cells are actually multiplying. And that happens you know if you get a cut on your skin this is the process inflammation proliferation. And the final step is remodeling. So you know all of this is happening over a 6 to 12 month period. So there there’s actually healing going on from a treatment for about a year. But it’s typically how many treatments you need is going to be based on how severe injuries at present and how much joint stability you need to keep yourself pain free. So a lot of times you’re going to need between 3 to 6 treatments, although in some cases you’re going to have great results even after just one. And a lot of times I’ve seen those great results in more hypermobile people and more flexible people. A lot of my patients might even have Danlos syndrome or other hypermobility disorders, and they’re going to have pain just from the ligament instability. So a lot of, physical therapists might talk about a concept of tissue tolerance. You know, how well can your tissue tolerate your activity? Okay. And then activity might just be sitting right. So when you’re sitting, you’re putting forces on a tissue. If they’re not strong enough to handle that force, they’re going to start causing you pain and dysfunction. So we need to get those tissues strong enough so that A you don’t feel the pain anymore. And that could be as simple as one, two, three treatments. And then be becomes stable and secure. So that’s not something that comes back. So generally the rule of thumb Piper can be 3 to 6 treatments. I have a lot of people, my patients 1 to 2, they feel a lot better. But generally if you want to have long term stability to an area, it’s going to be about 3 to 6 visits. And again, it can vary. I see some patients maybe a ten times depends on how severe their migraines are or where their whiplash injury was or their weird symptoms like muscle department, or surgical vertigo or all these other. The more nerves you got involved in it, the more often you have a longer treatment course. But simple pain issues, typically 3 to 6 treatments, and those are spaced about a month apart. During seasons. And when you’re competing, you want to make sure you start kind of on the gentler side of treatments, because I could inject two different people with the same substance, and you really want to and they’ll react differently, and you want to find out how that person’s healing curve is. So, so since people are all different in all of the treatments in regenerative medicine, do use your body to heal yourself. You want to see what the person’s nutritional status is. You want to optimize everything you can so they can feel fast. 

Piper Klemm [01:11:23] I always tell, I always tell horse trainers to take the care of themselves, that they would take care of a horse that they don’t like, because they all take perfect care of horses that they like and don’t like and then don’t take care of themselves. And they would do all of these things for every horse in their barn. 

Dr. David Woznica [01:11:43] I think you just get tired of taking care of things. And I think the person that loses out is yourself. Right? You know how how bad are we at cooking our own meals, right? It’s just, self-care is a tough thing to do. 

Piper Klemm [01:11:54] Absolutely. Doctor David Woznica thank you for joining us on the plaidcast. 

Dr. David Woznica [01:11:58] Hey, it’s been a pleasure talking to you, Piper. Thank you for your time. 

Piper Klemm [01:13:50] To learn more about anything we’ve discussed on today’s show, visit You can find show notes at Follow the plaid horse on all the social medias. You can subscribe to the print edition of the Plaid Horse Magazine at Please rate and review the plaidcast anywhere you listen to it. And if you enjoy this episode, please share it with your friends. I will see you at the ring!