There are many strategies for managing injuries beyond just confining a horse and waiting it out.

Considering the power of an equine athlete and his or her ability to accelerate, it is little wonder that horses develop musculoskeletal injuries while performing their jobs. But it's not just the elite equine athlete that suffers from musculoskeletal injuries; even the noncompetitive trail horse can suffer sprains and strains.

The wealth of medical possibilities for achieving an accurate diagnosis has improved the timeliness of therapeutic intervention. But successful resolution to healing also relies on effective treatment. Advances in therapeutic equipment have kept pace with expanding needs of our equine athletes and companions for inflammation control and physical therapy.

The Old Cold Gold Standard

For years, the most valuable tool available to horse owners for equine pain relief and resolution of swelling has been cold therapy. Cold therapy benefits an injury by reducing cellular metabolism to lessen hypoxic (reduced oxygen) injury to tissues. Cold also decreases blood vessel permeability to lessen swelling, and it reduces pain sensitivity and perception.

No longer must you stand your horse in a cold, running stream of water or leap out of the way as he kicks over a bucket of ice water. Manufacturers have taken this tried-and-true therapeutic approach and developed it into a high-tech, convenient format that includes compression.

One manufacturer that offers compression with cold is Game Ready Equine.

Kent Allen, DVM, owner of Virginia Equine Imaging, describes the compression feature of Game Ready: "This is not just static compression like a bandage that applies constant pressure to control swelling and edema, but, rather, 'active' compression 'squeezes and releases' to mimic natural muscle contractions that push edema 'fluid' into the lymphatic system for removal. In the 'releasing' phase of the cycle, fresh, oxygenated blood flow enters the injury site."

Also, compression improves the wrap's contact with the injury and the owner can select a specific pressure rather than relying on "feel" to determine if it's tight enough. Water circulates through the wrap, keeping the injury site cold. Allen remarks, "We see ice melting faster in acute phases of an injury as heat exchanges between the injury site and the ice bath. This cooling method is more effective than an ice or gel pack sitting on the skin's surface."

He continues, "In addition, dry cold therapy can be applied without risk of prolonged exposure of skin and hooves to wet applications. The wrap may be applied directly over a bandage-covered wound without concern for water saturation."


In contrast, an equine aqua spa involves completely immersing a horse's lower legs in cold salt water for whirlpool-type treatment of an acute injury or to promote recovery following rigorous workouts. Aerators massage limbs while the osmotic effect of salty water "pulls" swelling from inflamed tissues. Aeration of cold water (less than 48°F) increases its dissolved oxygen, which is thought to facilitate the immune response and healing.

Adding a treadmill to an underwater spa allows additional therapeutic gains for injured horse limbs--you can adjust water depth and temperature for variable benefits. As most swimmers know, water immersion reduces weight-bearing by 40-60%, and exercising on an aqua treadmill can mobilize soft tissues, lessen joint friction, and modulate pain.

Equine Land-Based Treadmills

Haynes Stevens, DVM, frequently manages soft tissue injuries in his Florida sport horse practice, remarking, "We're incorpo-rating biological therapy (stem cells, platelets, and growth factors) in our treatment, and like to get a horse exercising quickly rather than him standing around. Even a great surgical correction may fail if rehabilitation is inappropriately done."

He uses the land-based Horse Gym treadmill with its incline feature: "This equipment is especially useful for an injured horse you want to get back into the game. It allows muscle development and strengthening and develops aerobic conditioning without foot or joint concussion or without having to carry a rider's weight."

Cindi LaCroix, DVM, uses this treadmill in her Scottsdale, Ariz., sport horse practice. "I combine the treadmill with thermal imaging to detect and diagnose subtle lameness issues," she says. "It is invaluable for watching footfall, determining hoof imbalance, and assessing stiffness. I can assess stride length of individual limbs, straightness, limb placement, extension and flexion, and vertebral and lumbar movement to tailor an individualized program based on injury type and progress."

Haynes says shod or barefoot hooves grab the cushioned belt without slipping. He notes, "We prefer not to use the treadmill at trotting speeds since a hoof could jam. Instead, incline and walking speed are increased ... horses walk faster on the treadmill than they will under saddle."

La Croix says, "Horses walk 115 to 130 meters per minute--equivalent to 1�� football fields every minute! That is work!"

She adds, "Treadmill work doesn't only address different muscle groups; it is a total exercise regime for bone, muscle, tendons, ligaments, range of motion, and proprioception (the horse's awareness of where his limbs are). A horse lowers its head and neck for balance when moving on an incline; this posture of 'roundness' opens vertebral spaces, lengthens back and neck muscles, strengthens abdominal muscles by contraction, and flexes and extends the lumbosacral area."

Haynes reports that horses have safely completed more than 8,000 workouts on his treadmill.

Hyperbaric Oxygen Therapy

Nathan Slovis, DVM, Dipl. ACVIM, CHT, of Hagyard Equine Medical Institute in Lexington, Ky., regularly incorporates hyperbaric oxygen therapy (HBOT) into his treatment regimes. In HBOT a horse stands in a pressurized chamber and is exposed to concentrated oxygen. According to vets, HBOT increases (up to twentyfold) oxygen levels dissolved in blood plasma and facilitates cell uptake of antibiotics, such as gentamycin or cephalosporins, that require oxygen-mediated transport.

"At this time," Slovis reports, "we're collecting data on HBOT use in horses. Case selection considers extrapolations from scientifically based evidence on lab animals and humans."

Slovis explains, "Any condition with increased edema (fluid swelling) or decreased blood flow is helped by HBOT, as are chronic infections that have not responded to standard medical care. Decreasing edema lessens the distance between tissues, making blood supply and white blood cells more available. This improves both tissue concentrations of antibiotics and a horse's native immune response.

"I've found HBOT to be rewarding for treating osteomyelitis (bone infection), cellulitis, extensive wounds, hypoxic brain injuries, and following colic surgery of colon torsion with poor intestinal perfusion (return of blood flow to the intestinal wall)," says Slovis. "Crush injuries with compromised blood supply are also HBOT candidates to improve capillary development."

Endothelial growth factor (EGF), a chemical signal cells produce, stimulates new vessel growth and speeds blood supply resto-ration to injured tissue. Slovis says EGF levels rise after three to five daily HBOT treatments, persisting for 48 hours.

Conditions amenable to HBOT treatment include clostridial myositis--these bacteria prosper in an anaerobic environment, so supersaturating tissues with oxygen via HBOT should decrease toxin production. Slovis also finds HBOT useful after stem cell treatment of bowed tendons and on suspensory ligament injuries.

Slovis stresses that HBOT should be used as adjunctive treatment and not alone. He said that the horse owner must implement management changes and improve environmental conditions, along with using standard medical treatment, to achieve optimal therapeutic results.

Slovis offers this advice: "It is important to work with a veterinarian and discuss incorporation of this modality in your horse's care. Safest and best results are achieved by a veterinarian or certified technician who is trained in HBOT."

Take-Home Message

Equine musculoskeletal injuries abound, and there are many strategies to manage them besides confining a horse and waiting it out. LaCroix says to develop fitness of the entire animal--not just the injured area--to help reduce relapse.

Ask your veterinarian about therapeutic modalities that can help your horse return expediently to maximum performance.

About the Author

Nancy S. Loving, DVM

Nancy S. Loving, DVM, owns Loving Equine Clinic in Boulder, Colorado, and has a special interest in managing the care of sport horses. Her book, All Horse Systems Go, is a comprehensive veterinary care and conditioning resource in full color that covers all facets of horse care. She has also authored the books Go the Distance as a resource for endurance horse owners, Conformation and Performance, and First Aid for Horse and Rider in addition to many veterinary articles for both horse owner and professional audiences.

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