By Koren Briggs
There's something almost spiritual about the healing properties
of water. Humans have used this life-giving liquid to encourage
healing, in them and in their horses,
since the dawn of time. Water cleanses (in fact, several of the
world's religions have endowed it with symbolic purifying properties).
It soothes, it draws away inflammation and infection, and it does
so in the most natural way. Its simplicity itself, borne of a simple
molecule composed of two hydrogen atoms bound to an oxygen atom.
Even with all of the advances in veterinary medicine we've seen
over the past century, there's still no substitute for simple, soothing
water. For many equine injuries, hydrotherapy (applying water to
encourage healing) is just what the doctor ordered—and can
help the healing along better, and more cheaply, than many of our
chemically advanced lotions and potions or electronic gadgets.
"Hydrotherapy," says Sigle Magner-Skeries, a certified
equine massage therapist and founder of Treetops, an equine rehabilitative
center in Alliston, Ontario, "is just a fancy term for very
simple stuff we apply in our barns every day. You don't need to
be an expert to use it." Let's take a fresh look at what hydrotherapy
So basic, yet so effective: that's what hosing an injury is. When
you aim running water from a hose at (or just above) a new injury
site, you sweep away dirt and debris in the gentlest way. Provided
the water is cold, you also encourage the inflammatory process to
slow down, reducing the amount of swelling and pain your horse is
experiencing. Cold hosing can be one of the most useful ways of
reducing inflammation. Because the water is flowing, it doesn't
tend to warm up in reaction to equine body heat (and lose its effectiveness),
and because the hose is mobile, you can use it almost anywhere on
your horse's body. Cold hosing requires no special skills to apply,
other than a modicum of patience, and because it can be done almost
anywhere, anytime, it should be considered the first line of defense
when a new injury—a kick, a cut, a bump, a bruise—occurs.
To understand how and why cold hosing works, you need to understand
a little bit about the inflammatory process. Here's how the "panic
When cells are injured (from a cut or tear through the tissues,
or by concussive trauma, which causes bruising), they release enzymes
and proteins. These summon infection-fighting white blood cells,
or lymphocytes, from other areas in the body and cause blood vessel
walls in the vicinity of the injury to dilate and become more porous.
The lymphocytes rally to the cause, passing through the porous membranes
and entering the injured tissues to begin the infection-fighting
process. Extra fluids, carrying oxygen and proteins for tissue repair,
also pool nearby. The tissue damage also triggers the secretion
of prostaglandins, hormones which are responsible for much of the
pain the horse feels.
The three main symptoms of inflammation—pain, heat, and swelling—occur
in varying degrees, depending on the site, nature, and severity
of the problem. All three symptoms are natural and functional responses
to an injury. Pain alerts the horse to the problem and warns him
not to use the affected area. Heat is an indication of the increased
blood flow to the injury site, and swelling (or edema) helps immobilize
When inflammation rages out of control, however, it actually can
hinder the healing. Excess edema can create a "swamp like"
environment, which makes it difficult for healthy cells in the vicinity
of the injury to get enough oxygen from the blood (in essence, the
cells drown). The result is secondary tissue damage called hypoxic
injury, which can compound the problem. In addition, blood vessels
in (he area are put under increasing pressure by the fluid build-up,
so the flow of blood and lymph tends to stall. Often, edema can
interfere with an accurate diagnosis of the underlying injury—so
your first goal is to reduce the swelling and discomfort.
The safest way to break the destructive cycle of secondary cell
injury and excess edema is to use the horse's natural mechanism—his
circulatory system—to sweep away excess fluids that have collected
in the tissues. (While anti-inflammatory agents like bute can reduce
swelling and heat, they also can mask pain and confuse the diagnostic
picture.) There are two ways of encouraging this—applying
heat, and applying cold. Heat should never be applied to an acute
Cold Water Therapy
The application of cold hydrotherapy to the skin surface triggers
three reactions. It works at a cellular level, restraining the metabolic
response of the cells, so that they can better survive the not-so-beneficial
side-effects of healing. In essence, it puts them into a state of
hibernation, so that the cells need less oxygen to function, and
thereby suffer less hypoxic injury. Cold therapy also decreases
the permeability of the blood vessel walls, limiting the flow of
enzymes that sound the alarm and thus reducing the amount of fluid
that accumulates in the area. As anyone who has held an ice pack
to a black eye knows, the cold also numbs the area to a certain
degree, acting as a topical analgesic.
Magner-Skeries calls cold hosing one of the simplest forms of hydrotherapy,
"but one of the most beneficial, too. The horse gets a mini-massaging
action from the water flow, which can help stimulate circulation
and tissue regeneration."
Most veterinarians recommend that a new injury be cold-hosed for
about 20 minutes at a time, as many times a day as you can manage.
Shorter periods aren't as beneficial, as they don't give the blood
vessels enough time to react fully.
Another approach to cold therapy is the application of ice packs,
which can be pressed or wrapped on the affected area. Ice provides
a really concentrated cold response, which can stimulate faster
results. The only disadvantage is that because ice packs are stationary,
the horse's body will tend to heat them up, rendering them ineffective
after a few minutes. Therefore, you'll need to monitor the packs
and replace them as they thaw. Ice is particularly effective in
reducing swelling on a new injury, and it works best when applied
to moist skin (dry skin and hair are very effective insulators against
cold). Apply ice for 15 to 20 minutes, every two hours, for best
effect. You can damage the tissues if you apply ice for longer than
that. Here is another caution: if your horse has an open wound,
apply cold only until the swelling subsides, because it can retard
the formation of tissue to close the wound. If he has a "closed"
injury (such as a hematoma or bruise), however, it's safe to continue
applying cold until all of the heat has subsided. If you have any
doubts or questions, ask your veterinarian.
One of the best things about cold is that, unlike some other helps
sweep excess fluid out of the area, along with the dead cells and
other debris that are the residue of the healing process. The application
of heat helps ensure that the horse's body does a thorough job of
A hosing schedule similar to that you used when applying cold water
is appropriate. Be sure you are not going to scald your long-suffering
patient. You should be able to tolerate immersing your hand in the
water (aim for about 130 to 140° F).
Another variation is the hot compress, a soft cloth (old terry towels
or flannels are good, a bandage quilt also will work) soaked in
warm water and pressed on the injured area. This method works on
areas inaccessible to buckets, and it is particularly good for sore
backs. Whirlpool boots can as easily be filled with warm water as
cold. If you have access to the boots, whirlpool the injury for
one to two hours at a time, two to three times a day. In general,
moist heat, such as a compress provides, penetrates into tissues
better than dry heat, such as you'd get from a heating pad or heat
Although it might be soothing initially to surface nerves, heat
should never be applied when an injury is still warm to the touch.
Inflammation is still present if there is heat, and applying more
could send inflammation spiraling out of control, perpetuating cell
destruction and pain. In addition, any infection present in a fresh
injury will be encouraged to spread by the increased circulation
that heat therapy triggers. Heat does nothing to treat hard-tissue
problems, although a hot compress might ease surrounding tissue
stiffness and make an arthritic campaigner feel less creaky for
a while. But heat can be used to draw infection out of a cold injury,
such as an abscess in the foot, by encouraging the infection to
come to the surface and drain.
As a general rule of thumb, remember this: if the injury feels hot,
apply cold. If it feels cold, apply hot.
Running Hot And Cold
For chronic fluid congestion in the tissues, sometimes seen in
older injuries that just don't seem to be resolving completely,
Lopez suggests alternating hot and cold therapies. This approach
seems to "open up" the body processes and shut them down
again, stimulating the best beneficial effects of both. Cold hose
the area for 20 minutes, then follow with the application of a warm
compress. Repeat the process two or three times over the course
of a day.
Magner-Skeries uses a variation on this idea to help her clients'
approaches such as drug therapy; it will not override the beneficial
effects of the healing process. Corticosteroids, for example, can
reduce heat and inflammation, but they do it by shutting down the
whole healing process, while cold therapy merely controls and regulates
According to Mario Lopez, BVSc, a Toronto-area veterinarian whose
practice includes both sport horses and Thoroughbred and Standardised
racehorses, the best time to use cold therapy is when the injury
is new, hot, and painful, usually in the first 24 to 48 hours. This
is the period when inflammation is most likely to get out of hand.
Magner-Skeries agrees: "With a new injury, I recommend that
you get some cold water flowing on it right away, even before you
call your vet out. Your horse will get the most benefit out of it
if it's immediate." At Treetops, she often uses whirlpool boots
or tubs to treat new injuries. The Jacuzzi action helps gently massage
the tissues and further stimulates the healing process.
Hot Water Therapy
As the heat and pain subside (which can take from a day to a week
or more, depending on the nature and severity of the injury), slowing
the circulation to the site becomes less desirable. You have reached
phase two in the healing process, when you want to encourage circulation
as much as possible to maximize the healing effect. To do this,
you must switch to applying heat—which also can be done with
hydrotherapy, providing you have the luxury of a hot-water heater
in your bam.
When heat is applied to the skin surface, it causes blood vessels
to dilate, increasing blood flow to the site. As capillaries (the
tiniest blood vessels that surround the cells) open up, they allow
more oxygen and nutrients to reach the injured cells, supporting
the growth of new, healthy tissue. The increased blood flow also
helps horses improve their overall circulation. She calls it a "contrast
bath" and compares it to the practice of many vigorous Scandinavian
peoples (and even the ancient Romans) of jumping in a cool bath,
then steaming in a sauna. To give your horse a contrast bath, you'll
need a faucet that allows you to adjust the water temperature (many
people install a bathtub-type fixture in their wash stalls for this
purpose). After your horse has exercised, rinse him down first by
lightly spritzing him with cool water—a little cooler than
he'd normally like—for about a minute. The aim, says Magner-Skeries,
is not to wash him right down, but just to get him a little damp.
Then change the water temperature to slightly warmer than you'd
normally use, and repeat the quick spritz. Dial back to cool, then
to warm again, making each interval slightly more extreme in temperature—a
little colder than last time, then a little hotter. (Gradually,
your horse will become wet enough so that you can scrape off sweat
and dust from his workout, just like a regular bath.) If your horse
tends to stock up (experience edema and filling in his legs), she
suggests finishing up with a round of cold water. If he suffers
from stiffness or arthritis, he'll get the most benefit if you finish
up with hot water.
"A contrast bath," Magner-Skeries says, "is awesome
for activating your horse's internal temperature gauge. It stimulates
the tissues, and gets more highly oxygenated blood to those tissues
faster because of the dilation and contraction of the blood vessels.
My clients can't believe the difference in the overall tone and
vitality of their animals after doing this just a few times."
Another hydrotherapy technique used at Treetops is steaming the
horse with warm water and Epsom salts (magnesium sulfate), which
Magner-Skeries says is particularly therapeutic for horses who tend
to tie up, or for any horse who's just finished a strenuous workout
(such as a race, endurance ride, or a tough day out foxhunting).
When the horse's heart rate and breathing have recovered to a resting
rate, you can prepare his Epsom salts bath by pouring five to six
cups of Epsom salts (available at your local pharmacy) in a large
tub, such as a plastic muck-skip. Fill the tub with hot water and
stir to dissolve the salts. Then soak a wool cooler in the solution
(you might want to designate one cooler specifically for this purpose,
as the Epsom salts tend to stay in the fabric), wring it out, and
drape it over the horse in the usual way. Leave it on till it begins
to cool, then soak it again (you might have to add some more hot
water) and replace it on the horse. Repeat for a total of three
"This feels for the horse like a long, hot soak in a tub feels
for us at the end of the day," says Magner-Skeries. "A
horse who receives this treatment will often be less stiff the next
day. It also soothes bruises and bangs so that there'll be less
One important note: Magner-Skeries says that the documentation on
the effects of these kinds of hydrotherapies on horses is sketchy.
"As a therapist, I've had to borrow a lot of these rehabilitative
techniques from human physiotherapy or sports therapy. Their use
is well-documented in human athletes, but few studies have been
done specifically on horses to this point." Fortunately, hydrotherapy
has an extremely wide margin of safety, and Magner-Skeries says,
"You can't really go wrong using water." However, you
should consult with your veterinarian before you try any new treatment.
Let's take hydrotherapy one step further and talk about dunking
the whole horse, equine swimming pools are a time-honored way of
improving a horse's fitness level and allowing him to rehabilitate
from an injury while avoiding any weight-bearing concussive forces
on his limbs. Most often used for racehorses (some have to be assisted
with an inner tube around their necks!) But most accept the idea
of doing a few laps in the pool fairly readily. Having qualified
help available can be an important safety consideration, though.
Don't attempt to swim a horse by yourself unless you and your horse
are both very familiar with the routine.
Not everyone agrees that swimming is a useful therapy for horses.
Doug Hannum, of the Hannum Equine Sports Therapy Center in Nottingham,
Penn., notes, "Horses are not swimmers. You don't see a horse
naturally wade into a pond and go for a swim. When they do swim,
they're going against all their training (for a round top-line),
because they get completely inverted, with a high head and a hollow
back. It goes against their natural biomechanics.
"I've seen horses develop very sore backs from a regular swimming
routine, and I've also seen them develop stifle problems from the
motion of kicking down," he says. Furthermore, he suggests
that concussion on the limbs is a natural and essential part of
the healing process, and shouldn't be avoided.
The solution could be a hybrid machine that combines the therapeutic
effects of warm water, massage jets, and a treadmill, which Hannum
markets under the name Hydraciser. In essence, it's an equine Jacuzzi
with a treadmill bottom. (There are several companies that manufacture
underwater treadmills. Comparisons should be made to see which model
offers you the options you need for your animals.)
"In a Hydraciser tank," he explains, "you get concussion,
but it's reduced because the horse is 35-45% buoyant from the water
jets. The same idea is used in hydrotherapy for humans recovering
from injuries. The water is 98° Fahrenheit, and there are 18
powerful jets, so it's very soothing, and you tend to be able to
get the horse to flex stiff joints or areas of scar tissue well
The Hydraciser's heavy-duty fiberglass tank is approximately 15
feet long and five feet wide, and can accommodate even a large,
long-striding warmblood. It fills with water in approximately two
minutes, and drains in less than one. Most horses accept the confines
of the Hydraciser fairly readily, Hannum says, particularly racehorses
(who are accustomed to starting gates) and horses which have been
imported from Europe and have thus experienced an airline "crate."
He generally takes about three days to accustom a horse to the Hydraciser
before filling the tank with water and gradually starting the workout
However, over ground exercise is needed to build and maintain strength
in the musculoskeletal tissues that need it most. Also, heart rate
is lower during swimming than during overground exercise. Swimming
does stress the respiratory system due to pressure on the chest,
which is also unnatural for horses.
"What is really great about hydrotherapy in its most extreme
form—swimming—is that you can bring a horse who might
otherwise not be able to do any conditioning work at all (because
of an injury) to almost total fitness," says Magner-Skeries.
"If you have a pool, you can challenge your horse's musculoskeletal
system and cardiovascular system without concussing the injury.
Then by the time he's ready for concussive forces, he already has
a baseline of fitness and can go on from there. (Swimming) is great
resistance training, even for a sound horse."
She notes, however, that swimming won't take the place of speed
work. The main function of swimming is to improve cardiovascular
fitness and provide strength training. "Horses who get fit
through swimming don't tend to get lean," she says.
Even a few minutes in a swimming pool is a serious workout for most
horses; they're not naturally strong swimmers.
There are several advantages to using an underwater treadmill unit.
Hannum finds that horses which need hand-walking as part of their
rehabilitative routine often can be walked more safely in the confined
environment of the tank than they could down a lane. Furthermore,
recovering horses tend not to lose muscle tone when they exercise
against the current. "It's a tremendous workout," he says.
Although horses usually remain at a walk with an underwater treadmill,
the speed at which these units operate is variable, so the cardiovascular
system can be progressively challenged (useful for the injured horse
which is trying to maintain his fitness level, and for the sound
horse which is in a general conditioning program).
Underwater treadmill workouts are particularly good for horses suffering
from tendon and joint injuries, and those recovering , from orthopedic
surgery, says Hannum. The activity of the treadmill belt creates
turbulence in the water, which results in an underwater massage
effect on the tissues, encouraging increased circulation.
Hannum also finds that the underwater treadmills can be therapeutic
for horses with sore backs (even though the back of the horse is
not immersed—the water level comes to about midway on the
barrel), because the motion of the treadmill helps build muscle
strength in the lumbosacral area, and because the horse is working
in a normal frame, rather than an inverted one.
He starts most horses with five-minute sessions—like swimming,
this is high-intensity exercise. The fittest three-day event horses,
Hannum says, might work up to sessions of about 15 to 18 minutes,
during which the speed of the treadmill is varied several times
to create an interval training-type workout. Hydracisers played
a part in the fitness routines of a number of horses which competed
in the 1999 Rolex Kentucky Three-Day Event in Lexington, Ky., he
Unfortunately, underwater treadmills don't come cheap. The cost
of installation of one of Hannum's.units is about $85,000. Currently,
there are a few dozen Hydracisers across the United States, and
demand is increasing. You might be able to take your horse to an
equine therapy center to have him work in a tank with an underwater
treadmill. Hannum's base in Pennsylvania has a Hydraciser, as does
the Red Bank Equine Sports Therapy Center in Camden, S. C.
That's hydrotherapy, from the simple application to the most complex.
Any way you look at it, water is a life-affirming force—and
a valuable ally in your efforts to keep your horse at the pinnacle
© 1999, The Horse All rights reserved.
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