Equine Physical Therapy
By Les Sellnaw
Physical therapy long has been a mainstay for human athletes. Competitors
in sports ranging from football to gymnastics have utilized a variety
of approaches to help maintain physical fitness and to assist in
the recovery process when injury occurs to a joint, muscle, ligament,
Today, physical therapy also is a part of the racing and sport horse
world, and it seems it is here to stay. Equine physical therapists
are using a number of modalities and techniques that range from
simple stretching exercises to sophisticated laser equipment.
Controversy surrounds some of these methods and approaches and much
is yet to be learned. In upcoming articles on alternative therapies,
we will be delving into a variety of specific modalities. In this
article, we want to take a look at just what physical therapy is
all about, and what it can and cannot accomplish in preventing and
treating equine injuries.
Before advancing into the field of ultrasound, lasers, the use of
magnets, and the like, it seems wise to first take a look at some
basic approaches—warming up and stretching the competitive
horse prior to competition, and the application of cold and heat
when injury occurs.
The majority of the material that follows comes from Mimi Porter
of Lexington, Ky., a well-known equine physical therapist who authored
the book Equine Sports Therapy. Porter launched her physical therapy
career by serving as an athletic trainer at the University of Kentucky
for 10 years. She moved into the equine field because of a lifelong
love of horses and the firm belief that they have a physiology that
is similar to humans and that they suffer some of the same types
of injuries as do human athletes. Porter holds a masters degree
from the University of Kentucky and is a certified athletic trainer.
In the opening chapter other book Porter describes the role of the
equine sports therapist as follows:
"The role of the equine sports therapist can be compared to
that of the athletic trainer or sports therapist in human sports
medicine. The job of these specialists is considered adjunctive
to that of the sports medicine physician or orthopedist. The athletic
trainer works cooperatively with the physician as well as the coach
in setting up and carrying out conditioning and rehabilitation programs
for the athletes. He administers first aid to injured athletes and
applies protective devices or injury preventive equipment. Another
important function of the athletic trainer or sports therapist is
the application of therapeutic modalities to ease the discomfort
of injury and facilitate exercise. These modalities include ice,
heat, water, electricity, light, sound, exercise, and stretching."
Porter is quick to say that equine physical therapists should work
only on a referral basis from a veterinarian and that no invasive
techniques should be employed by the therapist.
In fact, that position is a cornerstone of the by-laws of the National
Equine Therapists Association, which was formed in 1987 to improve
the standards of equine therapy. One of the goals of the organization
is to establish a certification exam for equine therapists.
"Once this is established," notes Porter, "and more
direct educational opportunities develop, there will be considerable
professional advancement in this rapidly developing profession."
There are a number of goals that the physical therapist seeks to
reach. They include pain reduction, restoring range of motion, restoring
strength, and injury prevention.
Here is how Porter explains each of them:
"In an injury prevention or rehabilitation program, therapeutic
agents should be used with specific goals in mind. A primary goal
is pain reduction. This can mean a reduction in the amount of medication
necessary for pain relief, or it can mean pain control solely through
the use of the therapeutic modality."
Restoring Range of Motion—
"The pain of injury or surgery often leaves a Joint immobile.
Over a period of time, this immobility results in contractures in
the soft tissues around the joint. Shortening and stiffening of
those structures will cause immobility long after the pain is gone.
If a program of flexibility exercises is begun immediately after
surgery or injury, normal range of movement can be maintained. Stretching,
as part of a pre-exercise warm-up, will play an important role in
"It is nature's dictate that a body part should be rested after
an injury. Unfortunately, this rest leads to disuse atrophy in the
surrounding musculature. Weakened muscles are vulnerable to injury
themselves, and they set the stage for re-injury when there is a
return to activity."
There is still so much to learn about how to optimally condition
the horse for his work or sport. Perhaps, as we gain knowledge in
this area, ways of preventing sports injuries will come to light.
In the meantime, thermography, heart rate monitors, weight scales,
and diagnostic tools traditionally used by veterinarians should
be employed in a timely manner in hopes of discovering injury while
it is in a more easily treatable stage.
"Although therapeutic modalities and techniques are useful
in many ways in dealing with injury, they are non-invasive in nature.
As such, they are most effective in the early stages of the injury
process. Once the horse is visibly lame, an on-going process must
be reversed. Rehabilitation is a much more challenging task at this
Perhaps the most basic of physical therapy techniques involves
stretching. This procedure is relatively new for horse owners, although
human athletes have long recognized its value. Basketball players,
track contestants, gymnasts—the list could include every form
of athletic endeavor—spend valuable minutes before a competition
in warming up and in stretching and limbering exercises. If this
is important for the human athlete, one can logically reason, it
should be just as important for the equine athlete.
Porter provides this differentiation between stretching and warming
"Stretching exercises are those exercises designed specifically
to draw out or to extend the muscle and its connective tissue to
their full lengths. Warm-up is an activity or series of exercises
that raise the total body temperature, preparing the body for vigorous
activity. Warm-up exercises include walking, slow jogging, and gentle
"It is thought that a good warm-up will improve subsequent
physical performance by shortening the adjustment period of the
cardiovascular and muscular systems to the increased activity. Warm-up
exercises raise blood temperature, which enhances the dissociation
of oxygen from hemoglobin and myoglobin, making it more accessible
to the cells for metabolism."
Porter recommends that warm-up precede stretching because, she points
out, and attempting to stretch a cold muscle could result in small
tears in the muscle fibers.
Human athletes warm up and stretch so that tendons, muscles, and
ligaments are more elastic, allowing them to be agile. Equine sports
also demand great agility from competitors, so it stands to reason
that they, too, need elasticity of muscles, tendons, and ligaments.
"An additional benefit of manual stretching," Porter points
out, "is that it provides the opportunity to assess the physical
health of one's horse in a unique way. An opportunity is provided
to detect and assess imbalances in flexibility which could indicate
the development of injury. Noting resistance to gentle stretching
maneuvers, the handler has a clue that the muscle involved is not
being used to full capacity. Such an imbalance is a part of the
chronic injury syndrome or could lead to an acute injury.
"Stretching exercises can be of great benefit in providing
relief from certain types of pain. Pain derived from a condition
called fascial contracture responds to consistent repetition of
stretching exercises. Fascial contracture occurs when muscles and
their connective tissues tighten abnormally. Age, chilling, inactivity,
and muscle strain can result in pain. They also limit the power
the muscle is capable of producing during work."
No longer is it unusual on the backside of a racetrack or in the
barn area at a competitive event to see handlers stretching forelegs
and hind limbs of horses about to run or be involved in a contest.
Porter emphasizes that there are a couple of important things to
keep in mind when carrying out stretching exercises with the horse.
First of all, she states, the stretching should be done in a quiet,
relaxed manner. The limb should be guided through a range of motion,
held in that position briefly, and then gently returned to its normal
"Do not pull on your horse's limb," she admonishes, while
adding the following advice.
• Disregard what you hear in the gym about stretching to the
point of pain. Over stretching can produce microscopic tears in
the tissues which may lead to scarring and the eventual loss of
elasticity, the opposite of your goal.
• Human athletes work up to holding the stretch for 30 seconds.
No research has been done to indicate how long a stretch should
be held with a horse, so it is up to the owner to be aware of what
he/she is feeling in the horse...Never use a bouncing or jerky stretch.
• Muscles should always be warmed up before stretching.
• Never stretch an acutely torn muscle.
• Avoid excessive traction or pressure on the joints. Avoid
movements which twist the joints.
• Be aware of the normal range of motion of your horse's joints.
• Always consult your veterinarian before performing any stretching
exercises with your horse.
Heat And Cold Therapy
The use of cold and heat as part of physical therapy long has
been practiced by a number of knowledgeable horse owners and remains
a valuable modality today, despite the advent of a variety of sophisticated
equipment designed to alleviate problems that crop up following
Simply put, cold is used early in an injury to reduce inflammation,
and heat is utilized later to facilitate the healing process.
The key to success in utilizing cold as a therapy in the wake of
an injury is timing. The more quickly cold therapy is administered,
the more optimistic the prognosis for quick relief from pain and
swelling. Applying cold therapy in the first hour after an injury
"Cold therapy is indicated following all acute injuries,"
Porter declares, "and can be useful post-surgically. The use
of cold therapy slows chemical reactions in cells and inhibits enzyme
activity, thus reducing the inflammatory reaction. Although the
inflammatory reaction is necessary to draw cells to the area that
initiate healing, such as white blood cells, it should not be allowed
to persist. The inflammatory condition creates hypoxia (reduction
of oxygen supply) in the tissues. It is thought that cold therapy
reduces the oxygen requirement of the cells, allowing them to survive
the hypoxic condition.
"Chilling an injured area is effective in controlling the amount
of initial swelling after an acute injury. Swelling should be treated
in the first hour after injury by cold-induced vasoconstriction.
The longer one waits after the injury before treatment is begun,
the more damage that occurs."
A recent study involving human athletes has yielded information
that can maximize the application of cold following an injury, reports
In the study involving human runners as subjects, it was found that
during the first five minutes of cooling, no reduction in blood
flow was seen. After 10 minutes of cooling, blood flow was significantly
reduced. A maximum reduction of blood flow (69%) was seen 10 minutes
after the cooling period.
Because of this delayed reaction in reduction of intramuscular blood
flow, it was theorized that applying external compression along
with the cold would be more effective in reducing inflammation.
In other words, it would be more effective if one were to wrap the
injured member with an elastic bandage, then apply ice over the
bandage. Researchers believe that a good compression wrap will limit
the space into which blood can flow within the tissues and augments
the effects of ice. Be warned, however, that too much pressure can
lead to a compartment syndrome with increased tissue damage. Wrapping
with an elastic bandage should be done very carefully.
While it is highly important to apply cold therapy immediately after
an injury, it is not necessary to apply it for long periods of time.
"Ice applications longer than 30 minutes," advises Porter,
"should be strictly avoided. Hours of continuous ice application
will not increase the effectiveness of tissue cooling or extend
the period of analgesia. At the racetrack, horses are sometimes
made to stand in a tub of ice water for hours. This is unnecessary
and can be harmful. Excessive use of cold can cause such a decrease
in metabolic activity that local destruction of tissues can occur.
Also, overexposure to cold can result in increased edema due to
tissue damage and reflex vasodilation from prolonged exposure to
Generally speaking, heat produces effects that are the opposite
of cold. While cold serves to decrease metabolic activity in cells,
heat increases the activity. Thus, in the wake of injury, heat therapy
would not be used until the application of cold, with its beneficial
reduction of inflammation, had been completed.
Heat can facilitate the healing process because the increased metabolic
activity in the cells causes an increase in oxygen demand locally.
As a result, says Porter, vasodilation occurs to increase the amount
of blood bringing oxygen and nutrients to the area. Membrane diffusion
and enzymatic activity also increase, enabling oxygen consumption
and waste removal.
Applying heat correctly and utilizing the correct degree are extremely
important. One of the keys to success is knowing how much heat to
Porter offers these guidelines:
"In order to achieve a significant change in metabolic rate
and collagen distensibility, temperature of the target tissue must
rise at least five degrees. Temperature increases greater than 12
degrees create the sensation of pain rather than the sensation of
"Unfortunately, by the time pain is registered and the horse
attempts to move away, some damage may have already been done. The
skin temperature of a horse is generally 90-92° Fahrenheit.
The heat source must be warmer than this, obviously, to increase
tissue temperature. However, it is well documented that heat applications
over 133° Fahrenheit for prolonged periods will cause skin damage.
There is a nine degree 'window' or therapeutic range between effective
healing and surface tissue damage.
"Methods of heat application include heating pads, hot water
bottles, hydrocollator packs, heating lamps, hot water whirlpools,
hot towels, counter-irritating liniments, and ultrasound."
"Of all the heating devices listed, only therapeutic ultrasound
has the ability to penetrate through the skin to the deeper structures,
such as joint structures, tendons, and muscles. All the other sources
heat only the skin and perhaps the underlying connective tissue.
These two structures are not involved in most sport injuries. The
temperature of the injured tissue must increase to have significant
effect. That is not to say that the other forms of heat are useless.
A comfortable level of heat is soothing and relaxing and stimulation
of sensory nerves in the skin can have a damping effect on pain."
Whirlpools are frequently utilized by human athletes, but only in
recent years have they been employed for the benefit of equines.
Available today are a wide variety of whirlpools for horses that
are capable of combining gentle massage of an injured limb with
the application of superficial heat.
The agitation of the water, Porter points out, can also loosen scabs
and crusts on the skin surface and help remove debris from a wound.
Iodine should be added to the water to reduce the possibility of
transmitting infections and aid in cleansing abraded skin only on
the advice of a veterinarian. Using inappropriate iodine concentrations
could hinder wound healing.
Porter recommends that water temperature in whirlpools should be
between 103-110° Fahrenheit.
Also highly beneficial in applying heat therapy are hydrocollator
packs. They are cotton packs that contain a gel that absorbs heated
water and becomes soft, thus allowing it to conform to the contours
of the body. Porter describes the packs as being "perhaps the
most efficient of the superficial heating devices."
Future articles, as we mentioned, will explore other forms of alternative
therapies, ranging from ultrasound to magnets, but the wise horse
owner will always do well to remember that warming up and stretching
are important in preventing injury in horses which compete, and
that the application of cold and heat therapy at proper times remains
highly important in treating injuries when they do occur.
About The Author
Les Sellnow is a free-lance writer specializing in articles
on equine research. Based near Riverton, Wyo., Sellnow also is the
author of fiction and non-fiction books. As "well as being
a regular contributor to The Horse, Sellnow operates a ranch, -where
he raises horses and various livestock.
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