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Equine Hydrotherapy:

Treatment for lower leg injuries and lameness in horses.

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Hydrotherapy: Why it works.

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For centuries, the use of sea water has been recognised as an aid to the treatment and prevention of leg problems in horses.

According to his trainer, the infamous Grand National winner, Red Rum would not have been racing at all except for the benefits of training on the beach.

Cold water hosing, a common modality, cools the skin surface, but the temperature is uncontrolled and might not be cold enough to affect the structures most often involved in injury.

Cold sea water in particular has an anti-inflammatory effect which facilitates healing and helps guard against injury. Consequently, over the last 150 years or so, inventors have been patenting various devices for replicating the benefits of exposure to cold sea water in a controlled manner.

To comprehend how cold water hydrotherapy works we first need to understand how the body reacts to trauma such as strains, cuts, bruises etc.

Enzymes and proteins are released when cells are injured through a cut or tear, or by concussive trauma, causing the blood vessel walls in that vicinity to dilate and become more porous. Then lymphocytes are directed to the site of the trauma passing through the porous membranes and entering the injured tissues to begin fighting the infection. Extra fluids, carrying oxygen and proteins for tissue repair, also pool around the injured area. Tissue damage also triggers the secretion of hormones which are responsible for much of the pain the horse feels.

Pain, heat, and swelling, the three main symptoms of inflammation, occur in varying degrees, depending on the site, nature, and severity of the injury. Pain helps prevent overuse of the affected area. Heat results from the increased blood flow to the injury site, and swelling (or edema) helps immobilise the area.

The danger is that inflammation rages out of control and hinders the healing process resulting in secondary tissue damage called hypoxic injury, which can compound the problem. In addition, blood vessels in the area are put under increasing pressure by the fluid build-up, so the flow of blood and lymph tends to stall.

The safest way to break the destructive cycle of secondary cell injury and excess edema is to use the horse's 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 natural ways of encouraging the dispersal of excess fluids - applying heat, and applying cold. Heat, however, should never be applied to an acute injury which leaves us with cold in many cases.

Cold Water Therapy

The application of cold hydrotherapy triggers three basic reactions. At a cellular level, the metabolic response of the cells is reduced, so the cells need less oxygen to function and thereby suffer less hypoxic injury. Cold therapy also decreases the permeability of the blood vessel walls, thus reducing the amount of fluid that accumulates in the injured area. And thirdly, the cold numbs the area to a certain degree, acting as a topical analgesic.

Cold hosing is one of the simplest forms of hydrotherapy and a new injury can benefit from being cold-hosed for about 20 minutes at a time, as many times a day as possible. Shorter periods aren't as beneficial, as they don't give the blood vessels enough time to react fully.

Ice can provide a really concentrated cold response, which can stimulate faster results. The only disadvantage being the propensity for the horse's body to heat them up, rendering them ineffective after a few minutes.

Applying the ice for 15 to 20 minutes, every two hours, seems to have the best effect. Longer applications can lead to tissue damage and it is not suitable for prolonged treatment of open wounds. For open wounds, apply cold only until the swelling subsides otherwise it can retard the formation of new tissue around the area of the wound. One of the best things about cold is that, unlike some other approaches such as drug therapy, it will not override the beneficial effects of the healing process. Heat and inflammation, can be reduced by corticosteroids, for example, but they do it by shutting down the whole healing process, while cold therapy merely controls and regulates it.

Equine Cold Water Spas

Over the last 20 years major advances in the design of Equine Spas were made by inventors, particularly in the USA in the 80's and then in Australia in the early 90's. At the same time similar developments took place in Germany and the UK.

During the nineties a considerable amount of anecdotal evidence was reported as to the excellent results achieved in the treatment of leg injuries in horses.

However, it was still difficult to convince a sceptical veterinary profession of the efficacy of cold spa bath hydrotherapy in the treatment of lameness and lower leg injuries in horses.
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Consequently, a spa was donated to the University of Sydney to facilitate clinical trials and to establish an independent verdict on the benefits of cold water hydrotherapy. The trials were conducted by Associate Professor E R Hunt, MVSc, PhD, G Dip Ed (Tert) who had 30 years equine veterinary experience and described himself as the archetypical sceptic prior to the commencement of the trials.

The first trials were conducted during winter and the results were very encouraging. However as winter turned to summer Professor Hunt found it difficult to replicate the early positive results. Only when they experimented with different water temperatures was it ascertained that the lower ambient winter temperatures had a major impact on the outcome. Once the optimum temperature of the water was known further trials established the optimum salination of the water, as it was historically well documented that the salt in sea water had a significant anti-inflammatory effect.

Having established the optimum conditions required to facilitate healing, clinical trials were conducted on 27 horses initially.

Positive results were replicated across a whole range of leg injuries, from bowed tendons (grade 2 or 3 lesions) to suspensory ligament injury, inflammation of foreleg suspensory ligaments and chronic fetlock synovitis. One had had a chipped bone removed from the fetlock joint, and another had a penetrating wound of the digital flexor tendon sheath.

Subsequent treatment of 65 horses showed that open wounds responded rapidly to treatment, hoof growth was stimulated, laminitis responded well and even navicular syndrome responded in 2 out of 3 cases.

Today equine therapeutic spas have spread to Europe and North America with similar results being experienced across a range of leg injuries which cause lameness in horses.

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