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October 3, 2013

Ice Down To Ride On

Icing is one of the few therapies allowed in international competition, but hard-working horses at all levels can benefit from cold therapy. Sara Lieser photo.

Cold therapy may be ubiquitous for hard-working horses, but science hasn’t answered how effective the therapy is or even the best way to apply ice.

If you’ve ever iced a sore muscle or swollen ankle, then you’ve experienced firsthand the pain-relieving effects. Visit any training room for high-profile human athletes, and cold therapy will be part of the regimen.

But there are conflicting reports on the efficacy of ice for humans when it comes to improving recovery, and the research on ice and horses has mostly been limited to laminitis. In a world filled with high-tech therapeutic advances, is something as simple as ice really worth the time and effort?

“Absolutely,” said Max Corcoran, former head groom for Olympian eventer Karen O’Connor for 11 years. “In our barn, this was standard oper­ating procedure. In my opinion, you can definitely prolong a horse’s career and have him be more successful by using it.”

Gil Merrick served as the U.S. Equestrian Federation High Performance Dressage Director and U.S. Team Leader for five years, including during the 2006 FEI World Equestrian Games (Germany), 2007 Pan American Games (Rio de Janeiro), and 2008 Olympic Games (Hong Kong).

“Cold therapy is used by every inter­national team at every competition,” said Merrick. “Without a doubt, cold therapy got some of our team horses through. It’s called high performance for a reason, and the demands on the horses are high. On the international stage where therapeutic medication is not allowed to help with recovery or minor pain relief, icing is the primary way to maintain the horses’ comfort and performance.”

But cold therapy isn’t just for Olympic mounts. “Any level of perfor­mance horse can benefit, and not just at shows,” said Corcoran. “Maybe your horse has a chronic ankle sore­ness or is coming back from an injury. In our barn, those types of horses always got iced after galloping or jumping, even at home—part of an almost daily routine. Any inflamma­tion you can keep out of those legs is going to benefit them.”

Healing Heat

It’s a question of when, not if, when you’re talking about horse injuries. While a single bad step may cause an acute injury such as a ligament strain or tendon tear, simple wear and tear over time can have the same result. Therefore, minimizing the horse’s inflammatory response to stress may be key to preventing further injury.

Heat is generated in a horse’s body, including in the lower legs, as part of a normal physiological reaction to exer­cise. During periods of exertion such as racing, cross-country galloping or a challenging jumping round, the stress on joints, ligaments and tendons can injure tissue and activate inflammation, which is actually a protective response to damage. Inflammation helps the body remove damaged tissue components so it can begin to heal. Damaged capillaries leak fluid into surrounding tissue, and additional responses are provoked from the horse’s body to clean up the injured area. The leaking capillaries cause edema, or swelling.

Science has shown that some degree of inflammation is a normal and necessary part of the repair process, but too much can cause further tissue damage and prolong healing.

“The application of cold tempera­tures seems to act in a number of beneficial ways to assist with recovery,” said David Ramey, DVM, of Encino, Calif. “It cools tissue; lowers the metabolic rate of cells and decreases their demand for oxygen; lessens nerve signaling, causing temporary numbing and pain relief; and reduces the permeability of capillary walls, limiting the flow of enzymes and resulting reactions that cause swelling."

Get Your Chill On

So how effective is cold therapy in aiding the body’s healing process?

As a Fédération Equestre Internationale veterinarian treating high-performance endurance and combined driving horses, Anne Christopherson, DVM, of Morriston, Fla., has seen firsthand how cold therapy can work in her practice, especially for acute injuries. But she admits that evidence is more anecdotal than data driven.

“Research I have seen has been in relation to cold therapy for lami­nitis, not for horse sport,” said Christopherson. “Most studies regarding the effect of cold on soft tissues are out of the human world, where work done on treating injuries with RICE [rest, ice, compres­sion, elevation] seems to be beneficial. Horses aren’t very good at the eleva­tion part, but we can try to get them to cooperate with the other three.”

“While there may be some question as to how beneficial cold therapy actu­ally is for horses, there’s no doubt that any effectiveness depends upon how it’s applied,” agreed Ramey.

His preference is for patients to plunge right into a big tub of ice-cold water. “Studies have shown that the most effective way to apply cold is with full immersion in cold water such as with an ice boot or tub,” he said. “The problem is that it also tends to be the most cumbersome method.”

Corcoran uses a 50/50 mix of ice and water in a plastic muck tub or tall plastic leg boots for soaking her charges. “I do think it’s most effec­tive for complete and even coverage of the legs,” she said. “But they’re heavy and unwieldy when full. And if the horse misbehaves and tips it over, it’s a monumental mess.”

Corcoran also noted that some horses, like O’Connor’s 2007 Pan American double-gold medal partner Theodore O’Connor, won’t cooperate with this method. “ ‘Teddy’ would absolutely not stand in it,” she said. “He was very unsettled by the noise of the ice. So for a horse like him, we would have to use something else.”

A wide variety of cold therapy prod­ucts are on the market to help, ranging from simple wraps to Velcro boots and complex cooling machines, with an equally wide range of opinions about them.

“There are a thousand ways to get it done because each horse’s needs, as well as people’s preferences, are completely different,” said Corcoran, who, over the course of grooming during two Olympic Games, two Pan American Games and two World Equestrian Games, has utilized a multitude of methods of cold therapy for horses in her care.

In addition, technology in ice therapy has come a long way in recent years. Ice boots not only provide cold temperatures through long-lasting gel inserts, but also add therapeutic features such as magnets and battery-operated massage.

Additional products, including the popular Game Ready line, combine cold temperatures and compres­sion through a system of continuous circulation with boots, hoses and an external power unit. Many top riders and veterinarians swear by the approach.

“I prefer cold with compression over cold alone, especially intermittent compression which acts as a ‘pump’ to push edema out of the area while allowing for a flow of circulation back into the area,” said Christopherson. Others, like Corcoran, also found it effective but “somewhat cumbersome because of all the equipment.”

“The compression aspect is inter­esting and is fantastic for moving fluid out of an area when there’s edema,” said Ramey. “But in my opinion, if you have so much inflammation and damage that you have notice­able swelling in a leg, then you need to know why it’s happening, not just get rid of it and go on. That’s like sweeping dirt under the rug.”

Timing Is Everything

When utilizing cold therapy after an intense workout or injury, time can be of the essence.

To assist with post-performance recovery, Corcoran said she’ll even put on easy-to-apply boots such as Ice Horse Tendon Boots as soon as a horse finishes cross-country for the walk back to the barn. “I’ll follow that with additional cold therapy—usually I do a minimum of three sessions, but it depends on the situation,” she said. “Often I’ll ice them again on Sunday morning, sometimes right up to the jog.”

So how long should cold therapy be applied? Opinions vary. Some reports indicate that after only 20 minutes of exposure to cold, blood flow to a horse’s leg decreases by 25 percent.

“In human medicine, the general consensus is that 20 to 30 minutes at a time is plenty, but horses are certainly less sensitive than people to the bad effects of cold,” Ramey said. “After you take the cold away, you can get a rebound hyperthermia effect where the limb will try to heat back up, so consis­tent application of cold may be best. There isn’t anyone that I know of who has completely answered this question through scientific study on horses, but in my practice I advise doing at least 30 minutes of continuous cold when treating swollen or sore limbs.”

In the O’Connor barn, Corcoran would utilize several alternating 20-minute sessions in and out of ice.

Christopherson favors a similar method for acute injuries. “I will apply cold for 15 to 20 minutes at a time, as many times a day as possible for the first three days post-injury,” she said. “For best results, the entire affected area must be in contact with the ice. In a pinch, a bag of frozen peas works great.”

While direct ice to skin contact could theoretically result in skin damage, horses generally aren’t exposed to ice for long enough in routine cold therapy for this to be an issue. In one laminitis study, horses were iced for 48 hours with no detrimental effects. “I have seen some skin damage from constant ice contact, but I have seen more burns from ‘sweating’ legs,” said Christopherson.

However, ice mixed with water, which will never dip below 32 degrees, isn’t cold enough to cause frost bite, so this reinforces the idea that the safest and most effective way to cool down a limb is through immersion in ice water.

The Best System Is The One You’ll Use

The wide range of choices for cold therapy can be confusing, and some of the more technical set-ups are also quite expensive. How does an owner choose between a muck tub full of ice water, ice boots or a cold therapy compression system? Talk to your veterinarian about your horse’s physical condition and the possible, try different products prior to purchase.

“It can be a little bit of a process of elimination,” said Corcoran. “See if you can borrow stuff from your barn mates and ask them what they like and why.”

Ramey noted that horse owners should consider ease of use too. “If a product is difficult to use on a regular basis, that can be an impediment to getting therapy done,” he said. “People are more likely to apply a therapy if it’s easy. You also need to decide if the product you’re considering is worth the investment for your particular application.”

No matter which method you choose, practice using the product before you head to a competition. “You definitely need to train your horses how to be treated with cold at home, not just at a show, so they know that this is normal for them,” said Corcoran. “With my horses, it became part of the overall learning process to be an event horse. If you want to use a muck bucket, teach them to step into it when it’s filled with ice and water. It can be scary, and once they’re scared they won’t tolerate it, so practice and make it a good experience.”

Corcoran put this theory into practice with Mandiba, O’Connor’s mount for the 2010 WEG and 2008 Olympics. “When Mandiba was a young horse, I would get those tall ice boots and make him stand in them every night while he ate dinner,” she said. “That lesson that wearing the ice boots was a good thing remained with him throughout his career.”

While cold therapy can play a valuable role in your horse’s athletic performance and longevity, Ramey advised one last note of caution.

“Cold therapy may be an effective therapy, but it also can be used to mask signs of pain and inflammation that should otherwise be addressed,” he said. “Icing a horse just to get him back into the ring isn’t the right approach, and it could allow a horse to hurt himself further. In human medicine, studies have clearly shown that tissue that has been iced is less pliable and more prone to injury. In addition, athletic performance decreases when humans return to work immediately after cryotherapy. Sometimes the horse’s body is trying to tell us to back off, and we need to listen.”

Don’t Forget Those Feet

Tough competition may take a toll on a horse’s legs, but hooves take a pounding too.

“The approach of cold therapy should be as much for the feet as the legs,” said Max Corcoran. “Some venues are really hard, and their feet can get really stung and sore, espe­cially on the heels.”

If a horse won’t stand in full-immersion boots or a tub, Corcoran will try soaking with ice in a small rubber feed pan, an approach that is endorsed by Kentucky sport horse farrier Donny Brandenburg. “Is there any harm to hooves from standing in ice water? No, not really,” he said. “It’s for such a short time frame, no different than running a cross-country course through wet grass. The benefits far outweigh any drawbacks.”

For maximum therapeutic benefit, Corcoran and Brandenburg follow foot soaks with an overnight hoof packing material such as Magic Cushion or Magnapaste to further cool and reduce inflammation in the hoof.

And unlike icing limbs, a number of studies have established the efficacy of cold therapy for laminitis.

“The old stories about standing a foundered horse in a cold stream have some merit,” said David Ramey, DVM. “In this area, we do have scientific studies which prove that immersing a horse’s feet in ice for extended periods, sometimes as long as 72 hours at a time, is effective in reducing the severity of injury in acute laminitis.”

If you enjoyed this article and would like to read more like it, consider subscribing. "Ice Down To Ride On" ran in the Sept. 9, 2013 issue.

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