Hydrotherapy to Rehabilitate Injuries in Horses (AAEP 2011)

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Originally published on TheHorse.com

Humans hear it often when it's time to get back in shape after an injury or surgery: "Get in the pool." Doctors know the increased resistance and buoyancy of water makes you do a significant amount of muscular work to move while providing very low impact/stress on bones and joints, so it's an ideal rehabilitation method.

The same concepts apply to horses, and veterinarians can prescribe hydrotherapy (also called aquatic therapy) for rehabilitation in the form of swimming pools or underwater treadmills. Henry S. Adair III, MS, DVM, Dipl. ACVS, ACVSMR (American College of Veterinary Sports Medicine and Rehabilitation), Associate professor of equine surgery at the University of Tennessee, discussed hydrotherapy treatment protocols during the 2011 American Association of Equine Practitioners convention, held Nov. 18-22 in San Antonio, Texas.

According to Adair, hydrotherapy has several physiologic effects on horses, including increased cardiovascular fitness, increased blood pressure, limitation of normal respiration (from water pressure on the body), changes in muscle activity throughout the body compared to walking exercise, increased muscle strength/tone with lower risk of injury (due to less weight bearing), and potential healing/preventive benefits for lower limb injuries and laminitis if the water is cold.

"Both (pools and underwater treadmills) are safe when used properly; however, devastating results may occur if used by untrained individuals or treating conditions in which these modalities are contraindicated," he cautioned. "Proper diagnosis of the condition, having properly trained personnel, acclimation of the horse, and having specific treatment protocols are necessary for optimum results."

There are several scenarios in which hydrotherapy could be beneficial to the horse. Adair listed the following:

• For rehabilitation after injury or surgery;
• For rehabilitation of tendon injuries (suspensory desmitis, etc.);
• For conditioning post-arthroscopic surgery;
• As a replacement for hand-walking;
• To maintain fitness with nondisplaced fractures;
• To treat joint stiffness and osteoarthritis;
• To increase muscle development;
• To encourage symmetric gait and back development;
• To provide cardiovascular conditioning; and
• For Reconditioning after a layup.

However, veterinarians and owners should avoid using hydrotherapy to rehabilitate horses with the following conditions:

• Acute joint inflammation;
• Skin infection;
• Open wounds;
• Upper limb lameness (the increased muscular work often worsens these injuries when swimming, although treadmill work can be beneficial);
• Back pain (swimming is not recommended, but treadmill work can be beneficial);
• Acute myositis (muscle inflammation);
• Cardiac compromise; and
• Respiratory disease.

Adair explained that several aspects of underwater treadmill or swimming pool treatment can be varied to suit the patient's needs, including the following:

• Water level (to select the desired amount of buoyancy, weight bearing, and degree of joint flexion);
• Water temperature;
• Treadmill speed;
• Hydrojets on or off;
• Exercise duration, intensity, and frequency; and
• Warm-up/cooldown periods.

Adair described swimming pool and underwater treadmill configuration options and acclimation procedures, noting that sedation might be required for some horses to get used to this kind of therapy. Some horses might never become comfortable enough for this to be a valid treatment option.

"Safety is of paramount importance," he stated.

There is not yet much published research on the benefits of hydrotherapy in horses, he noted. However, with many treadmills and swimming pools now in use in equine veterinary applications, look for updates on this therapy in the future.

Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.

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