hydrotherapy

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Keeping South Africa’s equine athletes sound…


how hydrotherapy works

Equine Spa hydrotherapy relies on four basic factors, namely temperature, salt concentration, depth of water and aeration.




1. Temperature

The application of cold triggers three basic reactions.

Firstly, 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.  Secondly, the permeability of the blood vessel walls is decreased, 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.This provides analgesic pain management as well as inhibiting enzyme degeneration of tendons post injury.

One of the best things about cold is that it does not override the beneficial effects of the healing process. Please note that the application of cold should not be overdone. The overuse of ice, for example, can cause tissue damage.

2. Salt Concentration

The salt solution acts as a hypertonic poultice as well as having a natural healing effect on wounds. Water density increases with salt concentration, which in turn increases pressure to aid fluid and waste dispersal.  Additionally, the proportion of various salts has been found to influence the resolution of the injury.

3. Depth of Water

The greater the depth of the water the greater is the physical pressure exerted on the tissues which, again, aids in the dispersal of accumulated fluids.

4. Aeration& Dissolved Oxygen

Water at temperatures below 6 °c has a higher ability to carry oxygen and with the spas solution also being aerated, the oxygen content is increased dramatically. It is believed that the Spa has similar effects on internal leg injuries to the use of hyperbaric chambers in humans and with topical wounds, re-oxygenation allows phagocytosis and other natural defense mechanisms and other host defense mechanisms to intensify with hydrotherapy.

Water aeration also has a massaging effect on thehorseslegs which also increases the dissolved oxygen content of the spas water solution.

Biological Control:

With water hygiene levels continually being maintained with a combination of fine filtration, chlorination, cold water and salt, the Spa allows thousands of successive treatments. These same factors not only prevent further micro-biological infections but actually help treat any pre-existing conditions.



Why Hydrotherapy works

Traditionally horses were stood in cold running streams or walked in the sea as an aid
to the treatment and prevention of leg problems. Today, cold hosing is a standard modality for cooling down horses after exercise.



Sea water in particular with its very high salt content, has an anti-inflammatory effect which facilitates healing and helps guard against injury. However, the temperature of the water may not normally be sufficiently cold enough to affect the structures most often involved in injury.

To properly understand how the equine hydrotherapy spa works we need to review how the body reacts to the trauma of strains, cuts and bruises.

When soft tissue is injured through a cut, tear or concussive trauma, the body releases enzymes and proteins causing the blood vessel walls in that vicinity to dilate and become more porous.

Lymphocytes are directed to the site of the trauma, passing through the porous membranes and entering the injured tissues to begin fighting the infection. The extra fluids, carrying the oxygen and proteins for tissue repair, pool around the injured area causing edema or swelling, which helps in immobilizing the injury. Tissue damage also triggers the secretion of hormones, which causes much of the pain the horse feels in order to prevent the overuse of the affected limb. Additionally, the increased blood flow to the site of the injury results in a rise in temperature in the tissues in that specific vicinity.

The three main symptoms of inflammation; pain, heat, and swelling, occur in varying degrees depending on the site, nature, and severity of the injury.

The downside of inflammation is that it may rage out of control and hinder the healing process resulting in secondary tissue damage or hypoxic injury, which may compound the problem. In addition, blood vessels in the injured area are put under increasing pressure by the fluid build-up, thereby slowing down the flow of blood and lymphatic fluid.

The safest way to break the destructive cycle of secondary cell injury and the excess swelling is to use the horse's circulatory system to sweep away excess fluids that have collected in the tissues.

While anti-inflammatory agents such as bute may reduce swelling and heat, they may also mask pain, thereby confusing the diagnostic picture. Also, the use of corticosteroids to control heat and inflammation may have the disadvantage of shutting down the whole healing process.

The two natural ways of encouraging the dispersal of excess fluids are through the application of heat or cold. Heat, however, is not normally applied to any acute injury which leaves us with cold.



The Science behind Hydrotherapy

Generally 

Cold salt hydrotherapy treatment can be used for all forms of lower leg inflammation:
removing the painful fluid swellings associated with injury.


Specifically 

Tendonitis 

Injury to Superficial digital flexor, Check ligament, deep digital flexor Tendonitis is one of the principal injuries associated with performance horses as often repair is not fully successful. For example, initial injury may start as a bruise or strain to the collagen fibers which then become inflamed and further deteriorate under the influence of collagenase. In repair new collagen fibers form but often form cross links due to lingering swelling which are weak and re-injure. Cold hydrotherapy treatment minimizes the effect of collegenase by keeping the leg temperature lower; and by reducing the swelling, allows collagen fibers to repair neatly.

Desmitis

Suspensory strain or tear The suspensory apparatus supports the lower leg through attachment to the bones and injury is common when horses slip or twist the leg or where over extension of the fetlock occurs regularly during exercise. Injury of the ligament could occur in a similar manner to tendonitis or ligament separation from bone may result in intense inflammation and pain. Repair is slow and replacement collagen must form correctly to prevent re-injury, hence the importance to keep swelling down for straight collagen repair.

Arthritis

Injury to Fetlock and pastern, Knee and hock, coffin joint Bone provides the living scaffold for movement and injury can result in degeneration of bone and joint tissue with a weakening of the bone structure. Inflammation results in swelling and pain and unless the progressive changes are stopped deterioration will continue to worsen with concussion.

Hoof Injuries

Over reach, Abscesses, Stone Bruise, Corns, Laminitis or Founder, Thrush, Nail Prick All the different structures that go to make up the hoof can be injured either from concussion, trauma, shoeing or nutrition. Each form results in its own type of inflammation sometimes with associated infection. Cold poultice treatment to the hoof has been a traditional therapy and the spa improves this process in the above injury types.

Shin Splints

Sore shins, Bucked shins During exercise, pressure on the digital extensor tendon sheath down the front of the cannon bone, can cause the attachment of the sheath to the bone to lift in young horses. As exercise increases, the inflammation worsens with fluid separating the sheath and bone further. Spa treatment minimizes the inflammation.

Jar Up

Bruising Concussion soreness is a common result where horses work on hard surfaces after lead up exercise on softer going. This may result from a change in the going on grass tracks or change from all weather surfaces to firmer going in racehorses. The bone tissues are stressed and inflammation commences throughout the bones without showing signs of fluid or swelling.

Bursitis / Synovitis

Swollen joints, Wind galls or wind puffs Result where stress injury develops in the tissues surrounding joints and ligaments. The synovial membranes produce excess fluid causing the joint or tendon sheaths to swell.

Open Wounds and skin infections

Dermatitis, Greasy heel / Mud Fever / Rain Scald Skin Infection all commence with abrasion to skin cells which then allow entry of various micro-organisms resulting in inflammation. Both inflammation and the micro-organic cause require elimination and cold water hydrotherapy speed this process with the salt content of the water acting as a poultice. Many of the artificial surfaces that horses work on are abrasive and can irritate skin on lower leg.

Prevention

Normally the healing of these injuries may be prolonged with new tissue type being weak and prone to re-injury. Spa treatments resolve injuries faster in two ways; firstly, by keeping the leg temperature lower it minimizes the effect of fiber deteriorating collegenase; and secondly by reducing the swelling, it allows collagen fibers to repair neatly.

This reduced convalescence time is beneficial for the horse and all connections, however the perfect situation to utilize cold water hydrotherapy is within:

Injury Prevention 

Prevention is always better than cure. By regular use of cold therapy immediately after hard exercise, many of the stressors within tissues are removed before inflammation develops. Cold also significantly improves surface bone density reducing the opportunity for bone stress related injuries to commence.



The Therapeutic Effects

What can the ECB Equine Spa bring to your yard/rehabilitation centre?





Temperature:

The spas solution is maintained between 2 and 4 °c, to minimize heat and inflammation. This provides analgesic pain management as well as inhibiting enzyme degeneration of tendons post injury.

Salt Concentration:

The salt solution acts as a hypertonic poultice as well as having a natural healing effect on wounds. Water density increases with salt concentration, which in turn increases pressure to aid fluid and waste dispersal.

Aeration:

Water aeration has a massaging effect on the leg and increases the dissolved oxygen content of the spa solution.

Depth:

The depth of the water is proportional to the pressure exerted on the leg which aids fluid and waste dispersal; this can be varied according to position and severity of injury.

Biological Control:

With water hygiene levels continually being maintained with a combination of fine filtration, chlorination, cold water and salt, the Spa allows thousands of successive treatments. These same factors not only prevent further micro-biological infections but actually help treat any pre-existing conditions.

Dissolved Oxygen:

Water at temperatures below 6 °c has a higher ability to carry oxygen and with the spas solution also being aerated, the oxygen content is increased dramatically. It is believed that the Spa has similar effects on internal leg injuries to the use of hyperbaric chambers in humans; and with topical wounds, re-oxygenation allows phagocytosis and other natural defense mechanisms to intensify in their therapy.ify in their therapy. and other host defense mechanisms to intensify in their therapy.

The therapeutic factors of cold salt hydrotherapy can be used to treat any cause of inflammation within the tissues of the lower legs.



Downloadable PDF's


Cryotherapy and Laminitis Journal PDF
Prof Evan Hunt Journal PDF

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