Professional human athletes experience strain from frequent, rigorous training and performance. They use various complementary therapies to accelerate their bodies’ natural healing process and ease the discomfort they experience so it doesn’t interrupt their performance. Equine athletes might also benefit from a variety of integrative therapies to help them feel and perform their best.

A significant advantage to using complementary therapies is that they are drug-free and most are allowed during competitions. Electroacupuncture, shock wave therapy, Class IV laser therapy, and cryotherapy are an exception because they are not permitted during FEI-sanctioned events. (Always check the rules governing your competition).

While many complementary therapies can be useful and incorporated into a horse’s wellness program, Tracy Turner, DVM, MS, Dipl. ACVS, ACVSMR, founder of Turner Equine Sports Medicine and Surgery, in Stillwater, Minnesota, says he considers the cost/benefit ratio when deciding which to recommend to a client.

“What does it cost to use it?” he asks. “How much benefit will the horse get? That changes based on the scenario and part of the decisions made by the horse’s health-care team, including the veterinarian, horse owner, and trainer.”

He adds that knowing the goal for using complementary therapies is also critical. If you’re trying to help the horse achieve relaxation (which has its benefits), that’s one thing, but if it is to heal an injury, these therapies on their own will not achieve the desired outcome.

“It’s important to have your veterinarian do a whole-horse evaluation,” he says. “I firmly believe there’s no such thing as a single injury. Diagnosing the underlying issues is essential to knowing how the horse might be compensating in other areas (and) to decide what the horse needs, and fitness comes into the equation, too.”

Picking a modality for your horse and your discipline can feel as overwhelming as restaurant menus with too many choices. Here’s a selection of popular treatments for keeping performance horses feeling their best. Use this article to start a conversation with your veterinarian about options that make the most sense for your horse.

Acupuncture

“Acupuncture is a useful, time-tested modality that has a lot of science and thousands of years of use,” says Andris J. Kaneps, DVM, PhD, Dipl. ACVS, ACVSMR. He owns Kaneps Equine Sports Medicine and Surgery LLC, in Beverly, Massachusetts. More of that science appears in the human literature than in equine studies, however. “It’s gradually becoming more widely recognized as a valid treatment in horses,” he adds. (Read about acupuncture and a review of existing research at TheHorse.com/181626.)

“It has very valid support scientifically and anecdotally,” he says. “A key difference between acupuncture and what we call Western veterinary medicine is that the approach is completely different.”

For example, as a Western-trained veterinarian, he palpates for swelling or increased joint fluid, looks for pain with hoof testers, and performs a lameness evaluation for signs of discomfort. In Chinese medicine those factors are important, but practitioners also evaluate the sensitivity of acupoints throughout the body, assess tongue color and moisture, and examine other factors that aren’t in the normal diagnostic approach for Western medicine, he explains.

Kaneps especially likes acupuncture for horses with back pain because of the equine research that supports its use for such cases, and he has seen multiple horses experience significant improvements after treatment.

“As with all complementary therapies, this does not mean I just treat a horse with acupuncture,” he says. “I may use some Western modalities as well as other complementary techniques to reduce back pain in a horse. Using one alone may not do it, but using several together can improve the outcome.”

Spinal Manipulative Therapy

Inflammation of the nerves and other tissues surrounding joints, especially in the spine, can lead to pain and reduced function, especially when the joints are stiff or immobile. Spinal manipulation (described at TheHorse.com/113280) could help restore the range of motion.

“Chiropractic adjustments keep the horse limber and moving to prevent areas of fixation through the neck, back, pelvis, etc.,” says Ed Boldt, DVM, owner of Performance Horse Complementary Medicine, PLLC, in Fort Collins, Colorado. “Like human athletes, when (horses) are in better shape, they are less likely to have an injury.”

In Boldt’s opinion, horses that are not performing optimally are candidates for spinal manipulative therapy. He uses the example of a barrel horse running to the wall (where the horse runs past the barrel and doesn’t slow down to turn) or going flat (leaning on his front end) around the barrel.

A horse that is three-legged lame is not one that would benefit from chiropractic therapy, he says. “Those horses need a diagnosis and treatment plan, and then integrative therapies might be added to help healing,” he explains.

Boldt also believes veterinarians trained in chiropractic care should make the adjustments. Some states allow chiropractors licensed to work on humans to have animals as patients after completing approved continuing education.

“To me, it’s important the vet is involved either doing the treatment or at least approving of the treatment,” he says.

Chiropractic care without an equine practitioner’s examination might worsen a situation. Boldt remembers being called to examine a horse treated by a nonveterinarian, and the horse was getting sorer rather than improving. By watching the horse move and using hoof testers, Boldt identified the horse had an abscess.

In another case an older horse had fallen on an icy hill and injured his neck. The owner brought it to Boldt, who refused to provide an adjustment without radiographs.

“Thankfully, I insisted,” he says. “The horse had a fractured neck, and if I’d just gone in and adjusted the horse there could have been severe consequences.”

Kaneps agrees that equine chiropractic adjustment is a well-tested modality, and those trained in it should perform treatment.

Vibration Plate Therapy

The next time you watch a sporting event, notice how the athletes “jump” around on the sidelines, readying themselves for play. Turner likens the benefits of vibration therapy in horses to those loosening routines.

The gentle motion is believed to increase blood flow, lessen joint pain and inflammation, and warm and loosen muscles, which reduces horses’ muscle tension before a ride. Research findings on the effects of whole-body vibration are mixed. One example is a Michigan State University study in which researchers subjectively found no difference in flexion, stride length, or heart rate after vibration therapy, but horses exhibited behavioral changes such as relaxation and less stress.

In another study, out of Peninsula Equine Medical Center, in California, a researcher found that hooves grew faster after two months of whole-body vibration. Further, this vet and colleagues plus one from Western University of Health Sciences College of Veterinary Medicine observed an increase in back muscle size and symmetry after twice-daily whole-body vibration treatments five days a week for 60 days (Halsberghe et al., 2017).

“In general, horses really like it,” says Gabrielle Solum, DVM, a resident at Equine Sports Medicine and Rehabilitation, in Whitesboro, Texas. “They yawn and relax on there, so it’s a nice therapy for them to have. The biggest thing is if you achieve benefits like increased hoof growth and larger back muscles, it must be used daily and (you need to) recognize that there is no prolonged effect if you stop using the modality.”

Pulsed Electromagnetic Field (PEMF) Therapy

This approach uses pulsating magnetic fields, made by pulsing a small electrical current through wire coils, to jump-start and accelerate normal biological cellular reactions. Most of the information on PEMF therapy is on bone healing. Proponents say PEMF increases circulation and decreases pain and inflammation to accelerate healing.

“It is really good for muscle relaxation … when an animal is relaxed, they hold themself differently, and we want a horse to bear its weight correctly,” Turner says.

Pulsed electromagnetic field therapy is just one type of electrical stimulation treatment. One of Turner’s go-to modalities that also falls into this category is functional electrostimulation (FES), which works to strengthen a muscle that is not being used and can provide pain relief. This mimics nerve patterns signaling the muscles to contract, and he has found it particularly beneficial when an area has been inactive following an injury.

“Functional electrostimulation has a lot of uses,” Turner says. “It can be particularly helpful for horses needing multiple spinal or skeletal adjustments. The electrostimulation helps fatigue the muscles so you can better work on an area.”

Ice/Cryotherapy

Since the dawn of human sports medicine, doctors and surgeons have recommended ice baths to decrease inflammation and reduce pain. Solum says this easy-to-use treatment is underutilized.

“Ice boots are great to use after exercise for 20-30 minutes to decrease inflammation,” she says. “There are a lot of ice boots on the market, but it’s also acceptable to use a bucket of ice if your horse will tolerate it.”

She often pairs ice with heat, especially for horses with back pain or those performing athletically.

“You can place a warm towel on the horse’s back or use one of the microwavable products for humans,” says Solum. “I probably wouldn’t use an electric heating pad, but there are benefits to using heat along the axial skeleton to give more mobility and prepare the horse to be athletic. Then I’d follow that up with ice after activity.”

Be cautious about the material’s temperature; you can damage tissue if it’s too hot. If you cannot tolerate the heat on your skin, it’s unlikely the horse can.

Be sure to discuss ice and heat therapy with your veterinarian before using them on your horse, because in some situations one is more beneficial (or could be detrimental).

Maintenance Begins with Fitness

Complementary therapies offer diverse options for enhancing performance and well-being. Boldt says collaboration with veterinarians and integration with conventional therapies are key factors in developing a holistic approach to maintaining performance horses.

“Integrative therapies are another tool in the toolbox—another therapy we can use with conventional therapies,” he says. “They can’t be used for everything, and I’m an advocate that they are done by a veterinarian.”

Although it can be argued that conditioning and exercise fall under rehabilitation, our sources here agree they are fundamental. Kaneps explains that people don’t run a 10K or a marathon without proper training. If they do, they are likely to sustain an injury. The same is true in equine athletes.

“Rehabilitation and conditioning exercise are the basis for having a good, strong equine athlete who is capable, and it hopefully helps prevent injury,” he adds. “When we see a horse with a sore back, we may use laser, shock wave, injection, or acupuncture, and the pain may be removed. But ultimately the horse needs to build core strength, topline strength, and flexibility and through exercise to build up that core.”