Can Cold Therapy Safeguard Sport Horses From Injury?

Q. My friend always uses some sort of cold therapy on her horse’s legs after a ride, whether it’s just hosing him off with cold water or using ice boots. I’m familiar with using cold therapy for horses with injuries, but is this important or useful for sound horses, as well? Could it help prevent injury or unsoundness?

A. These questions touch on an interesting and potentially controversial discussion among medical and veterinary professionals. Most people are familiar with the acronym RICE: rest, ice, compression, and elevation. Historically, this has been a standard approach for dealing with sports-related injuries in human medicine. Similarly, cryotherapy, or cold therapy, has been widely used in veterinary medicine to treat our equine athletes. A quick Google search may return “ice” as a recommended treatment for musculoskeletal injuries. Interestingly, most recent research suggests that cold therapy might not be quite as beneficial as we once thought it was.

Taking a post-workout ice water bath is an age-old practice among human athletes that’s often referred to as cold water immersion. Take a walk down the barn aisle at an FEI-level eventing competition after the cross-country phase, and you’ll likely see a fair number of horses standing in buckets of ice water. Many human athletes and equine trainers alike feel that there’s plenty of anecdotal evidence to suggest cold therapy is beneficial for recovery after exercise. It’s hard to argue with a treatment that has for so long produced seemingly good results. But what does the science say?

The general idea behind ice baths is that lowering a body part’s temperature constricts the peripheral blood vessels, thereby minimizing the delivery of inflammatory mediators to the region and secondarily reducing edema (swelling). While this seems to be true in acute injuries, the verdict’s still out as to cold therapy’s exact mechanisms and benefits for post-exercise recovery and treatment of chronic injuries. Scientists have established that cooling can decrease nerve conduction, which may reduce soreness in the short term and create the perception of accelerated recovery after rigorous activity. However, studies have shown that the reduction of pain or soreness doesn’t consistently lead to improved function or performance and is certainly not a means of preventing injury.

For proposed benefits to occur, the treated limb should be cooled to a temperature between 10-15 degrees Celsius (50-60 degrees Fahrenheit). Depending on where you live and the season, the temperature of water from your garden hose is probably significantly higher, in which case it’s not possible to cool a horse’s extremity to an optimal therapeutic temperature using a “cold hosing” technique. Further, hosing, as opposed to immersion, is not effective at exchanging heat, even with adequately cold water. Of course, ice boots will cool your horse’s limb to a greater degree than hose water and may at least offer some pain relief. In combination with the compression applied by the boot, it might provide the additional benefit of decreased edema that may otherwise occur post-exercise.

It’s hard to say whether cold therapy reliably prevents or treats any particular condition or if it speeds recovery or improves athletic performance. Active recovery is arguably just as beneficial as cold therapy for post-exercise recovery and is what I typically recommend. Does this mean that I dissuade client’s from using cold therapy on their horses after a hard schooling session or demanding day of showing? Not at all. At the moment, the evidence for its efficacy is ambiguous and somewhat unconvincing, but if done appropriately there are few, if any negative effects.