Equine Physical Therapy: What Are Your Options?
When your horse suffers from an injury or a condition limiting his comfort, motion, or usefulness, what options do you have to help?

The answer: physical therapy (PT). Maureen Kelleher, DVM, Dipl. ACVS, assistant professor of sports medicine and surgery at Virginia Tech’s Marion duPont Scott Equine Medical Center, presented equine PT options during a webcast the school hosted on Nov. 12, 2020. PT, she said, encompasses a wide variety of methods designed rehabilitate acutely injured tissues or reduce pain from chronic conditions.

Kelleher listed thermotherapy, electrotherapy, exercise therapy, and manual therapy as broad categories that each contain many techniques designed to help your horse return to full function and form.


The oldest and most basic form of PT, thermotherapy uses temperature to heal:

  • Cold, best used for acute/sudden injuries. Cold reduces inflammation, pain, and swelling and can be applied post-exercise to prevent pain caused by inflammation, especially in areas of previous injury.
  • Heat, best used for chronic conditions. Heat increases blood flow to speed healing and slows nerve conduction, which decreases muscle spasms and increases muscle elasticity.

For cold therapy, owners and therapists can stand horses in buckets of cold water or cold-hose or apply ice to affected areas. Machine methods include saltwater spas and those that apply cold compression or circulate water around the affected area.

Kelleher said heat packs, damp towels, heating pads, heat-generating blankets, and infrared heaters transfer heat to affected tissues, whereas warming blankets that contain ceramic particles or magnets redirect natural body heat back onto the horse.


Kelleher said that although little has been published about electrotherapies’ effectiveness in horses, literature on its efficacy in humans abounds.

  • TENS (transcutaneous electrical nerve stimulation), also frequently used on humans, uses low-frequency electrical pulses that travel from the “e-stim” unit through wire leads to contacts applied to the skin. The pulses inhibit pain-carrying nerve impulses and stimulate release of endogenous (body-produced) opioids.
  • FES (functional electrical stimulation, aka neuromuscular electrical stimulation, or NMES) differs from TENS, said Kelleher, in that it produces large-muscle contractions rather than superficial contractions. FES mimics muscular movement generated by nerves, which decreases atrophy (wasting) and improves function, especially with spinal cord injuries.
  • PEMF (pulsed electromagnetic field therapy) uses magnetic current to raise tissue temperature. Various forms of PEMF are available, from circular rings to blankets.
  • EA (electro-acupuncture) adds electric stimulation to acupuncture needles.
  • Light/laser therapy (photobiomodulation) uses non-ionizing light to increase cellular metabolism, producing signaling molecules that induce cellular repair and produce genes that make growth factors and release neurotransmitters.
  • ESWT (extracorporeal shockwave therapy) applies targeted high-pressure sound waves to stimulate new blood vessel growth and release growth factors at the tissue’s sound wave interface.
  • Vibrational therapy, aka whole-body vibration, is also used by human patients from elite athletes to the bed-bound elderly to combat inflammation and decrease pain scores.
  • Kinesiology tape (K-tape) is breathable, stretchy fabric tape with an adhesive side. Because of cellular and nervous connections in the skin beneath it, the tape is purported to increase blood flow, support joints, improve range of motion, and reduce pain and swelling.

Exercise Therapies

  • Controlled exercise helps protect horses—even those on complete stall rest—from reinjury by overexuberance as they return to proper function.
  • Proprioceptive exercises help horses improve their sense of where their feet are.
  • Core/stability training’s goal is to lift the abdomen and activate back muscles to propel the hind limbs.
    • Passive range of motion exercises include such therapies as resistance bands around the hindquarters, attached to a surcingle, that work to engage muscles.
    • Tactile stability/core-strengthening exercises include sternal presses, butt tucks, foot manipulations such as bell boots and light, smooth pastern chains or ropes that encourage the horse to pick up his limbs.
    • Manual joint manipulations enhance athletic ability and include both fore and hind hoof and pastern flexion; head and neck manipulations; crossing forelegs; extending fore or hind legs. “It’s important to do lateral bends of the spine correctly,” Kelleher cautions. “Flexion should occur in the lower neck without rotation at the poll. The endpoint anatomy, which can be either the point of the shoulder, flank, or hindquarter, changes the part of the spine that’s engaged.”

Other manual therapies include massage, fascial release, and body work such as chiropractic (performed by a trained, licensed professional), acupuncture (by a veterinarian with specialized training), and acupressure.

Take-Home Message

With the wide variety of PT options available, your sore or injured horse has an excellent chance at full recovery or, at least, improvement and pain relief. Work with your veterinarian to design a PT routine for your individual horse.