Recently I had the privilege of visiting the Falconwood Equine Spa, where horses are treated using hydrotherapy. I was favourably impressed, even more so after studying a number of case reports and clinical studies. Hydrotherapy is not to be confused with simple swimming or exercising horses in a water-treadmill. But more about this later.

Every rider has a major fear for injury to the limbs of his horse, and rightly so. Such injuries, which can occur during training or while participating in a ride, are the most common cause of horse being withdrawn from competition.

Cuts and wounds on the lower limbs not only cause pain and discomfort, but are also more prone to the development of proudflesh, prolonging the healing time and often leaving a blemish. Muscle, tendon and ligament injury usually are the cause of semi-retirement or long lay-offs, putting an end to all thoughts of achieving one's goals for the year.

Inflammatory response
Whatever the cause of the injury, the body's reaction is referred to as an "inflammatory response". Upon injury, a number of chemicals are released from the cells. These chemicals cause blood vessels in the area to widen (thereby allowing more blood to flow to the area), and also make the walls of the blood vessels more porous (allowing fluid and cells to leak out of the vessels into the area surrounding the injured cells).

The chemical substances also increase the sensitivity of the nerves in the area, making the area painful, and act as messengers, attracting some of the body's natural defensive cells, such as leukocytes (white blood cells).

Two types of white blood cells are attracted. Neutrophils neutralise harmful bacteria that may be present, and macrophages engulf damaged and dying body cells as well as bacteria that may be present and ingest them, cleaning up the area.

What do you see and feel when examining an inflamed area?
• Redness as a result of the widening of the blood vessels
• Heat as a result of the increased blood flow to the area
• Swelling as a result of the walls of the blood vessels being more porous and fluid leaking out
• Pain as a result of the increased sensitivity of the nerves in the area
• Loss of function as a result of the swelling and pain. Limiting movement in this way, the body protects itself from aggravating the problem.

Although the above has the purpose of defending the body against harmful substances, remove damaged or dead tissue and promote healing, they can also be harmful. As more blood flows to the area, the swelling becomes more severe. This leads to a number of problems, the most important of which are related to pressure on the surrounding tissue.

As a result, the small blood vessels in the area are constricted and blood and oxygen supply to the tissue is reduced. Overlying skin is stretched beyond its limits, and can even rupture as a direct result of the accumulation of fluid. So, although the inflammatory response is essential in protecting and healing the body, one has to manage the response to prevent the negative effects.

The most obvious way, and probably the one most people would use first, is to give the horse a dose of anti-inflammatory drugs. "Bute" (phenylbutazone) has become a household term among all horse owners, and one gets the impression that most sports horse owners have a bigger supply of this drug than the average veterinary practice.

The drug is often used indiscriminately, and without realising that it has many negative side-effects, some of which could result in permanent damage to some of the organ systems. Further to this, "bute" also masks pain, and often leads to the horse being ridden long before the injury has healed, and thereby aggravating the problem.

It is preferable to try a non-medicinal approach. 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 water therapy and the use of ice packs are still some of the best ways of treating acute inflammation. The problem with these is that one cannot control the temperature, and often one does not achieve a drop in temperature in the deeper musculature.

Enters hydrotherapy
This is where hydrotherapy has its advantages. Hydrotherapy prevents the destructive effects of secondary cell injury and reduces the excess swelling by using the horse's circulatory system to sweep away excess fluids that have collected in the tissue. The Equine Spa utilises chilled, aerated salt water to reduce inflammation. The therapeutic effects are based on a number of factors – very cold temperatures, very strong concentration of sea salt and Epsom salts, massage and high levels of dissolved oxygen.

Crucial is the ultra-cool temperature and strong salinity of the water, which together improve upon the therapeutic qualities of either sea water or running fresh water in their natural states. After treatment, the tissues remain cold for up to 12 hours, something that cannot be achieved by hosing the legs down with cold water.

One could assume that the most benefit would be gained in cases of muscle, tendon or ligament injury. But this is far removed from the truth. Hydrotherapy is effective in all of those, but also when applied to bone and joint conditions, wounds, snake bite and chronic conditions such as laminitis. Positive effects have also been shown in cases of poor hoof growth. In short, any and all conditions of the equine lower limb can be treated using hydrotherapy.

If your horse suffers an injury or goes lame, it is essential to have him examined thoroughly by a veterinarian to make a diagnosis. Thereafter, if you happen to be in the Gauteng area, it will be well worth your while to ask the veterinarian for a report on his findings, and to make an appointment at the Falconwood Equine Spa. Take the veterinarian's report with you, and discuss the possibilities of treatment with the staff at the spa.

This will vary depending on the circumstances relating to each horse. For some conditions, it might be possible to treat the horse on a walk-through basis (where you take the horse to the spa, have the treatment, and take him right back home). For other conditions, such as a case of laminitis, the frequency of "spa-ing" will be such, that the horse will have to stay over at the spa.

But it is not only for injury that the spa can be used. As was discussed in a number of articles on the effects of exercise on tendon and bone, it is a well-known fact that microscopic lesions do occur. These usually go unnoticed, and gradually build up to a point where the structure can no longer take the strain and breaks down. Regular hydrotherapy sessions can heal these tiny lesions before the compound effect results in a more major injury. At the same time it improves circulation in the lower limb and hoof, preventing conditions such as laminitis and navicular.

How does it work?
Equine spa hydrotherapy relies on four basic factors, namely temperature, salt concentration, depth of water and aeration. 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
• Thirdly, the cold numbs the area to a certain degree, acting as a topical analgesic.

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.

Salt concentration: The salt concentration of the water has an impact on the healing process. Higher salt concentrations have a greater drawing effect influencing the dispersal of fluids accumulated around the injury. Additionally, the proportion of various salts has been found to influence the resolution of the injury.

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

Aeration: Aeration of the water has a two-fold effect, namely that the dissolved oxygen level of the water is increased and the soft tissue is subjected to a gentle massaging action. It is thought that the increased oxygen levels aid the healing process, much as hyperbaric chambers do for humans, while the massage effect influences dispersal of fluids. In addition, horses tend to relax more than in still cold water as is evidenced by reduced heart rates.