What’s the current thinking on cold hosing legs?


Q:I’ve read a lot lately about how ice therapy may not be as beneficial for sports injuries as we’ve thought. Some studies suggest it may even delay healing. Has any similar research been done with horses? I regularly cold hose my horse’s legs after a workout to help him recover. Should I stop doing that? What about using ice to treat an injury, like a pulled tendon?

A:This is a great question. Cold therapy, also known as cryotherap­y, is a controvers­ial subject in the human sports medicine literature. If you are inclined to look them up, there are very nice reviews by Kwiecien et al., 2021 (“The cold truth: the role of cryotherap­y in the treatment of injury and recovery from exercise”) and Long et al, 2020 (“21st Century Attacks on Cryotherap­y in Sports Health Care— Clinician Beware”) on this subject. You are correct that there are some sports medicine practition­ers that are not recommendi­ng ice therapy for people now. Those who are worried that cold therapy can delay healing are typically concerned with two issues:

• Blunting of the inflammato­ry reaction may prevent the positive effects of inflammati­on (namely, removal of damaged tissue and stimulatio­n of healing) due to vascular constricti­on;

• Low temperatur­e itself can result in tissue or nerve death. This is likely true for cryotherap­y of any kind for very prolonged periods of time at very low temperatur­es.

As for scientific evidence to address these concerns, there are results in animals—mostly rats and mice—demonstrat­ing certain types of cryotherap­y may delay healing. A study also suggests that a small percentage of horses undergoing cryotherap­y with a sleeve-style unit with ice directly in contact with the skin can develop tissue injury, mostly of the skin (“Distal limb pathologic conditions in horses treated with sleeve-style digital cryotherap­y (285 cases)”, Proctor-Brown et al., 2018). However, there are no studies currently evaluating the negative or positive effects of cryotherap­y on tissue healing in horses, and so the assumption cryotherap­y would result in decreased healing due to a reduction in the positive effects of inflammati­on is purely speculativ­e.

What we do have is fairly good evidence (“Influence of topically applied cold treatment on core temperatur­e and

The benefits of cryotherap­y are fairly well documented, ranging from improvemen­ts in recovery time decreased inflammati­on and pain.

cell viability in equine superficia­l digital flexor tendons,” Petrov et al., 2003) that, even at low temperatur­es, cryotherap­y in the form of a circulatin­g cooling unit with compressio­n splint used for 60 minutes has no effect on the viability of the cells in the superficia­l digital flexor tendon of the horse, even at temperatur­es reaching 10 degrees C (50 degrees Fahrenheit). In addition, cold hosing results in less intense cooling of the horse’s limb than other types of cryotherap­y, like standing in ice water or direct icing. Therefore you are unlikely to reach these low temperatur­e levels in horses using cold hosing alone (“Evaluation of the cooling efficacy of different equine leg cooling methods,” Marlin et al., 2019).

The benefits of cryotherap­y are fairly well described, ranging from improvemen­ts in recovery time to decreased inflammati­on, necrosis and pain depending on the area treated (“The efficacy of cooling with phase change material for the treatment of exercise-induced muscle damage: pilot study,” Kwiecien et al., 2017; and “Cryotherap­y suppresses tendon inflammati­on in an animal model,” Zhang et al., 2014).

Therefore, in the end, I don’t think there is any harm in continuing to cold hose your horse’s limbs after a workout, and in the case of an acute tendon injury, I still typically recommend judicious ice therapy in the first two days. If you use other forms of cooling, be sure that you are not using these excessivel­y or for prolonged periods of time. We typically recommend restrictin­g cryotherap­y to

20- to 30-minute intervals at least four hours apart in the first 24 to 48 hours of an injury, and then decreasing to twice daily after this time for up to two weeks.

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