1. EQS 200 - Lameness

2. Leg Therapy – Law of Opposites  In leg care, whatever problem you are having you need to go to the other extreme  Example:  Inflammation and heat = need to cool it down  Edema/cold swelling = need to heat it up  What can you do at the track or at the farm?  Cold therapy  Warm therapy  Healing fatigue techniques

3. Cold Therapy – What is it Used for?  Used for inflammation  Key to success in utilizing cold therapy in the wake of an injury is timing  Best results come from when applied in the acute phases  Acute = immediate  Chronic = long-term  Applying cold therapy in the first hour after injury is optimum  How does it work?  1 st need to look at how inflammation works

4. Inflammation  HOT  Body’s response to an assault  Is beneficial because it helps remove dead cells/tissues and toxins, brings red and white blood cells to the area  Three main symptoms – natural and functional responses  Pain  Alerts the horse to the problem  Heat  Indication of increased blood flow to the injury site  Swelling/Edema  Helps immobilize the area  When inflammation is out of control it can hinder the healing process  Too much edema makes it difficult for healthy cells to get oxygen – creates Hypoxia (reduction of oxygen supply)  Cells drown  Interferes with accurate diagnosis of the underlying injury, so we need to bring it down

5. How Cold Therapy Works  Cold therapy slows chemical reactions in cells and inhibits enzyme activity  Reduces the oxygen requirement of cells, allowing them to survive in the hypoxic condition  Limits the “alarm” of inflammation – reduces the amount of fluid that accumulates  To a certain degree, acts as a topical analgesic Maybe not that cold

6. How Long To Apply  No longer than 30 minutes  Why?  Hours of continuous ice application will not increase the effectiveness of tissue cooling or extend analgesic effects  Excessive cold therapy can actually decrease metabolic activity to the point where local destruction of tissues can occur  Overexposure to the cold can also result in increased edema due to tissue damage

7. Cold Therapy Types – Cold Hosing  Consider it as a first line of defense  Available in many situations  Hosing should occur at or above the injury site  Also aids in removing dirt and debris gently  Since the water is continuously flowing, it does not warm up in reaction to the horse’s body heat  Allows the area to stay cooler longer  Provides both a cooling and “massage” action  Helps stimulate circulation and tissue regeneration  Recommended for 20 minutes at a time  As many times as day as manageable  If it is shorter than 20 minutes it does not give blood vessels enough time to react fully

8. Cold Therapy Types – Cold Water Wraps & Ice Quilts  Cold Water Wraps  Soak polos or cold water bandages in ice water and then wrap on the horse’s leg(s)  Will need to change frequently to keep the leg cool  Good if you need to keep the horse mobile  Walking after a work, after a race, or before the race  Ice Quilts  Soaking quilts in ice water and applying to the leg with bandages  Provides longer coolness on the leg  Use stationary or mobile

9. Cold Therapy Types – Ice Boots  Ice Boots  Covers from a bit above the knee to mid- forearm to mid-pastern area  Held up by suspenders or Velcro  Horse is normally tied up or held  Need to check often to make sure the horse has not removed the boots and that they have not slipped down the leg  Use up to ½ hour  Disadvantages  Horse needs to be still, cannot walk in ice boots  Some horse get irritated with ice boots

10. Cold Therapy Types – Ice Tub  Normally used for the front legs  Allows cold therapy to be applied from the hoof up to the knee or past the knee  Combination of water and ice to make the water very cold  Similar to all cold therapies, should only be used for ½ hour  Horse needs to be accustomed to this technique  Must be tied or held  Take it to the next level  Game Ready System

11. Cold Therapy Types - Poultice  What is poultice?  Clay that is mineralized with cooling properties  Comes in many different brands, different ingredients  Commonly applied to the legs or soles of the hooves  Has a cooling & drawing effect  Cools the leg to reduce heat and swelling  Extra fluids can be pulled out towards the clay through osmosis as it dries  Good for new injury that does not have breaks in the skin  Needs to be applied thick (1/4 inch)  Best applied 1 st against the hair so it is as close to the skin has possible and then smoothed going with the direction of the hair  Poultice needs to be washed off the next morning  Dried is easier to remove than wet

12. Cold Therapy Types - Poultice Keep it open or wrap it up?  Keeping it Open  Keeping it open will result in the poultice drying out faster  Some horses also like to eat poultice  Could potentially come off if the horse lies down, rubs its legs, will get straw and debris on it  Wrapping Over it  Anytime you wrap over something you will create warmth!  Use wet brown paper or wet paper towel over the poultice to keep it active and wet and allow for little evaporation – then wrap a standing bandage over the leg  What about Saran Wrap?  Creates a “poultice sweat” effect  Keeps the poultice wet but it doesn’t have as much evaporation and will eventually get warm  Good for if you want to cool the leg and then warm it after

13. Cold Therapy Types – The Hoof  Temperature of the hoof can be indicative of internal conditions  Hot vs Cold  Also evaluate the horse’s stance  To draw out heat and potentially reduce any stinging we pack the feet with:  Mud  Poultice  Other foot packing product  Mud  Will come in powdered form and needs to be mixed  Trainers will often have their own “recipe”  Epsom salts, Apple cider vinegar, mineral oil  Poultice  Pre-mixed  More expensive than mud  Foot packing product  Magic Cushion

14. Warm Therapy – What is it Used for?  Used for edema (cold swelling) to:  Increase circulation and bring cold swelling down  Facilitate the healing process  Once heat and pain subside from an injury site (time varies), circulation to the site slows  In order to encourage circulation to maximize healing, heat is applied  Should not occur until reduction of inflammation has occurred  Why do the lower limbs have a tendency to swell?

15. How Warm Therapy Works  When heat is applied to the skin surface the blood vessels dilate  Which increase blood flow  As capillaries open up, it allows more oxygen and nutrients to reach the area, which supports growth of new and healthy tissue  Increase blood flow also removes excess fluid out of the area, dead cells, and debris

16. How Much Heat?  To have a significant change in metabolic rate, temperature of the target tissue must rise at least 5 degrees  Temperature increases greater than 12 degrees can create the sensation of pain rather than heat

17.  Of all the heating therapies available, only therapeutic ultrasound has shown the ability to penetrate through the skin to the deeper structures  Joint structures  Tendons & ligaments  Other heat therapies heat only the skin and possibly the underlying connective tissue  Not the most common tissues involved in most sport injuries  These other therapies do provide:  Soothing and relaxation effects  Stimulation of sensory nerves in the skin which can have a damping effect on pain How Far Can Heat Reach?

18. Warm Therapy Types - Liniment  What is a liniment?  Liquid or semi-liquid preparation that is applied to the skin to provide temporary relief for minor aches and pains  A standing bandage over the liniment area will keep warmth in after liniment is applied Antiseptic vs Analgesic  Antiseptic  Safe to use on superficial scrapes or cuts to help prevent infection  Also can aid in providing temporary relief for soreness, stiffness, or swelling  Analgesic  Not be used on open cuts of wounds  Contains pain-relieving ingredients that induce heat or cooling effects  Common ingredients – menthol, eucalyptus, capsaicin, camphor, mint oils

19.  Common liniments  Absorbine, Bigeloil, Ventrolin, Sore No More  Be careful what ingredients are in the liniment  Liniments can also be used as a body brace  Rub down liniment all over the body  Help relaxed fatigue muscles Warm Therapy Types - Liniment

20. Warm Therapy Types - Sweat  You can increase the effects of warm therapy by wrapping with cellophane (saran wrap)  Known as a sweat  Purpose of a sweat is to reduce fluid build-up  Materials  Commercial sweat product or Fura-Zone  Standing bandage materials  Saran wrap  Paper towel/cotton  Why Fura-Zone?  Powerful antibacterial ointment  Good if the cause of a swollen leg is because of a scratch or cut  Additional ingredients  DMSO

21. DMSO  Dimethlysulfoxide  Works to reduce inflammation by increasing circulation and getting warmth to the area  Absorbed instantly through the skin  Makes it a carrying agent for other medications  Often mixed with other substances to increase potency  Iodine, Cortisone  To increase body wide circulation, veterinarians will deliver it IV as a “Jug”  Horse will smell of garlic  Can be used straight to paint on legs, hocks, stifles  Always use gloves when handling!

22. Warm Therapy Considerations  Always read the instructions on the product you are using and keep a close eye on how the horse reacts  White legs tend to be more sensitive  Black legs not as sensitive  Depending on what ingredients you add to a liniment or sweat, you may not be able to apply it consecutively

23. Healing Fatigue  What is it?  Haven’t had complete healing in an area – disturb the area to start-up healing again – make it finish healing  Other Leg Therapy Techniques  Blistering  Pin Firing  Bar Firing  Therapeutic Laser  Therapeutic Ultrasound  Shockwave Therapy  Injecting a Joint

24. Blistering, Pin Firing, Bar Firing  Blistering  Using a stronger preparation for skin irritation  Good for superficial healings, injuries close to the skin  Needs rest afterwards  Pin Firing  Goes through the skin with heat to create controlled inflammation  Needs rest afterwards  Bar Firing  Pin firing taken further  Creates large inflammation  Affects the tendons

25. Therapeutic Laser & Ultrasound  Therapeutic Laser  Cold laser  Light energy increases cell energy, gets blood vessels to dilate, lymph vessels to move less sluggish, helps decrease the formation of adhesion.  Good for tendons and ligaments  Expensive & technical  Therapeutic Ultrasound  Soundwaves, create heat  Helps with the alignment of fibers  Commonly used on tendon healing, better for soft tissue issues

26. Shockwave Therapy  Shockwave Therapy  Soundwaves help increase cell metabolism  Really good for areas of insertion  Soft tissue connecting to hard  Really good for high suspensory injuries  Veterinarian needs to do it  Withdrawal rate  Well-documented analgesic effect  Shockwave example Shockwave example

27. Injecting a Joint  Goal is to decrease inflammation and increase the quality of joint fluid  Ingredients  HA (Hyaluronic Acid) “Legend”  Adequan  Corticosteroids  Depo-Medrol, Vetalog, Betamethasone  Look at the joint fluid when it is tapped  Color, viscosity  High risk of infection, so the injection area must be cleaned well and properly bandaged afterward  Some horses will have a chemical reaction  Injecting the hocks Injecting the hocks

28. Other Topical Agents  Ice-O-Gel  Gelled tightener and freezing product  Good for:  Tendon and ligament problems  Suspensory  Bowed tendons  Edema  Applications  Open  Directly on the leg and bandaged over  Use with cold water wraps, ice tub, or ice boots  Green Cool, Green Pack Jelly, Mineral Ice  Leg Paints  Not as much as a blister  Paint on with a brush and left open  Depending on the strength, will produce scurf

29. Please use the following password to access Quiz 3 in Blackboard… Therapy2015