May 13, 2020

A License to Chill with U.S. Team Veterinarian Dr. Susan Johns

By Claire Kelley - USEA Staff
The big yellow ice boots are a popular sight at most eventing barns. USEA/Jessica Duffy Photo.

This article originally appeared in the January/February 2019 issue of Eventing USA magazine.

The phase that captures the heart of an eventer, cross-country, is not for the weak. A true test of speed, stamina, and power – the essentials of cross-country – can have an effect on the horse’s body regardless of their power and strength. This is where hot and cold therapy come into play. Fire and ice, or in this case ice boots and hot packs, can be seen in the corners of barn aisles, in tack stalls at events, and on horses after cross-country. Land Rover U.S. Eventing Team Veterinarian Dr. Susan Johns shares her advice on when and how to appropriately use hot and cold therapies on an event horse.

Cold as Ice

Icing is a standard practice for three-day eventers, but what exactly does cold therapy do to help equine athletes stay happy, healthy, and sound? “Often at FEI events where therapeutic medication is limited to help reduce inflammation post performance, ice therapy is standard operating procedure as it helps reduce acute inflammation and swelling in an affected area and has pain relieving properties. Ice causes blood vessels to constrict, limiting blood flow to an area and reducing the amount of inflammatory mediators being released.”

While some horses have their own opinion about the right amount of time to stand in ice, 20 minutes is the norm. “As a rule of thumb in our practice, we ice for a maximum of 20 minutes between intervals depending on the location and type of inflammation we are addressing. Using cold therapy for too long is counterproductive,” shared Johns.

Front legs, hind legs, or all four legs – it is most common to see horses with ice on their front legs, the reason being that, “Front legs carry the significant load of the horse’s weight, so they are important to ice post strenuous exercise. However, if a horse has a hindlimb injury post exertion, such as a strained suspensory branch or superficial digital flexor tendon, these hindlimb areas are equally as important to address.”

Ever wonder why people are in a rush to put their horses in ice? The immediacy of icing is crucial. Johns explains, “Typically, we advise icing within 60 minutes following a hard workout. If cold therapy is advised by a veterinarian, begin the initial application as soon as possible. The first 24-48 hours are influential for addressing an acute injury.”

Ice wraps, buckets filled with ice, the big yellow ice boots, pressurized ice boots, and more – the different forms of icing can leave people wondering which product is best. Since grooms are one of the main influencers for a horse’s health and wellness, Johns believes they are the best people to turn to when discussing the variations of icing. “The grooms are the best resource for debating the pros and cons of different ice boots and cold therapy systems. A couple of the goals of ice therapy are to reduce inflammation, alleviate pain, and minimize swelling. The type and location of the injury will influence the best method of applying ice therapy. Horse compliance and safety of the support staff applying the therapy are of paramount importance. For instance, ice wraps applied incorrectly or for a prolonged period of time can damage the underlying tissue. Cold therapy may be administered to horses using many modalities, but they should all have the same end result. The ultimate goal is to decrease the temperature of targeted tissues and accelerate the healing response.”

Turn Up the Heat

A warm towel soaked in Epsom salts can help generate a feeling of relaxation. USEA/Claire Kelley Photo.

On the opposite end of the spectrum, heat is another standard procedure for therapy used in horses. “Heat therapy is often used in horses as a pain relieving and muscle relaxing therapy. It is effective in pain relief because it increases blood flow to an area reducing muscle spasm. Chronic back pain or muscle spasm post jumping or following an intense dressage workout is often aided by heat therapy by alleviating tension in muscle groups. Heat can also enhance the elasticity of connective tissue prior to exercise and can promote a general feeling of relaxation.” Apart from muscle relaxation, heat therapy can also be used to help treat injection-site abscesses, aid in chronic arthritis, and heal injured ligaments. “Chronic arthritic joints often respond favorably to applications of external heat to help increase soft tissue and joint mobility.”

Forms of heat therapy include hot towel compressions, heating pads, heating lamps, and warm water whirlpools which can be used pre or post workout. Therapeutic ultrasound is another form of heat therapy that is capable of heating deeper tissues while avoiding excessive heating of the overlying skin. This form of heat therapy can be beneficial in the healing process for strained muscles or injured ligaments.

Cold and heat therapies are valuable tools for equine ailments, but they must be applied properly. It is important to be careful to limit cold and heat therapy to prevent tissue, nerve and skin damage. “Cold therapy is overall very safe, and it is difficult to cause serious harm to a horse’s limb or body using ice and water. It is indicated to apply heat when there has been no significant increase in swelling for 24 hours, but excessive heat may result in blisters or painful burns.”

Johns’ final tip when dealing with ice and heat therapy: “Ice therapy and heat therapy are not a replacement for a diagnosis or treatment plan for an injury sustained by your equine athlete. It is important to follow your veterinarian’s instructions to maximize the therapeutic benefits of ice or heat therapy.”

How-Tos with Dr. Johns

How to treat an abrasion after hitting a cross-country fence

  • Therapy: ice
  • Time: within 60 minutes of cross-country run
  • What you’ll need: frozen bag of peas OR crushed ice in a plastic Ziploc bag
  • For how long: 20 minutes
  • Reason: “Post cross-country, I will often advise a groom to apply a bag of frozen peas or crushed ice in a plastic Ziploc to easily conform to a stifle or carpus that has sustained an abrasion from knocking a cross-country fence.”

How to help treat an inflamed foot

  • Therapy: heat and ice
  • Time: when painful to hoof testers
  • What you’ll need: warm and cold water
  • For how long: alternating 20 minute intervals
  • Reason: “Alternating heat and cold water therapy can help resolve an inflamed foot.”

How to generate relaxation before a dressage test

  • Therapy: heat
  • Time: prior to a dressage test
  • What you’ll need: warm towels soaked in Epsom salts
  • For how long: until towel is no longer warm
  • Reason: “Oftentimes grooms are encouraged to use warm towels soaked in Epsom salts along the back or neck of their horses prior to a dressage test to create a general feeling of relaxation and reduce pain and muscle spasm along the topline."

About Dr. Susan Johns

Dr. Susan Johns. USEA/Leslie Mintz Photo.

A Southern California native, Susan Johns graduated from Virginia Maryland Regional College of Veterinary Medicine in 2002. She completed a two year internship in sports medicine and diagnostic imaging at Virginia Equine Imaging following graduation, and eagerly stayed on as a senior associate. Dr. Johns has participated as an FEI permitted treating veterinarian since 2002 at the vast majority of three-day events both domestically and internationally. Since 2014, Johns has worked as the Land Rover U.S. Eventing Team Veterinarian.

Johns is the primary treating veterinarian for high performance horses such as Donner, the 16-year-old Thoroughbred gelding, who started his international career in 2010 and has finished all 36 international event he’s started – all while being under Dr. Johns’ care. Another equine athlete under Dr. Johns’ care is Arthur, the 20-year-old Irish Sport Horse gelding who completed his first three-star event in 2007, and continued to have a successful 10-year career at the three- and four-star levels.

Johns meticulousness, intelligence, and passion has helped her earn the respect of eventers all over the world. Taking pride in sustaining the longevity in equine athletes, Johns keeps countless horses happy, healthy, and sound at all levels of eventing.

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