How to Manage a Swollen Leg
Do you know what to do if your horse has a swollen leg? We can’t keep our horses wrapped in cotton wool so sooner or later as an equestrian you will probably have to deal with a swollen leg.
First if your horse is lame or in pain call the Vet. They can try to diagnose the cause and provide medication as necessary (pain relief, anti-inflammatory, antibiotic… ).
The advice below relates to general swelling like an acute or traumatic swollen leg. There are a huge variety of swellings, like unknown paddock incident, a tangle with a wire fence, a bump on the shin whilst riding or jumping, a tiny puncture wound... The swelling could be localised to a small spot or generalised all over and around the leg.
Don’t over think it. Cold hose it.
Don’t over mechanise it or make it more complicated than necessary. Do the basics consistently and well. Good old fashioned cold hosing and compression bandaging done regularly will do the job.
Who: you – take responsibility for managing swelling.
What: a leg that is hot, swollen, bigger than normal.
When: generally straight away, and several times a day; if you are proactive early it will resolve sooner.
Where: the entire area that is swollen, often means bandaging from knee to below coronet.
Why: some inflammation is useful and a normal part of the initial healing process, but if swelling is excessive or hangs around a long time, it is detrimental to regaining full pain free movement.
How: keep reading…
In humans (and horses) Physiotherapists use RICEMM, which stands for: Rest, Ice, Compression, Elevation, Movement, and Modalities.
Rest doesn’t mean staying it bed, it means relative rest, avoiding anything vigorous enough that may cause further injury. Rest allows recovery. A mild swelling (like a bump to the shin) might mean a rest from full training, but still able to be ridden out at a walk. For a moderate swelling rest from training and being kept in a smaller yard/ stable until the swelling has gone may be required. If in a big paddock with a mob of horses 24/7 then maybe in a smaller paddock by themselves or with a quiet companion. Or in a large yard. Box rest is usually reserved for more severe injuries, when there may be other tissues that need to be immobilised to allow them to knit back together for a few days before gradually being exposed to more movement. Generally 24-72hrs in a yard/stable where you can easily access them to carry out the other management strategies will be useful.
Ice - Cool the area of swelling. Standing the horse in a large bucket of cold water and ice cubes is one of the most effective ways to cool a limb down (see chart below). Good old fashioned cold hosing comes in second and is often the simplest and readily available. However splashing a bit of water on is not enough. Be patient – spend a full 20mins cold hosing, and repeat it frequently throughout the day. For people ice may be applied for 15mins every 2hrs for the first 72hrs, and continued at reduced frequency until the swelling is completely gone. So you can see that hosing once a day for 10mins is going to do very little, but cold hosing for 20mins 3 or 4 times a day will.
You can use a combination of different cooling techniques, for instance if the water from the hose isn't very cold, you might hose for 10mins, then apply an ice boot for 20mins. Remember don't put ice directly on the injury as this can cause ice burns, you can see in the graph below that 15oC water effectively cooled the leg by 0.8 oC per minute.
Compression – Remember the leg needs to be dry before bandaging. If still a little damp a terry towelling bandage pad, or absorbent wrap like cotton wool can be useful. Initially use a cotton wool roll and vetwrap bandage to provide even compression to the limb. Tip, unroll the vet wrap bandage and then re-roll it onto the tube, so you can control the tension as it comes off and get even wrap, not jerky. If there is a wound accompanying it, apply cream and dressing and stick down with tape such as fixomull, so the wound dressing doesn’t come off with the bandage. You will be removing the compression several times a day to apply the ice or cold water, but the wound dressing may stay undisturbed for 1 or 2 days before it needs changing, so useful to have it stuck down.
Or you can use a compression/exercise/sports bandage. I’m not a fan of the polar fleece bandages. I prefer a bandage pad and a bandage with some stretch in it. It can be tricky finding a bandage with a bit of stretch that is long enough for a stable bandage these days, if your exercise bandage is too short to cover the required area you are probably better using a vetwrap bandage. If you did the bandage too small you may get a band of swelling stuck below or above. You should be able to get a finger in the top of the bandage and carefully ease it all the way around. Not too tight, not too loose.
Bandage versus boot – some people use a boot or leg wrap, rather than a bandage, personally I think this is lazy. You get better conformity with a bandage, less pressure points, and you can control the amount of compression.
Compression sleeves and wraps - there are a variety of these on the market these days, some standard sizes, some custom made. If it fits your horse well, then go for it, remember to check for pressure points around zips and fastenings. I've personally not used any of these, so can't offer any extra do's or don'ts.
Some methods combine ice/cooling and compression: tubigrip and crushed ice, iceboot, ice gel bandage, evaporative cooling bandage... The main advantage of these is they may save you some time (as you can leave horse tied up whilst you do other stable chores), however looking at the graph they may not be as effective. You do not need to buy expensive products, use whatever works efficiently for you, so long as you are doing something to adequately tick the ice and compression boxes, there is no evidence to suggest that combining them is more effective that applying them separately. Ice boots may not fit the leg well, but you shouldn't leave the cooling device on longer than the 20mins anyway. They may keep the leg dryer so easier to reapply bandage afterwards. Perhaps alternate ice boots with water immersion/cold hosing throughout the day. And leave evaporative bandages/ water boots and poultices for the subacute phase.
Elevation – we can't really do this with a horse, but the aim of elevation is to make it easier for the excess fluid to be returned through the circulatory system. Providing comfortable stable bedding or a deep sand yard and companions nearby so your horse is relaxed enough to lye or sit down is the closest we can get. Other ways to boost circulation include: movement, massage, and modalities (see below), but don't forget the benefits of good old fashioned grooming - after being under a bandage the leg can be itchy with dirt, dead hairs/ skin cells trapped, so a soft body brush can help stimulate the skin health and the circulation.
Movement – helps reduce pooling of fluid in the distal limb, by using muscle contraction and frog pressure to pump it away. Remember it is relative rest not complete rest. Controlled movement, could be walking regularly on a lead, or moving the fetlock up and down. In more severe cases vibration and massage could be a low level of exposure to movement. If your horse is lame and on box rest, controlled movement may be slowly walking 20m and back 3-5 times a day. If your horse is not lame, it may be walking 100m or so and back (up and down the dressage arena) 3 times a day. Or letting them hand graze in the paddock on the lead rope. In the stable you can encourage movement of other body parts with carrot stretches for the back, neck and trunk; and gently bending, straightening, circling and stretching the limbs. A hay net fixed between wither and shoulder height encourages more weight shift and neck and body movement than eating from a feed bin on the ground.
Other machines and modalities - red lights, magnetic boots, vibration plates, electrical machines, to my mind these are all cherries on top of the cake. If you have done the basics well, as explained above, the swelling should resolve, if you have any of these extra cherries at your disposal, and you have checked that they won’t do any harm, then they may give an extra little boost (like a cherry). If you don’t have them your horse is not missing out, you still have cake and icing.
A benefit of these machines can be when a horse hasn’t been manged well initially and has stagnant swelling, one of these devices might give the body a bit of a kick along to get back on track to healing. Similarly if a horse has extensive injuries or other medical issues that might delay healing such as a fracture, or lymphatic drainage issue, something like kinesio tape or electro devices might give the body a little extra help to deal with the big repair task it faces.
Linaments – have minimal cooling effects and you need to be careful of skin irritation. Many are based on menthol, which creates a cooling sensation at the skin and modest changes in the temperature of deeper tissues. Some linaments contain herbal elements like arnica, comfrey, lavender..., these may provide some short term small reduction in pain. I believe much of the benefit from linaments is derived from massaging it in with little circles.
Clay Poultice – minimal cooling effects (see graph above), generally less irritation to the skin. Poultice is a useful visual reminder to hose the leg at least twice a day. You also have to hose long enough (20mins) to remove it all or combine massage whilst hosing to fully remove the clay. The whole wet newspaper and plastic wrap over top of poultice has gone out of fashion and you can see from the graph that covered poultice is less effective for reducing heat. If your horse still needs compression I feel you are better applying a proper compression bandage. I think the place of poultice is the sub-acute phase when you are transitioning from full bandaging and icing multiple times a day to paddock turn out and hosing twice a day. When turned out a bandage could hinder movement. Also longer term after exercise and a cold hose, poultice can be applied before the horse is turned out for the day.
Magnetic boots or wraps - limited evidence so far. Depends on strength and type of magnets. Some equestrians feel they help manage wind puffs. With an acutely swollen leg be careful how you use magnets. A thickly padded magnetic boot that fits loosely around the leg is not providing cooling or compression, it would increase heat and potentially swelling.
A routine might be -
Acute: cold hose for 20 mins (Ice), go for a walk to help leg air dry (Movement), include grazing some grass, towel dry leg, apply a modality eg.vibration (Modalities), make sure dry, apply compression bandage (Compression), return to stable (Rest) with clean fluffed up bedding and horse may decide to sit down (Elevation). In 4 hours time the routine might swap hosing for applying an ice boot whilst doing Carrot stretches. then a Walk.
Evening cold hose/stand in bucket of ice water. Walk. Haynet over night.
Subacute: walking longer distances. progressing to turned out in a paddock some of the time. reducing the thickness of the compression bandage from a Robert Jones bandage down to a sports bandage and padding over night. Reducing the frequency of icing/cooling.
Longer Term: After riding, cold hose, apply clay poultice, turn out. Hose and massage poultice off later in day. Gradually increase work load.
Returning to work. did you know 'Rebound Locomotion' is the phenomenon where after exercise has been restricted when the horse is allowed free range they will then over exercise, running and jumping around in excitement like they are trying to make up for lost time. This will often be seen when a quiet pony that has been kept in all day carriers off into the paddock galloping and bucking. Or when a horse stabled at night is taken out for a ride in the morning being 'fresh' and bouncy. This presents a risk for re-injury. It is therefore better to give them plenty of controlled exercise, such as walking on the lead/ in hand during the acute and subacute phases and also before turning them out in a paddock again.
Gradually return to work, if swelling returns or increases need to drop back to previous management until gone again. Box rest – walking in hand/ground schooling – riding at a walk – riding at a trot – riding including canter – poles – jumps – full training… That is at least 2 weeks.
Conservatively if you can do two sessions at the same intensity without flareup of symptoms you can progress to the next level. If a milder case and proactively managed perhaps a week from swelling being completely gone to returning to full work. How long it takes for the swelling to be gone depends on the size and type of injury.
Do’s- cold, get the vet, especially if cellulitis. RICEMM. Continue management until the swelling has completely gone.
Don’ts – heat (if stagnant swelling could do alternate hot and cold with allowing to return to normal temperature in between), exercise, nothing (instead be proactive).