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Helle Katrine Kleven


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Quick Guide to Ice Therapy: An Excerpt from ‘Physical Therapy for Horses’

In this excerpt from her book Physical Therapy for Horses, equine physical therapist Helle Katrine Kleven explains how the application of ice done early and correctly can minimize the extent of an acute injury.

Photo by Maximilian Schreiner.

Ice therapy is applied for all acute injuries—for example, bone, tendon, ligament, and muscle injuries (bruising, sprains, strains, fractures). In addition, in the case of an acute injury, ice is the most helpful and least expensive application there is.


The result of an injury is destruction of tissue and blood vessels. With an open wound, blood exits the wound. With an internal injury, blood enters surrounding tissue. Internal injuries result in swelling and hemorrhaging, leading to pain and a slowing of the healing process. This type of injury can be treated with ice effectively.

How Ice Affects Injured Tissue

The immediate application of ice to an acute injury triggers a response in the blood vessels surrounding the wound. The vessels contract, which leads to less bleeding in the area. And, in order to keep bruising (hemorrhaging) at a minimum, your goal is to stop additional bleeding into the injured tissue.

A few days after an injury, you enter the subacute phase of healing. During this phase, you need to increase circulation again. Ice can be useful here, too, but it needs to be applied with great caution.


Important: Don’t use ice directly on the skin. Always position a damp, thin cloth between the ice and the body part to avoid injury to the tissue. (Note: This rule does not apply when using the “ice lollipop,” since it is in constant motion, as I describe in the tips below.)

Acute Injury

In the case of an acute injury, it is your goal to stop the bleeding into the injured tissue. This means that the quicker you start treating an injury with ice, the better.

First, use a bandage or your hands to apply light pressure to the “internal wound” from the outside. Immediately afterward, apply the ice. In this way, you can compress the blood vessels, which suppresses swelling and bleeding. A superficial injury to muscle, tendon, or ligaments requires an application of ice for about 10 minutes, followed by a 20-minute break. Apply light pressure during the break. Repeat the application until bleeding in the tissue has stopped (two to four times).

Important: It is important to adhere to the times during the application. If ice is applied to the acute injury for too long, the body will register the cooling and will reopen the blood vessels in order to help the cold tissue. The result is that even more blood reaches the injured tissue and even more hemorrhaging occurs.

Subacute Phase

After a few days, should swelling and inflammation occur, you can continue treating with ice, but with different treatment times. Otherwise, you should stop treating with ice. During the subacute phase, you should use a “short ice” application, meaning, ice is now applied for short intervals only, since your objective is now to increase blood flow. The ice is applied for 1 to 3 minutes, followed by a 5-minute break. This pattern is repeated four to six times. The short cooling of the tissue increases cell activity and blood flow, but it also decreases the production of substances responsible for inflammation.

Again, it’s important to adhere to the times described here because applying ice for too long can actually injure the tissue: nerves can be irreparably damaged, lymphatic vessels can be destroyed, and cell activity can be decreased.

Ice Timing:

  • Acute muscle injury: 10-minute icing, 20-minute break.
  • Acute tendon and ligament injury: 10-minute icing, 20-minute break, as often as possible during the 48 hours directly following the injury.
  • Subacute injury: 1- to 3-minute icing, 5-minute break, four to six repetitions.

Photo by Maximilian Schreiner.

A Few Tips

Pure ice cubes made of water are well-suited for injuries. I always use the disposable ice cube bags. These can be directly applied by wrapping them around the leg and holding them in place with polo wraps. But remember: please use a damp towel/cloth between ice and leg.

Be careful with gel ice packs. They quickly lose their cooling ability and then actually start accumulating heat from the body. Heat is the last thing you want on an acute injury since it increases circulation!

You can also put wet towels or bandage liners in the freezer and then wrap them directly around the injury. They don’t hold cold very long and start storing heat after a while.

To create an “ice lollipop,” fill a paper cup with water and put it in the freezer. When the water is frozen, cut away half of the paper cup. Now you can massage the affected area of your horse for some time, without your fingers getting too cold. When you move the ice lollipop in small circles, you massage and cool the affected area at the same time. This is a great alternative to other ice applications. As mentioned, since the ice is in constant movement, you can apply it directly to the skin.

When You Shouldn’t Use Ice

The following injuries and changes in tissue are a contraindication to any treatment with ice:

  • Open wounds
  • Chronic damage to blood vessels and lymph vessels
  • Injury to nerves

This excerpt from Physical Therapy for Horses by Helle Katrine Kleven is reprinted with permission from Trafalgar Square Books (

Does Your Horse Have Stiff or Blocked Joints?

In this excerpt from her book Physical Therapy for Horses, former physical therapist for the German eventing and endurance teams Helle Katrine Kleven explains what is really happening inside the stiff horse.

Photo via Horse and Rider Books.

When a horse is worked incorrectly over a long period of time or, for example, he makes a sudden movement that’s too much for the joint, the soft tissue that surrounds the joint will be overburdened or overstretched. The musculature that lies around the joint is also rich in nerves and receptors, which measure the length of the muscles. This means the musculature shortens to protect the affected joint. This can only occur for a short period of time or else, worst case, the musculature will remain in this contracted state. This, in turn, leads to a blockage.

You’ve almost certainly experienced this yourself; for example, when you wake up in the morning and have a stiff neck, and can neither turn your head nor stretch. That’s a blockage in the neck and the pain that you feel is a tensing of the muscles—it’s not the joint. The joint experiences a movement limitation. This blockage can affect both sides, or just one side. Apply this to a horse, and it could mean that you ride to the right without any problem, but tracking left, it feels as if you’re riding a completely different horse.

The true source of blockages is the braced/tensed soft tissue, which can develop so much strength that it causes a vertebra to rotate or can even deform one. This disorder can be perceived both through touch and visually. You can feel the muscular tension and/or see a sideways-tilted spinous process in the thoracic or lumbar vertebra compared to other spinal processes, which are aligned. When you look down on the horse from above, it will be evident that the line of the spinal column includes small curves. Even the large pelvic bone can get pulled out of line by a tight muscle, resulting in a so-called misaligned pelvis. With such an example, it will become very clear how much strength the muscles can apply.

When the blockage is in the region of the spinal area, the connection between body and brain is interrupted. The reason is because the nerve must pass through a tight canal between two vertebrae before leaving the spinal column. Through the blockages in the vertebrae, the soft tissue swells around the column, which leads to pressure on the nerve. This, in turn, causes problems with coordination such as stumbling and uneven rhythm, lost strength, muscular tension, circulatory and metabolic disorders, and even lamenesses because the compressed nerve signals pain. As with people who have problems with their sciatic nerve, the pain may not show up in the back. These patients feel pain in the area of the hip joint, upper thigh, knee joint, or even ankle joint. In horses, unnatural sweat patterns (round, wet spots) can also be a hint about blockages in the spinal region, which demonstrates how the symptom can be located far from the source of the problem!

In an acute state, this muscular tension/blockage is very painful, as the circulation to the muscle is no longer good and it can very quickly become acidic. When the blockage exists over a long period of time, the affected soft tissue begins to change. The muscles “go to sleep” and, in the short term, they begin to work like a corset surrounding the joint. The blocked joint can no longer move optimally. In this condition, the joint itself is not the source of any pain, but for the musculoskeletal system it’s a major strain, which can quickly lead to secondary tension and injury. Somehow, the body must balance out the limitations on movement. So, the other areas must move more strongly, even “over-moving,” which once again can lead to overstressing those joints and, therefore, creating even further injury. It starts a vicious circle, which over time can lead to more secondary blocks or cause more injury—all originating from the primary blockage.

A misaligned pelvis can originate from blockages in the spinal column or trauma.
An acute blockage is always painful. This pain automatically triggers muscular tension and the horse attempts to relieve pain by adopting an “avoiding” posture. All of the factors lead to a circulatory disorder and secondary blockages. Injury and overstressing a body part are hardly avoidable. Over time, more and more body parts will continue to be pulled into this vicious circle. The intensity and number of problems will increase for the horse.

Normally, acute blocks that originate from a trauma or out-of-control movement go away by themselves in one to three days. If they stay or if they’re caused by ill use, they will be difficult to “release” through riding. It’s highly recommended that you allow them to be released by treatment from a physical therapist.

This excerpt from Physical Therapy for Horses by Helle Katrin Kleven is reprinted with permission from Trafalgar Square Books (