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 (www.horseandriderbooks.com).