Setting the Standard for Equine Sports Medicine

by Jen Roytz

Central Kentucky is known as the Horse Capital of the World, and for good reason. The concentration of so many horses in one relatively small geographic area is staggering, from elite Thoroughbred racing and breeding stock and nationally and internationally competitive show horses to lesson horses, therapy horses and thousands of beloved equine pets.

With such a breadth and depth of equine talent in one location, naturally those with a talent for caring for such animals have followed suit to make Kentucky their home.

It’s of little surprise that situated just outside of Lexington in the heart of Kentucky’s horse country sits a facility that has earned icon status among horsemen (and women) and equestrians the world over as the premier rehabilitation, conditioning and equine therapy facility in the world.

Hyperbaric Oxygen Therapy

KESMARC, short for Kentucky Equine Sports Medicine and Rehabilitation Center, is a state-ofthe-art facility that has been offering injury rehabilitation, post-surgical care, refreshing and conditioning for horses of all ages, breeds and athletic levels for more than 20 years.

KESMARC’s owner, Kirsten Johnson, oversees all aspects of the facility, having made equine sports medicine and horse health her life’s work.

One of Johnson’s and KESMARC’s main areas of concentration is hyperbaric oxygen therapy. Originally created to treat scuba divers suffering from decompression sickness (commonly referred to as “the bends”), hyperbaric oxygen therapy’s use has evolved to treat a wide variety of illnesses and afflictions, from severe burns and other serious wounds to infections, respiratory issues and more. The treatment modality involves putting a patient into a pressure-controlled chamber and having them breathe pure oxygen in an environment with higher-thannormal air pressure, allowing the lungs to take in more oxygen and disperse it through the bloodstream. In turn, the added oxygen in the bloodstream allows the body to heal faster and fight bacteria.

“Early hyperbarics were for divers that had to come to the surface too quickly from deep depths,” said Johnson. “Some of the divers had injuries and doctors began to realize their patients were healing exceedingly faster after being treated with hyperbarics.”

Since first implementing the modality into their menu of services in 2001, KESMARC has performed more than 30,000 hyperbaric treatments on horses and other animals. The facility has been on the cutting edge of developing protocols and taking part in studies to better understand the effects of oxygen therapy on a wide array of ailments, as well as the role it plays in recovery after extreme athletic performances.

“I became interested in hyperbarics after reading the book AIDS Under Pressure, which was about the use of hyperbaric oxygen therapy to treat infections and secondary illnesses of AIDS patients,” said Johnson. “The author did a research project over 5 years on AIDS patients in the 1990s when the life expectancy for those with full blown AIDS was not long. The patients remained on their respective

“It’s not just about addressing the injury, but the issues that caused the injury in the first place.”

–Kirsten Johnson

medications and were supported with regular hyperbaric treatments. After 5 years, all patients were still alive. At that early in my career, I was more focused on infections and helping horses to heal. As the human side evolved into high performance athletes using it, I started going that direction as well.”

Today, Johnson and her team use hyperbaric oxygen therapy, in conjunction with other medications and/or therapy modalities, to treat everything from infections and burns to respiratory issues, soft tissue injuries, fractures and more. She often attends conferences and symposiums focused on the use of hyperbarics in human medicine, then works in coordination with equine practitioners to apply the science to horses.

“Hyperbaric medicine is only as good as the diagnostics and the medicine it is practiced with, along with the cultures and sensitivities of lab work and testing, and as such using the right antibiotics,” she explained. “There are very few infections that hyperbarics alone can successfully treat. Resistant staphs, MRSAs - the chamber works in conjunction to engage the immune system and supports the antibiotics to help the body overcome the infection.”

Other Therapeutic Modalities

While KESMARC gained prominence early on as the pioneer of hyperbaric medicine in horses, it is just one of the many therapeutic modalities they offer.

One of the facility’s most popular therapy offerings is their equine swimming pool. Used for athletic conditioning and rehabilitation, swimming sessions are utilized for everything from sales yearlings and adult horses in need of conditioning to equine athletes recovering from injury.

The facility also offers an aquatred, which is a treadmill that operates under water. The water level of the aquatred can be adjusted, allowing for resistance training when the water level is lower and offering reduced weightbearing when the water level is higher, reaching the animal’s chest and barrel.

The saltwater cold spa is another hydrotherapy modality that KESMARC has spearheaded in recent years. Popular with human athletes as a post-competition regimen, the cold spa is set at 34-degrees and rapidly reduces inflammation and swelling in a horse’s lower limbs. The treatment is highly effective in post-workout recovery and the treatment of soft tissue injuries, cellulitis and laminitis, as the cold saltwater inhibits degenerative enzyme production that can further damage soft tissue, provides an analgesic effect, and increases circulation.

“The saltwater cold spa is a game-changer for post-workout recovery,” said Johnson. “It can really prevent a minor issue from becoming a major one.” All water treatment facilities at KESMARC are custom built for the facility and are underground, making them the safest way to use hydrotherapy to treat a horse. The KESMARC staff has safely put more horses through water therapies than any other facility in the world.

Respiratory issues are relatively common in horses, partially due to their biology and also due to the environmental factors to which they are exposed, such as dust from hay and bedding and airborne particulates common in barn areas. KESMARC has earned a reputation as one of the premier facilities to treat respiratory issues in horses. Nebulizer treatments provide a non-invasive way to treat conditions such as allergies and airway inflammation, as well as preparation and recovery from throat surgeries by aerosolizing medications such as silver (a natural antimicrobial), bronchodilators, corticosteroids and antibiotics.

In addition to water-based therapies, KESMARC also offers laser therapy, a vibrating platform, and a non-concussive jogging ring, which is perfect for bringing horses back into work without allowing them to do too much too soon.

“It’s so important to not let the horse overdo it when they are coming back into work under saddle after an injury,” said Johnson. “The footing is a mix of sand and synthetic, which makes it low impact compared to traditional dirt surfaces, and the indoor track with walls on both sides rather than a wide-open space, keeps the horses on-task and calmer.”

Tailoring the Treatment Plan to the Individual

Each horse receiving treatment therapies or rehabilitation at KESMARC is under the care of, not just Johnson, but a curated team of veterinarians and specialists specific to that horse and its unique injury or challenges. Their close proximity to many of the best equine veterinary practitioners, diagnostics, therapeutic specialists and podiatrists in the country allows Johnson to utilize outside consultants and put together teams when necessary to expertly address a horse’s unique circumstances at a more affordable price than otherwise possible.

Johnson’s staff, many of whom have been with the facility since it launched, are some of the most experienced and educated equine

sports medicine specialists in the world. They work with a horse’s team – including the owner, trainer, primary care vet and others to create a treatment plan aimed at returning a horse to its highest athletic level possible.

“KESMARC has rehabilitated more horses than any other facility in the world, and a large part of that success is putting teams together to get the best possible outcome for each horse,” she explained. “We take a very collaborative approach. We’re like the Switzerland of facilities; all veterinarians, farriers and specialists are welcome here. If the horse’s primary care team is not local, we’ll involve them in the process along with our local resources.”

Medicine, whether veterinary or human, is constantly evolving and refining. The result of the breadth and depth of its offerings is that KESMARC not only has access to the best people in equine sports medicine, but stays abreast of the latest treatment techniques and protocols.

“If you take a tour of KESMARC and then come back 5 years later and hear about the same approaches to the same things, I should be in trouble. Continuing education is huge in any medical field. We strive to always evolve not only what we do, but how we do it, and the more we know, the more we realize how little we know.”

Every horse that comes to KESMARC for rehabilitation from injury or illness leaves with not only a comprehensive treatment plan, but resources like Johnson, who are available for consultation well beyond the horse’s time in her care.

“It’s not just about addressing the injury, but the issues that caused the injury in the first place,” said Johnson. “Often the injury we are tasked with rehabilitating is secondary to what actually caused it. Taking time to address the issues that injured the horse in the first place, and bringing the horse back systematically and slowly while regularly monitoring their progress, is key to returning them to their highest level of athletic viability possible.” What to Do When YOUR Horse is Injured?

If you own horses long enough, you’ll either have one who hurts him or herself, or gets hurt by one of his or her “friends” badly enough to need medical intervention and long-term care and rehabilitation. KESMARC has played host to everything from Champion racehorses and top-level competitors from the sports of eventing, dressage, reining, show jumping and more, to family horses, trail mounts, and amateur competitors.

While the approach to injury rehabilitation will vary based on a horse’s age and fitness level, Johnson says being proactive and conscientious will pay off in the long run, both in the success of the rehabilitation and the cost of care.

“Our approach of putting together a team of specialists to address the horse’s issues is something anyone can and should do,” said Johnson. “The horse is a very compensatory creature. It’s important to work with your vet and/or specialists to identify not only what the horse injured, but why the horse incurred that injury. The rehabilitation and return to work protocol should take into account both of those factors and should continue to include checkins with the horse’s vet and/or treatment team.”

For competition horses rehabilitating from injury, such as racing athletes and show horses, Johnson underscores the importance of removing the animal from its typical environment during the layup period.

“The worst place for a horse that is injured is in the training setting, whatever their job,” said Johnson. “If they can’t do the job they’ve always done, they think they’re being punished because they don’t understand why they can’t do their job. That’s why KESMARC is so well-suited for injury rehabilitation and refreshing. Getting them out of that training setting, they are a lot quieter and happier.” ♦

Key Tips for Conditioning

One of the most dependable and proactive ways horse owners can prevent injuries to their equine partners is to ensure they are in proper condition for what will be asked of them. Whether coming off a layoff due to injury, or simply getting time off seasonally, or after a heavy competition calendar, a mindful approach to getting a horse into shape for whatever his or her job may be is key in preventing musculoskeletal and soft tissue injuries.

“Whether it’s a Grand Prix dressage horse, or a reiner, jumper, polo, or other equestrian sport horse, flat work done properly is the best way to prevent injury,” said Johnson. “The older a horse gets, the more creative you have to be to bring a horse back and maintain their soundness without a lot of pounding.”

She says regardless of what their previous levels of fitness and training were, it is important not to ask them, or let them, do too much too soon, no matter how eager they are.

“Listen to the horse,” she added. “Let them tell you how he or she feels. Pay attention and respect what they’re telling you.” ♦