ABSTRACT: Holistic care is an area that is increasing in small animal nursing and there could be similar benefits to equine patients. The authors discuss the potential benefits of massage as part of a holistic care system of nursing and consider the potential for reduction of morbidity associated with hospital in¬patient admissions. Massage has supporting evidence for it's use in stress reduction and we propose the reduction in stress by massage could be associated with improved wound healing, drug uptake from the gastro-intestinal tract and beneficial effects on the immune system, as well as health and safety for the horse and handlers.

An holistic approach is becoming more widely used in small animal practice.1 Grooming or massage treatment could be one way of extending this practice to equine patients as massage and tactile contact is commonly used to reassure and relieve stress in both humans and small animals.2 The purpose of the review is to determine if there is sufficient evidence to support massage as part of holistic care of in-patient equids.

Literature review

A literature review was carried out using Web of Knowledge, Pubmed (Ovid), and Google Scholar, using the search terms ‘horse’, ‘stress’ and ‘massage’ with the Boolean term AND applied. Results of the literature search indicated a paucity of evidence for or against applying massage techniques to equids, especially in relation to behavioural responses either in domiciliary or clinical settings.

Stress and morbidity

Stress has been shown to delay cutaneous wound healing in mice3 and humans.4 There is also evidence that the absorption and duration of action of drugs may be affected by stress – in one study the half life of intravenous omeprazole was significantly prolonged in stressed rats and the absorption following oral administration was also decreased.5

A decrease in the uptake of salt and water in the human jejunum during exposure to stress has also been reported.6 However, Dhabhar and Viswanathan (2005) suggest that some stress can have a positive effect – short-term stress at the time of immunisation, for instance, may induce a long-lasting increase in immunological memory in mice.7

Heart rate in humans increases as a result of mental stress, such as when undertaking mental arithmetic tasks under test conditions have been reported.8 There is also a reported increase in the heart rate of equids in the clinical environment.9

Heart rate measurement by auscultation

It is, however, difficult to establish if the increase in equid heart rate is from anxiety, agitation or excitement, but there is a correlation between stress and the release of catecholamines, such as adrenaline, causing an increase in heart rate and blood pressure.10 It may be that, regardless of the mode of catecholamine release, the effect of stimulation of the sympathetic nervous system is the observed increase in heart rate.

Massage has been reported to reduce anxiety and agitation in humans.11-12 Therefore, a reduction in heart rate following massage could be the consequence of a reduction in stress. From this it may be inferred that a reduction in heart rate in equids following massage may be the result of a decrease in stress and hence reduce the risk of morbidity associated with stress during hospital stays.

Hemmings et ah, (2004) reported that effleurage massage of the withers area in horses, significantly lowered observed heart rates and gave rise to the horses exhibiting high ‘scores’ on an assessment of positive behaviour, such as ‘leaning into the massage’ or ‘relaxation of the lower lip’.13 These findings have supporting evidence from studies undertaken by Normando et ah, (2002) and Feh & De Mazieres (1993) where a significant decrease in the heart rate of horses followed massage or grooming.14-15

Other non-equine studies by Kaye et al. (2008) support this view in that humans experience a significant decrease in both heart rate and blood pressure, having undergone massage treatment.16 Positive behavioural responses and a significant decrease in heart rate were also reported when dairy cattle underwent massage¬like stroking.17

However, Normando et ah, (2007) showed that heart rate significantly increased when horses that exhibited stereotypical behaviour were massaged.18 But they concluded that the findings were contradictory to other evidence and might be the result of a difference in cardiac activity between stereotypical horses and non-stereotypical horses, rather than the massage causing stress behaviour; whereas other authors consider that prior introduction to massage is required to elicit a positive effect.19

The location of the horse when it is being massaged is considered to have an effect. Normando et ah, (2003) observed that massage produced less of a drop in heart rate when the horse was treated in its usual stable than when it was treated in an isolated room used for vaccinations.9 The authors concluded that massage seemed to have a less significant effect on heart rate when psychological tension is minimal.

They also reported that the horses’ heart rate during the control period of standing in the vaccination room (with no other intervention) was ‘rather high’. This would suggest that horses find the clinical environment stressful.

Three sets of studies refer to both ‘massage’ and ‘grooming’. 9.13&17 However, the methods of applying moving pressure to the subjects is remarkably similar – both involving long, even pressure stroked with the human hand. It may, therefore, be reasonable to consider the terms interchangeable in the context of the relief of stress in equids.

Grooming or massage at the withers produces a more significant decrease in heart rate, compared to other body areas, such as the shoulder or the hip,9'20 which may be a consequence of the withers being a common site of allo-grooming in the horse.15

As well as reducing stress and, therefore, making horses easier to handle in the clinical environment, it has also been suggested that human contact – massage or grooming – makes horses easier to handle owing to enhancement of the horse-human relationship.21 Horses could also perceive human contact, such as stroking, to be ‘positive’, which may be linked to contact over areas used for allo-grooming.21

Grooming area

Massage area

Massage being carried out by the principal author


Although there is no conclusive evidence for the introduction of routine mass
age in equine patients, there is sufficient evidence for the effect of massage to be studied under controlled conditions, as the potential benefits are significant for the patient and staff. Benefits of massage may lead to increased compliance from the patient and reduced stress, leading in turn to decreased morbidity, such that it could be part of the advancement of nursing care towards holistic care of in-patient equids. 


Nicky Nurse Bsc (Hons) rvn

Nicky studied at the University of Bristol and graduated in 2009. This article is based on the dissertation submitted as part of her degree.

Alan Jones BSc (Hons)

Diploma in Advanced Surgical and Peri-operative Care (Cardiff University), ROOP

Alan has been at Langford since 1989 and he teaches on the BVSc and BSc Veterinary Nursing programmes. Prior to this, he worked in the NHS in theatres, ICU and emergency departments, and in private practice whilst an undergraduate.

To cite this article use either

DOI: 10.1111/j.2045-0648.2010.00041.x or Veterinary Nursing Journal Vol 26 pp 158-160 


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 • VOL 26 • May 2011 • Veterinary Nursing Journal