The evidence base for equine hydrotherapy is growing for specific musculoskeletal conditions, though study quality varies and individual horse responses require careful monitoring.
Evidence quality for equine hydrotherapy varies considerably by condition and modality. Distal limb spa therapy for laminitis, joint inflammation, and hoof conditions has the strongest evidence base and the most clearly defined protocols. Underwater treadmill rehabilitation for post-surgical recovery and tendon conditions has growing controlled trial support. The welfare benefit of hydrotherapy extends beyond direct therapeutic effects to include the mental stimulation and positive experience of a well-managed water environment for horses tolerant of the modality. Contraindications including open wounds, skin infections, and behavioral unsuitability must be assessed for each individual before initiating any hydrotherapy program.