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Extracorporeal Shock Wave Therapy

Indications for the Equine Patient

What is Extracorporeal Shock Wave Therapy?

Extracorporeal Shock Wave Therapy (ESWT) is a relatively newly emerging therapy to aid in the effective healing of orthopaedic and some musculoskeletal disorders.

 It was originally used in human medicine for the disintegration of kidney stones. It was later observed that patients which had undergone several round of this therapy showed increased bone density in the area that the shockwaves were focused. This led to further investigation as to the effects that shockwaves have on bone and also muscles and tendon attachments.

 This research is still ongoing, and the mechanisms by which shockwave therapy implements its effects are still not fully understood. However, equine practitioners and horse owners around the world have observed it’s beneficial effects of the treatment of a range of musculoskeletal disorders of the horse.

 “A shockwave is a pressure wave with very high amplitude and rapid rise time”.

Will it help MY horse?

ESWT has gained particular acclaim in the treatment of injuries to the bone, tendons and ligament attachments, and also lesions of the flexor tendons. It has proved to be particularly effective in the treatment of chronic injuries which have been resistant to conventional therapies, and have resulted in poor and/or inappropriate wound healing. 

However, it should be noted that ESWT will not be effective in every case of the disorders outlined below, and individual assessment of each patient should be sought from a veterinary practitioner with experience in the use of ESWT before initiation of a treatment protocol.

Conditions Indicated:

  • Avulsion fractures of the distal limb
  • Superficial/Deep Digital Flexor Tendon lesions
  • Suspensory ligament lesions/tendonitis
  • Chronic muscle calcification
  • Delayed-union fractures

How does it work?

The mechanism by which ESWT exerts it’s effects are not fully understood, but it has been theorized that the abrupt changes in pressure that occurs within the target zone tissues causes a disruption in the extracellular matrix (a complex arrangement of connective tissue and molecules that act as scaffolding for the cells which make up each tissue). This causes a breakdown in some of the matrix components.

 The implications of this will differ depending on the nature of the tissue it is directed at. In general this therapy would be directed at tissues which have undergone inappropriate healing, and so treatment would include the breakdown of calcification of tissues or the scar tissue which has formed from poor wound healing.

 This acute disruption initiates mechanisms that are essential for effective healing. Most notable, it has been shown to stimulate angiogenesis, which is the formation of new blood vessels growing into the wounded tissue. This delivers the essential nutrients and growth stimulating factors required for regeneration of new tissue, rather than the formation of scar tissue.

How will it benefit my horse?

 SHORT TERM RESULTS:

As this therapy is aimed at re-stimulating the healing processes, you should allow the same amount of time for the wound to heal as if it had been newly created. Although, you may observe in your horse’s individual case a reduction in the healing time of chronic lesions and fractures.

The most significant short-term effect is a period of analgesia (pain relief) noted almost immediately after treatment, and continues for up to 4 days after initial treatment. For this reason it is important to confine the horse and restrict exercise for the duration of therapy, or until indicated by your veterinarian, to prevent the horse from further injuring themselves.

 LONG TERM BENEFITS

The final outcome of this treatment is very variable, and is dependant on the nature of the injury, its location and severity and the stage in the healing process that the horse is presented to the veterinarian. Results can range from a reduction in the severity of pain relating to the injury and some return of function to complete restoration of tissue structure and function. It is even possible in some cases to show little or no response to treatment. Response to treatment can usually be gauged by the treating veterinarian by the time of the second treatment.