Shockwave therapy or extracorporeal shockwave therapy (ESWT) is a relatively recently developed treatment first applied to human sports injuries and being increasingly used in the treatment of a number of conditions in specialised equine veterinary practice and sports medicine.
Since purchasing the equipment about 3 years ago the equine vets at our practice have treated well over a hundred patients suffering from a number of orthopaedic injuries, using shockwave therapy as either the sole treatment or in combination with other therapies.
Shockwave therapy is a non-invasive treatment; the probe is applied directly to the skin over the affected area. Due to the local sensation of slight discomfort and vibrations from the compressor, most patients are lightly sedated to minimise distress and for operator/equipment safety reasons. The treatment works in two ways; desensitisation of local nerve ends provides effective and quite prompt pain relief and reduction in muscle spasms, while also stimulating tissue healing by promoting blood flow to the affected area.
The equipment is portable so treatment can be undertaken either our clinic or at home. An initial course involves three treatments, at fortnightly intervals, with each treatment taking around 10-20 minutes to complete, depending on how many or how large an area is involved. Depending on response to treatment, some patients will have further individual sessions over the following months whilst undertaking a graduated exercise regime.
The primary indications for its use in the equine population of Norfolk and Suffolk include:
Primary back injuries: These include muscle and ligament strains and sprains, kissing spines (impinging dorsal spinous processes) and sacro-iliac injuries.
Back pain/muscle spasm secondary to primary lameness: Many horses with single or multiple limb lameness have pronounced muscle spasms along the back, particularly under and just behind the saddle. Any horse with back pain should be assessed by an experienced equine vet for evidence of mild lameness.
Ligament injuries: The suspensory ligament is the most frequently injured and treated ligament, particularly injuries involving the top portion of the ligament where it attaches to the cannon bone just below the knee and hock (proximal suspensory desmitis). Forelimb suspensory ligaments and to a lesser extent hindlimb injuries can respond well to treatment. We have also successfully treated damaged check ligaments, annular ligaments (fetlock), patellar ligaments (stifle) and collateral joint ligaments (mainly pastern and coffin joints).
Tendon injuries: Injuries to the lower leg, primarily involving the superficial and deep digital flexor tendons are treated with shockwave therapy in a similar manner to ligament injuries. Improved quality of healing in terms of the ultrasonographic appearance of the tendons can be seen, although a prolonged period of graduated exercise is still essential to minimise the risk of recurrence.
Angular limb deformities in foals: Recent studies have found that shockwave treatment can be helpful in treating foals with abnormal bending of the limbs, either from birth or as an acquired condition during the first year of life. Limb deviations usually involve the growth plates close to the knee, hock and fetlock joints in the fore or hind limbs and can lead to permanent deformities if left untreated, preventing any form of athletic career. Treatment of the growth plate with shockwave therapy appears to slow down the rate of growth on the affected side of the leg, thereby allowing the other side of the limb to catch up. This treatment can be used in conjunction with remedial hoof trimming and special glue on shoes. We have treated several foals successfully over the last two stud seasons which would otherwise have required surgical correction of the deformities at considerably greater expense and risk to the foals.