Extracorporeal Shockwave Therapy (ESWT) is a non-invasive regenerative treatment option used to stimulate healing in many injuries commonly seen in performance horses today. The original use for Shockwave therapy was to fragment kidney stones in humans. It has been FDA approved for treatment of heel spurs, tennis elbow and is used extensively in Europe for non-union fractures. Many other human clinical trials are underway including chronic wound care treatment, and use during open heart surgery for regeneration of ischemic heart tissue. ESWT is currently used to aid healing in horses with a variety of conditions including flexor tendon and suspensory ligament injuries; degenerative joint disease (DJD) of hocks, pasterns, coffin joints; collateral ligament injuries, navicular syndrome; bone bruising; and splint bone inflammation or fractures. ESWT is also showing promise in treating conditions of the spine from the poll to the pelvis.
WHAT IS EXTRACORPOREAL SHOCKWAVE THERAPY?
Shock waves are acoustic (sound) waves that result from a rapid increase in pressure. Thunder is the shock wave created by lightning, earthquakes send shock waves through the ground. ESWT is not an electrical shock, but rather the application of pressure waves to living tissue. There are two types of devices commonly used in treatment, ones that emit true shock waves and those that produce a radial pressure wave. True shock waves are pressure waves that meet specific physical parameters including a rapid rise time and a high peak pressure with a more gradual decrease. ESWT aims a highly concentrated powerful acoustical energy source to a focal area. Unfocused units emit radial pressure waves which transmit significantly less energy with limited tissue penetration. Radial waves dissipate quickly as they travel through the tissue and do not appear to appreciably affect bone remodeling or blood flow in deep tissues.
HOW DOES ESWT WORK?
The energy from ESWT is hundreds of times greater than those from ultrasound waves. These high energy waves pass relatively unimpeded through fluid-filled tissues like skin, fat and muscle until they meet the resistance of denser structures like ligament or bone when the waves are brought almost to a halt. The rapid and intense pressure changes result in cavitation (the formation and collapse of tiny bubbles). Repeated shock waves applied to an area creates a microtrauma. The exact mechanism of therapy from ESWT is unknown, however researchers have documented an increased activity in bone producing cells, and an increase in the circulation in the treated region. This translates into faster healing, a better fiber alignment and the lesion size reduced more quickly.
Focused ESWT units target a very specific area of concern and cause minimal effects on surrounding tissues. It is important to avoid treating non-injured tissue whenever possible. Serious injury may result if shock waves are misdirected at tissues not dense enough to absorb the pressure waves such as blood vessels, and gas-filled structures like lung and intestine.
WHAT CAN I EXPECT FROM A SHOCKWAVE SESSION?
During an ESWT session, the area to be treated is clipped, cleaned and a contact gel is applied to the horse’s skin. The handheld therapy head of the unit is applied to the horse to deliver the shock wave pulses. The treatment takes just minutes. Mild sedation is often administered during ESWT since it causes some noise and discomfort for the patient. The anticipated results are usually seen with one to three treatments spaced at one to three week intervals. It takes time for the biological responses to take place, and therefore the healing is seen over a period of time, not immediately. However, ESWT does cause immediate analgesic (pain-killing) effects that last three to four days after treatment. It is very important to use ESWT as an addition to multiple therapies such as controlled exercise, NSAIDS, and cold therapy for orthopedic injuries. Your veterinarian will create a well structured, quality rehabilitation exercise program for your horse’s unique injury.
In acute conditions, ESWT initiates a more rapid and effective healing phase. It is useful to elicit active inflammation in chronic non-healing injuries by jump starting the healing process.
Additional therapeutic applications include treatment of wounds to decrease bacterial contamination and infection, and regrow skin to contract more rapidly. ESWT has also demonstrated positive healing outcomes when used to stimulate bone repair and reduce pain in conditions of the spine (neck pain, kissing spines, dorsal myalgia, sacroiliac pain, lumbosacral pain).
WHAT EQUIPMENT DOES CYPRESS EQUINE SERVICES USE?
Cypress Equine Services is excited to offer VetGold Focused Shock Wave Therapy. This unit has a wide energy range that can be varied to treat the particular area of concern and provide a high dose of focused shock waves to a greater therapeutic area. The soft focused therapy head reduces pain and surpasses the clinical effectiveness of other products on the market by increasing the biologic response and stimulating more tissue. Cypress Equine Services now features the Power Probe, and is one of the few practices in the country to offer this new technology. The Power Probe therapy head maintains the high energy density where it is needed to achieve therapeutic success for sore necks, backs, feet, and very large horses. Many insurance companies will cover treatment with VetGold high energy focused shock wave therapy.