Is shockwave therapy for horses worth it?

What is shockwave therapy?

Despite its name, extracorporeal shock wave therapy (ESWT) is not a form of electric shock, it actually involves high-energy sound waves. It’s increasingly offered to horses – but why? And does it work?

How does it work?

A specialised machine generates high-intensity pressure waves which are directed through a probe or transducer head. This probe is placed on the body at the site of an injury, enabling the impulses to travel through the tissues in the body at a precise location. Although the exact effect of shockwave therapy on the body is unknown, it is thought that the impulses improve healing of the tissues by: 

• encouraging the growth of blood vessels,
• stimulating growth factors to be released in the area,
• breaking down blood clots, and
• encouraging movement of fluid from the area.

These actions are thought to reduce inflammation and pain in the affected area. As well as encouraging healing of the tissues. 

What can it be used for?

In humans, shockwave therapy was originally used to break down kidney stones but it was then found to be useful for orthopaedic (muscle, bone, joint, and tendon) conditions. Therefore was introduced to the veterinary sector, mainly for use in equine athletes. Shockwave has been found to be most useful for treating injuries occurring at locations where soft tissue and bone meet. These are often areas that are difficult to treat with other medical or surgical methods. 

Shockwave is considered to be safe and non-invasive and therefore has been used to treat a number of conditions in the horse, most commonly; proximal suspensory desmitis, collateral ligament injuries, and sacroiliac disease. Although shockwave can be used alone, it may be more effective when used in addition to other treatments and usually, the horse will be given a rehabilitation plan to follow after the session.

Is there any evidence that it works?

A number of scientific papers have demonstrated that the use of shockwave therapy has resulted in a quicker return to exercise when used to treat proximal suspensory ligament injuries, quicker healing of injuries to the superficial digital flexor tendon, and an improvement in performance after application to the horse’s back. However, a small number of horses were recruited to these studies and there may have been other concurrent therapies. Also, the energy settings, number of treatments required, and number of pulses per session have not been determined and the effect of shockwave therapy on the continued strength of the tissue and recurrence of disease has not been assessed.

How often does it need to be given

Usually, a course of 3 to 5 treatments is recommended, with one session performed every 1-2 weeks. Although the procedure is not painful, it may feel like a strange sensation for the horse so they are usually sedated to ensure that the treatment can be performed easily. Sometimes the hair is clipped and usually, a gel is applied to improve the contact of the probe. Controlled exercise is recommended between treatments but no bandaging is required. It is unknown how long the pain relief effect of shockwave lasts, but it is generally thought to be around 48 to 72 hours after the session. Subsequent courses of treatment may be required, although a recommended treatment interval has not been determined. 

Can it be used prior to competition?

The FEI and BHA both state that shockwave therapy cannot be used for 5 days prior to competition. This is mainly due to the pain-relieving effects that are thought to be produced and the fact that a breakdown of the horse could occur if the pain from an injury is masked. Although it is not possible to detect whether shockwave has been used or not, in the future there may be a way of measuring the inflammatory biomarkers that are produced during treatment.