Many of us have heard the term shockwave therapy, some of us have used shockwave therapy to treat injuries in our horses, but how much do we really know about the principles behind this innovative treatment?

First, what exactly is a shockwave? A shockwave is a pressure wave, a high frequency sound wave. Any action that displaces its surrounding medium is a shockwave. The ripple in the water created when a rock is thrown into a pond is a shockwave. An earthquake is a shockwave in the earth.

The shockwaves used in veterinary medicine can be generated in three different ways: electrohydraulically, piezoelectrically or through an electromagnetic field. Shockwaves are focused, and can be directed to the precise area of the injury. They are transmitted readily from the transducer head, through ultrasound coupling gel, and through soft tissue where the energy of the wave is released at a specific depth, depending on the transducer head that is used.

With that knowledge, what do shockwaves do that is therapeutic? Shockwave therapy is involved in the healing process on many levels and has a role in a myriad of different metabolic processes important in healing. Shockwave therapy has been shown to stimulate new bone growth in fractures, stimulate the in-growth of new blood vessels (neovascularization), increase cell permeability and possibly stimulate fibroblast formation (the cells important in repairing tendons and ligaments).

In addition, shockwave therapy stimulates stem cells that occur naturally in the animal’s body to migrate to the area that is treated. It has a potent anti-inflammatory effect and has also been found to have anti-bacterial capabilities. Shockwave therapy has a transient analgesic effect as well.

Used extensively in Europe, Asia, and South America to treat a wide variety of soft tissue and orthopedic injuries in people, it is the treatment of choice in many areas of the world for non-union fractures. It is also very effective at treating chronic, infected wounds that have not responded to traditional therapies. It has been approved in the U.S. by the FDA for selected conditions.

Shockwave therapy has been used in the U.S. in veterinary medicine for approximately 10 years. It has been successfully used to treat both soft tissue and bony problems, both acute and chronic, including suspensory ligament injuries, with or without avulsion fractures, tendon injuries, arthritis, collateral ligament injuries, navicular syndrome, impar ligament injuries, ringbone, joint inflammation and pain, back pain, neck pain, and muscle tears and strains.

The treatment protocol depends on the diagnosis of each individual patient. Treatment varies in the number of shockwaves and the energy of those shockwaves. For example, in the case of an acute tendon injury, the energy would be decreased and the number of impulses would be reduced as compared to the treatment of an injury that was a month old. Most conditions are treated a total of 3 times, spaced at two to three week intervals. The optimum treatment regime for each animal is determined after a careful review of the history and diagnostic work-up information by the veterinarians working on the case. Usually, the treatment can be performed at the horse’s home barn, eliminating the need for the animal to be shipped to a distant facility for treatment.

After treatment, there may be a reduction in pain and/or swelling within hours. This may last for 2-4 days and then the animal will return to close to the original status. Over the next 2-3 weeks, actual healing will take place. It is important to note that shockwave therapy does not necessarily speed up the healing process, but will generally lead to a higher success rate and a better end result. In competition horses, shockwave therapy can be an important non-invasive adjunct to help keep a horse comfortable. For example, it can be very useful in helping a horse with a sore back to achieve comfort and freedom through his back.

One very important aspect of shockwave therapy is to recognize that not all shockwave machines are created equal. There are some machines that have been marketed as shockwave machines that do not generate a true shockwave, but instead generate what is call a ballistic or radial wave. Treatment with this type of machine is generally considerably less expensive than with a true focused shockwave, but it is not comparable in terms of technology or results and can possibly have detrimental effects.

For the future, shockwave therapy holds potential in many different areas. The 10th International Congress of the International Society for Musculoskeletal Shockwave, an international organization consisting largely of human orthopedic surgeons, chiropractors, physiologists and basic researchers that are involved in using shockwave therapy in the human medical field, showcased over 100 different research projects that are currently being conducted into shockwave therapy. One of the most exciting new areas of research is in the treatment of wounds and burns with shockwave therapy. Currently, the U.S. Army and U.S. Navy are collaborating on a prospective study using shockwave therapy to treat burns and wounds in soldiers returning from Iraq and Afghanistan.

Dr. Jenny Johnson, Calabasas, CA, has treated a horse with extensive burns sustained in a trailer fire with remarkable results: “Within 24 hours of treatment, there were new blood vessels visible at the burn edge, the smell was gone, and the pus that was oozing through the scabs was markedly reduced. In addition, the horse was significantly more comfortable.”

In short, shockwave therapy is useful for much more than just suspensory injuries. It is a non-invasive therapy that can significantly aid the healing of many types of injuries. “It helps the body heal itself” says Dr. Johnson.

Dr Jenny Johnson is a 1986 graduate of the University of Pennsylvania School of Veterinary Medicine, where she also completed an internship in large animal medicine and surgery. She had a solo practice in Wellington, FL specializing in high performance hunter, jumper and dressage horses for approximately 10 years. Since coming to California, she has continued to be active with lameness consultations, has served as the official show veterinarian at shows in Colorado, and is currently working toward her FEI Veterinary Delegate certification. Dr. Johnson started Oakhill Shockwave in 2005 to bring this innovative technology to the horses of Southern California.

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Reprinted with permission from Dr. Jenny Johnson, Schockwave Therapy. This newsletter is for informational use only and does not express the opinions or views of C. Jarvis Insurance Agency. Consult your veterinarian for all your equine health related issues.