Shockwave Therapy is a non-invasive treatment that can speed the healing of many types of orthopedic and soft tissue injuries and conditions. This technology has been used to treat a broad range of conditions in people for over 2 decades. Shockwave therapy has been used in veterinary medicine in the United States for approximately 8 years, however new applications are always emerging.
Here are some of the most frequently asked questions regarding shockwave therapy.
What is a shockwave?
A shockwave is a pressure wave – any action that displaces its surrounding medium is a shockwave. The ripple created when a stone is thrown into a pond is a shockwave. Shockwaves are not electrical but they are high energy sound waves. These high energy sound waves can easily pass through fluid filled structures like skin, fat, and muscle. These waves do not pass through tendons, ligaments or bone. When the sound waves hit these structures they “crash” and release energy. The released energy penetrates the surrounding tissue and increases blood flow to the area. This stimulates various cells which are responsible for tissue repair of the injured structures. Shockwave therapy not only promotes and speeds up the healing process, but ultimately causes various soft tissue injuries to heal more thoroughly with less fibrous tissue accumulation.
The shockwaves used in equine medicine are generated in a fluid medium inside a transducer head and are then transmitted readily through skin, fat, and muscle. The high energy waves are focused within the transducer head so that the shockwave can be directed to the precise area of the injury. When the shockwave hits an area of higher acoustic impedance, such as bone, the waves slow dramatically and a large amount of energy is released into the surrounding tissue.
What can shockwaves treat in horses?
Shockwave therapy for horses has been successfully used to treat many soft tissue and bony problems, both acute and chronic. These include, but are not limited to:
- Soft tissue injuries such as flexor tendon strains, suspensory ligament sprains, annular ligament syndrome/inflammation.
- Chronic orthopaedic conditions such as pain associated with arthritis e.g. spavin, caudal foot pain or navicular syndrome.
- Persistent pain associated with active ‘splint’ formation and ‘sore shins’.
- Musculoskeletal disorders of the back- vertebral arthrosis, dorsal spinous process impingement or ‘kissing spines’, sacroiliac strains.
- A non-invasive treatment for angular limb deformities (crooked limbs) in foals.
What is the treatment protocol?
After a full diagnostic lameness workup, the veterinarian determines if shockwave therapy would be a beneficial and appropriate treatment plan.
The precise treatment protocol depends on the diagnosis of each individual patient. Treatment varies in the number of shockwaves administered and the energy, or depth, of those shockwaves. Most conditions are treated a total of three times spaced at 2-3 week intervals. Occasionally, additional treatments will be required in more severe injuries. The treatments are easily performed at your barn or here at the clinic. Treatments usually take 15-20 minutes. Some patients may require mild sedation.
When will results be seen?
Typically, the horse will start to see some reduction in pain and/or swelling within hours. This will generally last 2-4 days and then the horse will return to close to the original status. Then, over the next two to three weeks, actual healing will take place.
Does shockwave therapy work on every case?
No, there is no treatment that is successful in every case. Shockwave therapy is one of the most exciting therapies to become available to veterinary medicine in quite some time. It is extremely important to have an accurate diagnosis and a clearly defined area of injury in order to direct the shockwave to the appropriate area.
What type of machine is used to deliver the shockwaves?
There are several machines currently marketed as shockwave machines that do not generate a true shockwave. They generate what is called a ballistic or radial wave. The physics of this type of wave are completely different from that of a true shockwave. A ballistic or radial wave is created when a projectile is rapidly accelerated by compressed air – it looks like a small jackhammer. The problem with this type of wave is that all of the energy is deposited at the skin, and the energy drops off rapidly as you move away from the skin. The result being that unless the injury is at the skin, the injured area is not receiving the necessary energy to help the healing process. Additionally, since the wave is not focused with this type of machine, the entire area around the treatment site is receiving the wave, which can potentially have harmful effects.
It is also important to recognize that not all focused shockwave machines are equal. There are now some focused shockwave machines on the market that advertise a deeper penetration of the shockwave into the tissue. The problem with these machines is that the focal zone for the release of the shockwave energy is so concentrated, almost like a pinpoint, that there is potential for tissue damage with this type of machine. Additionally, with this type of machine, because the focal zone is so small, there is a much greater likelihood of missing the desired target tissue or injury, thereby rendering the treatment useless or worse.
The equipment used at Black Strap Hill Vet is a focused, electro-hydraulic machine manufactured by Healthtronics (HMT). This machine is currently used in 18 University Veterinary Hospitals and is largely considered to be state of the art. With this machine the shockwaves are focused so that they can be directed precisely to the particular area of injury. Additionally, the energy level and the depth of penetration of the shockwaves can be adjusted specifically for the injury being treated.