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EQUINE REVIEW
AUTUMN 2010
6
In
VETERINARY MEDICINE
every now and again a new treatment comes
along which will change the way in which we approach and treat a condition.
These sometimes arrive with the downside of complications of the method of
drug-administration, side effects or reactions with other drugs.
ARTICLE BY
MERVYN DREVER
, ARDENE HOUSE VETERINARY PRACTICE, ABERDEEN
EQUINE
SHOCK WAVE THERAPY
Our recent experience with a new therapy
using shock waves is that we have found a
very effective non-invasive approach for the
treatment of musculoskeletal disorders causing
pain and lameness in horses.
Shock waves are energy-laden sound waves
which are directed at the affected area
triggering the body's own repair mechanisms,
helping the body to heal. Although the
mechanism by how it achieves this is not fully
understood we do know from recent studies
that there are a number of beneficial effects.
These include a decrease in inflammation,
improved new blood vessel formation, an
increase in the number of 'repair' cells at the
injury site and the production of various innate
substances which improve the speed and
quality of healing of the damaged tissue. It
also stimulates the body to 'recruit' more stem
cells which are destined to become the new
specialised healed-areas of tissue. Scientists
have also shown, through various mechanisms,
that pain which emanates from degenerative
diseases in bone (such as arthritis) and injuries
to soft tissue is alleviated. Extracorporeal
Shock Wave Therapy (ESWT) is most effective
when the generating machine has the ability
to focus shock waves on the problem area.
ESWT has been around in human medicine
from the early 1970s and has been utilised
for fracturing bladder stones and the treatment
of tendonitis (conditions such as tennis elbow).
Thereafter as its human usage became more
widespread, particularly in the treatment of
sports injuries, there was a parallel and
corresponding proliferation of its use in horses.
Recent scientific work confirming its treatment
credentials and safety in horses has seen an
increase in the number of machines available
in vet practices in the UK. This expansion is
only mitigated by the cost of these machines
which is around £27,000 at present.
We have found ESWT to be very helpful
in the treatment of many different painful
lameness and back conditions. Tendon and
ligament injuries respond particularly well to
ESWT as it is good at stimulating an increase
in the speed and quality of healing. This
means we have a new and helpful weapon
in our armoury for the treatment of Flexor
Tendon sprains and Suspensory Ligament
injuries. The therapy appears to turn more
chronic conditions into more 'acute' types
which seems to be of value in stimulating
further healing; there is a theory that the
body may have 'forgotten' these injuries
exist allowing them to grumble on.
More recent investigations in the USA by
some top practitioners have shown that
ESWT has a very beneficial effect on painful
Osteoarthritis in horse limbs. This study
indicated there was a recommended role
in the treatment of the age-old scourges of
Spavin, Ringbone and Navicular Syndrome.
Not only was ESWT useful on its own but
it could be used safely and effectively in
conjunction with other remedies such as
anti-inflammatories and painkillers. Painful
back and pelvic conditions have also been
demonstrated to respond positively to ESWT
whether they are of an arthritic, muscular or
ligamentous nature.
Recent research has shown a beneficial effect
on wound healing, decreasing the time to
completion. This is thought to be due to the
stimulation of fine blood vessels in the wound
and its ability to destroy bacteria in the
wound-site. Some of this work is longer
established in humans where ESWT has
been successfully used to treat indolent foot
ulcers in diabetic patients or wounds in
burn victims.
What has also made this therapy more
desirable is its non-invasive nature, the
beneficial effects having the ability to be
focused on tissue as deep as 40mm under
the skin. Many horses passively accept the
treatment and will stand while the treatment is
administered. In some cases a mild sedation
may be required. This makes ESWT attractive
as the horse need only attend our hospital as
an outpatient and each treatment cycle takes
only 10-20 minutes. Two or three cycles are
normally required to complete the treatment.
The future of ESWT and its use in the horse
(and other species) holds great promise.
As horse owners, over the coming years
you should expect to see an increase in the
equine veterinarians' use of ESWT in an
array of conditions.
‘Shock waves are energy-laden sound waves
which are directed at the affected area triggering
the body's own repair mechanisms, helping the
body to heal. Although the mechanism by how it
achieves this is not fully understood we do know
from recent studies that there are a number of
beneficial effects...’
Mervyn Drever
Ardene House Veterinary Practice