Hi - I was all gangbusters to do shockwave for my horse with a check ligament injury until I spoke with a friend who said it is actually bad? She said there is research to show that long term is causes damage to ligaments. Anyone out there have input? I was going to do a session next week. Thx!
There appear to be two different things occurring. Damaged tendons and ligaments have been observed to heal more quickly.
However, in normal tendons and ligaments there is observable disruption of collagen fibers.
The question is: is the repair process in injured tissue more robust than the possible collateral damage to non-injured tissue in the immediate vicinity? I’m not sure that’s been answered yet.
The other thing to keep in mind is the analgesic effect following treatment–the effect has been shown to be on a par with local anesthesia, so one needs to ensure that the horse doesn’t aggravate the injury in the short-term following.
Sorry to provide even more confusion 
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I did PRP for my mare’s check ligament injury and was really happy with the result.
I haven’t done the shockwave therapy.
[QUOTE=Ghazzu;8447449]
There appear to be two different things occurring. Damaged tendons and ligaments have been observed to heal more quickly.
However, in normal tendons and ligaments there is observable disruption of collagen fibers.
The question is: is the repair process in injured tissue more robust than the possible collateral damage to non-injured tissue in the immediate vicinity? I’m not sure that’s been answered yet.
The other thing to keep in mind is the analgesic effect following treatment–the effect has been shown to be on a par with local anesthesia, so one needs to ensure that the horse doesn’t aggravate the injury in the short-term following.
Sorry to provide even more confusion ;)[/QUOTE]
Very informative. Didn’t know this.
I did shockwave and PRP on my mare’s torn suspensory and did shockwave on my TB’s kissing spine. My mare is back in full work and my gelding feels better. I don’t have anything else to add.
Ghazzu, your posts are always so informative. Thank you for continuing to share your knowledge and experience.
I have used Shockwave for several injuries, all of which were successfully rehabilitated. I did not know about its effects on normal tissues.
As I said, the signifcance of the collagen fiber disruption in normal tissue is unclear.
It does resolve over time.
I did spend awhile this afternoon poking around for recent papers, and, interestingly, found a couple recent ones that indicated no decrease in time for actual resolution of ligament/tendon lesions in shockwave compared to controls.
I find that interesting.
I’ll keep poking around in the journals and see what else I can find.
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It’s illegal in racing and horse sports because of the analgesic effect. I’m not sure how long before competition it is banned.
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I can personally attest to the analgesic effect.
In a moment of weakness I was able to persuade my vet to zap my back. It is an area of chronic issue for me because I have a spondylolisthesis. Everything was extremely loose for about four days, I mean warm and loose. Lovely. I’m glad that I had read about the “don’t over do it” warning, so I was careful. I thought it was quite helpful because as I recovered, things stayed nicer than before, for a long time.
I can absolutely see how I could have really messed myself up if I had ridden hard, gone dancing like a maniac, or done any other difficult physical activity even if it was normal for me.
So, just a PSA: be very careful in the return to work, turnout, everything…
Hmmm I shock waved my elbow about 5 years ago. The problem (muckers elbow lol ) never returned.
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So interesting! She said that they found problems in the long term as well - that the ligament/tendons don’t heal as well. My friend was going to get some research on it which I’ll share when she sends it. Ghazzu if you do find anything I’d love to know - thanks so much for sharing your knowledge. I find it fascinating - been poking around but can’t find much on the negatives. The horse is very mellow so I’m hoping her attitude won’t change very much (she’s one of those that could live a life of eating, walking, getting fat and being spoiled).
I did shockwave on the nuchal ligament attachment at my horse’s poll. The ligament was ok (not torn) but bothering him, and there was a lot of effusion around the ligament. Over two months after treatment, the area looked normal on ultrasound.
Very interesting, I had not heard of this before. I did shockwave on a suspensory ligament this fall. The horse repulled the ligament after the final treatment and will no longer be competition sound.
Soft tissue damage is so difficult to measure. Each horse is different, and how they handle rehab is different. There’s just so many different variables to keep track of.
I would love to see some research supporting this theory.
[QUOTE=pacific_jumper;8447978]
Very interesting, I had not heard of this before. I did shockwave on a suspensory ligament this fall. The horse repulled the ligament after the final treatment and will no longer be competition sound.
Soft tissue damage is so difficult to measure. Each horse is different, and how they handle rehab is different. There’s just so many different variables to keep track of.
I would love to see some research supporting this theory.[/QUOTE]
Several of the studies published have been experimental studies with the lesion indued by injecting collagenase, and the opposite limb on the animal being used as a control. That’s about as close as you can come to reduction of variables with an in vivo study.
In no particular order, some publications on ESWT in the equine:
Equine Vet J. 2007 May;39(3):226-31.
Effect of extracorporeal shock wave therapy on the biochemical composition and metabolic activity of tenocytes in normal tendinous structures in ponies.
Bosch G, Lin YL, van Schie HT, Barneveld A, van Weeren PR
POTENTIAL RELEVANCE:
The stimulating short-term effect of ESWT might accelerate the initiation of the healing process in injured tendons. The long-term effect seems less beneficial. Further research should aim at determining the duration of this effect and at assessing its relevance for end-stage tendon quality.
From the same authors as above:
Equine Vet J. 2009 Apr;41(4):335-41.
The effect of focused extracorporeal shock wave therapy on collagen matrix and gene expression in normal tendons and ligaments.
POTENTIAL RELEVANCE:
The observed disorganisation of the collagen network warrants caution when using ESWT. Exposing noninjured tissue to ESWT should be avoided and it may be advisable to restrict exercise in recently treated patients. However, the induced tissue disorganisation might also be a trigger for repair in chronic tendinopathies.
Vet Surg. 2011 Jun;40(4):450-6.
Effects of extracorporeal shock wave therapy on desmitis of the accessory ligament of the deep digital flexor tendon in the horse.
Waguespack RW1, Burba DJ, Hubert JD, Vidal MA, Lomax LG, Chirgwin SR, Lopez MJ.
CONCLUSIONS:
Our results do not support an effect of ESWT on collagenase-induced lesions in the equine ALDDFT
Am J Vet Res. 2005 May;66(5):892-6.
Ultrastructural and immunocytochemical evaluation of the effects of extracorporeal shock wave treatment in the hind limbs of horses with experimentally induced suspensory ligament desmitis.
Caminoto EH1, Alves AL, Amorim RL, Thomassian A, Hussni CA, Nicoletti JL.
CONCLUSIONS AND CLINICAL RELEVANCE:
Results have indicated that ESWT appears to facilitate the healing process in horses with experimentally induced hind limb suspensory ligament desmitis.
Vet Comp Orthop Traumatol. 2006;19(2):99-105.
The evaluation of extracorporeal shock wave therapy on collagenase induced superficial digital flexor tendonitis.
Kersh KD, McClure SR, Van Sickle D, Evans RB.
Extracorporeal shock wave therapy (ESWT) is being used to treat desmitis and tendonitis in horses. This paper compares the clinical, ultrasonographic and histological characteristics of ESWT treated collagenase induced superficial digital flexor tendon (SDFT) lesions, versus untreated controls. This blinded study utilizes six mature, healthy horses where bilateral forelimb SDFT lesions were induced. One forelimb was treated while the other served as an untreated control. Three shock wave treatments were administered at three week intervals. At weekly intervals, ultrasonograms were used to measure: 1) percentage lesion at the maximum injury zone (MIZ), 2) the grey scale of the SDFT at the MIZ, 3) the percentage disruption of the longitudinal fibres at the MIZ. The data were also summed from 8-20 cm distal to the accessory carpal bone. Measurements of the external width of the SDFT were obtained through the study period. Examinations were performed on four occasions to evaluate heat, response to palpation, presence/character of swelling over the SDFT, and lameness. At the completion of the study all tendons were evaluated histologicalally. The lesion size, grey scale, and longitudinal fibre disruption at the MIZ, and sum of each variable changed significantly over time, however, there was no difference between treated and control groups. Histopathology showed increased neovascularization in treated tendons (p = 0.001). When compared to untreated controls, ESWT did not change the ultrasonographic appearance of the tendons. However, it did increase neovascularization.
That research appears to go along with what my vet has told me: Don’t do shockwave on tendon injuries, but it can help heal ligament injuries. Is that right? That’s what I’m gathering from the quoted summaries.
Oh okay - had to look this up neovascularization is the development of new blood cells especially where blood circulation has been impaired. That appears from this article to be the difference between the group that was shock waved and the group that was not. I still can’t find any documentation on negative responses from the treatment. I am going to go forward with the treatment against my friends advice as I just don’t see evidence to not. I’m hoping it may help some of the swelling which hasn’t decreased even after 2 months of hand walking, icing. I do have to say tho - I’ve been using the BOT wraps - which sort of similar in that it increasing blood circulation. Even left on for only 2-3 hours the leg looks hot and angry - we’ve stopped using the wraps as of now. I’ll try reintroducing them for an 1-2 hours in a week or two. Thanks so much everyone…I love this forum!
Close. Neovasculatization is the development of new blood vessels, not cells. The vessels do, however, provide access to the area for the cellular elements of blood.
I realize I am bumping up an older thread.
I am wondering if @Ghazzu or any other COTHers can chime in on whether or not there has been any newer information presented as to the proven beneficial (or negative) effects of ESWT on soft tissue injuries. I am currently evaluating whether or not to invest in this as a supportive therapy to treat a Hind Proximal Suspensory Strain (see other active thread for more info).
My high end vet still swears by it but it is a money maker.
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