In racetrack medicine, the emphasis is often on alleviating pain so the horse can run again; which isn’t always in the horses’ best interest. What I most appreciate about shockwave technology are both the analgesic and the therapeutic benefits. It is a better and more ethical alternative then injecting the animal with cortisone to bypass pain so it can continue to race or perform. This technology not only helps the horse feel better but aides in the healing process. Many modalities do one or the other, but shockwave therapy accomplishes both at the same time. Often, when there is pain in one area, the horse will compensate or overcompensate in another area, creating additional problems and a vicious cycle. If you can stop the pain cycle and address the problem at the level of causation, it makes a big difference. The horse not only feels better, you’re actually making him better — and supporting the horse’s wellbeing and longevity. I’ve seen quite a few very nice turnarounds with shockwave therapy in cases where there was initial concern about the horse’s career being in jeopardy. I have used the Storz MP 50 Vet shockwave therapy machine with many cases over the years and have had great success treating a variety of problems and conditions including tendonitis, suspensory ligament desmitis, joints, backs, fractures, endostietis, etc. Recently I have used the technology to treat severe lacerations, wounds and bone abnormalities. I have found the decrease in healing time to be very impressive. A recent case I initially estimated 4-6 months for healing, but the horse was out of the clinic and on their way home in 45 days. I was amazed and pleased with the results. In fact, I have documented — and am in the process of writing up — this particular case of hind leg trauma and the dramatically shortened healing time using shockwave therapy. Shockwave is a great adjunct therapy when used in conjunction with many other treatment modalities. For instance, I’ll commonly use shockwave on the feet of horses running on hard surfaces in conjunction with corrective shoeing. Of course shockwave can’t be used in isolation. It’s important to make a big picture assessment, which may involve corrective shoeing, equipment changes or training modification, thus allowing the horse sufficient time to heal. Shockwave therapy is absolutely a great piece of therapy to add to the mix to keep the horse at the top of its game and as pain free as possible for as long as possible.

I worked there as an equine physiotherapist and rehab specialist and we began incorporating it into that aspect of the practice. In 2005 Mike Davis, who was a partner and surgeon at Rochester founded and opened New England Equine Medical & Surgical Center, a 35,000 square foot state of the art referral hospital in nearby Dover NH. Again, as part of the equine physiotherapy and rehab program Dr. Davis and I continued to incorporate shock wave into the practice there. I am happy to say that we have never had any type of negative impact on a case from applying shock wave therapy.

Certainly some cases respond more favorably and more immediately than others, but providing that your case selection is based on good solid diagnostic work, shock wave therapy is a highly effective treatment for a variety of lameness conditions in the horse. Extra corporeal shock wave therapy is a non invasive therapy that I feel 100% comfortable using because, in our experience, it has proven itself to be safe, effective, and when used appropriately has no risk or “downside” unlike some of the more invasive treatment techniques.

At New England Equine, we had been using a lower energy, radial shockwave device with good results since 2005, but we recently purchased the Storz Duolith® Vet system because we wanted a higher energy, focused device to be able to treat additional deeper seated lesions. With the addition of MRI and CT technologies to the practice occurring over the last few years, we’re now able to identify problems that we couldn’t image previously; and with the high focus shockwave device we can treat at those deeper levels. For example, with distal DDFT (deep digital flexor tendon) lesions which are difficult to access because they’re so far down within the foot, we can now get the depth of penetration needed to effectively treat those lesions. Depending on the exact location of the lesion, we treat through the bulbs of the heels or through the frog, or in some cases both. We can also treat other structures within the hoof such as the impar ligament and even the navicular bone. With the increased depth of penetration, we are now also able to treat sacroiliac desmitis as well. Those ligaments are located deep under thick layers of muscle tissue and with the lower energy system we never felt like we could get to those structures effectively so we didn’t treat them with shock wave, we usually injected them. We continue to treat proximal hind and fore limb suspensories on a very regular basis as we have for many years.

We tried all the leading high-energy devices on the market and settled on the Duolith, for a few reasons. One of which is that it provides both focused and radial shockwave options and we do feel there are cases where we would still opt for radial shock wave over focused. With the Duolith we have that choice. The other devices out there are also highly effective and good quality but the Duolith is significantly quieter than other high-energy focused devices and more comfortable for the patient (we have applied it to ourselves to test this). These are important features to us. The probes are also smaller and are easier to fit between the bars of a horses shoe when treating through the frog. We can get a better contact with the frog surface during treatment which is essential for the transmission of those waves into the hoof. There are standoffs to attach to the probe to adjust depth of penetration as opposed to having to change out probes and are easy to use. The depth of penetration and maximum energy levels are greater than any lesion should require and are fully adjustable so you can tailor the treatment specifically for each individual case.

We use shock wave therapy for a number of applications. Suspensory desmopathy is one of the primary applications in our practice along with many other ligament and tendon injuries. We also treat non union fractures, dorsal spinous process disease (“kissing spines”) and certain osteoarthritis conditions.

CASE #1
One of our most interesting shock wave cases is a 12-year-old Westphalian gelding who was hit by a car around the first of the year. He was struck in such a way that, unknown at the time, the medial collateral ligament of his left hock was torn along with significant bone trauma to the hock joints themselves. There was diffuse soft tissue damage and tearing of the attachments of the joint capsule. He had been rested and treated conservatively for 6 months as he surprisingly did not present initially with a significant lameness. It was not until several months later, when he got very excited and tore around his paddock that he came up acutely lame and his hock swelled severely. He then presented to us in early June for additional diagnostics and a further lameness workup. This horse was significantly lame and based on the diagnostic imaging results, his prognosis was guarded for a return to athleticism. We treated the medial collateral ligament and the dorsal and dorsomedial aspect of the hock (over the joint capsule) with the Storz Duolith focused probe with a medium energy level a total of 5 times on average two weeks apart. We also injected his distal hock joints and his tarsocrural joint and he has done remarkably well. This hock had been severely effused and had significant soft tissue swelling/thickening over the medial, dorsomedial and dorsal surfaces of the hock. The medial collateral ligament had significant fiber disruption and loss of integrity. We just saw this horse a few weeks ago, (approximately 4 months out from the start of treatment), for a lameness re evaluation. He is sound and the hock appearance is near normal. Ultrasonographically the collateral ligament is still larger than that of the contralateral limb but it has healed very well and has good fiber pattern and integrity. We have given the go ahead to gradually move forward from the light work he is currently in to a return to normal training. We can hardly believe he has recovered so well. It is truly a remarkable recovery.

CASE #2
Another recent case we treated with the Storz Duolith is a 13-year-old Appendix Quarter Horse gelding that had been significantly lame in his left fore limb for approximately one week. He was referred in for a lameness work up and diagnostic imaging. This horse was a grade 3/5 lame on baseline. Nerve blocks followed by an ultrasonographic examination confirmed the lameness to be attributed to an injury to his left front deep digital flexor tendon (DDFT) at the level of the pastern. There was severe fiber disruption involving approximately 50 % of the deep flexor tendon. This horse received shock wave therapy over the damaged DDFT using a focused probe on a medium energy level (2000 impulses) at two week intervals. After three treatments this horse improved two full grades of lameness to a 1/5 LF baseline lameness. Prior to his fifth treatment (two months from the start of treatment) this horse was very nearly sound in a straight line and on the right circle and only a grade 1+ to 2- lame on the left circle. We have recommended the owner begin walking under saddle and that the horse return in four weeks for a follow up ultrasound exam to determine if structurally this horse can continue with a gradual return to previous levels of exercise. We are very encouraged by the progress seen so far and this horse’s response to treatment.

at the old facility Rochester Equine Clinic from 1999 to 2005 and since 2005 at our new state of the art hospital New England Equine Medical and Surgical Center located in Dover NH. I specialize in lameness in sport horses and equine orthopedic surgery so I see a lot of sports injuries which end up being good candidates for shock wave therapy. We of course use other regenerative therapies including stem cell and platelet rich plasma injections but there are certain cases in which shock wave is the best choice in treatment, particularly when an attachment of soft tissue to bone is involved. We also have begun combining shock wave therapy with these other regenerative therapies and have so far been pleased with these results. Good case selection and diagnostics are essential when treating with shock wave therapy. In our experience certain cases will benefit more from shock wave therapy than others and for some cases shock wave just is not an appropriate therapy. In my opinion you have to be confident that you can get the energy effectively transmitted to the site of the lesion (injury) otherwise you are not going to have good results.

Prior to this year we had been using a lower energy radial device and had consistently good results, however, since we have added an advanced imaging center to our practice which includes MRI and CT we have begun to identify many more injuries that we previously could not diagnose nor could we access them with the lower energy shock wave device. We felt that we needed to add a high energy focused device to our practice to be able to treat these lesions, many of which are located deep within the horse’s foot.

After trying all of the devices on the market we settled on the Storz Duolith, which gives the option of using radial shock waves as well as very high energy focused shock waves. There were several reasons for selecting the Duolith but one major factor was the operating cost. All of these high-energy devices are more expensive to operate than the radial devices but the Storz operating cost is a fraction of what the others are. The Duolith probe lasts for 1 million impulses where as the others typically last for only 50,000 impulses before you have to turn the probe in and purchase a new one. As we are always trying to keep the cost of treatment down for our clients without compromising the quality of the treatment it made sense to choose a device which allowed us to administer the necessary number of impulses without worrying about the high cost associated with each single impulse.

If you start treating with less impulses to keep your costs down rather than treating with the appropriate number of impulses then you are not providing the best service to your client or patient. At New England Equine, we charge a flat rate to our clients for the first 2000 impulses which is the average dose per treatment site. For larger more extensive lesions you obviously need to treat with more impulses to get the necessary energy delivered to the entire injury site. For larger treatment areas requiring more impulses we charge a small additional fee base on the additional impulses to cover the increased cost that we sustain. It still keeps the treatment cost to the client quite reasonable. If our per impulse cost was say 5 to 8 times what it is with the Duolith (as it would be with some of the other devices) we would have to choose between either “under treating” to keep the cost down or treating appropriately and charging exorbitantly.