Clinical Experiences with Radial Shock Wave Therapy in Performance Horses
these conditions were soft tissue injuries and insertional desmopathies, that carried guarded prognoses, had high reoccurrence rates, were slow healers, or did not respond to other types of treatments.
Many of these horses were lame (grade 1-5 / 5 on the AAEP scale) during exercise at the time of presentation. Although lameness grades and clinical appearance of lesions were improved in almost all cases, success or failure was often determined by whether or not a horse raced or performed for at least 6 starts or 3 months duration post treatment and recuperation time, as evidenced on the clinical scoring system used in the study. Comparison of race records and performance of the 68 Standardbreds, before and after RSWT treatments, was used to evaluate return to racing or not, plus the level of performance. All horses in the study had clinical follow ups, while most (over 90%) had radiographic or ultrasonic follow ups as indicated to assess the healing or improvement of lesions. One complicating factor, was that many horses had multiple problems on one leg or on multiple legs giving, sometimes giving combined diagnoses. This was accounted for in the individual condition summaries, which showed higher levels of success than overall rates. For example, suspensory desmitis conditions came in at 79% successful and several other soft tissue injuries, like inferior check ligament desmitis injuries proved to be 100% success rates.
The suspensory desmitis success rate attained here, plus that of other equine practitioners6,7 mirrors that found in human medicine with insertional tendon/ligament injuries, where many papers report 80% or higher success rates post ESWT treatments.8-10 This does indeed imply that shock wave therapy has its greatest potential effect on soft tissue interfaces like tendon or ligament origin and insertion sites, and also has healing effects on these often chronic injuries, in both human and equine medicine.
Fifty per cent of the failures, not surprisingly, involved superficial digital flexor tendinitis problems, the bulk of which were chronic, recurrent, and had other forms of treatment performed. The successful tendon problems were all detected early, had ultrasonic evidence of mild to moderate injuries, and all had sufficient rest periods (walking only), followed by a period of controlled exercise (jogging or small paddock turn out). Superficial digital flexor tendinitis conditions were labeled as low, mid or high, yet many were combinations of more extensive tendon injury, as is often the case. However, the 43% success rate achieved was perhaps higher than other forms of treatment, and one noticeable trait seen, was that the recovered horses had long term success on the track with no evidence of reoccurrence and all performed at the same or higher levels.
A good proportion of the horses in this study had Radial Shock Wave Therapy and appropriate rest periods as a sole form of treatment, but many had previous unsuccessful treatments as well, including extended rest periods. This fact alone says that they could not achieve success prior to RSWT treatments, which would seem to indicate that the therapy is a very useful treatment modality, even if it attains only a 50% level of success in these difficult and often disappointing performance horse injuries. Future research and refined techniques will improve success rates even more than they are today.