WHAT IS SHOCKWAVE THERAPY
Extracorporeal Shockwave Therapy (ESWT) is a non-invasive treatment that uses focused acoustic (sound) energy waves to stimulate healing in injured or painful tissues. Originally developed in human medicine, it is now well-established in equine practice as a tool for managing musculoskeletal conditions contributing to lameness.
The term “extracorporeal” simply means the treatment is delivered from outside the body – no surgery or needles are involved. A handheld probe is placed against the skin over the area being treated, and pulses of acoustic energy are directed precisely into the target tissue beneath.
How Does It Work?
Shockwaves trigger a series of biological responses that support the body’s own healing process. These include:
– Stimulating tissue repair: Shockwaves activate cellular pathways that release growth factors and proteins involved in healing through a process called mechanotransduction — mechanical signals are converted into biochemical responses that drive cell proliferation and repair.
– Promoting new blood vessel formation: Improved blood supply to damaged tissue delivers oxygen and nutrients essential for recovery.
– Reducing pain: ESWT raises the mechanical pain threshold and disrupts pain-signalling pathways — providing both short-term relief and long-term improvement in comfort.
– Reducing inflammation: The therapy has anti-inflammatory effects at the cellular level.
– Stimulating collagen remodelling: Focused shockwaves have been shown to stimulate collagen type I expression in equine tendinous tissue, supporting structural repair of damaged tendons and ligaments.
What Conditions Can It Treat in Horses?
A 2024 systematic review specifically examining equine applications identified the following as the primary conditions treated with ESWT in horses:
– Suspensory ligament desmitis — one of the most common indications; ESWT has been shown to reduce pain, swelling, and lameness and to support ligament healing
– Superficial digital flexor tendinitis (SDFT) — used to promote tendon repair and reduce inflammation
– Navicular syndrome (palmar foot pain / caudal heel pain) — evidence for benefit exists, though results are variable and depend on the specific structures involved
– Osteoarthritis — studies have demonstrated improvements in subchondral bone health and synovial biomarkers in horses with experimentally induced and naturally occurring joint disease
– Back pain (thoracolumbar pain) — myofascial pain and restricted mobility of the back respond favourably to ESWT
– Cervical (neck) pain — emerging evidence supports its use for soft tissue and osteoarthritic sources of cervical pain
A systematic review of the literature noted that for conditions such as short-term pain relief, ligament injury, and osteoarthritis, results are promising and support continued use as part of a multi-modal management plan.
Focused vs Radial Shockwave: What’s the Difference, and Why Does It Matter?
Not all shockwave machines are the same. There are two main types used in clinical practice, and understanding the difference helps explain why we use the technology we do.
Radial Shockwave
Radial shockwave therapy uses a ballistic mechanism — a projectile inside the handpiece strikes a transmitter at the skin surface, generating pressure waves that spread outward (radially) from the point of contact. Energy is greatest at the skin surface and dissipates as it travels deeper into tissue. Radial shockwave is useful for superficial and widespread treatment areas, and tends to be lower cost. However, for structures deeper in the limb — such as ligaments, deep tendons, and joints — the energy may not reliably reach the target.
Focused Shockwave
Focused shockwave therapy generates true acoustic shockwaves inside the device, which are then concentrated by a lens or reflector into a precise, egg-shaped focal zone at a defined depth within the tissue — typically between 20–80 mm below the skin surface. This means:
– Energy is delivered directly where it is needed — to deep structures like the suspensory ligament, SDFT, navicular apparatus, and joint surfaces
– Higher energy flux density at the target — focused shockwaves achieve greater tissue stimulation at depth than radial waves, which are strongest at the surface
– More precise treatment — the focal zone can be positioned with accuracy under ultrasound guidance, ensuring the correct structure is targeted
– Greater biological evidence base — the majority of research into ESWT mechanisms in tendons and ligaments — including equine studies — has been conducted using focused shockwave devices
In equine lameness specifically, where the conditions we treat are often deep-seated (suspensory ligament, SDFT, navicular apparatus, coffin and fetlock joints), focused shockwave therapy is the more appropriate technology. Radial shockwave may be insufficient to reach these structures at therapeutic energy levels.
SWT produces a temporary period of local analgesia (pain relief) after the session. While this is therapeutically beneficial, it also means your horse may not feel discomfort that would normally signal tissue overload. Horses must be kept on restricted exercise for a minimum of 48–72 hours after each session to prevent inadvertent injury during this analgesic window.
How Many Sessions Are Needed?
Most equine protocols involve 3 sessions at 2–3 week intervals. Post-surgical or more complex cases may require sessions over a longer period. Your veterinarian will tailor the protocol to your horse’s specific condition and response to treatment.
Is It Safe?
Focused ESWT has a well-established safety profile in equine practice. Side effects are generally minor and transient:
– Mild local soreness or skin reaction at the treatment site
– Temporary increase in lameness for 24–48 hours (a normal inflammatory response)
Serious complications are uncommon. ESWT is not used over active infections, open wounds, growth plates in young horses, or areas overlying major blood vessels. Your veterinarian will screen for these before proceeding.
What Results Can I Expect?
Evidence consistently shows measurable improvements in lameness and tissue healing for the conditions listed above, particularly for tendon and ligament injuries where ESWT has been shown to reduce pain, swelling, and lameness scores and promote tissue repair. Improvements in lameness have been objectively measured using force-plate analysis following ESWT in horses.
It is important to understand that:
– Results vary depending on the condition, its severity, and how long it has been present
– ESWT works best as part of a broader management plan, which may include controlled exercise, physiotherapy, joint medication, or other regenerative therapies
– Some horses show improvement after the first session; in others, the full benefit becomes apparent over several weeks following the final treatment
– Chronic or severe lesions may require repeat courses over time
FAQS
Will my horse be in pain during the treatment?
Horses are sedated for each session, so they are relaxed and comfortable throughout. Most horses tolerate the procedure well.
How soon will I see results?
Improvement is often noted within 2–4 weeks of the first session. For tendon and ligament injuries, significant improvement may take 6–8 weeks following the completion of the course, as tissue remodelling continues after treatment.
Can shockwave therapy replace other treatments?
In some cases ESWT may reduce or remove the need for more invasive interventions. In others, it works most effectively alongside joint injections, regenerative therapies (such as PRP or IRAP), and structured rehabilitation. Your veterinarian will advise on the best combined approach.
Does my horse need to be rested during the treatment course?
This depends on the condition. For tendon and ligament injuries, structured rest and controlled exercise are usually recommended. For back pain and osteoarthritis, appropriate exercise is often encouraged. Guidance will be tailored to your horse.