Extracorporeal Shock Wave Therapy FAQ's

What is ESWT?

What are Shockwaves?

How are shockwaves used in human medicine?

Which horse injuries respond to ESWT?

What is the treatment protocol of ESWT?

What are the negative side effects of ESWT?

How does Dr. Revenaugh feel about ESWT?

How should I manage my horse following ESWT (Extra-Corporeal Shock Wave) Therapy?

Question: What is ESWT?

Answer: ESWT stands for Extracorporeal Shock Wave Therapy. ESWT has been shown to dramatically enhance the rate of soft tissue and bone healing in both people and now horses. Dr. Revenaugh is a pioneer in this treatment and has answers these questions from the experience of treating over 600 horses over the past 4 years with this method.

See the interview with Dr. Revenaugh by Lauren Davis Baker: Shock Wave Therapy, Treating Orthopedic Injuries in Horses in the January 2002 Issue of Flying Changes Magazine ( www.flyingchanges.com )

Dr. Revenaugh has also published a scientific paper discussing the Clinical Applications of ESWT Treatment of Osteoarthritis in the Veterinary Clinics of North America Equine Practice (Vet Clin Equine 21 (2005) 609-625). This journal is available to veterinarians only through subscription. If you are a member click here and go to the December 2005 Issue 21. If you are not a member a copy of the article can be requested in PDF format by sending a specific request with your email address to sue@equinepi.com .

Extracorporeal Shock Wave Therapy for Treatment of Osteoarthritis in the Horse: Clinical Applications by Mark S. Revenaugh as published in the December 2005 issue of Veterinary Clinics of North America Equine Practice. ( A copy of this article can be requested by email – click here and request the article by title.)

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Question: What are Shockwaves?

Answer: Shockwaves are strong positive pressure acoustic waves. These waves transmit energy thru the skin into deeper tissues where the energy is "released". In order to understand the concept, one might compare a jackhammer to a shockwave unit. However, the energy wave of the shockwave has very unique characteristics and is extremely fine-tuned in order to achieve the desired physiologic response. In fact, the shockwaves are actually focused to various depths and energy-levels depending on what injury is being treated.

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Question: How are shockwaves used in human medicine?

Answer: The first shockwave units were used for pulverizing kidney stones in people, (lithotrypsy). A lot of excitement was generated because, by using such a device, kidney stones were cured without ever "breaking the skin". These devices are still widely used today for this purpose.

More recently, shockwave units have been used for treatment of a variety of orthopedic injuries in people. Specifically, ESWT has been used to successfully treat frustrating injuries such as: "tennis elbow", "Heel Spurs/ plantar fascistic", as well as calcifying tendonitis and delayed union, (non-healing), fractures and other injuries.

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Question: Which horse injuries respond to ESWT?

Answer: ESWT appears to stimulate tissue healing in a broad variety of tissues. As mentioned above, most bone injuries, (fractures, insert ional injuries, etc.) will potentially respond to ESWT. For example, favorable responses have been seen after treatment of bucked shins, splint-bone injuries, sesamoid-bone injuries and high-suspensory disease to name a few.

Similarly, some horses with "ringbone", lower hock joint arthritis, and navicular disease have also responded dramatically. Unfortunately, because of the multifactorial nature of these problems, predicting which horses will respond can be challenging. It is important to recognize that not all horses respond. In a retrospective study presented at the annual American Association of Equine Sports Medicine meeting this year, we calculated that approximately 10% of the 45 horses treated for high-suspensory disease did not respond.
ESWT is also used widely for treatment of a variety of soft tissue injuries including: tendonitis, suspensory ligament injuries and check ligament injuries. In acute, (new), injuries a lower energy level is used, whereas older injuries require more energy to achieve the desired response. In many cases, dramatic results are seen. Horses with neck, back and pelvic injuries have also been treated with favorable results.

It is also important to emphasize that in order to have a successful outcome; one must first have an accurate diagnosis of the problem. Once the diagnosis is made, the shockwave machine can be applied to the identified area.

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Question: What is the treatment protocol of ESWT?

Answer: ESWT is usually done one an outpatient basis. The horse is brought to the clinic where he/she is sedated before treatment. Many horses also require application of a twitch. Treatment lasts approximately 5-15 minutes. When the sedation has worn off, the horse can ship home.

Treatment protocols vary depending upon the specific injury. Anywhere from 1-4 treatment sessions are conducted. If more than one treatment is conducted, the treatments are ideally spaced at least 14 days apart. Price also varies, depending upon how many "shocks" are administered. One can expect to pay anywhere from $300 to $600 per treatment of a horse, (a recent newspaper article quoted between $2,500-$7000 for the same treatment on people!)

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Question: What are the negative side effects of ESWT?

Answer: When treated with appropriate dosages, mild soft tissue swelling occasionally occurs. Such swelling is mild, and is gone within 48 hours. No other negative side effects have been identified. One of the best aspects of ESWT is that we are oftentimes able to make a dramatic change in the healing/remodeling process without ever breaking the skin. Very few medical therapeutic modalities operate with this level of safety.

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Question: How does Dr. Revenaugh feel about ESWT?

Answer: The use of ESWT on equine orthopedic injuries is still in its infancy at this time. Because of the cost, ESWT is usually used after traditional therapies have failed. We are finding favorable results with ESWT, even on many otherwise frustrating cases. After treating thousands of horses over the past 6 years and watching the responses, it appears that we are only beginning to realize the full potential of ESWT.

ESWT does not fix everything. Furthermore, a small number of cases that "should," respond don't respond. Hopefully, as we learn more, we will be more able to determine which cases do and do not respond.

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Question: How should I manage my horse following ESWT (Extra-Corporeal Shock Wave) Therapy?

Answer: ESWT therapy stimulates the horse's tissues to reactivate the healing process via a process of "controlled re-injury". Following treatment, analgesia of the area treated is possible for a period of up to 1 week. Therefore it is important to rest your horse without turnout during this period to prevent further injury.

Monitor the injection site for heat, swelling, pain or tenderness. Some horses exhibit swelling and/or pain in the region treated for up to 72 hours following treatment. If this does occur treat the symptoms on an as needed basis with oral bute, and cold hosing or ice directly over the region.

Typically shock wave therapy involves a series of 3 treatments with a normal interval between treatments of 2-4 weeks (not less than 10 days). Individual response to treatment does vary from dramatic to minimal. Therefore re-evaluation is critical to the treatment plans.

If you have any concerns about the region treated, or the aftercare instructions please contact N.W.E.P. at the number listed.

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