Jenny E. Johnson, V.M.D.
Calabasas, CA

(818) 809-SHWV (7498)
(818) 878-9458 - fax

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  April 2008
Shockwave Therapy
What is it and what can it be used for?
Many of us have heard the term shockwave therapy, and some of us have used shockwave therapy to treat injuries in our horses, but how much do we really know about the principles behind this innovative treatment?

First, what exactly is a shockwave? A shockwave is a pressure wave, a high frequency sound wave. Any action that displaces its surrounding medium is a shockwave. The ripple in the water created when a rock is thrown into a pond is a shockwave. An earthquake is a shockwave in the earth.

The shockwaves used in veterinary medicine can be generated in three different ways: electrohydraulically, piezoelectrically, or through an electromagnetic field. The shockwaves are focused in the transducer head and can be directed to the precise area of the injury. The shockwaves are transmitted readily from the transducer head, through ultrasound coupling gel, and through soft tissue and the energy of the wave is released at a specific depth, depending on the transducer head that is used.

With that knowledge, what do shockwaves do that is therapeutic? The effect of shockwaves in the healing process is achieved through their influence on a myriad of metabolic processes. Shockwave therapy has been shown to stimulate new bone growth in fractures, stimulate the in-growth of new blood vessels (neovascularization), increase cell permeability and possibly stimulate fibroblast formation (the cells important in repairing tendons and ligaments).

In addition, shockwave therapy stimulates stem cells that occur naturally in the animal's body to migrate to the area that is treated with shockwave therapy. It has a potent anti-inflammatory effect and has also been found to have anti-bacterial capabilitites. Shockwave therapy has a transient analgesic effect as well.

Shockwave therapy has been used extensively in Europe, Asia, and South America to treat a wide variety of soft tissue and orthopedic injuries in people. It is the treatment of choice in many areas of the world for non-union fractures. It is also very effective at treating chronic, infected wounds that have not responded to traditional therapies. It has been approved by the U.S. Food and Drug Administration for use in people to treat tennis elbow and plantar fasciitis that have not responded to conventional treatment.

What can it treat?
Shockwave therapy has been used in the United States in veterinary medicine for approximately 8 years. It has been successfully used to treat both soft tissue and bony problems, both acute and chronic, including suspensory ligament injuries, with or without avulsion fractures, tendon injuries, arthritis, collateral ligament injuries, navicular syndrome, impar ligament injuries, ringbone, joint inflammation and pain, back pain, neck pain, and muscle tears and strains.

The treatment protocol depends on the diagnosis of each individual patient. Treatment varies in the number of shockwaves and the energy of those shockwaves. For example, in the case of an acute tendon injury, the energy would be decreased and the number of impulses would be reduced as compared to the treatment of an injury that was a month old. Most conditions are treated a total of 3 times, spaced at two to three week intervals. The optimum treatment regime for each animal is determined after a careful review of the history and diagnostic work-up information by the veterinarians working on the case. Usually, the treatment can be performed at the horse's home barn, eliminating the need for the animal to be shipped to a distant facility for treatment.

After treatment, there may be a reduction in pain and/or swelling within hours. This may last for 2-4 days and then the animal will return to close to the original status. Over the next 2-3 weeks, actual healing will take place. It is important to note that shockwave therapy does not necessarily speed up the healing process, but will generally lead to a higher success rate and a better end result. In competing horses, shockwave therapy can be an important non-invasive adjunct to help keep a horse comfortable. For example, it can be very useful in helping a horse with a sore back to achieve comfort and freedom through his back.

Are all shockwave machines the same?
One very important aspect of shockwave therapy is to recognize that not all shockwave machines are created equal. There are some machines that have been marketed as shockwave machines that do not generate a true shockwave. They generate what is called a ballistic or radial wave. The physics of this type of wave are completely different from that of a true shockwave. These machines look like a small jackhammer. The problem with this type of wave is that most of the energy is deposited at the skin, and the energy drops off rapidly as you move into tissues deeper than the skin. These units can be useful in treating skin lesions or wounds, but in injuries of deeper tissues, the injured area is not likely to be receiving the necessary energy to help the healing process. Additionally, the entire area around the treatment site is receiving the wave, which can potentially have harmful effects. Treatment with this type of machine is generally considerably less expensive than with a true focused shockwave, but it is not comparable in terms of technology or results. It is essential for the horse owner or trainer to understand this difference as most insurance companies will only cover treatment performed with a true focused shockwave machine.

The shockwave machine used by Dr. Johnson is a true focused machine, manufactured by Sanuwave. This is the same equipment that is currently being used in 18 University veterinary teaching hospitals.

The future...
For the future, shockwave therapy holds potential in many different areas. The 10th International Congress of the International Society for Musculoskeletal Shockwave Therapy, an international organization consisting largely of human orthopedic surgeons, chiropractors, physiologists and basic researchers that are involved in using shockwave therapy in the human medical field, showcased over 70 different research projects that are currently being conducted into shockwave therapy. One of the most exciting new areas of research is in the treatment of wounds and burns with shockwave therapy. Currently, the U.S. Army and U.S. Navy are collaborating on a prospective study using shockwave therapy to treat burns and wounds in soldiers returning from Iraq and Afghanistan.

Dr. Johnson, of Calabasas, CA, has treated a horse with extensive burns sustained in a trailer fire with remarkable results: "Within 24 hours of treatment, there were new blood vessels visible at the burn edge, the smell was gone, and the pus that was oozing through the scabs was markedly reduced. In addition, the horse was significantly more comfortable."
Shockwave Q&A  

Q: I have a horse with a chronically inflamed front suspensory ligament. He is serviceably sound and I show him lightly, but I would like to decrease the inflammation and perhaps the size of the suspensory. Would shockwave therapy help?

A: Shockwave therapy has a significant anti-inflammatory effect and decreasing the inflammation in the suspensory ligament you describe is likely to improve your horse's comfort level. In addition to the anti-inflammatory effect, shockwave therapy will stimulate stem cells in the horse's body to migrate to the area that is treated and will stimulate a cascade of healing processes. This combination has the potential to stimulate real healing of the suspensory ligament. It essentially "jump starts" the healing process in a case like this and it is possible to improve the architecture and structure of the suspensory ligament and lead to a long lasting improvement in the horse's soundness.

Q: My horse has a sore back - will shockwave therapy help?

A: Any time a horse has a sore back, it is first necessary to have a complete musculoskeletal evaluation completed by your veterinarian. Back pain is frequently secondary to pain somewhere else in the body, and those areas must be treated first. If all the other areas of pain have been addressed and the horse still has back pain, then it is important to try and determine why the horse has back pain. It may be muscular in origin, a result of dorsal spinous processes that are impinging on one another (called "kissing spines"), or a dislocation of a portion of the spinal column.

Depending on the source of the pain, shockwave therapy may be very helpful. In the case of "kissing spines", shockwave therapy in combination with mesotherapy has been very helpful in providing long lasting relief. If the pain is muscular in origin, shockwave therapy can also be very therapeutic. If the pain is a result of a "malalignment" or "dislocation" of a portion of the spine, shockwave therapy can be an important adjunct to chiropractic adjustment. Treating the horse with shockwave therapy after the horse is adjusted may help to relieve tension in the muscles.
About Dr. Johnson  
Dr. Jenny Johnson is a 1986 graduate of the University of Pennsylvania School of Veterinary Medicine, where she also completed an internship in large animal medicine and surgery. She had a solo practice in Wellington, FL specializing in high performance hunter, jumper and dressage horses for approximately 10 years. Since coming to California, she has continued to be active with lameness consultations, has served as the official show veterinarian at shows in Colorado and California, and is currently working toward her FEI Veterinary Delegate certification.

Dr. Johnson started Oakhill Shockwave in 2005 to bring this innovative technology to the horses of Southern California. As well as being a veterinarian, Dr. Johnson is an active competitive show jumping rider and truly understands the physical and mental demands placed on equine athletes.

For more information on shockwave therapy, please contact her at Oakhill Shockwave, 818-809-7498, or visit Dr. Johnson has devoted her veterinary practice (Oakhill Shockwave) to performing shockwave therapy. She works in cooperation with your regular veterinarian to insure a seamless continuum of care for your horse.

She is available for consultation and shockwave treatment of your horse. Please call 818-809-7498 today for an appointment.
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