Review of the application and efficacy of extracorporeal shockwave therapy in equine tendon and ligament injuries
Authors: Yocom A. F., Bass L. D.
Journal: Equine Veterinary Education
Summary
# Extracorporeal Shockwave Therapy in Equine Tendon and Ligament Injuries: Current Evidence and Future Directions Extracorporeal shockwave therapy (ESWT) has gained traction amongst equine practitioners as a treatment modality for musculoskeletal injury, with reported benefits including improved lameness scores, shortened healing timescales, and enhanced ultrasonographic tissue quality in affected tendons and ligaments. Yocom and Bass's 2019 review synthesises the existing literature on ESWT efficacy but identifies a critical limitation: the evidence base is substantially undermined by positive publication bias and methodological weaknesses across most available studies, with relatively few randomised controlled trials meeting rigorous experimental standards. The authors highlight significant gaps in our current understanding, particularly regarding optimal energy settings, dosing protocols, treatment frequency, and anatomical region-specific case selection criteria. Additionally, the long-term outcomes and potential synergistic or antagonistic effects when combining ESWT with regenerative biological therapies (such as stem cell or platelet-rich plasma treatments) remain unclear. Practitioners considering ESWT should therefore remain cautiously optimistic about its potential whilst recognising that robust clinical evidence to guide treatment protocols is still lacking, emphasising the need for well-designed trials before establishing ESWT as a standard component of soft-tissue injury management protocols.
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Practical Takeaways
- •ESWT shows promise for treating tendon and ligament injuries in horses, but current evidence quality is limited by bias and weak study design—demand high-quality clinical data before adopting as standard protocol
- •Optimal energy settings, dosing, treatment frequency, and case selection criteria for different anatomical locations remain undefined—standardized protocols are needed for consistent clinical outcomes
- •Before combining ESWT with other regenerative therapies (stem cells, PRP), understand that interactions and long-term effects have not been adequately studied
Key Findings
- •ESWT has been shown to improve lameness in horses with musculoskeletal injuries
- •ESWT decreases healing time for tendon and ligament injuries
- •ESWT improves ultrasonographic appearance of injured tendons and ligaments
- •Most current literature on ESWT in veterinary medicine exhibits positive bias with lower levels of evidence-based experimental design