Equine shock wave therapy - where are we now?
Authors: Johnson Sherry A, Richards Roderick B, Frisbie David D, Esselman Angie M, McClure Scott R
Journal: Equine veterinary journal
Summary
# Editorial Summary: Extracorporeal Shock Wave Therapy in Equine Practice Electrohydraulic extracorporeal shock wave therapy (ESWT) has become increasingly prevalent in equine orthopaedic medicine over the past 30 years, yet clinical protocols remain largely anecdotal rather than evidence-based. This comprehensive review examined current ESWT technology, mechanisms of action and clinical applications, finding that electrohydraulic systems now dominate the market due to superior waveform control compared with electromagnetic and piezoelectric alternatives. The proposed mechanism involves mechanotransduction triggering cellular activation and downstream signalling, with experimental evidence supporting beneficial effects on bone, soft tissue and wound healing; clinical investigation has focused on osteoarthritis, thoracolumbar pain, navicular syndrome, tendinopathy and proximal suspensory desmopathy, with emerging interest in combination protocols using biologics. Critically, direct comparative trials investigating long-term efficacy across different energy levels, treatment depths and tissue types remain absent, meaning practitioners currently lack robust evidence-based guidance for optimal dosing and patient selection. To advance safe and judicious clinical application, the authors emphasise the importance of standardised protocols, hearing protection, appropriate sedation and restraint, whilst highlighting the need for rigorously controlled studies that move beyond anecdotal recommendations to establish definitive treatment parameters.
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Practical Takeaways
- •ESWT technology has evolved significantly with electrohydraulic systems now dominant; ensure your chosen system can properly focus and control the therapeutic waveform
- •While ESWT shows experimental and clinical promise for common orthopaedic problems (navicular, tendinopathy, suspensory lesions), definitive protocol recommendations don't yet exist—treatment decisions should remain based on individual case assessment
- •Current safety advancements including hearing protection and light sedation protocols should be standard practice; continued research is refining optimal treatment parameters
Key Findings
- •Electrohydraulic systems have predominated over the past decade due to superior ability to focus and control therapeutic waveforms
- •ESWT's primary mechanism is believed to be mechanotransduction leading to cellular activation and downstream signalling
- •Clinical trials demonstrate ESWT application across multiple orthopaedic conditions, with combined use with biologics representing active research
- •Direct protocol comparisons regarding long-term efficacy with variables of energy, depth and tissue type remain lacking, with evidence-based recommendations largely anecdotal