Shock Wave Therapy
Extracorporeal shock wave therapy (ESWT) is a relatively new treatment that has been adapted from human medicine for use in the horse. The machine used in the hospital generates a high intensity pressure wave which travels through fluid and tissue to be focused at the site of the injury. Shockwave treatments can be performed at the hospital or at your premises.
Shockwave therapy has been found to be most therapeutically beneficial treatment for injuries at the soft tissue-bone interface, i.e the attachement of ligaments to bone. These areas are often difficult to medicate, and unsuitable for surgery. Therefore, the non-invasive and focused attributes of ESWT have proved extremely valuable.
Examples of such injuries are:
- Proximal suspensory desmitis
- Collateral ligament injuries
- Navicular Disease
- Sacro-iliac injuries
ESWT has been shown to stimulate and accelerate the healing process. This is achieved by having an immediate analgesic (pain killing) effect and reducing the inflammation in the affected area.
Most treatment protocols to promote healing of acute injuries involve 1000-2500 impulses, delivered at the target area once every 2-3 three weeks for 3 treatments. The type and location of the injury determines the energy required, the depth of focus, and the number of pulses the tissue requires. The horses are usually restricted to stable rest and controlled exercise between treatments. The horses are then re-evaluated. Post treatment exercise levels are guided by the nature of the original injury and the improvement seen with treatment.
At Oakham we have been particularly impressed with the ESWT's ability to provide pain relief for those horses with chronic conditions such as kissings spines, mild proximal suspensory desmitis, and neck osteoarthritis. We treat a number of international competition horses with these conditions. The results and riders strongly support the pain killing and anti inflammatory effects. A shockwave treatment of a chronic injury in the week preceeding an event or competition really seems to help the horse's ability to perform.
IRAP® is a biological treatment which has been used recently as an aid in the management of lameness caused by inflammation and/or degeneration within joints. By harnessing the regenerative and anti-inflammatory properties of the horse’s own blood cells, damaged musculoskeletal tissues are encouraged to heal. One of the principle benefits of the IRAP® product is that it provides a drug free method of getting horses back into competitive work, as the treatment utilises the horse's own biological material to produce the healing proteins.
IRAP® offers an exciting addition to our range of therapies for treating lameness. The studies so far have produced very promising results and the treatment is widely used in Europe and America.
PRP - Platelet rich plasma
Platelet rich plasma is a new therapy for the treatment of equine tendon and ligament injuries. Horses suffering tendon and ligament injuries have historically had a poor prognosis for a return to athletic ability due to the limited ability of tendons to repair after injury. The repair tissue is often functionally inferior to normal tendon tissue and this goes hand in hand with an increased risk of re-injury.
The collection and preparation of platelet rich plasma is simple, non-invasive and takes only about 30 minutes. Firstly, 60mls of venous blood is collected from the horses' jugular vein. The blood is transferred to a holding device, which is then placed into a portable centrifuge and spun for 3 minutes. This process separates the serum from the red blood cells. The serum is removed from this sample, placed into the centrifuge and spun for a further 15 minutes. This process leaves the platelets concentrated at the bottom of the sample. Excess serum is then removed and the platelets are re-suspended and ready for injection into the injured tendon. The injured horse is mildly sedated and a nerve block is administered to anaesthetise the injured area. The platelet rich plasma is then injected back into the injured tendon under ultrasound guidance.
After an initial period of box rest, a gradual exercise program is commenced with the aim of returning the horse to full activity over a period of 6-12 months depending on the degree of injury and ligament injured.
Stem Cell Therapy
Stem cell therapy is at the forefront of the modern approach to treating injured tendons and ligaments in horses. Stem cells have the ability to change their function and become numerous different types of cells. Equine tendon injuries normally heal very slowly by producing scar tissue, which, while strong enough to allow some activity, is mechanically very different from a normal tendon. By using stem cells, we can improve the quality of healing by providing cells that have the ability to recreate normal tendon tissue, rather than scar tissue.
The first step is to extract the stem cells from a sample of the horse's bone marrow. This is normally taken from the sternum, (chest) under sedation and local anaesthesia. The stem cells are then cultured and separated from the other cells within the bone marrow. After a period of 2-3 weeks they are then re-suspended in fluid from the bone marrow sample and are now ready to be injected back into the injury site of the horse.
Probably the most important stage in the whole process is the rehabilitation and return to exercise program that follows the treatment. Your vet will provide you with detailed instructions that must be strictly adhered to. Rehabilitation programs can range in length from 24 weeks for check ligament and mild suspensory injuries, to 36 for severe suspensory damage, up to 48 weeks for flexor tendon injuries. For the most part, these programs begin with a 12 week period of box rest with controlled walking in hand, after which time they can be ridden again and light trot work commenced. Ultrasound scans are performed at regular intervals to monitor the healing process.