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Equine Health Resource

Extracorporeal Shockwave Therapy, ESWT



Shockwave therapy is a noninvasive treatment used as a means to improve the healing of musculoskeletal injuries, specifically tendon, bone, ligament and joint injuries. It has even been used to treat slow-healing wounds. There is disagreement in the veterinary profession about the effectiveness of the treatment.

Shockwaves are high-energy sound waves. The precise way that shockwave improves healing is not fully understood. It is suggested that micro-trauma of repeated shock waves at the affected area create new blood flow into the area. It is this new blood flow that is thought to promote tissue healing. Shockwave may also induce the production of cells that create bone and cartilage, and may stimulate the immune response. These effects are not proven at this time.

Shockwave is also thought to create a more organized, parallel fiber pattern in healing tissues such as suspensory ligaments or flexor tendons, but this effect has been questioned by some.

Shockwave is performed in a sedated, standing horse. The area associated with the injury is cleaned and clipped if the hair is long. The correct probe is selected depending on its depth of penetration for a specific treatment.

A dose (# of shocks) and strength is selected. A coupling gel is applied to the skin and the probe. The probe is placed over the injured area and directed as needed to treat the relevant structures. The procedure usually only takes about 15 minutes. The machine makes a loud clicking or popping sound when in use. Generally, horses are rested for 72 hours after treatment due to apparent numbing of the treated anatomy. Follow-up treatment or assessment is scheduled.

I personally find it hard to assess healing of an injury using this treatment because it is so hard to know how it would have healed without the treatment. However, in recent studies, shockwave has been found to help horses with navicular syndrome, chronic suspensory ligament disease, arthritis and even non-healing wounds.

Consider Potential Side Effects & Complications

Shockwave is mildly to moderately painful as it is delivered. I have tried it on myself and can speak from experience. For this reason, we typically sedate horses for the treatment.

Excessive treatment could cause damage to the treated anatomy.

Shockwave therapy can result in numbness of the skin of the treated area (and dulled pain of the treated injury) for several days. Because of this, a treated horse could overexert and potentially further injure the already damaged area.

Consider Reasons Not To Use This Treatment

Shockwave is not used on the head, near lung, or over large nerves or vessels.

This therapy has no preventative effects. It is intended to treat a specific diagnosed injury.

Many disciplines prohibit use of shockwave within days of competition because of its numbing effects. FEI prohibits use of shockwave within 5-7 days of competition.

Is It working? Timeframe for effect

In most cases, a series of follow-up treatments are required, usually a total of 2-3 treatments. An assessment of healing is made weeks to months later and in most cases involves ultrasound or x-ray, and clinical evaluation of the injured structure. This might include reduction in swelling or lameness.

Questions To Ask My Vet

  • Why do you suggest this treatment over others?
  • Will several treatments be required?
  • How can I assess the effectiveness of this treatment?
  • Do you have convincing evidence for the effectiveness of this treatment?
Author: Coauthored by Doug Thal DVM DABVP & Susan Shaffer DVM


Verwilghen D, Ponthier J, et al. The use of radial extracorporeal shockwave therapy in the treatment of urethral urolithiasis in the horse: a preliminary study. J Vet Intern Med 2008;22(6):1449-51.McClure S. Shock wave therapy: how it has shocked or bored us. Compendium Equine April 2009;110-14.Frisbie DD, Kawcak CE, et al. Evaluation of the effect of extracorporeal shock wave treatment on experimentally induces osteoarthritis in middle carpal joints of horses. Am J Vet Res 2009;68(4):449-54.Morgan DD, McClure S, Yaeger MJ, et al. Effects of extracorporeal shock wave therapy on wounds of the distal portion of the limbs in horses. J Am Vet Med Assoc 2009:234(1):1154-61.Bosch G, Lin YL, et al. Effect of extracorporeal shock wave therapy on the biochemical composition and metabolic activity of tenocytes in normal tendinous structures in ponies. Equine Vet J 2007;39(3):226-31.Morgan DD, McClure S, Yaeger MJ, et al. Effects of extracorporeal shock wave therapy on wounds of the distal portion of the limbs in horses. J Am Vet Med Assoc 2009:234(1):1154-61.


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