Q. My veterinarian recently diagnosed my 14-year-old Quarter Horse mare that competes in barrel racing at rodeos and jackpots with proximal suspensory desmitis. He mentioned shock wave therapy as a treatment option, but I’m curious: How quickly does it heal these types of injuries? I’m finding good things about the therapy, but minimal on the speed of healing and how exactly it works to heal the area. Also, how can we pair shock wave with pulsed electromagnetic field therapy (PEMF) sessions for the best results?

A. It is worth considering advanced therapeutics for a suspensory ligament injury of a horse in their teens who participates in a speed event. Shock wave, platelet-rich plasma, laser, stem cells, and alpha-2 macroglobulin are all relatively new and widely used therapeutics. Shock wave is a well-accepted, relatively easy to perform, noninvasive therapeutic backed by research reporting an increased potential of the patient returning to work.

Shock wave machines send a short burst of energy through tissues in the form of sound waves. The waves are delivered to an injured area through a probe. Settings on the machine control the depth of penetration and degree of energy delivered. The sound waves affect the injuries, especially at tissue interfaces, such as where ligament attaches to bone.

Shock wave is typically applied every two to three weeks for three treatments. The time between treatments and the number of treatments can vary with the injury and preferences of the veterinarian. The injury is monitored by clinical and ultrasound exams, allowing for decisions on treatment and management of the horse.

We do not know the exact mechanisms behind shock wave’s ability to improve healing. It is thought it causes the release of molecules from cells, such as growth factors and cytokines, which are known to promote healing. Research has shown shock wave has beneficial effects on local blood supply. It can promote bone production by increasing osteoblast cells involved in making new bone. Shock wave also recruits stem cells, which are integral in the healing process.

It is hard to tell what the effect of shock wave is on the rate of healing. It makes sense it would decrease healing time by improving the healing process. This is a hard area to research with so many variables eventually affecting the outcome. Ultimately, it is most important an injury heals as well as possible rather than as fast as possible, and shock wave might help with this.