cold laser therapy

Electrotherapy, directing small currents of electricity through the skin for medical treatment, has been widely used in human sports medicine and rehabilitation to treat injuries and optimize performance. Various modalities have made their way into sport horse medicine and rehabilitation. Electrotherapies are built around energy sources that range from acoustics to vibrations.

Electrical Stimulation

Electrostimulation is commonly used for pain relief. Varying pulse durations and intensities mimic nerve patterns, causing muscles to contract. Transcutaneous electrical nerve stimulation (TENS) operates at 250 hertz (Hz), with the nerves closest to the surface of the skin activated first. Treatment occurs over 20-30 minutes, continuously or intermittently throughout the day. Use in humans is well-researched, but evidence for use in horses is limited.

Neuromuscular electrical stimulation (NMES), commercially available as functional electrical stimulation (FES) units, is used to contract large muscles. Similar to TENS, it has longer pulse durations, variable amplitude and a frequency >50 Hz. Repetitions are increased over three to five weeks, with one to five sessions per week. One study reported that FES improved contraction and decreased muscle spasms in equine epaxial muscles, those located on the back directly under where the saddle sits (Schils et al. 2014).

Since these modalities involve placing electrodes on the skin, irritation can occur at the contact points if left on for too long. Minimal complications have been reported with proper use.

Magnetic Waves

Pulsed electromagnetic field therapy (PEMF) uses low-frequency magnetic waves to generate electrical currents in tissues. These units are found as blankets and wraps with built-in coils and batteries, with the size of the coil determining the size and strength of the magnetic field. Treatment protocols vary by manufacturer, and side effects are rare. Research has not shown any significant soft tissue benefits for horses or humans. However, evidence suggests the best application might be to bone healing, such as in cases of slow-healing fractures (Schlacter and Lewis, 2016).

Sound and Pressure Waves

Therapeutic ultrasound uses vibration frequencies of 1-3 megahertz (MHz) to generate waves of acoustic energy (inaudible to humans) that can reach deep tissues–effectively a tissue micromassage. It is used for pain relief, to decrease muscle spasms, and to increase blood flow. Treatments occur daily for seven to 10 days, can be pulsed or continuous, and might include the application of heat. Research has shown that equine tendons are effectively heated with therapeutic ultrasound, but heating of muscle has not been reported.

Extracorporeal shockwave therapy uses pressure waves that increase as they move through tissues. This results in microdamage caused by the generation and collapse of tiny air bubbles, leading to the formation of new blood vessels and increased blood flow. Protocols consist of three to six treatments at two to three week intervals to allow for proper healing of the microtrauma. Unlike therapeutic ultrasound, which can reach deep tissues, shockwaves only penetrate 50-110 mm. Studies have reported improved healing and reduced lameness in cases of front and hind-limb sensory desmitis (Caminoto et al., 2005McClure et al., 2004). Another study showed reduced lameness in horses with induced osteoarthritis, but no beneficial effects were identified in the synovial fluid, tissue, or cartilage of the affected joint. Since pain relief has been reported to last several days, masking a horse’s pain level, organizations such as the Fédération Équestre Internationale (FEI) have withdrawal time regulations prior to competition. Under California Horse Racing Board (CHRB) regulations, horses in California are unable to race or work until 10 days after shockwave therapy.

Good skin contact is required, as neither shockwaves nor ultrasound waves function through air. Patients must be clean and clipped, if possible. Gel is used to maximize contact.

Lasers

Laser therapy can reduce pain and inflammation. It has comparable benefits to acupuncture and is often used on similar trigger points. Low- (power output <500 mW) and high-power (output >500 mW) lasers have been used in horses. Daily, weekly, or monthly treatments of five to 30 minutes are performed based on the location and type of injury. Tissues can overheat if the therapy is not properly applied. Studies suggest lasers are beneficial for tendon healing (Pluim et al. 2018). Research into the effects of laser therapy on wound-healing is ongoing.

Vibration

Vibration plates create energy in an up-and-down or side-to-side direction, with amplitude and speed determining the magnitude of the vibration. Vibrations are thought to improve circulation through involuntary muscle contractions. Vibration plates might also promote joint stability by stimulating and strengthening associated muscles. Sessions are typically 10 to 15 minutes. To date, no undesirable effects have been reported. One study showed no changes in bone markers for horses that underwent vibration therapy (Carstanjen et al., 2013). However, maintenance of bone density was reported in stalled horses (Hulak et al., 2015), and muscle was increased in horses that underwent vibration therapy for 60 days (Halsberghe et al., 2016). Whole body vibration therapy might also be beneficial for increasing hoof growth rate (Halsberghe 2018).

Electrotherapy is an evolving field. Although many applications are noninvasive, individual horses might not tolerate certain approaches. Many modalities are unregulated and, although research is ongoing, available peer-reviewed studies are minimal. It is important to work with your veterinarian to determine the best course of treatment for your specific situation.

This article was originally written by Amy Young and published in the Horse Report from the Center for Equine Health at the UC Davis School of Veterinary Medicine in Summer 2022.

Schils, S., & Turner, T. Functional electrical stimulation for equine epaxial muscle spasms: Retrospective Study of 241 Clinical Cases. Jan. 2014. Comparative Exercise Physiology, 10(2), 89-97.

Schlachter, C., & Lewis, C. Electrophysical Therapies for the Equine Athlete. The Veterinary clinics of North America. April 2016. Equine practice, 32(1), 127–147.

Caminoto, E. H., Alves, et al. Ultrastructural and immunocytochemical evaluation of the effects of extracorporeal shock wave treatment in the hind limbs of horses with experimentally induced suspensory ligament desmitis. May 2005. American journal of veterinary research, 66(5), 892–896.

McClure, S. R., VanSickle, D., Evans, R., Reinertson, E. L., & Moran, L. The effects of extracorporeal shock-wave therapy on the ultrasonographic and histologic appearance of collagenase-induced equine forelimb suspensory ligament desmitis. April 2004. Ultrasound in medicine & biology, 30(4), 461–467.

Pluim, M., Martens, A., et al. Short- and long term follow-up of 150 sports horses diagnosed with tendinopathy or desmopathy by ultrasonographic examination and treated with high-power laser therapy. Aug. 2018. Research in veterinary science, 119, 232–238.

Carstanjen B., & Balali M., et al. Short-term whole body vibration exercise in adult healthy horses. 2013. Polish Journal of Veterinary Sciences 16(2), 403–405

Hulak E., Influence of whole body vibration on bone density in the stalled horse. 2015. Middle Tennessee State University ProQuest Dissertations Publishing

B. T. Halsberghe, P. Gordon-Ross, et al. Whole body vibration affects the cross-sectional area and symmetry of the m. multifidus of the thoracolumbar spine in the horse. Oct. 2016. Equine Vet Education, 29: 493-499.

B. T. Halsberghe. Effect of two months whole body vibration on hoof growth rate in the horse: A pilot study. Aug 2018. Research in veterinary science, 119, 37-42