Noninvasive Therapies For Sport Horses
Modalities ranging from PEMF to vibration plates might help manage equine injury or improve performance
Veterinarians and therapy professionals have access to many modalities designed to support equine athletes’ optimal performance, recovery, and rehabilitation. Similar to approaches used in humans, these equine therapies can be invaluable for improving performance and reducing recovery times.
Many treatment protocols were initially developed after extrapolation from scientifically validated use in humans. However, many unproven—and at times unhelpful or even harmful—therapies also exist. Rehabilitation and physical therapy for horses has become a popular topic with increasing treatment options and formal training, such as that provided through the American College of Veterinary Sports Medicine and Rehabilitation board-certification program. While limited published research supports the use of some of these treatments, vets and researchers are striving to put more science behind them.
In this article we’ll focus on the supportive and noninvasive treatments being used in horses. Veterinarians typically recommend these as adjuncts to other medications and therapies. Reviewing their benefits and limitations can help you understand how they might fit into your sport horse care strategy. Work with a practitioner who is well-versed in these treatments and has thoroughly examined your horse to determine how to best manage an injury or improve performance.
Shock Wave Therapy
Veterinarians use extracorporeal shock wave therapy (ESWT) to treat a wide variety of equine injuries, primarily musculoskeletal. Shock wave describes the intense, short pulses of energy the generator creates and transmits rapidly through a probe to the desired area of treatment. While ESWT’s exact mechanism remains unknown, equine practitioners have found success with the therapy and have developed detailed protocols for managing many conditions. Common uses include treating desmitis and tendinitis (ligament and tendon injury and inflammation, respectively), osteoarthritis, muscle pain, and podotrochlosis (aka navicular syndrome), often alongside other therapies, with varying levels of effectiveness.
“I typically use shock wave and (Class IV) laser in conjunction when treating tendon or ligament injuries,” says Nathan Mitts, DVM, of Peterson Smith Equine Hospital, in Ocala, Florida. “The combined use of modalities, along with regular, thorough rechecks, leads to the best recovery and outcome.”
Some horses might need to be sedated for ESWT administration, depending on the targeted tissue, because it can cause momentary discomfort. Shock wave therapy can exert an analgesic, or pain-relieving, effect that lasts as long as four days, so rest and recovery should account for this. Its analgesic properties have also led organizations such as the United States Equestrian Federation (USEF) and the Fédération Equestre Internationale (FEI) to place restrictions on treatments prior or during competition.
Pulsed Electromagnetic Field Therapy
Pulsed electromagnetic field (PEMF) therapy involves using blankets or loops that emit electromagnetic pulses to different areas of the body. These pulses appear to promote healing through a variety of pathways that reduce inflammation and improve tissue repair (Gaynor et al., 2018). A single treatment might only provide a short duration of increased comfort. However, with frequency of use, PEMF might be an effective healing aid. Several PEMF products are on the market, but studies assessing their mode of action and efficacy are limited.
In a recent study (King et al., 2022), a type of PEMF known as bio-electromagnetic energy regulation, or BEMER, improved epaxial (back muscle) pain in a small group of horses. It’s provided via a blanket or by cuffs to smaller portions of the body. Vets might recommend this Class II medical device to temporarily improve circulation, which can decrease inflammation and improve healing and comfort.
Review the governing body’s competition rules for your sport, because some do place restrictions on the timing of PEMF therapy relative to competition.
With therapeutic laser, aka photobiomodulation, lightwaves are transmitted to affected tissues, where scientists say a cellular response decreases pain and inflammation and improves tissue healing. Lasers have different classifications, with high-level Class IV being the most frequently used in veterinary medicine.
Katherine Johnson, DVM, CERP, of Veterinary Rehabilitation Services of Virginia, in Gordonsville, says she finds Class IV laser therapy to be effective in managing soft tissue injuries, including those involving tendons and ligaments. She says she’s also observed that wounds heal more rapidly with less excessive granulation tissue, or proud flesh, development. While anecdotal evidence of Class IV laser’s effects is significant, she says, limited published equine veterinary research on it exists. However, recent study results out of Belgium and Germany are promising, showing improved healing of suspensory ligament injuries (TheHorse.com/195661).
The proper protocol, timing, and wavelength are important for effective laser use. Sedation is not usually necessary. Veterinarians and handlers should, however, take caution and wear protective eyewear when using the laser. As with other therapies, review your discipline’s rules, because some sanctioning bodies might restrict or prohibit laser therapy on showgrounds or before a competition.
Whole-body vibration treatment involves the horse standing on a platform that vibrates for a specific period at certain frequencies. Many practitioners believe it improves circulation and muscle strength. Anecdotally, owners have reported horses to be more relaxed and better behaved after vibration sessions, but researchers have not seen statistically significant improvement in lameness or recovery from injury. In one study from Peninsula Equine Medical Center, researchers reported an increase in hoof growth over 30 and 60 days of continued treatment. In a 2018 study out of Michigan State, investigators showed no lameness improvement after horses underwent three weeks of daily 30-minute vibration plate sessions. The treated horses were, however, calmer and more relaxed than horses in the control group.
While more studies are needed, Mitts says vibration plates can be helpful for horses with restricted turnout, whether due to injury, behavior, or management. Regardless of whether researchers discover a limited healing effect, he adds, this treatment allows horses to relax and, thus, potentially feel better.
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy (HBOT) was originally developed to treat scuba divers for decompression sickness. Within HBOT chambers, the air pressure is two to three times greater than normal atmospheric pressure, and the patient breathes 100% oxygen while inside. The oxygen gets transported through the body via the bloodstream, resulting in improved healing of sick or injured tissues. The FDA has approved HBOT for treating many illnesses in humans. Veterinary use has primarily been extrapolated from human use as well as some animal model studies.
During an HBOT session the horse is enclosed alone (no handler) in the hyperbaric chamber while pressure increases gradually. The treatment typically lasts about an hour. Most horses do not need to be sedated, as standing in the chamber is similar to being loaded in a horse trailer. Because the therapy uses pressurized oxygen, it comes with a small risk of fire. Therefore, the horse’s shoes should be removed to avoid causing a spark, were the horse to kick.
Just as it helps humans recovering from injury, water exercise allows for lower-impact rehab in horses recovering from musculoskeletal injury. With regular use, water treadmills reduce weight-bearing in healing limbs, increase range of motion of the limbs and back, and improve aerobic capacity. Johnson says a water treadmill is an effective method to help rehabilitate tendon and ligament injuries in horses. She recommends introducing the horse to the treadmill gradually through regular sessions. Also observe the horse and his stride during a session carefully, and alter treadmill rate and water depth as needed to either increase or decrease the horse’s work. Water treadmill exercise can also be useful for strengthening a healthy athlete.
Your vet might recommend other noninvasive therapies to help your horse’s rehabilitation or performance. These might include thermo- or cryotherapy (hot or cold therapy), electrical stimulation, kinesiotape, core conditioning systems, and therapeutic ultrasound. He or she might also recommend exercise and physiotherapy protocols such as chiropractic, massage therapy, and acupuncture.
With the many tools available, it’s important to remember the physical exam and continued veterinary observation are the most valuable parts of rehabilitation.
“The most important and effective tool I have is my exam and manual palpation,” says Johnson.
“Regular and thorough rechecks to assess progress are imperative,” adds Mitts.
To design a rehab protocol properly, you must have an accurate diagnosis and knowledge of the resources available. Understanding how and when to schedule these treatments is crucial to their beneficial use. Time and rest are critical for allowing many injuries to recover, but with additional treatments and monitoring, the duration of healing might be shorter.
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