Position Statement on the Use of Extracorporeal Shockwave Therapy (ESWT)

Shockwave therapy, also known as extracorporeal shockwave therapy, is a non-invasive treatment modality that utilizes acoustic waves to deliver mechanical energy to musculoskeletal tissues. This position statement aims to provide guidance on the use of shockwave therapy in equine veterinary medicine based on the current evidence and best practice recommendations.

Efficacy and Indications

1. Evidence-Based Indications: Shockwave therapy has demonstrated efficacy in the treatment of certain chronic soft tissue injuries and conditions in horses, such as suspensory ligament desmitis, tendonitis, and osteoarthritis. Clinical studies and meta-analyses have provided evidence supporting its use in reducing pain and improving function in these conditions.
2. Emerging Applications: Investigations are ongoing into the broader applications of shockwave therapy in equine medicine, including its use for myofascial pain syndrome, wound healing, and its potential role in accelerating tissue regeneration. Equine veterinarians should keep abreast of new evidence as it becomes available and consider these emerging applications cautiously. 

Safety Considerations

1. Contraindications: Shockwave therapy is generally considered safe when administered by licensed veterinarians. However, it is contraindicated in certain patient populations, including horses with malignant tumors in the treatment area, horses with bleeding disorders or on anticoagulant therapy, pregnant mares, and over areas with epiphyseal growth plates in foals.
2. Adverse Effects: Typical side effects are usually mild and short-lived, including pain, reddening or bruising of the skin, and discomfort during treatment. Serious complications are rare but should be monitored and managed appropriately. 

Clinical Guidelines

1. Professional Training: Shockwave therapy should only be administered by licensed veterinarians, or licensed veterinary technicians under the direct supervision of a veterinarian (where allowed in the state’s practice act). This includes understanding the appropriate settings, techniques, and patient selection to ensure safety and maximize treatment efficacy. Veterinarians are encouraged to stay up to date about current research protocols for its use.
2. Patient Evaluation: A thorough patient evaluation, including history and physical examination, is essential for appropriate patient selection. Shockwave therapy should be considered part of a comprehensive treatment plan, which may also include physical therapy, pharmacotherapy, or other interventions.
3. Personalized Treatment: Treatment regimens should be tailored to the individual needs of the horse, considering factors such as specific condition, severity, and response to previous treatments. Protocols, including the number of sessions and energy levels, should be guided by evidence-based practices.
4. Monitoring and Follow-Up: Continuous monitoring of patient outcomes and follow-up assessments are essential to evaluate the effectiveness of the treatment and to make necessary adjustments. Feedback from the horse’s owner and periodic re-evaluation should guide ongoing treatment decisions.

Ethical Considerations

Ethical considerations for shockwave therapy in horses include balancing potential benefits with the risk of masking pain, which could result in reinjury of compromised tissues, and ultimately, the safety of horse and rider. Shockwave therapy treatments should be administered by licensed veterinarians with a valid VCPR, or licensed veterinary technicians under direct veterinary supervision. While many of the breed and discipline groups have specific withdrawal times for the use of shockwave therapy, the AAEP recommends a minimum 72-hour withdrawal time on its use. The veterinarian should be familiar with the appropriate rules of the particular competition or racing jurisdiction in which they are practicing, as adherance to the regulations regarding competition eligibility is paramount to maintain the ethical focus on the health and welfare of the horse and the integrity of the competition.

Conclusion

Shockwave therapy is a valuable tool in the management of various musculoskeletal conditions in horses. While existing evidence supports its use in certain scenarios, further research is needed to understand its full scope and efficacy across different conditions. Equine veterinarians should employ evidence-based principles, rigorous patient assessment, and careful technique to optimize outcomes. As shockwave therapy continues to evolve, this position statement will be revised to reflect new insights from ongoing research and clinical practice.

Approved by AAEP board of directors in 2025