FREE SHIPPING over $40
OVER 10000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Equine veterinary journal2019; 52(2); 250-257; doi: 10.1111/evj.13159

Extracorporeal shockwave therapy raises mechanical nociceptive threshold in horses with thoracolumbar pain.

Abstract: Although extracorporeal shockwave therapy (ESWT) is a common treatment for horses with back pain, effects on mechanical nociceptive threshold (MNT) and multifidus muscle cross sectional area (CSA) in the spine are unknown. Objective: To evaluate effects of ESWT on spinal MNT and multifidus muscle CSA in horses with thoracolumbar pain. Methods: Non-randomised trial. Methods: Thoracolumbar spines of 12 horses with thoracolumbar pain were radiographed to document existing pathology. Each horse received three ESWT treatments, 2 weeks apart (days 0, 14, 28). Palpation scores were documented (days 0, 45 and 65). Ultrasonographic CSA of left and right multifidus muscles was recorded at T12, T14, T16, T18, L3 and L5 (days 0, 45 and 65). MNT was measured at the same spinal sites every 7 days (day 0-56). Results: Mechanical nociceptive threshold in 10/12 horses (83%) was greater at each time point compared with day 0 (P < 0.05). Mechanical nociceptive threshold increased at all time points at six sites in 2/12 (16%), at five sites in 3/12 (25%), at four sites in 4/12 (33%) and at one site in 1/12 (8%; P < 0.05). Mechanical nociceptive threshold average per cent  increase from day 0 to 56 was 64% for the thoracic region (T12-T18) and 29% for the lumbar region (L3-L5). There was no statistical difference in MNT from day 35 to 56 (P = 0.25). A bimodal analgesic trend was observed following ESWT. Degree of radiographic change was not associated with response to treatment. No significant change in multifidus muscle CSA was observed. Conclusions: Small study size and lack of control group. Conclusions: Three treatments of ESWT 2 weeks apart raised MNT over a 56-day period in horses with back pain, but did not influence change in CSA of the multifidus muscle. While ESWT appears justifiable for analgesia, physiotherapeutic techniques may be necessary in conjunction for concurrent muscle rehabilitation.
© 2019 EVJ Ltd.
Get Full Text
Publication Date: 2019-09-04 PubMed ID: 31393628DOI: 10.1111/evj.13159Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research investigates the effects of extracorporeal shockwave therapy (ESWT) on horses with back pain, specifically regarding mechanical nociceptive threshold (pain reception) and changes in the cross-sectional area of a major back muscle. ESWT treatments showed a sizeable increase in the pain tolerance in most horses, but no significant changes in muscle size were observed.

Study Methodology

The study was conducted using a non-randomized trial involving 12 horses with thoracolumbar pain, or back pain. The horses underwent thoracolumbar spine radiographs to document any pre-existing conditions. ESWT treatments were administered to the horses on three occasions, each session 2 weeks apart from the other. Various measurements were recorded across the treatment period, including:

  • Palpation scores (an assessment of pain through touch by a trained professional) documented on days 0, 45, and 65
  • Cross-sectional area (CSA) of the left and right multifidus muscles – important muscles in spinal stability – recorded at various points along the spine (T12, T14, T16, T18, L3, and L5) on days 0, 45, and 65
  • Mechanical nociceptive threshold (pain reception to mechanical stress) measured at the same spinal sites on a weekly basis from day 0 to 56

Study Findings

The study found that 10 out of 12 horses showed an increase in their pain tolerance at each time point when compared to the start of the treatment. No significant difference in MNT was observed from day 35 to 56, indicating the effects of ESWT potentially plateau. Interestingly, the degree of radiographic change (indicative of physical changes in the spine’s structure) did not correlate with the response to the treatment. Despite the increased tolerance to pain, no significant change was observed in the CSA of the multifidus muscle, suggesting that ESWT might not influence muscular rehabilitation.

Conclusions

While the small study size and lack of a control group were identified as limitations, the study concluded that three ESWT treatments, spaced two weeks apart, raised the mechanical nociceptive threshold over a 56-day period in horses with back pain. This implies that ESWT could effectively increase pain tolerance in horses with back pain. However, because it didn’t influence the change in the multifidus muscle’s CSA, physiotherapeutic techniques might need to be used in conjunction for comprehensive muscle rehabilitation.

Cite This Article

APA
Trager LR, Funk RA, Clapp KS, Dahlgren LA, Werre SR, Hodgson DR, Pleasant RS. (2019). Extracorporeal shockwave therapy raises mechanical nociceptive threshold in horses with thoracolumbar pain. Equine Vet J, 52(2), 250-257. https://doi.org/10.1111/evj.13159

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 52
Issue: 2
Pages: 250-257

Researcher Affiliations

Trager, L R
  • Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.
Funk, R A
  • Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.
Clapp, K S
  • Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.
Dahlgren, L A
  • Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.
Werre, S R
  • Laboratory for Study Design and Statistical Analysis, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.
Hodgson, D R
  • Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.
Pleasant, R S
  • Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.

MeSH Terms

  • Animals
  • Back Pain / veterinary
  • Extracorporeal Shockwave Therapy / veterinary
  • Horse Diseases / therapy
  • Horses
  • Lumbosacral Region
  • Spine

Grant Funding

  • 449746 / Virginia Horse Industry Board

References

This article includes 37 references
  1. Allen AK, Johns S, Hyman SS, Sislak MD, Davis S, Amory J. How to diagnose and treat back pain in the horse. Proc. Am. Ass. Equine Practnrs 56, 384-388.
  2. Jeffcott L. Disorders of the thoracolumbar spine of the horse-a survey of 443 cases. Equine Vet. J. 12, 197-210.
  3. Walmsley J, Pettersson H, Winberg F, McEvoy F. Impingement of the dorsal spinous processes in two hundred and fifteen horses: case selection, surgical technique and results. Equine Vet. J. 34, 23-28.
  4. Townsend H, Leach D, Doige C, Kirkaldy-Willis W. Relationship between spinal biomechanics and pathological changes in the equine thoracolumbar spine. Equine Vet. J. 18, 107-112.
  5. Turner TA. Overriding spinous processes (“kissing spines”) in horses: diagnosis, treatment, and outcome in 212 cases. Proc. Am. Ass. Equine Practnrs 57, 424-430.
  6. Stubbs NC, Riggs CM, Hodges PW, Jeffcott LB, Hodgson DR, Clayton HM, McGowan CM. Osseous spinal pathology and epaxial muscle ultrasonography in Thoroughbred racehorses. Equine Vet. J. 42, 654-661.
  7. Hodges PW. The role of the motor system in spinal pain- implications for rehabilitation of the athlete following lower back pain. J. Sci. Med. Sport 3, 243-253.
  8. Stubbs NC, Kaiser LJ, Hauptman J, Clayton HM. Dynamic mobilisation exercises increase cross sectional area of musculus multifidus. Equine Vet. J. 43, 522-529.
  9. Halsberghe BT, Gordon-Ross P, Peterson R. Whole body vibration affects the cross-sectional area and symmetry of the m. multifidus of the thoracolumbar spine in the horse. Equine Vet. Educ. 29, 493-499.
  10. Haussler K, Erb H. Pressure algometry for the detection of induced back pain in horses: a preliminary study. Equine Vet. J. 38, 76-81.
  11. Varcoe-Cocks K, Sagar KN, Jeffcott LB, McGowan CM. Pressure algometry to quantify muscle pain in racehorses with suspected sacroiliac dysfunction. Equine Vet. J. 38, 558-562.
  12. Fischer AA. Pressure algometry over normal muscles: Standard values, validity and reproducibility of pressure threshold. Pain 30, 115-126.
  13. Haussler K, Erb H. Mechanical nociceptive thresholds in the axial skeleton of horses. Equine Vet. J. 38, 70-75.
  14. McClure S, Weinberger T. Extracorporeal shock wave therapy: Clinical applications and regulation. Clin. Tech. Equine Pract. 2, 358-367.
  15. Coomer RP, McKane SA, Smith N, Vandeweerd JM. A controlled study evaluating a novel surgical treatment for kissing spines in standing sedated horses. Vet. Surg. 41, 890-897.
  16. Jacklin BD, Minshall GJ, Wright IM. A new technique for subtotal (cranial wedge) ostectomy in the treatment of impinging/overriding spinous processes: description of technique and outcome of 25 cases. Equine Vet. J. 46, 339-344.
  17. Sullivan K, Hill A, Haussler K. The effects of chiropractic, massage and phenylbutazone on spinal mechanical nociceptive thresholds in horses without clinical signs. Equine Vet. J. 40, 14-20.
  18. Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J. Orthop. Surg. Res. 7, 1-8.
  19. Ogden JA, Alvarez RG, Levitt R, Marlow M. Shock wave therapy in musculoskeletal disorders. J. Clin. Orthop. 387, 22-40.
  20. Xie H, Colahan PT, Ott EA. Evaluation of electroacupuncture treatment of horses with signs of chronic thoracolumbar pain. J. Am. Vet. Med. Ass. 227, 281-286.
  21. Denoix JM, Dyson S. Thoracolumbar spine. Diagnosis and Management of Lameness in the Horse 1st edn., Eds: M. Ross and S. Dyson, Elsevier Science, St. Louis, MO. pp 509-521.
  22. Ogden JA, Tóth-Kischkat A, Schultheiss R. Principles of shock wave therapy. J. Clin. Orthop. 387, 8-17.
  23. Wang CJ, Yang KD, Wang FS, Huang CC, Yang LJ. Shock wave induces neovascularization at the tendon-bone junction. A study in rabbits. J. Orthop. Res. 21, 984-989.
  24. Ciampa AR, de Prati AC, Amelio E, Cavalieri E, Persichini T, Colasanti M, Musci G, Marlinghaus E, Suzuki H, Mariotto S. Nitric oxide mediates anti-inflammatory action of extracorporeal shock waves. FEBS Lett. 579, 6839-6845.
  25. Hausdorf J, Lemmens MA, Heck KD, Grolms N, Korr H, Kertschanska S, Steinbusch HW, Schmitz C, Maier M. Selective loss of unmyelinated nerve fibers after extracorporeal shockwave application to the musculoskeletal system. Neuroscience 155, 138-144.
  26. Denoix JM. Spinal biomechanics and functional anatomy. Vet. Clin. N. Am.: Equine Pract. 15, 27-60.
  27. Wennerstrand J, Johnston C, Roethlisberger-Holm K, Erichsen C, Eksell P, Drevemo S. Kinematic evaluation of the back in the sport horse with back pain. Equine Vet. J. 36, 707-711.
  28. de Cocq P, van Weeren PR, Back W. Effects of girth, saddle and weight on movements of the horse. Equine Vet. J. 36, 758-763.
  29. Bolt DM, Burba DJ, Hubert JD, Strain GM, Hosgood GL, Henk WG, Cho D-Y. Determination of functional and morphologic changes in palmar digital nerves after nonfocused extracorporeal shock wave treatment in horses. Am. J. Vet. Res. 65, 1714-1718.
  30. Dahlberg JA, McClure SR, Evans RB, Reinertson EL. Force platform evaluation of lameness severity following extracorporeal shock wave therapy in horses with unilateral forelimb lameness. J. Am. Vet. Med. Ass. 229, 100-103.
  31. Kinser AM, Sands WA, Stone MH. Reliability and validity of a pressure algometer. J. Strength Cond. Res. 23, 312-314.
  32. De Heus P, Van Oossanen G, Van Dierendonck MC, Back W. A Pressure Algometer Is a Useful Tool to Objectively Monitor the Effect of Diagnostic Palpation by a Physiotherapist in Warmblood Horses. J. Equine Vet. Sci. 30, 310-321.
  33. Zimmerman M, Dyson S, Murray R. Comparison of radiographic and scintigraphic findings of the spinous processes in the equine thoracolumbar region. Vet. Radiol. Ultrasound 52, 661-671.
  34. Zimmerman M, Dyson S, Murray R. Close, impinging and overriding spinous processes in the thoracolumbar spine: the relationship between radiological and scintigraphic findings and clinical signs. Equine Vet. J. 44, 178-184.
  35. Girodroux M, Dyson S, Murray R. Osteoarthritis of the thoracolumbar synovial intervertebral articulations: clinical and radiographic features in 77 horses with poor performance and back pain. Equine Vet. J. 41, 130-138.
  36. Erichsen C, Eksell P, Roethlisberger Holm K, Lord P, Johnston C. Relationship between scintigraphic and radiographic evaluations of spinous processes in the thoracolumbar spine in riding horses without clinical signs of back problems. Equine Vet. J. 36, 458-465.
  37. Zissler A, Steinbacher P, Zimmermann R, Pittner S, Stoiber W, Bathke AC, Sanger AM. Extracorporeal shock wave therapy accelerates regeneration after acute skeletal muscle injury. Am. J. Sports Med. 45, 676-684.

Citations

This article has been cited 10 times.
  1. Qiu Z, Wang J, Zhang Y, Liu X, Wei C, Ma T. Extracorporeal shock wave therapy for equine musculoskeletal disorders: from biological mechanisms to clinical applications. Front Vet Sci 2025;12:1719123.
    doi: 10.3389/fvets.2025.1719123pubmed: 41487475google scholar: lookup
  2. Pilati N, Pressanto MC, Palumbo Piccionello A, De Angelis Corvi F, Beccati F. Impinging and Overriding Spinous Processes in Horses: A Narrative Review. Animals (Basel) 2025 Sep 13;15(18).
    doi: 10.3390/ani15182679pubmed: 41007924google scholar: lookup
  3. Boström A, Bergh A, Hyytiäinen H, Asplund K. Systematic Review of Complementary and Alternative Veterinary Medicine in Sport and Companion Animals: Extracorporeal Shockwave Therapy. Animals (Basel) 2022 Nov 12;12(22).
    doi: 10.3390/ani12223124pubmed: 36428352google scholar: lookup
  4. Dybczyńska M, Goleman M, Garbiec A, Karpiński M. Selected Techniques for Physiotherapy in Dogs. Animals (Basel) 2022 Jul 8;12(14).
    doi: 10.3390/ani12141760pubmed: 35883307google scholar: lookup
  5. Ryskalin L, Morucci G, Natale G, Soldani P, Gesi M. Molecular Mechanisms Underlying the Pain-Relieving Effects of Extracorporeal Shock Wave Therapy: A Focus on Fascia Nociceptors. Life (Basel) 2022 May 17;12(5).
    doi: 10.3390/life12050743pubmed: 35629410google scholar: lookup
  6. Biedrzycki AH, Elane GL. Three-Dimensional Modeling and In Silico Kinematic Evaluation of Interspinous Ligament Desmotomy in Horses. Front Bioeng Biotechnol 2022;10:817300.
    doi: 10.3389/fbioe.2022.817300pubmed: 35433641google scholar: lookup
  7. Atalaia T, Prazeres J, Abrantes J, Clayton HM. Equine Rehabilitation: A Scoping Review of the Literature. Animals (Basel) 2021 May 22;11(6).
    doi: 10.3390/ani11061508pubmed: 34067449google scholar: lookup
  8. Story MR, Haussler KK, Nout-Lomas YS, Aboellail TA, Kawcak CE, Barrett MF, Frisbie DD, McIlwraith CW. Equine Cervical Pain and Dysfunction: Pathology, Diagnosis and Treatment. Animals (Basel) 2021 Feb 6;11(2).
    doi: 10.3390/ani11020422pubmed: 33562089google scholar: lookup
  9. Argüelles D, Becero M, Muñoz A, Saitua A, Ramón T, Gascón E, Sánchez de Medina A, Prades M. Accelerometric Changes before and after Capacitive Resistive Electric Transfer Therapy in Horses with Thoracolumbar Pain Compared to a SHAM Procedure. Animals (Basel) 2020 Dec 5;10(12).
    doi: 10.3390/ani10122305pubmed: 33291357google scholar: lookup
  10. Haussler KK. Pressure Algometry for the Detection of Mechanical Nociceptive Thresholds in Horses. Animals (Basel) 2020 Nov 24;10(12).
    doi: 10.3390/ani10122195pubmed: 33255216google scholar: lookup
Subscribe to our newsletter
Join 100,113 horse owners like you who receive our email updates on horse health and nutrition.