Physical modalities for equine treatment — once confined to specialist referral centres — are now commercially available for ambulatory equine practice and mid-size equine hospitals. Extracorporeal shockwave therapy (ESWT), class IV therapeutic laser and therapeutic ultrasound address different tissue types and different injury patterns. Understanding each modality’s evidence base helps clinicians apply them where they deliver genuine clinical benefit.
Extracorporeal shockwave therapy (ESWT)
ESWT delivers acoustic pressure waves into musculoskeletal tissue, stimulating cellular repair mechanisms, promoting neovascularisation, and modulating local pain. In equine medicine, the best-supported indications are:
- Proximal suspensory ligament desmitis (fore and hindlimb)
- Navicular syndrome and podotrochlear bursitis
- Tendinopathy (superficial digital flexor tendon, deep digital flexor tendon)
- Stress fracture and cortical bone remodelling support
- Osteoarthritis pain management
A typical ESWT course is three sessions at two-week intervals. High-energy protocols applied over the heel region and navicular area generally require sedation; lower-energy protocols for soft-tissue injuries can often be tolerated without chemical restraint.
The LumaVet SWT series ESWT units — SWT10, SWT20 and SWT30 — are radial and focused shockwave platforms configured for equine musculoskeletal use, with applicator probe sets for distal limb and back treatment.
Class IV therapeutic laser
Class IV laser (4–10 W continuous) delivers photobiomodulation to tissue depths of 3–5 cm, promoting ATP synthesis, reducing inflammation and accelerating wound healing. In equine practice, primary indications include:
- Superficial wound healing (lacerations, proud flesh management)
- Insertion-point desmopathy
- Post-injection site inflammation
- Post-surgical incision management
Class IV laser requires operator eye protection (optical density-appropriate goggles) for both clinician and patient at all times. Treatment times are shorter than class IIIb — typically 2–5 minutes per site at therapeutic power levels.
Therapeutic ultrasound
Diagnostic ultrasound and therapeutic ultrasound are entirely different technologies. Therapeutic ultrasound delivers continuous or pulsed low-frequency acoustic energy (1 or 3 MHz) to tissue, producing mild thermal effects at 1 MHz or predominantly non-thermal mechanical effects at 3 MHz. Equine applications include:
- Tendon and ligament remodelling support post-acute phase
- Promoting scar tissue maturation
- Joint capsule contracture management
Combining modalities
ESWT, laser and therapeutic ultrasound are complementary. ESWT targets deeper musculoskeletal structures; laser optimises superficial tissue healing and reduces inflammation; therapeutic ultrasound supports the remodelling phase. A physiotherapy protocol combining all three is used by many equine performance centres in Europe and Australasia, and the practice is expanding in Southeast Asian markets serving racing, polo and pleasure horse populations.
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