Donnington Grove offers a wide range of treatment and therapies to aid a horse’s recovery from orthopaedic injury and help get them get back competing again or as part of a maintenance programme to keep them ‘on the road’.
Below are details of some of the therapies we offer to aid the quality of and speed of repair in addition to some of the more traditional therapies.
EXTRA CORPOREAL SHOCKWAVE (ESWT)
ESWT is a non-invasive treatment that uses sound waves to stimulate healing of many types of orthopaedic and soft tissue injuries. Shockwaves are high energy acoustic waves that, when targeted correctly, release a high amount of energy at tissue interfaces. This can increase blood flow to the area, improve tendon/ligament fibre alignment and reduce pain – all essential in the rehabilitation process. We use the technique most commonly in cases of back pain, during the non-surgical management of proximal suspensory desmitis and in the treatment of angular limb deformities in foals. Protocols vary depending on the injury, but usually are performed every 1-2 weeks for 3-5 consecutive treatments under light sedation. It is worth noting that the use of shockwave is regulated for horses in elite competition. The BHA and FEI do not allow ESWT within 7 days of a race or competition.
CLASS IV LASER
Laser therapy is a non-invasive rehabilitation technique that utilises photobiomodulation. This process of deep heat application accelerates healing and restores tissue function by causing a cascade of events at a cellular level, all of which improve microcirculation/tissue metabolism, reduce inflammation and relieve pain. It is generally used by us for tendon and ligament injuries.
The type of laser used is exceptionally important, with targeted class IV/V laser therapy being far superior at improving tissue function compared to other laser treatments. Treatment protocols needed to produce the required therapeutic effect are frequent. Daily treatments are ideal, and often horses are admitted to the hospital in order to have this performed.
Interleukin-1 Receptor Antagonist Peptide (IRAP) is a protein produced by the horse’s immune system in order to fight the major cause of inflammation within joints (IL-1). As it is a normal protein produced by the body, it is classed as an autologous product which is very unlikely to be rejected. Blood is collected aseptically from your horse and incubated for 24hrs at the hospital, encouraging the cells to produce a high concentration of IRAP. The resultant IRAP serum is drawn off and subsequently injected into the area of interest, with excess serum frozen for future use. IRAP is most often used in the management of osteoarthritis. It has no competition withdrawal and is relatively safe with limited side effects due to it being an autologous product.
Mesenchymal stem cells have a number of beneficial effects that can theoretically be harnessed to aid the treatment of a variety of tendon, ligament and joint diseases. They can stimulate tissue repair by changing into other cell types, preventing cell death and aiding the movement of regenerative cells/growth factors into an area of injury. They are usually taken aseptically from the bone marrow, blood or fatty tissue and harvested over a period of time in order to produce a high volume of stem cells. However, recently, a commercially available stem cell preparation has become available that skips this time-consuming step. The resultant solution can then be injected into the target area, usually a tendon/ligament or joint under arthroscopic/ultrasound or MRI guidance. Complications are rare, it has no withdrawal time and experimental evidence of its use in a variety of different conditions is encouraging.
Platelet Rich Plasma is another autologous product, mainly used in the management of tendon/ligament core lesions. Approximately 60ml of blood is taken from your horse and then filtered, either on yard using a specialised filtration system or at the clinic via centrifuge. A plasma is subsequently produced that is high in growth factors and regenerative cytokines. This product can then be injected aseptically, usually via ultrasound guidance, sedation and local anaesthesia in soft tissue injuries, into a lesion in order to stimulate the movement of regenerative cells into the area, theoretically improving the healing process. It can be used in a variety of situations, however, has limited evidence currently in osteoarthritis management. Timing of injection (sometimes multiple are needed), filtration method and accurate placement of the product are exceptionally important, as it has the potential to cause a fibrotic reaction if injected outside the target area. Otherwise, it has limited side effects, doesn’t alter the rehabilitation process and is deemed relatively safe when used appropriately, alongside having no withdrawal time for competition.
Polyacrylamide Hydrogels first came into use as non-degradable tissue fillers in human plastic surgery. However, they since have been found to incorporate into the synovial membrane when injected into joints, forming a protective barrier against recurrent inflammation and improving shock absorption. They have shown promise in the management of varying degrees of osteoarthritis and are important in horses where subchondral pain plays a major part in the disease process. They are injected under sterile conditions, and take approximately 6-8 weeks to reach maximum effect, which must be noted as this is longer than other treatment options. Horses are often walked following injection to dissipate the medication throughout the joint, rested for 48hrs before starting a graduated return to exercise. Side effects are rare and, although repeat medication may be needed at the 6-8week stage, more and more evidence of a long-term beneficial effect is being found. Currently, no withdrawal times are published and so a mandatory stand down time of 14 days before competition is encouraged.