— MODALITIES & EQUIPMENT—
IMAGING
Portable Radiology (X-Ray)
Our digital x-ray machine is 100% portable! We can take radiographs of your horse in the comfort of your own barn as a part of a full performance evaluation. We can evaluate the images on site within seconds and develop a treatment plan for your horse right away.
Portable Ultrasound
All of our equipment is portable! We use our ultrasound machine to help guide our needle during certain joint injections. Ultrasound uses sound waves to produce an image of the inside of the body and joint injections are performed to help decrease inflammation, which is the primary cause of pain and joint damage.
SHOCKWAVE THERAPY
Neck & Back
Soft tissue
Arthritis
Platelet activation
Shockwave therapy uses sound waves to reduce pain and inflammation. It is a non-invasive treatment that stimulates the body’s natural healing process. The shockwave machine can direct sound, or acoustic, waves directly into injured tissues.
The acoustic waves help break up soft tissue calcifications, enhance collagen synthesis, release growth factors, and stimulate your horse’s healing process, while increasing blood flow, and activating cell metabolism to improve pain and help him stay active. Shockwave is extremely beneficial for patients who are suffering from acute or chronic injuries or who have arthritis. It can also be used to help foals suffering from angular limb deformity.
Shockwave therapy can be performed on any soft tissue in the body, including muscles, tendons, and ligaments, and works well when combined with many of our other treatment modalities. If your horse is suffering from an injury, arthritis, or pain, shockwave can be a wonderful treatment option — plus, it’s portable and non-invasive so we can perform a treatment in your horse’s own barn!
INJECTIONS
NOTE:
There are many different kinds of injectable solutions that may be used by your veterinarian depending on the symptoms, diagnosis, and treatment plan for your horse. We value transparency above all else, so please feel free to ask about the many different modalities of injections available and why they may be the best fit for your horse.
Corticosteroid Medications
Joint injections can be very beneficial for your equine athlete if they are lame, injured, or arthritic. Excessive fluid build up within the joint is called joint effusion, and is caused by damage to the structures of the joint from trauma, overuse, arthritis, or infection. Excessive effusion build up leads to inflammation of the structures of the joint. Removing the effusion can relieve swelling and pain in the joint and allow the structures to heal.
Joint injections are a wonderful option for a sore horse. Injecting steroids, stem cells, ProStride, or PRP (platelet-rich plasma) into the joint reduces inflammation and pain, and can potentially promote healing. Decreasing the inflammation and excessive fluid build up will lead to:
Decreased pain
Improved range of motion and joint mobility
Decreased swelling and excess fluid in the joint
Decreased joint damage
Increased willingness to work
Improved performance
Will I have to keep giving my horse injections forever?
If you’re hesitating to try joint injections for your horse because you think they’ll have to keep getting more indefinitely, that’s not always the case! You don’t have to keep getting joint injections in your horse!
There are a few different reasons why we would recommend joint injections. The purpose of joint injections are to decrease inflammation, which is the primary cause of pain and joint damage; however, it is possible for injections to lose their effectiveness. You will know when the injections are wearing off because your horse will show signs of pain again. Once the injection wears off, we can discuss whether to inject again or explore other options.
Some of the bad publicity cortisone therapy gets is because osteoarthritis is a progressive disease. You can control the pain and short-term progression of arthritic inflammation with steroids and injections, but as long your horse is working, the process is likely to continue. It is our job as veterinarians is to slow the process down
There are other ways to manage inflammation either in combination with injections or as an alternative treatment. Oral or injectable anti-inflammatories, oral or injectable joint support medications, shockwave therapy, or chiropractic adjustments are all beneficial therapies. Maintaining a healthy weight and daily exercise are also beneficial for osteoarthritis management.
Hyaluronic Acid (Legend; HA)
Hyaluronic acid (HA) is a compound that is commonly added to corticosteroids when injecting joints. It adds another “healing” element to the cortisone and helps nourish the joint by reducing friction, stimulating the joint to produce better joint fluid, reducing enzyme release, and providing pain relief — providing the best mixture of anti-inflammatory compounds for your horse’s healing and performance. HA is the primary active ingredient in Legend, which has been proven to decrease the presence of inflammation in the joint, reducing the degree of lameness.
Platelet-Rich Plasma (PRP) & IRAP
Platelet-rich plasma is a scientifically backed regenerative medicine treatment for soft tissue injuries. PRP is a concentrated solution of plasma created from your horse’s own blood. IRAP is used to produce autologous condition serum (ACS). By harnessing the regenerative and anti-inflammatory properties of the horse's own blood cells, damaged tissues are encouraged to heal. The solutions can be prepared right in your own barn in around 30 minutes. A sample of blood will be drawn from your horse, then placed into a centrifuge, where the platelet rich plasma will be separated, then the solution can be injected into the injured area of the horse.
PRP provides anti-inflammatory cytokines, which play a significant role in the healing, repair, and regeneration of soft tissue including tendons, ligaments, muscles. When platelets become activated, growth factors, white blood cells and anti-inflammatories are released, which play a significant role in natural healing, repair, and regeneration of injured tissue. Improvement can be seen within a few days of injection, with maximum results at 2-4 weeks post injection.
Because it is made from the patient’s own cells, it is a very safe treatment. IRAP and PRP can also be further processed into Pro-Stride!
Pro-Stride
Pro-Stride is an evidence- and research-backed autologous protein solution consisting of white blood cells, platelets, and concentrated plasma used to treat horses with osteoarthritis. The white blood cells contain cytokines which contain anti-inflammatory properties that reduce pain. Platelets contribute growth factors that promote healing. The concentrated plasma contains anabolic growth factors and cytokines. This concentrated cell solution has been proven to reduce pain, inhibit cartilage damage and joint breakdown, and regulate inflammation, restoring a healthy environment within the joint.
Pro-Stride injections have shown improvement in lameness, pain in flexion, gait analysis, and observed range of motion. Improvement is seen within a few days, peaking at 2-4 weeks after injection, and lasting upward of a year. Using Pro-Stride also reduces the need for repeated corticosteroid injections. This solution can be prepared right in your barn, requiring just a centrifuge once a blood sample has been collected.
Noltrex / Arthramid (Polyacrylamide)
Polyacrylamide products can be a fantastic solution to certain cases of advanced osteoarthritis in horses. Noltrex and Arthramid are synthetic polyacrylamide hydrogels used to provide improved joint lubrication by physically reducing friction within the joint. Hydrogels are injected directly into the joint to cushion the joint tissue and cartilage to re-establish healthy lubrication. Arthramid and Noltrex function in a similar way to hyaluronic acid, but do not degrade as quickly over time, providing significant long-term therapy and support for compromised joints.
Injection Locations: Ultrasound- & Radiology-Guided
When we perform joint injections, we use an ultrasound as a guide to see the needle while inserting it into the joint cavity. Ultrasound uses sound waves to produce an image of the inside of the body while performing the procedure. We can then see the medication flowing into the joint space as it’s injected.
For certain areas of the body, the veterinarian may choose to take portable radiographs, or x-rays, rather than an ultrasound, to visualize the needle as it enters the joint. Particularly intricate injection areas such as the navicular bursa, sesamoids, or TMJ, are not as easily articulated via ultrasound, so your vet may choose to perform the procedure with radiographs instead.
Using these modalities during injections ensures a perfect placement for accurate delivery of the medication. Radiology-guided injections are more accurate than blind injections, which are performed without imaging. With ultrasound guidance, the accuracy of joint injections is over 90% and can even be close to 100% in many cases. Blind injections, even in the hands of experienced practitioners, can be as inaccurate as 30-40% in some joints.
Mesotherapy
If your horse is suffering from inflammation or arthritis pain in the neck and back, then mesotherapy is a wonderful treatment option! Mesotherapy is performed by injecting the middle layer of skin (known as the mesoderm) on either side of the spine with Vitamin B12 using several small needles, which cause the small bumps you see in the image. A multi-injector is used, with three to four rows of injections made on each side of the affected area. The bumps disappear within a few days.
Mesotherapy is effective in treating a horse’s back and the cervical vertebrae. The injections activate the mesodermal layer of the skin and block nerve pain receptors which helps to stop the pain spasm cycle. The purpose of mesotherapy is to stop the restricted mobility in a certain area, which in isolation — or in combination with other treatments — can help restore normal function and movement.
Reasons for mesotherapy can include:
Sacroiliac pain
“Kissing spine” discomfort
Arthritis of the back or neck
One-sided neck stiffness
Generalized back discomfort
Can be enhanced when combined with chiropractic
Nerve Blocks
Botox has been used to treat laminitis in horses, which is a painful condition caused by inflammation or damage to the laminae tissue of the hoof wall causing increased tension to the tendons. It is injected into the deep digital flexor muscle and works by blocking the release of neurotransmitters in the nerve endings of the digital flexor tendon, allowing the muscle to relax. This treatment mimics a tenotomy, but is significantly less invasive.
Botox is a neurotoxin that is used for injected nerve blocks even in medical therapies and treatments for humans, whether for spasticity control, pain management, or muscular disorders. Many studies in both equine veterinary and human medicine support the beneficial activity of such toxins to manage pain and to treat a variety of conditions.
Laminitis impacts approximately 2% of the horse population each year. Because of the level of inflammation and chronic pain, it is frequently necessary to euthanize horses with high-severity cases, with another 20% often suffering permanent damage. The transition from laminitis to laminar failure is believed to be caused by the weight of the horse adding to the forces created by walking and other activity driving the navicular bone down into the hoof capsule. Treatment of laminitis often includes trying to reduce the pull of the deep digital flexor tendon on the pedal bone. The paralyzing effect of Botox will result in a decrease of these forces from the tendon, and therefore will aid in the prevention or treatment of laminitis.
