In the not-so-distant past, therapeutic options available for use on horses were somewhat limited. Although therapeutic ultrasound and electrical stimulation devices have been used in human sports medicine and hospitals since the 1950s and low energy lasers have been available since the early 1980s, many of these devices were not ideally configured for use on horses, being too large or heavy, requiring the use of electric cords, or requiring special training to use properly.
A new option has recently emerged to offer the horseman an easy-to-use, safe, and effective choice for stimulating tissue repair. Low Intensity Therapeutic Ultrasound (LITUS) systems have begun to emerge in the equine world as a treatment option for both daily maintenance and the rehabilitation of serious injuries.
Low intensity ultrasound provides the same healing benefit as traditional therapeutic ultrasound but does so by spreading the therapy safely over a long duration treatment. LITUS treatments range from 2-6 hours, but unlike traditional bulky systems, LITUS is worn unattended during the entire therapy. No supervision is required.
This particular system is ideal because it is very user-friendly, which allows the barn manager or trainer to apply the therapy daily without a licensed therapist or veterinarian involved. The advantages include:
* Intensity, mode, and frequency are preset to their most effective levels by the manufacturer. There is no worry that the system can be mis-administered or that your horse isn’t getting the optimal levels of ultrasonic energy.
* Exact placement of the device is not necessary due to a large saturation volume and long duration treatments. Your veterinarian or therapist should assist you with treatment site selection, but anyone can apply the device on a daily basis.
* The device is wearable, meaning that the horseman applies it to the problem site, secures it with the accompanying wrap, and leaves it in place for the prescribed time period. The horse remains in his stall and there is no need to supervise the treatment. This is a great savings in man-hour expenses.
SUPPORTED BY RESEARCH
A great deal of scientific study supports the use of LITUS, evidenced by numerous controlled animal studies in the last 10 years. LITUS has been field tested by veterinarians and equine therapists and proven to be a sturdy and effective therapy.
Some of the biggest problems facing our equine athletes include accelerated tendon and ligament healing , successful treatment of splints, and healing bone fractures.
Tendon and ligament injuries are the most common cripplers of the horse. A bowed tendon is the result of overstrain or tearing of the connective tissue fibers that make up the superficial flexor tendon. Scientific studies have shown that LITUS can accelerate processes involved in the early stages of tendon healing. A study comparing tensile strength (strength under stretch) between low intensity ultrasound treated and non-treated tendons showed that at 2 weeks the treated tendons were significantly stronger than the control group. Also the treated group showed denser granulation tissue at the tendon/bone interface in the early weeks of healing indicating acceleration in this phase of repair.
Splints are one of the most common lesions in the young horse. An acute splint is a tearing of the interosseous ligament that holds the third metacarpal bone (splint bone) to the second metacarpal bone (cannon bone), resulting in a sub periosteal hematoma and appearing as a swollen, hot, painful area in the space between the splint bone and the cannon bone, usually in the front leg.
Fracture healing is promoted with LITUS by stimulating bone cells to grow and repair. The sound waves produce micro-mechanical stresses to which bone cells respond.
It is interesting to note that the amount of energy deposited in treatment sites during one 4-6 hour session of LITUS is more than 10 times the amount of energy deposited in a single 15-minute high intensity session. Reviews of multiple studies show a strong correlation between total amount of energy deposited and rate of healing.
RECENT EQUINE AVAILABILITY
LITUS systems became available for equine use in 2011. Because of the versatility, safety, and ease of use, LITUS has already seen significant growth in use for the care of equine injuries, particularly in the competitive Hunter/Jumper world. This modality is made even more valuable to the horseman because of the scarcity of trained equine therapists presently in the US. Healing therapies in many forms, such as sound waves, light emission, magnetic fields, and electric fields are gaining appreciation and understanding from horsemen as their stimulating effects on equine tissue are becoming recognized. LITUS represents the latest evolutionary change in therapeutic devices for horses.
CASE REPORTS USING LITUS
Accelerated Tendon and Ligament Healing
* A seven year old Warmblood gelding was treated with anti-inflammatories, shockwave, and LITUS following an injury to the right hind lateral suspensory branch. The injury was treated in the acute stage and lameness resolved in 2 weeks. LITUS continued for 4 hours daily for 30 days. The veterinarian’s impression of the treatment outcome was that the suspensory ligament had a better response than is typical with other therapies alone. This horse returned to full work.
* A Hanovarian mare with a right front distal check ligament injury had persistent grade 1 lameness for two years, despite shock wave therapy treatments and controlled exercise. LITUS was applied daily for 4 hours over three weeks, resulting in an improvement in lameness and significant reduction of the swelling that had persisted at the injury site.
Successfully Treating Splints
* A Thoroughbred event horse presented with grade 3 lameness of the right forelimb due to a new splint formation. Treatment consisted of oral and injected anti-inflammatory medications along with stall rest for 7 days. Tack walking and small paddock turnout followed for the next 30 days. A low intensity ultrasound unit was utilized beginning two days after the initial injection of anti-inflammatory medication and was applied for 4 hours daily for three weeks. This application was well tolerated by the horse and the unit stayed in place overnight with no difficulties. The horse was 40% improved at 7 days, and 100% sound at two weeks with the splint reducing in size by 50% by week three.
* A case presented to a Hagyard Equine Medical Institute veterinarian exhibited a fractured accessory carpal bone that had failed to show bony healing following 3 months of stall rest and hand walking, bandaging for support, and 3 shock wave treatments. At this point there was significant instability present on medial-lateral manipulation of the accessory carpal bone while the leg was flexed. The horse then received 3 additional shock wave treatments one week apart, a treatment of Tildren, and the addition of low intensity ultrasound treatments applied for 4-6 hours daily for 30 consecutive days. Radiographic exams 1 month later showed significant bony healing and remodeling. The accessory carpal bone was much more stable on palpation, with very little medial to lateral movement.
Note: Case reports utilized UltrOZ Elite, manufactured and distributed by Zetroz LLC. The company’s technology was developed in collaboration with Cornell University, home of the world renowned Cornell Veterinary Hospital. For more information on the system, company or ultrasound therapy visit www.ultroz.com
Mimi Porter is the founder of Equine Therapy, Inc., a therapy service business for horses, and www.equinehealthcare.com , a website for equine therapists. Mimi is also the director of a Bachelor's degree curriculum in equine therapy at Midway College and has written a book, The New Equine Sports Therapy.