A range of regenerative therapies are widely applied in the sport horse world on a daily basis. Whether it’s stem cell therapy, platelet-rich plasma (PRP), physical rehabilitation or laser therapy, they all have the same purpose: to replace or repair damage to tissues and organs commonly caused by injury and disease, and/or influenced by age and congenital defects.
The science and application of laser therapy (not to be confused with laser surgery) was explained in detail at a recent seminar presented by Ronald J. Riegel, DVM, at The Sanctuary Sports Therapy & Rehabilitation Center in Ocala, Florida. Riegel is a co-founder of the American Institute of Medical Laser Applications and is the author of Laser Therapy in the Companion Animal Practice, and co-author of Laser Therapy for the Equine Athlete.
What is It?
Low-level laser therapy (LLLT) is a form of laser treatment used in veterinary practice and by horse owners that uses low-power lasers to alter cellular function. Where high-power lasers used in surgery ablate tissue, low-power lasers instead stimulate tissue and encourage the cells to function.
When and How
Laser therapy is used for a number of reasons: to reduce pain and inflammation, to speed the healing of tendons and ligament problems, improve circulation, and accelerate tissue repair and wound healing. It can also blast bladder stones and stimulate acupuncture points. Laser therapy provides pain relief by increasing both blood flow and the local production of endorphins and serotonin. Inflammation is modulated by decreasing inflammatory prostaglandins and increasing metabolic activity.
In humans it has been proven that Class IV laser therapy decreases pain and increases function in people with epicondylitis (aka: tennis elbow). Pain and function are also positively affected in women with the chronic neurosensory disorder fibromyalgia. Laser therapy has also been shown to improve healing of oral ulcers caused by radiation and chemotherapy treatments for head and neck cancers.
In a rat model for ligament injury, laser therapy increased the rate of healing in experimentally-induced medial collateral injuries. Unfortunately, there are no peer-reviewed controlled clinical trials describing the effects of laser therapy in horses. So while the background knowledge is present and the anecdotal evidence is there, the scientific jury is still out.
What we Know
Fractures, suspensory tears, tendon injuries, osteoarthritis, and musculoskeletal injuries can all benefit from laser treatment. What is even more compelling is the rate at which laser treatment is effective in these processes. The speed of recovery from surgical incisions appears to be accelerated with the use of laser treatment, especially post-operative and in the management of acute and chronic pain. Horse owners who have watched the benefits of laser treatment will need no more convincing. There are, however, some contraindications to keep in mind, specifically with regard to cancerous tissue and sites of hemorrhaging. Caution should also be given when treating injection sites, testicles, horses with cardiac conditions, pregnant mares, and young horses with epiphysitis (inflamed growth plates).
Vet vs. Layman
Sport horse rehabilitation is multidimensional and while riders and grooms have become increasingly educated and adept in applying therapies, there is room for caution in understanding the line between the veterinarian’s role and the layman’s convenience. Even though there is no special training required to use laser therapy, the science cannot be understated. Like any sophisticated treatment, the application is best carried out by professionals to ensure maximum effect and safety. Dr. Riegel, who has become a global expert, confirms that laser therapy is a complex process.
Before treatment can begin it is important to fully understand the extent of the wavelength, how deep it goes, the power and correct dosage, as well as the frequency of administration. Also for consideration is body mass, skin color, and anatomical area. There are also variances in the mode of application, e.g. scanning or point-to-point and contact versus non-contact. Because no clinical trials exist in equine patients, there are no standard protocols for various injuries or body parts. Each treatment must be customized for the animal based on veterinary evaluation and knowledge of the effects of laser therapy.
Dr. Reigel also explained that mutually agreed upon goals needed to be set with the client for the frequency of the various stages of treatment from aggressive, to transitional, to maintenance. The benefits of laser therapy are cumulative in effect. The initial aggressive phase involves every day or every-other-day treatments. The transitional phase comprises once to twice weekly sessions. Less frequent treatments are needed during the maintenance phase.
There are several biological effects of laser treatment in addition to being an anti-inflammatory and accelerating the healing of wounds, tissue repair and cell growth. Therapy can also act as an analgesic, improving vascular and metabolic activity; reducing fibrous tissue formation and improving nerve function and the control of immune responses.
Rehabilitation modalities should always be carried out in consultation with your veterinarian and supervised by trained personnel. While there is no shortcut to restoring a horse to full health and performance, the application of regenerative therapies has clearly enhanced the process while minimizing any long-term damage or effects of injuries and illness.
