Cases

Dr. Stuart Shoemaker, DVM

“I was introduced to the P3 at the NRHA Futurity and was able to get a good reference from Todd Bergen. He was impressed with the results using the P3 on some of his horses. Having a trainer you know with the skills Todd has was very important in getting me interested,” says Shoemaker.

“Since that time, we have been using the P-3 for two years for a variety of issues in performance horses in an attempt to characterize its value,” he says. Early on, his goal was to establish a clinical impression of response to a specific group of injuries. He elected to use the P3 for muscle and soft tissue injuries associated with back, sacroiliac area, gluteal muscle and other large muscle masses of the hind limb.

Shoemaker ran hematology for muscle enzymes (CPK, AST) before and after treatment in several cases to ensure no elevations were present pre-treatment and that none became elevated with treatment. Surface temperature was taken pre- and post-treatment to get a clinical impression of blood flow.

“Case selection is always challenging. The young western performance horse has numerous lameness/ reduced performance conditions associated with muscle, tendon-bone and ligament-bone interfaces which can be challenging to manage. We chose these cases because there is no good therapeutic option that is agreed upon in the literature or by clinicians,” explains Shoemaker.

“We treated selected patients a minimum of three times for 30 minutes per treatment. In most cases, the treatments were on consecutive days. A number of patients had 7 or more treatments. All patients tolerated the treatment well and most seemed to like it after the first few minutes. At no time were any adverse side effects seen,” he says.

“At this point, we are using the machine for soft tissue (predominantly muscle) injuries. It is important to realize that professional equine athletes suffer from many soft tissue and muscle injuries. These are very common in performance horses and represent a significant problem in training. The ability to increase blood supply to promote healing is crucial and the P3 technology does increase circulation to the treated area. In addition the P3 has a profound effect on muscle pain and spasm. Getting the large muscle masses we see in the horse to be less painful and to relax allows continued exercise and rehabilitation which is crucial to keeping an athlete in competition,” says Shoemaker.

“This therapy is not a one time treatment. These types of injuries require continued therapy daily or multiple times per week to allow the horse to achieve the maximum benefit. The key to most of these soft tissue injuries is early recognition and appropriate intervention. This, coupled with a well-constructed rehab program, can keep many horses in athletic training,” he explains.

“Response to treatment has been excellent for muscle soreness and muscle-bone interface problems. There is an analgesic effect shortly after treatment that lasts for varying amounts of time depending on the individual. We have seen an extremely high success rate in sore backs and gluteal muscle soreness. Response for other soft tissue injuries (suspensory ligament, tendon/tendon sheath, sacroiliac) have been very good, but due to the diversity of cases and variations in severity it is difficult to assess the long term outcome yet. Our impressions are very favorable. The P3 is a very effective non-invasive method of treatment for soft tissue orthopedic problems. More clinical research is needed for specific conditions, but the initial data is very encouraging,” he says.

“In addition to treating injuries, this technology can be extremely valuable to reduce the muscle soreness incurred during intense physical exercise and training. Young performance horses are learning new skills and developing physically and this causes significant muscular effort. P3 therapy provides a very beneficial non-invasive approach to total body care,” says Shoemaker.

Dr. Alan Donnell, DVM

Dr. Donnell has been using the P3 for two years and finds it safe, simple to use, non-invasive, and he says that horses feel better and perform better after its use. Donnell routinely takes the P3 to horse shows where it is in almost constant use. “The primary thing I use it for is horses with sore backs. In my practice we stopped using shockwave treatment on backs because this therapy replaces it. Sometimes the soreness is transient and returns; in other instances the pain goes away for quite a while,” says Donnell. He surmises that “deep stimulation opens the lymphatic system and allows the body to transport waste products out of the tissues thus relieving soreness.” He feels it is similar to a very deep massage and helps increase blood circulation to the area being treated.

“There is little if any scientific proof to back up what we are doing,” says Dr. Donnell. “At this time, however, I do know of one study in progress at the University of Illinois focusing on sacroiliac pain and trying to figure out why the P3 relieves the pain. The study is not completed yet, so at this point we are basing use of the P3 on the clinical and/or anecdotal results that we get,” he says. He has run blood work before and after application of the P3 and has seen no changes to suggest that the P3 does any harm to the horses.

“Clinically, we are getting some very good response to the P3 therapy in multiple areas, but primarily the back. This is our number one treatment. Other areas on which we use the P3 are chronic suspensory ligaments and wounds to expedite healing. We have used the P3 on a few horses with acute tying up syndrome –not only on the back, but also in the muscles of the hamstrings and gluteal muscles–with very good results,” he says.

“The P3 also helps stimulate hoof growth. We did a case study on one horse that we could not get to grow hoof. We had used shockwave therapy on one foot daily for 30 days (20 minutes per day) and used the P3 on the other foot. We got a dramatic increase in growth on the P3 foot as compared to the shockwave foot. The horse had bad seedy toe and we had done contrast studies – a venogram of his foot that showed a very decreased blood supply at the front of his foot because of fungal infection and seedy toe,” says Donnell. After treatment with the P3, the venogram was normal.

“We find that the P3 works well on the upper and lower leg although there is visibly more reaction to the P3 over larger muscle groups (back, etc.). It looks like it’s vibrating the horse. There is very little muscle in the lower leg, however. It is primarily tendon and bone,” he explains.

“I have been asked if it is safe to use the P3 on a pregnant mare. I would assume that it would not be an issue until the last trimester. I would try not to do anything on the abdomen of a pregnant mare in the last trimester. I don’t think there would be any problem using the P3 on the foot however,” says Donnell.

“When I was at the World Equestrian Games in September, 2006, the P3 probably ran about 8 hours per day. It is very safe and very dependable. With most of the high tech machines we usually have to have something done to them every month to keep them running. The P3 does not require expensive maintenance,” says Donnell.

This is not the only pulse machine on the market. We have had ours for two years and have worked it very hard.” He also likes it because it doesn’t take up much space and is very portable. One of the most popular uses for it is at horse shows, keeping athletes in top form for their competitive events.

“There are many uses for the P3 therapy currently and we continue to experiment with other applications. This is a type of therapy that is never going to hurt a horse,” says Donnell.

“The P3 is a relatively inexpensive treatment. To go over the entire horse it runs about $150 to $160 for a 30 minute treatment, but it might be as low as $50 to $60 to focus on just one specific area. When you look at what is spent on horses in today’s scheme of things, this is not very much,” says Donnell. As a “complimentary” therapy device that is non-invasive, he is confident that use of the P3 should continue to increase as more research is done on it. “With more information we should be able to tell clients exactly what the P3 does.”

Dr. David McCarroll, DVM

David McCarroll treats many athletic horses that compete in strenuous events such as reining and cutting and has used a P3 unit for 3 years. “When applied to the horse along the back or other large muscle masses, the muscles will actually fire or contract because of the pulsed magnetic flow through the body,” says McCarroll. “If you apply the P3 to a joint or bony surface where there is not a lot of muscle, you don’t see the muscle activity, but the P3 is still having a beneficial effect on circulation,” he says.

“The therapy does not cause pain but it can surprise a horse the first time you use it because of the unusual sensation. Once a horse gets used to it, however, he tends to relax quite a bit and acts sleepy, even though his muscles are twitching,” says McCarroll.

“You need to be careful the first time you apply it to the horse’s body. While operating the P3, there may be a small amount static electricity produced, like rubbing your feet across a carpet and then touching something. It does not cause the horse any discomfort, but could startle him if you happened to touch him. The coil should be held 4 to 8 inches from the body or the leg you are treating,” he says.

Dr. McCarroll has used the P3 on himself and knows that it does alleviate pain very quickly. “I have tendonitis in my right Achilles tendon, and when it flares up I just lean that coil against my leg and turn it on for about 5 minutes, and it makes the pain go away for several days. It doesn’t take very long, treating that spot, to tell the difference. My brother, who is also a veterinarian, has one of these machines and uses it on his back as well as on his horse patients. When he has back pain he just leans the coil up against the back of a chair and sits next to it. It helps him become more comfortable right away. So from this personal experimentation, I know that it works,” says McCarroll.

“I use the P3 mainly on conditions of inflammation and soreness, especially at horse shows. It is very helpful for sore joints such as ankles, knees, hocks, and stifles, and especially sore backs, necks, and hamstring muscles. It is a great help to athletic horses that have worked hard and are getting tired or may have some strained muscles or joints,” he says.

“You can take a horse that reacts quite a bit when you run your thumb down his back (flinching in pain) before you use the machine, and if you do that same test after you use it, the horse doesn’t show any pain at all. It’s a very beneficial physical therapy. I’m not sure how it works, but I have observed it hundreds of times and know that it does improve a horse’s comfort level in short order. I can tell right away that horses with pain in a certain area tend to be a lot less sensitive almost immediately following its use,” says McCarroll. The pulsing seems to relieve pain and tension, muscle tightness and/or spasms, and relieves soreness around joints.

“I also use it on sore feet, with areas of inflammation. I’ve noticed a very positive response – probably because it stimulates circulation in the affected area. To treat a foot, I use the slot (tunnel) where I slide my x-ray plates under the foot for taking an x-ray. The coil fits very nicely inside that tunnel. The horse stands on this for 5 to 10 minutes (per foot) while the P3 is running. I’ve seen a dramatic response and relief of foot pain and elimination of lameness,” he says.

“I have used it here in our hospital to improve circulation in the feet of horses with acute laminitis. I don’t have enough numbers yet to report that it makes a statistical difference in the outcome, but I think that anything you can do to support the circulation of the foot is beneficial,” he explains.

Dr. McCarroll usually treats a horse at shows once per day. “You can use the P3 more frequently, however, with no harmful effects. I think it helps normalize circulation where it has been impaired–opens up the blood vessels and improves the exchange of metabolites and hastens the elimination of waste material away from the area,” he says.

“I am very pleased with the benefits resulting from use of P3 therapy and it has been an easy sell to clients. We are at the point where people know that it is reliably effective and seek us out to have it used on their horses,” says Dr. McCarroll.

Dr. Keith Merritt, DVM

Keith Merritt has been using the P3 in his practice for two years. “I use it mostly for sore backs (from withers to croup) and sacroiliac problems. I think that the P3 is the best thing we have ever used for these conditions. I do not know how it works, but I do know that the P3 does have pain-relieving effects because I have used it on myself,” says Merritt. He had two surgeries on his lower back last year and continues to have some pain, so he uses this therapy on his own back and it relieves the pain.

“How it helps these horses for so long I have no clue. I don’t understand why the pain relief lasts for six to eight weeks on certain horses. I have some clients’ horses that have chronic sacroiliac disease that we injected, and they’d get better for two weeks. These were diagnosed with bone scans. I was unable to block these horses sound, so we did bone scans and found increased uptake in the sacroiliac joints. We injected them and the pain relief lasted about two weeks. So we used shockwave therapy and it lasted about two weeks, but when we use the P3 machine, we get about six to eight weeks of relief,” he says.

“Since I started using the P3, during the past two years I have injected less than six horses for sacroiliac pain. Before that, I was injecting horses all the time. The P3 is a much more desirable alternative; the pain relief lasts three to four times as long as an injection or the shockwave, is cheaper, and non-invasive. You are not putting drugs into the horses – a big advantage and a better way to go,” says Merritt.

“The horse’s back is a difficult area to treat, and this is a revolutionary new therapy that has turned many horses around. The P3 has worked so well on backs that three of my clients, who are trainers, bought units for their own show horses with chronic back problems so that the horses could keep working and showing without medication. Even though the unit is expensive, these trainers feel it is well worth it,” says Merritt. “It can help top athletes perform at their peak ability, and it saves on veterinary bills.”

How often a horse is treated depends on the horse. “In my practice, in most instances a horse will be treated for five days in a row, for about 18 to 24 minutes per day, then won’t need it repeated for quite awhile. It all depends on the show schedule, and how severe the back injury is. The main use is for chronic back soreness rather than an acute injury,” he says. The chronic pain keeps the horse from performing at its best—similar to a person with a bad back.

“Many trainers have a chiropractor and acupuncturist (which may be the same person) work on these horses, too. The horses are easier to adjust—getting the back in line again—after they’ve had the P3 treatment. It may relax the back so it can be manipulated easier,” says Merritt.

Some horses also get degenerative joint disease in the spine between the dorsal facets of the vertebrae. “This is an osteoarthritis in the joints, just like you’d get in the hock or some other joint. The P3 machine also helps these horses, but the pain relief doesn’t last as long. It does help with the pain and helps them to move better and jump better, so I use it as a pain management tool on those horses,” he says. “It’s non-invasive and doesn’t hurt them, and helps them feel better.”

He hasn’t used it on very many feet, just because he doesn’t get many laminitis problems in his case load. “The feet I’ve use it on, it helped, but I’m not sure why. I’ve also used it on suspensory ligament injuries, but only found it of benefit on one horse out of 15 that I tried it on.”

“I know that the P3 is very safe. I have 2 units which we have used for many hours and have not experienced a single problem with the horses or the person operating the P3,” says Merritt. He bought his first unit in 2006 and took it with him to Wellington, Florida (where he spends every other week, from January to April), but this past year when he took the machine, his colleagues at the Illinois hospital felt they couldn’t be without it, so he had to buy another one.

Brenda McDuffee

In addition to many other state-of-the-art complementary therapies including the hyperbaric chamber, The Sanctuary recently acquired a P3,” says Brenda McDuffee, general manager. Brenda shows horses at top levels and became familiar with the benefits of the P3 as a result of her professional relationship with a number of the veterinarians and trainers featured in this article.

“It is the mission of The Sanctuary to have available to veterinarians a number of complementary therapies–and staff to use them–that will help to most expeditiously return your equine athlete to compete at 100 percent of his ability; also to provide equipment that will help to condition your athlete so as to prevent injury,” she says.

Much of what is being used now in equine sports therapy is a spinoff from human sports medicine. “It’s exciting, what we are able to do for these horses in treatment and rehabilitation, where not so long ago some of these injuries would have been career-ending,” says McDuffee.