Following on from last month's edition where I discussed tendon and ligament injuries, I would go into some of the more veterinary related treatments which we have available.

Historically, tendon injuries can take a long time to heal, with an increased chance of re-injury because the damaged area never repairs as good as new.

We, as vets, are always on the look- out for new and better ways to speed up recovery.

Stem cell treatment This is the newest technique available and must still be considered a developing technology as we don't know how horses will respond in the long term - although short-term results are looking encouraging.

Stem cells are very clever cells that are unspecified', which means, in theory, that they can be converted into any different cell type we desire.

By inserting stem cells into a damaged area of tendon, the unspecified' cell will be converted into a specialised tenocyte, a cell which makes up the building block of healthy and normal tendons.

Normal tendon is made up of type 1 collagen', while repaired tendon is made of up type 2 collagen', which is weaker.

By using stem cells, we aim to repair' the damaged tendon as type 1 collagen, which means it will be the same strength as undamaged tendon, and so not at increased risk of re-injury.

If we are going to use stem cells, it is important that they are used as soon as possible in the healing process - that is, a decision is made to use them at the first scan.

Currently, stem cells are used mainly in moderate to severe injuries, and works best in core lesions.

The best source of adult stem cells is from bone marrow, and the easiest place to extract bone marrow from is from your horse's sternum (breastbone) or hip.

Once we have extracted the bone marrow, it is sent off to a special lab where the stem cells are harvested and multiplied up over a four-week period, until there are about 2,000,000 cells.

These stem cells are then injected into the damaged area of tendon, under ultrasound guidance (to make sure we put them in the right place).

Your horse will obviously be sedated while this is done, and his leg clipped and cleaned in a sterile preparation, to prevent introducing infection, which would be catastrophic.

After this procedure, your horse will require a few days' box rest and bandaging, before going back into an in-hand walking exercise programme.

Shockwave therapy We have been using shockwave therapy for a number of years, as an adjunct to treating tendon injuries, as well as a number of other orthopaedic disorders.

The shockwave is created by pressurised air - and is not an electrical shock in any way!

It provides short-term pain relief and, more importantly, it stimulates the healing process.

We have certainly had encouraging results with this treatment. It seems to be particularly useful in treating old, recurring injuries.

It is a non-invasive technique that can often be done in an unsedated horse - obviously depending on their temperament.

We usually do three to five cycles of treatment, 10-14 days apart, and usually 4-8 weeks after the injury occurred.