By Dr. Becker
Shockwave therapy -- officially called extracorporeal shockwave therapy (ESWT) – is generally understood by most of the veterinary community as useful in treating musculoskeletal injuries, osteoarthritis (OA), and wound healing in horses. According to Clinician’s Brief, the use of ESWT to aid healing in companion animals like dogs and cats is not as well recognized.
Many people hear the word “shockwave” and immediately think of an electrical shock. But the shockwaves used in ESWT are high-energy sound waves (acoustic energy) that are directed to a target treatment area on an animal’s body. The shockwaves trigger the body’s own repair mechanisms, which speeds healing and provides long-term improvement.
How ESWT Helps the Healing Process
ESWT has been used in human medicine for over 20 years to provide non-invasive treatment for urologic and orthopedic conditions.
ESWT employs electrohydraulic technology to generate shockwaves. The high-intensity sound waves interact with the tissues of the body, leading to a host of beneficial effects including development of new blood vessels, reversal of chronic inflammation, stimulation of collagen and dissolution of calcium build-up. This activity creates an optimal healing environment, and as the damaged area returns to normal, pain is alleviated and functionality is restored.
When shockwave therapy is applied to areas of non-healing tissue, it may trigger release of acute cytokines that stimulate healing. Accompanying pain relief may be the result of increased serotonin activity in the dorsal horn (located in the spinal cord).
Conditions Successfully Treated with Shockwave Therapy
Shockwave therapy is known to be beneficial in treating the following conditions in companion animals:
Hip and elbow dysplasia Painful scar tissue Degenerative joint disease (hip, elbow) Chronic back pain Osteoarthritis Lick granuloma Spondylosis (degeneration of joints in the spine) Sesamoiditis (chronic inflammation of bones in the foot) Tendon and ligament injuries Chronic wound care Legg-Calve-Perthes disease (degeneration of the head of the femur bone in the hind leg) Trigger points Non-healing (non-union) or delayed healing (delayed union) fractures Acupressure points
Actual Results of ESWT for Dogs
According to Clinician’s Brief:
- Of 4 dogs treated for non-healing fractures, 3 had significant improvement in bone healing following ESWT treatment.
- In a study of dogs with distal radial fracture non-unions (a break near the bottom of the front limb, just above the wrist joint), all dogs that received ESWT showed complete bone healing after 12 weeks, while no dogs in the control group achieved complete bony union.
- In a study of dogs with lameness resulting from soft tissue shoulder conditions, 88 percent showed improvement after shockwave therapy, with no surgical intervention.
- ESWT was also shown to significantly reduce distal ligament thickening in dogs with inflammation of knee joints following surgery for a CCL rupture.
- Shockwave therapy has proved beneficial in promoting the development of new blood vessels at the bone-tendon interface of the Achilles tendon in dogs.
- ESWT has been shown to modulate osteoarthritis in animals by decreasing production of nitric oxide in joints and inhibiting cell death in healthy cartilage. Shockwave therapy can also be beneficial in managing the pain of arthritis.
- Studies have demonstrated positive results in joint range of motion and peak vertical force in dogs with knee, hip and elbow arthritis.
Currently, there are only unpublished case reports on shockwave therapy for treating chronic wounds in small animals. However, based on its mechanism of action, ESWT may prove valuable in managing skin flaps and difficult and chronic wounds.
Treatment Specifics and Average Timeframes
The equipment used in ESWT can be loud, and the treatment can be painful, so animals are sedated. Since shockwave therapy is often used in combination with surgery, some patients may already be anesthetized at the time of treatment.
Treatment time depends on the strength of the shockwaves and the number of locations being treated. A common dose is 800 pulses per joint, which can be accomplished in under 4 minutes.
Animals normally begin to experience pain relief from ESWT within about 24 hours. Of course, depending on the condition being treated, other types of pain management may be necessary as well.
When treating musculoskeletal conditions, therapy is recommended every 2 to 3 weeks for 1 to 3 treatments or until symptom improvement or resolution is achieved. Wounds are usually treated once a week for as many weeks as necessary. With arthritis patients, ESWT is typically repeated every 6 to 12 months as needed.
Shockwave therapy should be used in conjunction with physical therapy (called “rehabilitation” in animals) to return patients to full activity.