APPLICATION OF SHOCKWAVE THERAPY OR EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT) IN DOG’S HEALINGS & PAIN MANAGEMENT
Shockwave therapy, officially named extracorporeal shockwave therapy (ESWT), has been used in dogs since 1999 when the first testing began but has been used in humans since 1992 to treat a variety of painful orthopedic conditions including rotator cuff injuries, plantar fasciitis and bone fractures. Shock waves are high-energy concentrated sound waves that originate outside the body and can be directed to a specific location within it. Since initial testing of shockwave therapy in dogs by numerous veterinary schools, there have been good results reported for the treatment of orthopedic conditions in dogs. At this time, the amount of studies is still limited.
What is shockwave therapy?
Shockwave therapy is a high-energy sound wave technology offering a noninvasive treatment option of dogs experiencing lameness and pain. The high-energy sound waves – sometimes called pulses – travel through soft tissue at customized depths, reaching specific treatment areas. These waves trigger the body’s repair system to activate. Different sized applicator heads (5mm and 20mm) allow shockwaves to penetrate to specific depths. Various energy settings allow for customization of application. Shockwave therapy employs admitting shockwaves to an area of the body. The high-intensity sound waves interact with the tissues in the dog’s body resulting in the stimulation of blood vessels, reducing chronic inflammation, stimulating the production of collagen, and dissolving calcium buildup. The act of applying shockwaves to a non-healing area is believed to encourage the healing process and promote pain relief to chronic conditions. The true effectiveness of stimulating healing is still being evaluated.
Shockwave therapy is a sonic pulse that uses high energy acoustic waves paired with a high peak-pressure. The treatment cycle is short lived, only lasting for a few minutes and the energy produced by the sonic pulse must be focused in order to achieve the best quality of treatment. Shockwave therapy is a procedure performed by a licensed veterinarian that specializes in therapies or shockwave therapy specifically.
Shockwaves result in higher energy outputs and deeper penetration than ultrasound or lasers. This kind of therapy has been proven effective with reducing healing time, improving mobility, and relieving pain. It can be used as part of a rehabilitation/routine postoperative program or in place of increased NSAID doses.
Shockwave therapy is a device used in human orthopaedics, physiotherapy, sports medicine, urology as well as veterinary medicine.Its main benefits are fast pain relief and restoring mobility. Together with being a non-surgical treatment with minimal need for painkillers makes it an ideal therapy to speed up recovery and cure various conditions causing acute or chronic pain.
Shockwave – despite its name is NOT an electric shock at all. It is a special frequency acoustic (sound) wave that carries high energy to painful areas and can be used to treat specific musculo-skeletal conditions. This energy promotes regeneration of bones, tendons and other soft tissues.
How does shockwave work?
Shockwave therapy aids in healing by stimulating the body’s regeneration process. The waves work on a cellular level, releasing proteins that accelerate healing. Energy is released as a shockwave as tissue interfaces where the density of the tissue or impedance of the sound waves changes. Neovascularization takes place, leading to increased blood supply to the treated tissue, resulting in tissue regeneration in tendons, joints, and bone. Shockwave is noninvasive so dogs are able to receive treatment with minimal recovery time. Many pets begin to see relief in one to three treatments. Results may seem to appear immediately, however, it takes time for the biological responses to take place.
Non-invasive shockwave therapy is completed on an outpatient basis, meaning treatment, recovery and discharge can be performed while owners wait. A typical treatment lasts 5-10 minutes. Because there is non-invasive sound energy and deep tissue penetration, your pet will only require a short acting sedative. We do this to ensure optimal comfort and minimal distress.
Preparation of the treatment area is minimal. A technician will clip any fur overlying the treatment area. This ensures uninterrupted sound transmission. Conductive gel is applied and the applicator head gently moves over the affected area. Gel is removed immediately after treatment so no mess goes home. It is important that dogs do not take part in strenuous or high-impact activity for a few days so their body may effectively heal. Depending on the case, additional treatments may be needed after 2-3 weeks.
Shockwave Therapy Procedure in Dogs
The veterinarian will first perform a routine diagnostic examination of the canine. Routine testing will include a physical exam, blood work, a urinalysis and possibly a fecal examination. Radiographs and/or an ultrasound of the injured area may also be taken prior to conducting the shockwave therapy procedure. The shockwave unit consists of a handheld wand that attaches to the energy source. The follow describes a simple shock wave procedure in a step-by-step format:
- The dog will be lightly sedated to keep the canine calm and ensure the treatment is applied accurately.
- The area of the dog’s body that requires treatment will be shaved to provide a better field of contact.
- A contact gel will then be placed on the dog’s freshly shaved skin, similar to the lubricant used during an ultrasound.
- The handheld wand is applied to the dog’s affected area and the deliverance of shock waves begin.
What conditions does Shockwave therapy treat in dogs?
Backed by more than a decade of clinical research, shockwave can be used to decrease lameness, increase mobility and relive pain in dogs with:
It’s been proven that shockwave therapy for dogs can help numerous amount orthopedic conditions including:
- Osteoarthritis
- Hip and Elbow dysplasia
- Chronic wounds
- Tendon and Ligament injuries
- Non- or delayed healing bone fractures
- Degenerative disc disease
- Degenerative joint disease
- Tendonitis
- Back pain
- Osteochondrosis lesions (OCD)
- Lick granulomas
What is the difference between shockwave therapy and laser therapy?
- The biggest difference between shockwave and lasers is the energy source. Lasers use light energy while shockwaves use sound energy.
- Shockwaves create higher energy outputs and can penetrate deeper than a laser. Lasers are mostly beneficial for superficial indications that require a few millimeters in depth.
- One to three shockwave treatments can provide long-term healing. In contrast, lasers require 10-15 treatments for any given injury. There is no proof using lasers for long-term healing is effective.
- Shockwave therapy is FDA-approved. There is over 10 years of shockwave research in both veterinary and human medicine.
- There are no risks of burns with sound energy. No protective eye wear is needed.
- Shockwave therapy has had no adverse effects reported.
History of veterinary use:
Bythe late 1990s, veterinarians began exploring the use of ESWT for horses to speed healing of broken bones (including those that failed to heal normally), treat tendon and ligament injuries, and ease the pain of arthritis.
The use of ESWT for horses has been evaluated at a number of veterinary schools, including the University of Tennessee, Purdue University, Iowa State University, Colorado State University, the University of California at Davis, and the University of Wisconsin. Clinical trials demonstrate that ESWT has been effective in treating musculoskeletal disorders that include bone spavin, stress fractures, navicular syndrome, bowed tendon, bucked shin, arthritic joints, and more.
Experimental treatment of dogs using ESWT began in 1999. Good results have been reported for treatment of various orthopedic conditions in dogs, but the number of controlled clinical studies is still very limited. Conditions likely to benefit from this treatment include osteoarthritis (shoulder, hip, back, elbow, knee, wrist and ankle), hip dysplasia, chronic back pain (spondylosis deformans, chronic intravertebral disk disease, lumbosacral instability), osteochondrosis lesions, sesamoiditis,tendon and ligament injuries, tendonitis, non-union or delayed-healing fractures, and lick granulomas. Treatment can be used alone or in combination with other therapies. Both young, athletic dogs and geriatric dogs can benefit. One manufacturer is promoting ESWT for four weeks prior to casting on toy dogs with broken legs when it is not possible to use screws.
Most studies show significant improvement in a majority of animals treated, but this treatment is still in the experimental stage, and results are not always consistent. This may be due to a poor understanding of the mechanisms and lack of guidance about the appropriate settings on the various devices on the market and optimal treatment regimen. As use of ESWT becomes more widespread, it is likely that overall results will improve as more is learned about how this methodology is best applied.
Practitioners interviewed in 2003 reported that approximately 70 percent of patients demonstrate a remarkable response to treatment. Another 15 percent exhibit improvement that is not as significant as the first group. Some of these may improve further with a second treatment. About 15 percent show no improvement. Shoulders, backs and hips seemed to respond best to ESWT, while treatment of knee injuries had the least response.
According to SanuWave, makers of VersaTron shock wave devices for horses and small animals, most cases demonstrate very significant improvement within a week. A second shock wave treatment two to three weeks later often improves the results further.
How does it work?
ESWT devices generate a series of focused high-pressure acoustic pulses (sound waves) that travel from the probe through the skin and soft tissue. When the waves meet tissue interfaces of different densities, such as where soft tissue, tendons, ligaments, cartilage and bone meet, the energy contained in the shock waves is released and interacts with the tissue, producing both mechanical and cellular effects.
The shock waves appear to relieve pain and stimulate healing within the injured tissue, although the mechanism for these effects is unclear. Researchers believe that ESWT stimulates the body’s own resources to speed healing, including increasing vascularization (blood supply) to the area being treated, increasing osteoblastic activity resulting in increased bone growth and cartilage synthesis, and increased osteoclastic activity resulting in absorption of unwanted bone spurs and calcium deposits, as well as other factors.
The reason that this treatment relieves arthritis pain is even less clear, but may have to do with depletion of neuropeptides that lead to the sensation of pain and can contribute to the inflammatory response. Shock waves do not appear to slow the progression of osteoarthritis, but rather reduce the pain associated with it.
ESWT devices consist of a box that generates the waves, and a wand (probe) that is used to target the waves to specific spots.
Mechanisms for generating shock waves:
Extracorporeal shock waves are pressure waves generated outside the body that can be focused at a specific site within the body. There are three types of ESWT devices, which generate high-energy, focused shock waves. They consist of electrohydraulic, electromagnetic and piezoelectric devices. All of these mechanisms convert electrical energy into a pressure wave within a fluid media (the body). No significant difference in effectiveness between these different methods of producing shock waves has yet been demonstrated. Electrohydraulic devices have been approved by the FDA for treatment of multiple conditions in humans.
A fourth type of device produces low- to medium-energy radial waves, also called ballistic or pressure waves. This type of treatment is most accurately called radial pressure wave therapy (RPWT), but is also sometimes referred to as radial shock wave therapy (RSWT) or grouped together with ESWT. RPWT utilizes a projectile mechanism to stimulate a pressure wave.
With ESWT, maximum energy is focused on a specific point,while with RPWT, energy is applied to the surface and radiates from there. More treatments with less time in between may be needed when using RPWT. Most studies in the US have been done using ESWT, which are the only devices approved by the FDA for treating humans. RPWT is widely used in Europe.
Safety Issues:
ESWT is generally considered safe, though high-intensity or prolonged treatment (beyond 1,000 pulses) might be capable of damaging tissue or bone. There are anecdotal reports of horses that have fractured bones following shock wave therapy, but the cause of the fracture is unknown. It is possible that the analgesic (pain-relieving) effect can lead to overuse, which would make injury more likely.
Care must be taken during treatment to avoid the brain, heart, lungs and intestines, as well as neurovascular structures (major nerves and blood vessels). ESWT is not recommended for dogs with clotting disorders due to the potential for bruising. Dogs that are immune-compromised may not respond as well to therapy, which is thought to rely on the body’s own immune system for healing.
With proper use, side effects are insignificant, limited to some bruising of the skin where the pulses are applied if bubbles are present or good contact with the probe cannot be achieved.
How the treatment is performed:
Physical exam is required to diagnose musculoskeletal disorder and to rule out neurological disease that cannot be treated with ESWT. It’s important to identify all the painful areas that should be treated, including secondary issues that may have developed due to compensation for an injured or painful joint. X-rays are usually required to help determine treatment, and other standard tests such as blood work and urinalysis may be done to ensure your dog is healthy prior to anesthesia.
Treatment is done under heavy sedation or short general anesthesia, as it causes discomfort that can range from mild to severe depending on the intensity used. The machines that generate the pulses are usually quite loud, which can also be frightening to the patient. It takes only a few minutes to treat each site. The area to be treated must be shaved and a gel applied to ensure transfer of energy from the probe head to the patient’s tissues, as any air between the probe and the skin will interfere with the mechanism. The veterinarian determines the energy level used and the number of pulses delivered based on the location, type and severity of the disorder.
Treatment regimen varies, but generally is repeated anywhere from one to three times, two weeks to a month apart. The dog may be a little more sore for 12 to 24 hours following treatment, though sometimes the opposite is the case and the treatment produces a short-term anesthetic effect, during which time you must be careful that your dog doesn’t overdo it. Improvement may be seen right away, or it may take a few weeks to see the full effects of the treatment. The process may need to be repeated yearly, though it lasts much longer in some dogs.
Compiled & Shared by- Team, LITD (Livestock Institute of Training & Development)
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