What is Shockwave therapy and how does it work?
Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment option for patients with causes of lameness involving mainly ligament and tendon injuries. It works by sending high-pressure and high-velocity acoustic waves with very short pulses. The strength of the pulse breaks the sound barrier which creates a shockwave that reaches the desired tissue that it is applied on (Chamberlain and Colborne, 2016; Yocom and Bass, 2017). The mechanical stimulation created by the waves creates a microdamage in the tissue that re-starts the body’s own natural healing response. This means that the chronic condition returns to an acute state to re initiate the healing process, which is essential for efficient repair, healthy growth and improved functionality of the tissue (Modena et al., 2021; Chen et al., 2022).
There is extensive research that states some of the common causes of tendinopathies (chronic tendon injuries) are gradual wear and tear from overuse of the tendon or aging. Besides the repetitive movements in day-to-day life activities or overuse during sports training, traumatic injuries including full rupture can also occur (Del Buono et al., 2011; Gerdesmeyer et al., 2015). Regardless of the cause of damage, the lack of functionality of the tissue will have a negative effect on the mobility of the joints restricting their movement and causing lameness and pain in the limbs (BOSCH et al., 2007; Del Buono et al., 2011; Nourissat, Berenbaum and Duprez, 2015).
Injured tendons can take up 6 months to heal and even at the end of the healing process with conservative management, the tissue will have reduced tensile strength and elasticity due to the poor healing properties of the tissue. The scar tissue that is formed to patch up the tissue is not strong enough to withstand the pressures of healthy tissues and can increase the risk of re-injury and make recovery longer and more difficult (Arvind and Huang, 2021).
The therapeutic effects of the ESWT are valuable for tissues with slow repair properties and at chronic stages. Using the ESWT during the remodelling stage of healing, tendinopathies can be managed by breaking down the calcified deposits and scar tissue and promote the regression of the injury. This can be achieved by enhancing the blood supply, improve cell function to replace the scar tissue with optimal collagen fibres with improved elasticity and tensile strength, and finally allow these fibres to re-align in a more efficient pattern for movement (Leeman et al., 2016; Chen et al., 2022). Most importantly, the ESWT hold advantage over other non-invasive therapies due to the ability to aid in tissue regeneration and optimise its healing process and remodelling (BOSCH et al., 2007; Simplicio et al., 2020; Arvind and Huang, 2021; Modena et al., 2021). Therefore, the use of ESWT treatments will support the tissue through the stages of healing efficiently to allow the patients to reach full recovery, reduce risk of re-injury and promote pain relief.
Common conditions that can be treated
Some of the common conditions that can be treated with EST include, but are not limited to:
- Biceps/Supraspinatus tendinopathies
- Achilles tendon injuries
- Fibrotic myopathy
- Iliopsoas injuries
Regarding procedure:
ESWT treatments are performed by licenced veterinarians specialised and trained to use the electrotherapy. If ESWT is advised for your pet, sedation is used to keep your pet comfortable and stress free during the treatment session. Before using Shockwave therapy, a MSK diagnosis is required to diagnose the level of damage and the stage of healing in the tissue and for that, the area must be minimally shaved. Then, gel is applied on the skin to help with wave transmission and the probe is applied to the skin over the affected area to initiate the treatment.
The treatment itself has a short-lasting cycle, however the sedation and recovery time makes the total procedure time longer.
References
Gerdesmeyer, L., Mittermayr, R., Fuerst, M., Al Muderis, M., Thiele, R., Saxena, A. and Gollwitzer, H. (2015). Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy. International Journal of Surgery, 24, pp.154–159. doi: https://doi.org/10.1016/j.ijsu.2015.07.718.
Chamberlain, G. and Colborne, R. (2016). A review of the cellular and molecular effects of extracorporeal shockwave therapy. Veterinary and Comparative Orthopaedics and Traumatology, 29(02), pp.99–107. doi: https://doi.org/10.3415/vcot-15-04-0057.
Yocom, A.F. and Bass, L.D. (2017). Review of the application and efficacy of extracorporeal shockwave therapy in equine tendon and ligament injuries. Equine Veterinary Education, 31(5). doi: https://doi.org/10.1111/eve.12780.
BOSCH, G., LIN, Y.L., SCHIE, H.T.M., LEST, C.H.A., BARNEVELD, A. and WEEREN, P.R. (2007). Effect of extracorporeal shock wave therapy on the biochemical composition and metabolic activity of tenocytes in normal tendinous structures in ponies. Equine Veterinary Journal, 39(3), pp.226–231. doi: https://doi.org/10.2746/042516407x180408.
Del Buono, A., Battery, L., Denaro, V., Maccauro, G. and Maffulli, N. (2011). Tendinopathy and Inflammation: Some Truths. International Journal of Immunopathology and Pharmacology, 24(1_suppl2), pp.45–50. doi: https://doi.org/10.1177/03946320110241s209.
Nourissat, G., Berenbaum, F. and Duprez, D. (2015). Tendon injury: from biology to tendon repair. Nature Reviews Rheumatology, 11(4), pp.223–233. doi: https://doi.org/10.1038/nrrheum.2015.26.
Modena, D.A.O., Soares, C.D., Candido, E.C., Chaim, F.D.M., Cazzo, E. and Chaim, E.A. (2021). Effect of extracorporeal shock waves on inflammation and angiogenesis of integumentary tissue in obese individuals: stimulating repair and regeneration. Lasers in Medical Science.
doi: https://doi.org/10.1007/s10103-021-03387-x.
Chen, Y., Lyu, K., Lu, J., Jiang, L., Zhu, B., Liu, X., Li, Y., Liu, X., Long, L., Wang, X., Xu, H., Wang, D. and Li, S. (2022). Biological response of extracorporeal shock wave therapy to tendinopathy in vivo (review). Frontiers in Veterinary Science, 9. doi:https://doi.org/10.3389/fvets.2022.851894.
Arvind, V. and Huang, A.H. (2021). Reparative and Maladaptive Inflammation in Tendon Healing. Frontiers in Bioengineering and Biotechnology, [online] 9, p.719047.
doi: https://doi.org/10.3389/fbioe.2021.719047.
Leeman, J.J., Shaw, K.K., Mison, M.B., Perry, J.A., Carr, A. and Shultz, R. (2016). Extracorporeal shockwave therapy and therapeutic exercise for supraspinatus and biceps tendinopathies in 29 dogs. Veterinary Record, 179(15), pp.385–385. doi: https://doi.org/10.1136/vr.103487.
Simplicio, C.L., Purita, J., Murrell, W., Santos, G.S., dos Santos, R.G. and Lana, J.F.S.D. (2020). Extracorporeal shock wave therapy mechanisms in musculoskeletal regenerative medicine. Journal of Clinical Orthopaedics and Trauma, [online] 11(Suppl 3), pp.S309–S318. doi: https://doi.org/10.1016/j.jcot.2020.02.004.
