Shock wave therapy has been around for medical purposes in humans and animals for over 25 years. It was first discovered during World War II when research indicated that shock waves created by depth charges led to internal damage in the lungs of castaways. The first medical shock wave use was developed for the treatment of kidney stones. The use of shock waves for treatment of soft tissue injuries began in the mid-90's.
Shock waves are not electrical shocks. They are pressure waves generated through various mechanisms. Each mechanism creates a characteristic waveform and energy density. There are currently 2 main types of shockwave used therapeutically; focused and radial. It is important to understand the difference between the two types.
Focused waves can be generated electrohydraulically, piezoelectrically, and electromagnetically. Focused shock waves converge on a small target point and do not expose surrounding tissues to the same peak pressures. Radial shock waves are generated pneumatically. Radial shock waves have lower peak pressures and reduced depth of penetration and expose all tissues to similar pressures. Due to the fact that many of the conditions that require shock wave therapy are deeper than can be reached with radial shock wave therapy, focused shock wave is often more beneficial. In addition, focused shock wave therapy does not damage surrounding tissue, as can happen with radial shock wave.
People ask how you tell the difference between radial and focused shock wave units. The easiest way to tell the difference is by the cost charged to the owner. A quick survey of veterinarians using radial shockwave in the Midwest found that they were charging $140 to $200. The veterinarians using the focused units were charging $250 to $500. The focused shock wave units cost about $40,000, whereas the radial units cost around $18,000. The machine at Conley and Koontz Equine Hospital is a focused shock wave using electrohydraulic pressure waves. The fee for a treatment starts at approximately $275.
Another way you can tell the difference between the two types of shockwave units is by the style of handpiece. A focused unit handpiece has a soft funnel shaped end. The handpiece of a radial unit is long and slender like the barrel of a gun.
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| Figure 1: Focused Shockwave Handpeice |
Figure 2: Radial Shockwave Handpiece |
It has been demonstrated that shock waves increase regional blood flow, have direct cellular effects, and activated osteogenic factors. The direct cellular effects include; increase tissue regeneration, induce new blood vessel development, and increase blood supply. It is also well recognized that shockwave provides pain relief. The level and duration of pain relief has not been demonstrated. Shock wave therapy treatment is used in humans for the treatment of plantar fasciitis, heel spurs, tennis elbow, non-healing fractures, and tendonitis. Up to 80% improvement has been demonstrated in tennis elbow and heel spurs.
In veterinary medicine, shock wave has demonstrated great success with most of these conditions in the horse:
- wound healing
- navicular disease
- tendon, ligament, and other soft tissue injuries
- muscle pain
- osteoarthritis
- tibial stress fractures
- bucked shins
- impinging dorsal spinous processes (withers)
- proximal sesamoid bone fractures
- incomplete long pastern fractures
- subchondral bone pain
- angular limb deformities
Watch our video demonstration of shockwave therapy with an equine patient. Recently a study published from Iowa State University demonstrated that focused extracorporeal shock wave therapy can speed wound healing on the lower leg, resulting in wounds healing up to two weeks faster than wounds without shock wave therapy. In our practice we like to administer shock wave therapy to wounds once they have a nice granulation bed formed. It has demonstrated great benefit on wounds that have been slow to heel or wounds where we are limited in the amount of time that we have to achieve a cosmetic outcome. Figure 3 and 4 demonstrates a wound before and seven days after shock wave therapy. The wound margins are considerably smaller and the granulation tissue has a healthier appearance just 7 days after the shock wave therapy has been performed.
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Figure 3: Before Shock Wave therapy |
Figure 4: Seven days after Shock Wave Therapy. Notice the smaller wound margins and healthier granulation tissue. |
At Conley and Koontz Equine Hospital, we have been recently using shock wave therapy on horses with diagnosed heel pain (Figure 5). These horses may suffer from navicular syndrome/disease or soft tissue injuries within the heel region. Shock wave therapy used in this region improves healing of soft tissue injuries, but also reduces pain. We routinely use shock wave for the analgesic effect that it provides to the heel region. To learn how shockwave has been used in our clinic for treatment of navicular syndrome, Click Here.
| Figure 5: Shock wave of heel area |
In addition to the healing benefit of shock wave therapy in the horses, we have been using shock wave therapy for horses suffering muscle, neck, and back pain. Horses that have been showing all season and are starting to tire respond very well to shockwave therapy for pain relief.
At Conley and Koontz Equine Hospital we have used shock wave therapy for multiple conditions with great success. If you have any questions or concerns, or would like to schedule a shock wave therapy appointment, please feel free to contact us. To learn more about shock wave therapy and equipment you can also visit FOCUS-IT.