We are pleased to announce the arrival this month of our newest treatment modality which will soon be available at A Well Adjusted Pet: Extracorporeal Shock-Wave Therapy (ESWT) which provides a simple, alternative, and non-invasive treatment to assist in the multimodal approach to how I manage pain in my animal patients.
ESWT was first used for fragmentation of kidney stones (lithotripsy) in humans in the 1970's, and currently remains the state of the art for this purpose.
Musculoskeletal uses for ESWT in humans has included treatment of plantar fasciitis (where it is FDA approved), "tennis elbow", non-union fractures, calcifying tendonitis especially with achilles and shoulder injuries, and hip and knee arthritis pain and disease. ESWT is approved for human use as a "class III medical device", suggesting that it is safe and effective- but also has potential for risk if not used by a well trained medical provider appropriately.
"Shock-wave" is a physics term used to describe a rapid increase in pressure, such as the energy from an explosion or as an example- the energy from the sound heard when a clap of "thunder" is released into the atmosphere from a bolt of electricity or "lightening". In the case of ESWT, shock waves are generated in a therapy head outside the body by electro-hydraulic, electro-magnetic or piezo-electric means, and these sound waves are then transmitted through a gel probe into the tissue (much like a very powerful ultrasound machine). When the shock-wave in the body encounters a change in impedance (such as at a place of scar tissue, ligament or tendon attachment, or in a "muscle knot") the sound energy is released and absorbed by that tissue.
Typical pressures generated by ESWT are in the range of 500 BAR, which for reference represents the pressure on the seafloor at a depth of 3.125 miles! Energy delivered to a defined area of tissue (focal point) is defined as "energy flux density (EFD)", and given in mJ/mm2. (millijoules per millimeter squared)
The therapeutic mechanism of action of shock-waves on body tissues is still being studied, but is almost certainly multi-factorial. Potential mechanisms include stimulation of local nociceptors (pain receptors) that in turn block transmission of pain signals to the spinal cord and brain; the induction of pain relieving Nitric Oxide synthesis in tissues; the stimulation of osteoblast activity (bone building cells); the micro-rupture of poorly vascular tissues (ligaments, tendons, scar tissues) to encourage re-vascularization and recruitment of appropriate blood flow to bring in healing stem cells; and the stimulation of angiogenic (blood vessel growing) chemicals called cytokines. The biological effect of ESWT may vary with EFD. However current research is discovering that less forceful shock-waves, which can also be turned up or down in intensity during treatment and also focally directed at the unhealthy tissues, is as good or even better than higher pressure shock-wave forces made which also are less focused and travel in a more radial pathway through tissues. The new technology of our new PiezoWave2 Vet Unit, uses Piezoelectric Crystals to produce the high pressure sound waves and it has made ESWT machinery smaller, more affordable, and more accessible for animals to receive treatment without sedation, since it is less painful not as scary or loud to use !
With ESWT at A Well Adjusted Pet, we hope to better treat painful myofascial hardenings or "muscle trigger points" also known as "muscle knots" - which commonly restrict normal neuromuscular signaling and can inhibit muscle contractions making it hard to improve function and strengthening of weak muscles, and they also are very painful!
We will also better be able to treat other pain causing diseases of tendons and joint synovial sheaths, chronic arthritis and joint pain, pain caused by changes to the vertebrae (spinal arthritis or "spondylosis"), pain caused by deformities of the hip, elbow or shoulder, and also accelerate healing of bone following fractures or surgery.
We are excited to apply this newly offered modality to our patients and look forward to a consultation if you think that your animal has pain and would like to try this very effective ESWT treatment! I have had treatment on my own scar tissue, muscle knots, and joint pain with this amazing modality and can speak first hand to it's enormous pain relieving benefits. The human health providers who are currently utilizing this treatment modality are in private practice or work with professional sports teams in the area- including the San Francisco 49ers!
So- get ready for the newest and best treatments that physical/ sports medicine has to offer which is now available for our animal companions- and let us know if you'd like to schedule time to evaluate if your dog or cat or bunny may be a candidate for therapy.
Often results are seen within 1 treatment but it seems that 2-5 treatments are needed in some cases with monthly or quarterly maintenance treatment protocols dictated by patient condition, chronicity of the problem, and patient injury or discomfort or impaired mobility.