160 Canine Sports Medicine and Rehabilitation
Extracorporeal shock wave therapy
(ESWT)
Extracorporeal shock wave therapy (ESWT),
also known as high‐energy focused sound
wave therapy, was first introduced in the early
1980s as a noninvasive method for treating
kidney stones (Sems et al., 2006). Shock waves
are single pulsed sound waves that dissipate
mechanical energy at the interface of substances
with different acoustic impedance. Shock
waves produce approximately 1000 times the
pressure magnitude of ultrasound waves and
deliver energy at a controlled focal volume.
The mechanical energy transferred to tissues
following ESWT causes various biological
responses at the cellular level. This modality
has been increasingly used to treat a variety of
musculoskeletal conditions in humans and
veterinary patients (Rompe et al., 1996; Schaden
et al., 2001; Laverty and McClure, 2002; Dahlberg
et al., 2005; Sems et al., 2006; Mueller et al., 2007).
Benefits of ESWT include: increased bone, ten
don, and ligament healing, accelerated wound
healing, antibacterial properties, and pain relief
(Rompe et al., 1996; Laverty & McClure, 2002;
Sems et al., 2006). The exact mechanism of
action of ESWT has yet to be fully elucidated;
however, the mechanical stimulation of cells is
hypothesized to result in increased expression
of cytokines and growth factors leading to
decreased inflammation, neovascularization,
and cellular proliferation (Wang et al., 2002,
2003, 2005; Sems et al., 2006). ESWT has also
been demonstrated to speed healing and
increase quality of healing in soft tissue and
bone, protect chondrocytes, disintegrate calcifi
cations, and recruit stem cells to the treatment
site (Schaden et al., 2001; Gerdesmeyer et al.,
2003;Wang et al., 2005; Aicher et al., 2006; MorettiCase Study 7.2 Hip dysplasia—physical modalitiesSignalment: 11 y.o. F/S Golden Retriever.
Presenting complaint/history: Referred for pain and
weakness associated with bilateral (B) hip dysplasia
and severe DJD. Receiving NSAID. Tolerating two
10‐minute walks per day; difficulty negotiating stairs
at home.
Initial evaluation:● Gait (walk): lack of hip extension at end‐stance,
narrow-based pelvic limbs, increased weight
shifted onto thoracic limbs.
● Hip ROM: B extension 70% of normal.
● Muscle atrophy: significant atrophy of B ham-
string and gluteal groups.
● Flexibility/palpation: B iliopsoas, B deep gluteals,
B piriformis muscles tight and tender.
Assessment: Significant ROM, strength, flexibility
restrictions associated with chronic hip DJD, result-
ing in functional deficits.
Goals: Improve joint and muscular comfort to pro-
mote increased ROM, strength, flexibility and overall
mobility to allow continued leashed‐walks with client
and to negotiate the stairs in the home 3× per day in
10–12 weeks.Treatment plan: In addition to manual therapies,
therapeutic exercises, and continual instruction inappropriate home exercises, the following physical
modalities were included in the treatment plan:● NMES, B gluteals and hamstrings (frequency: 25
Hz; pulse duration: 150 μs; 2 s ramp; 10 s on, 30 s
off; amplitude to patient tolerance for 10 min).
Used throughout rehabilitation in progressively
more functional positions (sternal, standing, dur-
ing sit‐to‐stand transfer, etc.).
● Hot packs, B hips during NMES before active
exercise, 10 min. Patient’s skin checked every
3 minutes.
● TUS, B iliopsoas—area shaved before treatment
(mode: continuous; frequency: 1 MHz; intensity:
1.0 W/cm^2 : duration: 10 min), gentle stretch
applied during last 2 minutes. Discontinued when
flexibility and comfort sufficiently improved.
● Cryotherapy, B hips, 20 min during ride home
from session (second client in backseat with
patient). Used throughout rehabilitation course to
decrease pain and inflammation.
● LLLT, bilateral hips, 7 J/cm^2 , increasing to 9 J/cm^2
as therapy progressed. B iliopsoas 6 J/cm^2. Used
throughout rehabilitation course for pain control.With 12 weeks of therapy, the patient regained func-
tional hip extension range, increased muscle mass,
improved active hip extension and control during
gait, and was able to easily complete two 30‐minute
walks per day and negotiate the stairs at home.