Clean Run - October 2017 - 18

Shockwave therapy improves lameness
in dogs with osteoarthritis of the elbows,
hips, and stifles, and improves comfort in
dogs with lumbosacral disease.

Shockwave therapy can be applied to
the stifle joint for treatment of patellar
tendonitis, osteoarthritis, and to accelerate
bone healing after surgery.

Shockwaves have also been utilized to
improve wound healing.

Contraindications to Shockwave
Therapy
Shockwave therapy should not be performed over sites of tumors, unstable
fractures, or in patients with neurologic
disease. Shockwave therapy should also
not be performed over gas-filled cavities
like the chest, or a gas-filled organ like
the stomach, because this can result in
high energy transfer and tissue damage.
At Veterinary Orthopedic and Sports
Medicine Group (VOSM) in Annapolis
Junction, Maryland, shockwave therapy
is not applied to areas that have been
treated with stem cells in order to prevent altering the regenerative function
of the cells.

Clinical Application of Extracorporeal Shockwave Therapy
Shockwave therapy should always be
integrated into a customized, compre-

hensive rehabilitation therapy program for each patient. For almost all patients, activity
modification, such as elimination of running, jumping, and off-leash activity, is recommended during recovery from injury. Daily therapeutic home exercises are prescribed
to help restore muscle strength and joint mobility, which in turn result in greater support to the injured area. Other rehabilitation techniques such as magnetic field therapy,
massage, and hydrotherapy may also be recommended. A certified canine rehabilitation veterinarian will determine the best treatment plan for each canine athlete.
Shockwave therapy is loud and can cause some discomfort during treatment. For this
reason, sedation or light anesthesia is administered to facilitate treatment. In order to
maximize energy transmission, the hair is clipped from the treatment site and ultrasound gel is placed on the applicator. Different size trodes are available so that the
treatment area can be efficiently targeted, with the larger trode used for larger sites
like the lumbar spine, and the smaller trode used for smaller sites like the elbow. Unlike with laser therapy, no personal protective equipment, like goggles, is required for
the therapist or assistant.
Most treatment sessions last 5 to 10 minutes. During a session, the trode is gently
moved along the target tissue until the pre-selected number of shocks has been delivered. In general, 500 to 1000 shocks are delivered per session, with smaller dogs or
smaller treatment areas receiving fewer shocks than large dogs or large treatment
areas. For most musculoskeletal conditions, two to three treatment sessions are
performed, two to three weeks apart. Patients typically show improvement in their
lameness within 24 hours of the first treatment. The need for repeated sessions is
determined by the condition being treated and clinical reassessment. For fractures
or delayed unions, treatments are repeated until radiographs show that the bone is
healed. Tendinopathies are re-assessed based upon evaluation of lameness, either
subjectively or objectively using gait analysis, and diagnostic musculoskeletal ultrasound. Wounds should be treated until they are fully healed.
For osteoarthritis, in which long-term resolution is not expected, effects can last for
months, with treatments generally performed every 6 to 12 months as needed.
Adverse effects of shockwave therapy are rare. The most common reported side effect is reddening or bruising at the application site. For patients that experience bruising or discomfort, pain medications like tramadol or anti-inflammatory medications
can be used.

Conclusion
Extracorporeal shockwave therapy can be applied to multiple conditions which are
frequently encountered in canine athletes. Compared to other modalities like low
level laser therapy and therapeutic ultrasound, shockwave therapy requires fewer
treatment sessions and can have long lasting effects.
Like all rehabilitation therapy modalities, shockwave therapy should be incorporated into a customized plan for the individual patient by a certified rehabilitation
veterinarian. D

Lauren Meltzer, DVM, is currently an orthopedic surgery and sports medicine intern at VOSM. She earned her BA in biology from Washington University in St. Louis.
She received her Doctor of Veterinary Medicine from Purdue University. After graduation, she completed a small animal medicine and surgery internship at Iowa State
University. She then spent three years working in small animal general practice in Indiana before returning to specialized medicine for a small animal surgery internship
at Mission Veterinary Specialists in San Antonio, Texas. Dr. Meltzer's current research involves complications and outcomes of total hip replacement surgery in dogs.
Debra Canapp, DVM, CVA, CCRT, DACVSMR, became a board-certified diplomate with the American College of Veterinary Sports Medicine and Rehabilitation
(ACVSMR) in 2012. Her area of interest, clinical work, lecturing, and research, focuses on sports medicine and rehabilitation therapy-specifically canine
sports-related injury, sport rehabilitation, and performance. Dr. Canapp has completed advanced courses in canine rehabilitation, hydrotherapy,
acupuncture, sports medicine, orthopedics, and stem cell therapy. Currently, Dr. Canapp practices sports medicine, acupuncture, musculoskeletal ultrasound,
and rehabilitation therapy at VOSM, where she is also co-principal and medical director. To learn more about Dr. Canapp, please visit www.VOSM.com.
Sherman O. Canapp, Jr., DVM, MS, CCRT, DACVS-SA, DACVSMR, completed a combined Doctor of Veterinary Medicine/Master of Science at Kansas State University, an
internship in small animal medicine and surgery at the University of Missouri, and a three-year residency in small animal surgery at the University of Florida. Dr. Canapp
currently practices orthopedic surgery and sports medicine at VOSM, where he is chief of staff, and has earned diplomate status from both the American College of
Veterinary Surgeons and ACVSMR. His primary focus and research is in arthroscopy, regenerative medicine, and sports medicine. Dr. Canapp lectures nationally and
internationally, and is a consultant for numerous organizations and medical companies. Dr. Canapp is also president of Orthobiologic Innovations, LLC, which is dedicated
to research and development in sports medicine and regenerative medicine. To learn more about Dr. Canapp, please visit www.VOSM.com.
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