Dear Dr. Thompson:
My vet has recommended shock wave therapy to help my dog recover from a partial ACL tear. They did the initial therapy but want to do it two more times. I've done some research which shows it to be received positively by many vets, but a final verdict is still out. Given the expense, do you recommend shock wave therapy?
Shock wave therapy, also known as extracorporeal shock wave therapy (ESWT), is the application of high and low energy acoustic waves across the skin with the intention of helping breakdown tissue or to promote healing and repair.
This technology was originally developed to help break down kidney stones non-surgically that many people know as lithotripsy. Further investigation into ESWT has provided some promising results in promoting healing musculoskeletal disorders and injuries and as a result can help lessen pain in some patients. These results in human medicine have led to interest in its use for rehabilitation in veterinary patients, but as you mentioned definite research is still needed and while consensus is growing for the benefit of the therapy, it is far from concrete.
ESWT works in a couple of ways which can be either focused shock waves or radial pressure waves. The focused method is the most common modality in veterinary rehabilitation and can be used in awake patients with the average treatment lasting only a few minutes. It’s generally recommended to use one to three treatments spaced by two to three weeks and the goal of treatment is to accelerate tissue or bone healing. There seems to be good evidence for its use in tendon (attaches muscle to a bone) injuries in human and veterinary patients, but your situation is a little more complex given the nature of CrCL/ACL pathology in dogs.
Cranial cruciate ligament (CrCL) disorders in dogs, synonymous with ACL in people, generally has a progressive, degenerative component. This means that partial tears will inevitably progress to complete tears regardless of rehabilitation or rest and ultimately surgery will be needed. However, rehabilitation does have a place in these patients to improve muscle mass and maintain function leading up to surgery.
This has been loosely called “prehab” and the value pre-operatively is becoming to be more widely accepted. Rehabilitation is a critical part of recovery from surgery which can be a combination of at-home work and/or formal rehabilitation. Shock wave therapy can play a useful role in post-op healing and your veterinarian may recommend this treatment for your dog. Good luck with the eventual surgery and subsequent post-operative rehabilitation.
First Published July 28, 2024, 11:00 a.m.
