Specialty Spotlight: Extracorporeal Shockwave Therapy (ESWT)

December 16th, 2025 | Posted in General, Medical Articles

Extracorporeal Shockwave Therapy (ESWT)

Laura Perez, DVM, CVA, CCRT, FFCP

Upstate Veterinary Specialties is excited to now offer Extracorporeal Shockwave Therapy (ESWT) to our patients.

Lithotripsy or extracorporeal shockwave lithotripsy (ESWL) has been available for over 30 years and is used in human medicine to break up urinary and renal calculi with acoustic soundwaves. Extracorporeal shockwave therapy (ESWT) was derived from lithotripsy and was first successfully used to treat a non-union fracture in a human in 1988. Successful treatment of tendinitis, epicondylitis, and heel spur pain soon followed. ESWT is now used to treat a wide variety of chronic and acute musculoskeletal pain in humans. As efficacy was shown in human medicine, veterinary medicine quickly followed, initially with treatment of osteoarthritis and suspensory desmitis in horses. By the 1990s, ESWT was being used successfully in small animals for bone, joint, and tendon injuries, as well as for osteoarthritis.

The source from which the shockwaves are generated is located outside of the body = extra – corporeal. This is opposed to intracorporeal shockwave, which requires the use of an endoscope to deliver the pulses inside the body. While outside the body, ESWT can deliver shockwaves or pulses deep inside the body, reaching their peak pressure precisely at the target tissue.  These pulses dissipate mechanical energy into these tissues.

What are the effects of ESWT?

The mechanical energy transferred to tissues during ESWT causes a variety of biological responses at the cellular level.  It is hypothesized to result in increased expression of cytokines and growth factors leading to decreased inflammation, neovascularization, and cellular proliferation.

• Stimulates new blood vessel formation
• Regulates inflammation
• Releases nitric oxide (NO)
  • Vasodilation
  • Angiogenesis
  • Anti-inflammatory effect
• Changes levels of substance P
• Stimulates bone metabolism
  • activates osteogenesis by osteoblast differentiation and then by increased proliferation
  • induces proliferation of periosteal cells
• Releases growth factors
• Exhibits chondroprotective effects
  • inhibit cartilage degeneration and promote the rebuilding of subchondral bone
• Dissolution of calcified fibroblasts
• Stimulates lubricin production
  • Lubricin is a protein that acts as a natural lubricant in joints, reducing friction between articular cartilage surfaces
• Stimulates stem cells
• Antibacterial effects
• Pain relief
  • Increased serotonin in the dorsal horn and descending inhibition of pain signals

What is ESWT used to treat?

The array of conditions that ESWT has been shown to successfully treat continues to grow.  Below are areas most commonly being treated in small animals at this time:

• Tendinopathies – bicipital tenosynovitis, insertional tendinopathies, Achilles tendinopathies
• Degenerative joint disease
• Acute and chronic tendon and ligament injuries
• IVDD and lumbosacral stenosis
• Wounds
• Osteochondrosis dessicans
• Non-unions
• Trigger points

Contraindications

There are some basic contraindications/precautions where ESWT should not be used or used with caution.  This should be based on the knowledge and experience of the veterinary medical professional administering the treatment.

• Malignant tissue in the focal area
• Areas of infection that are not being appropriately treated in the focal area
• Coagulation disorders
• In conjunction with blood-thinning medication
• Pregnancy/fetus near the focal area
• Lung tissue in the focal area
• Brain tissue or spinal cord in the focal area
• Eyes in the focal area
• Epiphyseal growth plate in the focal area – In a recent animal study, ESWT was shown not to have a negative effect on growth plates, with different energy levels used having different effects on the growth plates.

Many of these contraindications are specific to the focal area.  For example, a pregnant dog with stifle osteoarthritis could still have treatment on their stifle.

Patient preparation and aftercare

The acoustic pulses require a liquid medium to travel through.  Air is the enemy of shockwave!  This is usually accomplished with the use of a coupling gel (ultrasound gel) and occasionally water to dampen the fur.  Shaving or clipping hair is rarely necessary.  Sedation is also often unnecessary.  The PiezoWave allows for treatments to be modified to be less intense as the patient adjusts or if they show any signs of discomfort.  Some conditions, such as OCD and non-unions, are known to be more painful with treatment, so sedation should be considered to make the treatment more tolerable.  While one of its benefits, it is important to remember that shockwave has an analgesic effect, so activity should be appropriately modified post-treatment for at least 72 hours.

The “Mechanics” of Shockwave:

 What is a shockwave or pulse?

The physical characteristics of a shockwave include:

• A single pulse high-pressure wave
• High peak pressure
• Short rise time and steep slope that occurs in nanoseconds
  • Followed by negative pressure, low tensile wave
• Small pulse width
  • Both waves occur over about 5-10 microseconds

The sharp, rapid increase in pressure waves is followed by a negative pressure drop. This results in generation of cavitation bubbles with subsequent collapse, leading to increased cellular permeability and production of free radicals. This is followed by the generation of anti-inflammatory cytokines and growth factors to decrease pain and inflammation and remodel soft tissues.

How are shockwaves generated?

There are several systems that can generate a shockwave including electrohydraulic, electromagnetic, and piezoelectric.  The technologies differ in terms of how the shockwave is generated, and other properties such as noise level, focal size, adjustment and focusing of the pulse, penetration depth, and pulse intensity.  UVS has a piezoelectric system, the PiezoWave2.  This system allows for selection of penetration depth and intensity to best treat the desired focal zone/tissue within the threshold of the patient.

Radial shockwave

These sound waves do not reach the same high peak pressure and require a longer time to reach their peak pressure.  The pressure wave generated spreads outward or radially, creating the highest energy flux density at the skin level.  This pressure decreases below the skin level.

We are excited to offer this modality to our patients as yet another means of pain management and to expedite healing.  If you have questions or a patient who you think may benefit from extracorporeal shockwave, please contact the rehabilitation service at 518-783-3198 or rehab@uvsonline.com.

-Laura Perez, DVM, CVA, CCRT, FFCP