Extracorporeal shockwave therapy vs laser therapy

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Adam Christman, DVM, MBA: You know, we hear this a lot in the profession about laser therapy versus shockwave therapy And I know this is probably many questions many of you have out there too is like what are the indications or you know What are some recommendations? So share with us a little bit about the differences between those two and indications for either one.

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: Yeah, this comes up a lot. Yeah, and in my field veterinary rehabilitation Modalities are big. I always laugh that Rehabilitation is underwater treadmill and laser, you know, and then you did rehab, right? so I think laser is used for everything and While I think it has some really excellent applications. It's not the panacea the big difference is well There's a there's a lot of difference completely different modalities. This is a sound wave energy Very high pressure high velocity sound waves. So it's an acoustic type of therapy Laser is photobiomodulation. So it's actually light waves. It's photons. So it's a light therapy So, you know, really totally different. So apples to oranges where they have similarities is both of them are anti -inflammatory Both of them do increase blood flow and both of them are known to have pain relieving effects So then that begs to question. Well Why not just use laser because lasers used for a lot of other things? What I would say is very very different between the types of Responses that we're gonna have from extracorporeal shockwave therapy can pray compared to laser is this is a much bigger change at a cellular level than in laser So laser on a cellular level level is actually stimulating the mitochondria to make more ATP. That's the energy powerhouse Yep, but it does need to be done. You need repeated therapy So like one laser treatment is not likely to do anything you're gonna need repeated treatments over time So I would say comparatively comparatively it is it's a much softer therapy You're not quite doing as much of a big change This is really good when you have tissues that are not likely to heal on their own again, you know Surgery is not gonna help these are chronic repetitive injuries So if I had for example a chronic shoulder tendinopathy a biceps tendinopathy, I'm not gonna be lasering that I'm gonna be reaching for my shockwave. If I have a patient that has sore muscles and I'm looking to relax those, then I'm gonna be reaching for my laser OA. That's a really good one to talk about because we do have evidence that laser can help. In particular, there was a study on elbow OA and it showed that laser was helpful for that. I think laser is something a patient's coming in for weekly rehab. You can laser them every single week with a laser and that's totally fine. This, again, is it's a bigger treatment. There's just gonna be that two to three treatments in space, two to three weeks apart. And I'm gonna reach for this in my patients that, you know what, we did laser and it just didn't really do much. Let's go for the, you know, this more, it's gonna bring more blood flow. It's gonna have a bigger effect.

Adam Christman, DVM, MBA: And it just, so it sounds like laser has more sessions, we would need, generally speaking, and shockwave therapy would have less. And I just also think it from a business perspective, from a cost savings perspective, from a client, I think it, you know, might be more beneficial because we just know how busy we all are trying to get into the office with their pets. So, you know, if I knew as a pet owner, I'd probably get the shockwave therapy knowing that.

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: You know, I'll tell you, I'll tell you that. I mean, maybe I'm not supposed to say this, but I'll just be very honest. If I had one modality to choose in my rehab practice, it would be shockwave, not laser. Because not only is it fewer visits to the office, this will give you longer lasting results. Absolutely longer lasting results. And the other really big difference that I forgot to mention is the thermal effect. So laser, because it is a photo energy, it's a light energy, there is always the risk of burning your patient. And particularly these higher energy class four lasers that have become really popular, there's a reason why you have to move them. Because if you don't move them, you will burn your patient. Shockwave has no thermal effect whatsoever. So actually, if you look at it, this is actually safer. All the contraindications we talked about with pulse vet, those are all same contraindications with laser except the lungs, like you don't worry about the lungs. But you also don't do laser on major blood vessels. But the big difference with the laser is if you have a dark coated dog, you can burn them and I have seen it. I have seen patients be burned with it. That will never happen with the shockwave.