Shockwave Therapy and Nerve Regeneration for Veterinary Rehabilitation
In both human and animal medicine, extracorporeal shockwave therapy (ESWT) has long been used to treat orthopedic issues like tendon and ligament injuries or delayed bone healing. But research over the past two decades has revealed something even more impressive — shock waves can help damaged nerves regenerate.
For animals recovering from trauma, surgery, or nerve compression, this technology may offer a non-invasive, drug-free way to speed healing and restore mobility.
The first clues that shock waves could affect nerves came from early neuroscience research on small animals.
In 2001, Ohtori and colleagues found that applying ESWT caused a temporary degeneration of sensory nerve fibers followed by rapid regrowth and reinnervation (Ohtori et al., 2001). This reversible effect suggested controlled stimulation rather than damage.
A few years later, studies by Takahashi et al. (2003, 2006) showed that repeated low-energy treatments decreased pain-related neuropeptides (CGRP) providing a scientific explanation for the pain-relieving benefits seen in veterinary patients. They observed the reduced CGRP expression in the specific spinal dorsal horn cells (DRG cells) that innervate the rat footpad.
In 2006, a landmark study by Murata et al. revealed that ESWT increased neuron-regeneration proteins like GAP-43 and ATF3, both of which are essential for nerve healing (Murata et al., 2006).
The above studies all used a very similar rat model system. An electrohydraulic Dornier shock wave was used to apply 1000 shocks at 0.08 mJ/mm2 to the plantar surface of the hind paw. One treatment was applied and the data was collected 2 weeks after the treatment.
Scientific Proof: Nerves Do Regrow Faster With ESWT
The first clear demonstration of true nerve regeneration came from Hausner et al. (2012) in rats. Their study showed that animals treated with low-energy ESWT (300 pulses at 0.1 mJ/mm2 with an electrohydraulic OrthoWave 180) after sciatic nerve grafting had:
• Faster axonal regeneration
• More myelinated nerve fibers
• Earlier functional recovery measured through gait tests
Follow-up research by Mense and Hoheisel (2013) confirmed these results, showing quicker sensory and motor recovery
The two studies referenced above used a rat crush model on different nerves with significantly different shockwave protocols. Together, these studies support an evolving view of ESWT as more than a tool for pain relief, highlighting its potential role as a biological stimulator for nerve healing.
How Shock Waves Help Nerves Heal
Researchers have pinpointed several key phenomena associated with how therapeutic shockwave affects nerves:
• Axonal Regeneration – ESWT stimulates injured axons to regrow faster toward their target muscles (Hausner 2012).
• Remyelination – Schwann cells, the “insulating” glial cells of the peripheral nerve, multiply and promote myelin repair post ESWT therapy (Lee & Kim, 2015; Park et al., 2020)
• Growth Factor Activation – ESWT boosts molecules like VEGF, BDNF, and NGF, improving nerve blood flow and supporting regrowth (Guo et al., 2022)
• Cell Mechanotransduction – Mechanical impulses from ESWT convert into biochemical signals that activate repair genes in neural cells (Császár et al., 2015)
• Inflammation Control – Shock waves modulate cytokines through NF-κB pathways, reducing chronic inflammation while stimulating healing (Guo et al., 2022)
In animal rehabilitation, these mechanisms translate into quicker recovery from nerve injuries, improved balance, and stronger muscle return.
Real-World Applications in Veterinary Practice
Veterinary physiotherapists and rehabilitation specialists are now applying ESWT to:
• Dogs recovering from sciatic or radial nerve injuries after trauma or surgery
• Horses suffering from suprascapular neuropathy (“Sweeney shoulder”) or other peripheral nerve injury
• Small animals with post-paralysis nerve weakness after disc surgery or spinal trauma
Clinically, caregivers often see:
• Reduced hind-limb weakness
• Better gait symmetry
• A faster return to voluntary movement
• The non-invasive, safe nature also makes ESWT ideal for animals that cannot tolerate anesthesia
A Sound Future for Animal Recovery
For dogs, cats, and horses struggling with nerve-related lameness, paralysis, or post-surgical weakness, extracorporeal shockwave therapy offers a hopeful new frontier. It can provide improved nerve conduction and motor recovery without drugs or invasive surgery. ESWT is quickly becoming part of multimodal neurorehabilitation programs across modern veterinary practice.
It is important to recognize that the referenced clinical studies utilize different animal models, shockwave technologies, and treatment protocols. Careful attention to the specific model systems and parameters used in each study is essential when extrapolating findings to clinical ESWT applications. Direct comparisons between devices or studies are not appropriate without considering these differences. Clinicians must integrate the available research with a sound understanding of shockwave physics, nerve cell physiology, and the individual patient’s condition to develop case-specific therapeutic shockwave treatment plans.
References
Császár, N. B., Angstman, N. B., Milz, S., Sprecher, C. M., Kobel, P., Farhat, M., & Schmitz, C. (2015). Radial shock wave devices generate cavitation. PLoS ONE, 10(10), e0140541. https://doi.org/10.1371/journal.pone.0140541
Guo, J., Hai, H., & Ma, Y. (2022). Application of extracorporeal shock wave therapy in nervous system diseases: A review. Frontiers in Neurology, 13, 963849. https://doi.org/10.3389/fneur.2022.963849
Hausner, T., Pajer, K., Halat, G., Hopf, R., Schmidhammer, R., Redl, H., & Nógrádi, A. (2012). Improved rate of peripheral nerve regeneration induced by extracorporeal shock wave treatment in the rat. Experimental Neurology, 236(2), 363–370. https://doi.org/10.1016/j.expneurol.2012.04.019
Jokinen, L. L. J., Wuerfel, T., & Schmitz, C. (2023). Application of extracorporeal shock wave therapy in nervous system diseases. Frontiers in Neurology, 14, 1281684. https://doi.org/10.3389/fneur.2023.1281684
Kenmoku, T., Ochiai, N., Ohtori, S., Saisu, T., Sasho, T., Nakagawa, K., … Takahashi, K. (2012). Degeneration and recovery of the neuromuscular junction after application of extracorporeal shock wave therapy. Journal of Orthopaedic Research, 30(8), 1293–1299. https://doi.org/10.1002/jor.22111
Lee, J. H., & Kim, S. G. (2015). Effects of extracorporeal shock wave therapy on functional recovery and neurotrophin-3 expression after crushed sciatic nerve injury in rats. Ultrasound in Medicine & Biology, 41(3), 790–796.
Mense, S., & Hoheisel, U. (2013). Shock wave treatment improves nerve regeneration in the rat. Muscle & Nerve, 47(5), 702–710. https://doi.org/10.1002/mus.23631
Murata, R., Ohtori, S., Ochiai, N., Takahashi, N., Saisu, T., Moriya, H., & Takahashi, K. (2006). Extracorporeal shock waves induce the expression of ATF3 and GAP-43 in rat dorsal root ganglion neurons. Autonomic Neuroscience, 128(1–2), 96–100.
Ohtori, S., Inoue, G., Mannoji, C., Saisu, T., Takahashi, K., Mitsuhashi, S., … Moriya, H. (2001). Shock wave application to rat skin induces degeneration and reinnervation of sensory nerve fibers. Neuroscience Letters, 315(1–2), 57–60.
Park, H. J., Hong, J., Piao, Y., Shin, H. J., Lee, S. J., Rhyu, I. J., Yi, M. H., Kim, J., Kim, D. W., & Beom, J. (2020). Extracorporeal shockwave therapy enhances peripheral nerve remyelination and gait function in a crush model. Advances in Clinical and Experimental Medicine, 29(7), 819–824. https://doi.org/10.17219/acem/122177
Takahashi, N., Wada, Y., Ohtori, S., Saisu, T., Moriya, H., & Wada, Y. (2003). Application of shock waves to rat skin decreases calcitonin gene-related peptide immunoreactivity in dorsal root ganglion neurons. Autonomic Neuroscience, 107(1), 81–84.