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the differences between species and breeds. Goniometry
has been validated in Labrador Retrievers [361] and
cats, [362] but significant differences between breeds have
been reported, [363, 364] and there is no universal table of
normal ROM measurements; what is normal for one
breed may be joint instability for another. That is why
it is crucial to do bilateral measurements, so we can
compare the pathological limb with the contralateral
one.
Table 9.3 is for reference. It is based on data pub-
lished by Millis and Levine, [365] Cook et al., [366] Mann
et al. [363] (dogs under anesthesia), Jaegger et al. [361]
(Labradors), Thomovsky et al. [364] (Dachshunds), and Figure 9.9 Anatomical references of the hip area: tuber
Jaeger et al. [362] (cats). You can check Appendix B for a ischiadicum, tuber sacrale, and greater trochanter.
more visual and graphic reminder of ROMs.

9.7 How to improve results make sure he/she knows how to find it, and the area
around it you want to be treated.
9.7.1 Asking the right questions • Is the size of the treatment area consistent? If
the hip is going to be treated, focusing a particu-
Generally speaking, your chances of getting the clinical lar number of joules over the greater trochanter is
improvement you expect depend on the initial situa- very different from spreading that same amount
tion, the type of patient, and the therapeutic approach. of energy from the sacroiliac joint to the proximal
Although the following points should be considered third of the femur; in the second case, your J/cm
2
from the beginning, they should be reassessed if the will decrease. Having clear anatomical references is
progression is not as good as expected. important (Fig. 9.9). Also, covering the entire area
you want to treat will give you better results than
• Is the diagnosis correct? This also includes: just treating some points within it.
• What is the diagnosis based on? Have X-rays/ • Are dose and power enough? Some refractory
magnetic resonance imaging (MRI)/other tests painful conditions need an increase in both of these
been performed if necessary? parameters. Treat chronic conditions with higher
• Have malignancies been ruled out? doses: for a hip, 8–10 J/cm is a good starting dose,
2
• Is the diagnosis complete? Make sure you perform but increase it by 20–30% in following treatments
a good general, neurological, and orthopedic exam. if there is no improvement after 2–3 sessions.
Assess compensation and overload areas. A biome- Increase power density in obese animals, to com-
chanical change in the body affects other areas, as in pensate for the subcutaneous fat. As usual, be aware
2
a chain reaction. Many patients with hip problems of the power density (W/cm ) being used and how it
will have soreness in their backs, or the neck and increases local temperature; you may need to use a
shoulders may be overloaded if the animal is putting higher hand speed. This is especially true for darker
less weight on the caudal extremities. If a cruciate coats. If the coat is also long and frizzy, as in some
ligament is damaged, the contralateral one will be Belgian sheepdogs (Groenendael), for instance, it
under more strain. All of these situations or extra may be advisable to stop the treatment every once in
sore areas need to be addressed in the treatment a while to remove the hair that may have got stuck
plan for your patient. in the hand-piece.
• Is the right area being treated? A perfect diagno- • Again, are you sure of the dose you are applying?
sis on the report does not mean the person who is Depending on the patient, you may decide to include
delivering the therapy has a good knowledge of the a larger or smaller area for each joint. For instance,
anatomy. For instance, if you are trusting the treat- to treat an elbow, some will include all the area from
ment of a patellar ligament to your new technician, the distal third of the humerus to the proximal third

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