This relatively recent treatment option (derived from lithotripsy), initially used more in equine sports medicine, involves very high energy mechanical shock waves delivered to the area of pathology. This initiates similar biochemical responses to laser which cause neovascularisation and promotion of healing, particularly valuable in ligament and tendon but also bone healing and remarkably in lumbo sacral pain. This is non-invasive but requires general anaesthesia in pets (people can be persuaded to take the pain!) and is often repeated 3 times at 3 weekly intervals. We have used this increasingly over the last 3 years with some excellent results.