Shockwave therapy, also known as extracorporeal shockwave therapy (ESWT), is a non-invasive therapeutic intervention that utilises high-energy acoustic waves. It is believed to stimulate healing for various musculoskeletal disorders. It has primarily been used in the field of orthopedics and sports medicine but has also found applications in other medical specialties.
During shockwave therapy, a device delivers controlled, mechanical pressure waves to the affected area of the body. These pressure waves are generated outside the body and transmitted through the skin to the targeted tissue. The waves pass through the tissue, causing microtrauma at a cellular level. This microtrauma triggers the body’s natural healing process, promoting tissue regeneration, neovascularization (formation of new blood vessels), and increased metabolic activity in the treated area.
The exact mechanism of action of shockwave therapy is not fully understood, but it is believed to have several beneficial effects. These include:
Enhanced blood circulation:
Shockwaves stimulate the formation of new blood vessels, improving blood supply to the treated area. This increased blood flow delivers oxygen, nutrients, and growth factors necessary for tissue healing.
Increased cell activity:
Shockwaves stimulate cellular activity, including the production of collagen, which is a crucial component of connective tissue. This helps in the repair and remodelling of damaged tissues.
Pain reduction:
Shockwaves can disrupt pain pathways and stimulate the release of pain-relieving substances in the body, providing analgesic effects. This makes it useful in the treatment of chronic pain conditions.
Shockwave therapy has been used to treat a range of musculoskeletal disorders. The vast majority of the research is into use of Shockwave therapy to treat pain caused by our tendons. It’s use for tendon rehabilitation include:
It’s worth noting that shockwave therapy is typically considered after more conservative treatments (e.g., rest, physical therapy, medication) have not provided sufficient relief. The treatment regimen usually involves multiple sessions, depending on the condition being treated. Sessions typically last about 10 to 15 minutes.
How Does Shockwave Therapy Work?
It is theorised that shockwave works through a number of mechanisms which help to stimulate the healing process including neovascularization (the formation of new blood vessels) and increased collagen production.
HOWEVER! with recent and ever-growing research.
The Types of Shockwave therapy:
Radial shock wave therapy and extracorporeal shock wave therapy (ESWT) are two different types of shockwave therapy techniques, primarily differing in the way the shockwaves are generated and delivered to the body. The key differences between radial shockwave therapy and extracorporeal shockwave therapy include:
Shockwave Generation:
In radial shock wave therapy, the shockwaves are generated electromagnetically or with compressed air. The shockwave pulses are then transmitted through a handpiece that is applied directly to the skin over the affected area. The generated shockwaves spread radially (in a circular pattern) from the point of contact.
In extracorporeal shock wave therapy, the shockwaves are generated using electrohydraulic, electromagnetic, or piezoelectric methods. The shockwaves are produced outside the body and transmitted through a gel medium or a water-filled cushion to the skin over the targeted area. These shockwaves are focused on the specific point of treatment using an applicator.
Depth of Penetration:
Radial shock wave therapy is typically used for treating superficial musculoskeletal conditions, such as tendinopathies near the skin surface or in shallow tissues. The radial shockwaves spread out and affect a larger area, which is beneficial for conditions that involve a broader treatment area.
Extracorporeal shock wave therapy is capable of reaching deeper tissues, making it suitable for treating conditions that involve deeper structures like tendons, ligaments, or bones. The focused shockwaves penetrate more deeply into the tissues, allowing for targeted treatment.
Treatment Technique:
In radial shockwave therapy, the handpiece is moved in a circular or sweeping motion over the skin, covering the entire area of the affected tissue. The shockwaves are applied in a diffuse manner, treating a broader region around the point of contact.
In extracorporeal shockwave therapy, the shockwaves are focused on the specific point of treatment. The applicator is precisely positioned over the target area, and the shockwaves are delivered in a more concentrated manner at the desired depth.
Intensity and Sensation:
Radial shockwave therapy generally delivers shockwaves with a lower peak pressure and intensity compared to extracorporeal shockwave therapy. The treatment is typically more comfortable for patients, causing minimal discomfort or pain during the procedure.
Extracorporeal shockwave therapy can deliver shockwaves with higher peak pressures and intensity levels. Patients may experience some discomfort or mild pain during the treatment, which can be managed with local anesthesia or analgesics if necessary.
Effectiveness and Safety of Shockwave Therapy in Tendinopathies:
Shockwave therapy has been found to be effective in the treatment of tendinopathy. This is a condition typically characterised by sudden or chronic tendon overload. More common tendinopathies include the Achilles tendon, patellar tendon, elbow (tennis/golfer’s elbow), and rotator cuff (we’ve all had one of these at some stage).
Numerous studies have investigated the use of shockwave therapy for tendinopathy, and overall, the results are promising. Although it should not be considered as the first treatment modality for tendon rehabilitation, shockwave therapy can help to reduce pain in stubborn or recalcitrant cases. It is also theorised that it helps to stimulate the healing process.
Treatment should typically be a minimum of 3 sessions. If there is a significant benefit from treatment, then typically 5 sessions in total may be of further help.
Shockwave therapy should be an adjunct to a comprehensive and holistic program including strengthening exercises, taping or orthosis if necessary, and activity modifications.
It’s important to note that the effectiveness of shockwave therapy for tendinopathy can vary depending on several factors, including the specific tendon involved, the severity and duration of the condition, and individual patient characteristics. Additionally, the optimal dosage and treatment protocols (e.g., number of sessions, frequency) may differ based on the research and clinical recommendations.
How long does a session of shockwave take?
The duration of a shockwave therapy session can vary depending on the specific condition being treated and the healthcare provider’s preferences. Typically, a single session of shockwave therapy can last between 10 to 30 minutes.
Shockwave therapy is a non-invasive medical treatment that uses high-energy shockwaves to stimulate healing and reduce pain in various musculoskeletal conditions, such as plantar fasciitis, tendinitis, and calcific shoulder tendinopathy, among others.
During the procedure, a device generates and delivers shockwaves to the affected area, and the patient may experience some discomfort or mild pain during the treatment. However, most patients tolerate the procedure well, and it is generally considered safe when performed by trained professionals.
Keep in mind that the number of sessions required can vary depending on the specific condition and the individual’s response to treatment. Some patient’s may need only one or a few sessions, while others may require multiple sessions spread over several weeks to achieve the desired results. It’s essential to consult with a healthcare provider to determine the most appropriate treatment plan for your specific condition.
Contraindications to Shockwave Therapy:
Contraindications are specific situations or conditions in which the treatment should not be performed due to potential risks or adverse effects. Below are some of the common contraindications to shockwave therapy:
Pregnancy: Shockwave therapy should be avoided during pregnancy to prevent any potential harm to the fetus.
Blood clotting disorders: Individuals with blood clotting disorders or those taking anticoagulant medications may not be suitable candidates for shockwave therapy due to the risk of increased bleeding or hematoma formation.
Cancer: Patients with cancer or a history of cancer in the treatment area should avoid shockwave therapy as it may promote tumor growth or metastasis.
Open wounds or infections: Shockwave therapy should not be applied to areas with open wounds or active infections as it can exacerbate the condition and increase the risk of spreading the infection.
Nerve-related conditions: Patients with certain neurological conditions or peripheral neuropathy may be at increased risk of nerve damage from shockwave therapy.
Severe circulatory disorders: Individuals with severe peripheral artery disease or other circulatory disorders may not be suitable candidates for shockwave therapy due to potential complications.
Corticosteroid injections: Recent corticosteroid injections in the target area may interfere with the effectiveness of shockwave therapy.
Children and adolescents: Shockwave therapy is generally not recommended for children and adolescents, as there is limited research on its safety and effectiveness in this age group.
Bone-related issues: Patients with certain bone conditions or bone fractures near the treatment area should avoid shockwave therapy, as it may worsen the condition or delay healing.
Implantable devices: Patients with implantable devices (e.g., pacemakers, defibrillators) should not receive shockwave therapy, as it may interfere with the functioning of these devices.
If you are considering booking shockwave therapy, ensure you DO NOT have any of the above contraindications. You may wish to chat to one of our Physios to discuss potential risks, benefits, and alternatives based on your specific situation.
