What Shockwave Therapy Can Do For You
What is Shockwave Therapy?
Shockwave therapy or extracorporeal shock wave therapy is a non-invasive treatment that is used in the treatment of many musculoskeletal conditions. The machine creates a series of acoustic energy wave impulses that are applied directly through the skin by a prob, similar to an ultrasound head. The device resembles a small, very low-powered jackhammer that creates high frequency mechanical pulses. The technology was initially used in 1982 for urologic conditions and the treatment of urinary stones as it was shown that sound waves were able to break down kidney and gallstones. Since then, it has become another tool for physiotherapists to use for chronic conditions (greater than 6 weeks), primarily those involving connective tissues such as ligaments and tendons.
Depending on the condition being treated, shockwave treatment is usually done once a week for 3-6 weeks. The treatment can produce some mild discomfort, but it only lasts 3-4 minutes, and the intensity can be adjusted to keep it comfortable. There is also some noise with the treatment from the mechanical pulse, ear plugs can be used if there are any sound sensitivities.
What conditions are commonly treated with Shockwave?
- Plantar Fasciitis or foot pain
- Achilles Tendinopathy or heel pain
- Lateral Epicondylosis (Tennis Elbow)
- Medial Epicondylosis (Golfer’s Elbow)
- Rotator cuff calcific tendinopathy
- Patellar Tendinosis (Jumper’s Knee)
- Greater trochanteric bursitis/gluteal tendinopathy (hip bursitis)
- Stress fractures
- Myofascial trigger point release
Shockwave is most suited for those conditions that are typically chronic in nature (greater than 6 weeks) which have not responded to other treatment. These are usually overuse injuries or repetitive strain injuries.
How does shockwave therapy work?
Shockwaves are sound waves that have specific physical characteristics, including nonlinearity, high peak pressure followed by low tensile amplitude, short rise time, and short duration (10 ms). They have a single pulse, a wide frequency range (0-20 MHz) and a high-pressure amplitude (0-120 MPa). This produces a positive and negative phase of shockwave. The positive phase produces direct mechanical forces, whereas the negative phase generates cavitation and gas bubbles that subsequently implode at high speeds, generating a second wave of shockwaves. In comparison to ultrasound, another commonly used modality in physiotherapy, the shockwave peak pressure is approximately 1000 times greater than the peak pressure of an ultrasound wave.
This shockwave technology has the following effects:
- The mechanical pulse and tension forces on the tissue have been shown to improve microscopic circulation and metabolism in the area by increasing cell membrane permeability. This improves blood supply and oxygenation of the treated area and supports faster healing of both tendon and bone.
- The collapse of the bubbles created by the negative phase of the acoustic waves cause a force that can mechanically break down calcific deposits in damaged tissues.
- Stimulates the production of collagen
- Shockwaves stimulate osteoblasts are cells responsible for bone healing and new bone production.
- Shockwaves stimulate fibroblasts that are the cells responsible for healing of connective tissue such as tendons.
OR IN OTHER WORDS…it triggers the body’s natural healing response!
- It reduces pain both in the short-term by overwhelming local nerve endings and diminishing their activity, and in the long-term through the Gate-control theory of pain. Most clients will report an immediate reduction in pain with movement following the treatment.
- It also releases trigger points in muscles by unblocking the calcium pump and reverses the metabolic crisis in the myofilaments causing the tension and sensitivity in that area.
What are the advantages of Shockwave Therapy?
- Accelerates healing
- Effective for chronic conditions
- Minimal side effects
- Non-invasive treatment option that may help to avoid surgery or other invasive procedures such as cortisone injections or plasma rich protein (PRP) injections
- No medication is needed
- Quickly reduces pain
Are there any side effects of Shockwave Therapy?
Since Shockwave therapy is stimulating an inflammatory response, you may have some temporary soreness, swelling, or tenderness around the treatment site. You will be counselled by your physiotherapist to not use anti-inflammatories (Advil/Aleve/etc.) or ice as it could slow down the body’s natural healing response. You can use Tylenol to help with pain if needed. Beneficial effects are often experienced after only 1 or 2 treatments and you can return to most activities immediately.
How will you know if you are a good candidate for Shockwave therapy?
First, you will need to be assessed by a physiotherapist to determine the cause of your pain and/or issue. They will be able to educate you on your condition and confirm if you are a candidate for Shockwave therapy or not. Most therapists will use Shockwave as a conjunct to other treatment methods such as exercise, activity modification, and addressing other contributing factors (Posture, muscle weakness and/or tightness).
Who should not have Shockwave treatment?
Those that have circulatory disorders, open wounds, infection, cancer, pacemakers, are pregnant, or have advanced osteoporosis are not eligible for treatment.
What does the research say?
Patients can achieve good to excellent clinical outcomes after shockwave therapy, ultrasound (US)-guided needling, and arthroscopy (surgery) for calcific tendinopathy of the shoulder. Side effects and post-treatment complications should be considered when a decision is being made for each individual patient. Physicians should consider shockwave therapy and US-guided needling as minimally invasive treatment options when primary conservative treatment fails (Arthroscopy: The Journal of Arthroscopic & Related Surgery 2016;32(1):165-175).
Compared with patients who received other therapies for chronic plantar fasciitis, patients treated with shockwave responded better, had less complications and showed a clear difference in efficacy between shockwave and other therapy in chronic plantar fasciitis (Foot and Ankle Surgery 2018).
There is currently no standardized protocol for the implementation of Shockwave therapy for specific musculoskeletal conditions. A systematic review shows that results can be dose dependent, with conditions typically responding better to higher dose regimes (Br J Sports Med. 2014 Nov;48(21):1538-42).
Moderate evidence indicates that shockwave therapy is more effective than home training and corticosteroid injection in the short (<12 months) and long (>12 months) term for greater trochanteric pain syndrome. Limited evidence indicates that shockwave is more effective than alternative nonoperative treatments including nonsteroidal anti-inflammatory drugs, physical therapy, and an exercise program and equal to patellar tenotomy surgery in the long term for patellar tendinopathy. Moderate evidence indicates that shockwave is more effective than eccentric loading for insertional Achilles tendinopathy and equal to eccentric loading for midportion Achilles tendinopathy in the short term. Additionally, there is moderate evidence that combining shockwave and eccentric loading in midportion Achilles tendinopathy may produce superior outcomes to eccentric loading alone (The American Journal of Sports Medicine 2015; 43(3):752-761).
Allison Simpson Registered Physiotherapist, BScKIN, MPT, Dry Needling Certified