SHOCK WAVE THERAPY

What is shockwave therapy?

Shockwave therapy is a non-invasive treatment that stimulates the body’s natural healing process. The therapy involves the delivery of high-frequency shock waves (sound impulses) to the injured area to stimulate healing.

It can relieve pain and promote healing of injured tendons, ligaments, and other soft tissues (1). Shockwave therapy is sometimes referred to as extracorporeal shockwave treatment  (ESWT). The device sends shockwaves into the injured tissues, stimulating increased blood flow and growth hormones to the area, promoting new tissue growth, breaking down calcified deposits and reducing pain by overstimulating nerve areas in the effected area.

In comparison to ultrasound waves, the shockwave peak pressure is approximately 1000 times greater than the peak pressure of an ultrasound wave (1).

The treatment can also promote healing after orthopedic surgery — for instance, if a hip impingement has damaged tendons and ligaments around the hip. Surgery may correct the hip impingement, but after years of overworking and degeneration because of the impingement, the surrounding tendons often remain painful. Shockwave therapy can be used to address this secondary issue.

What injuries can be treated with shockwave therapy?

Shockwave therapy is used to reduce pain and promote healing from tendinopathy and many other sports injuries (2- 17). Some examples include:

  • foot pain: plantar fascitis and Achilles’ tendinopathy
  • Achilles’ tendinopathies
  • knee pain:patella tendinopathy (jumper’s knee)
  • leg pain:hamstring injuries
  • hip pain:rectus femoris and lateral hip pain with gluteal tendinopathies
  • elbow pain: Golfers and tennis elbow
  • shoulder pain:rotator cuff injuries
  • Bursistis : Common sites for bursitis include the shoulder (subacromial bursa), hip (trochanteric bursa), knee (prepatellar bursa), elbow (olecranon bursa), Achilles tendon (retrocalcaneal bursa) and foot.
  • Adhesive Capsulitis (frozen shoulder)
  • Osteoarthritis of the knee
  • Periostitis / shin splints /
  • Medial Tibial Stress Syndrome

Shockwave therapy is often used in combination with other therapies such as physical therapy rehabilitation and specialised excercises. In the case of sports-related injuries, we work with the athlete to analyse their movement patterns and help them build strength and adjust their technique, so they are less prone to re-injury.

Is shockwave therapy painful?

Most patients report some discomfort during shockwave therapy, but most do not find it painful. The amount of discomfort depends in part on the person, their injury, and whether the damaged tissues are close to a bone. (Treatments delivered closer to a bone are generally more uncomfortable.)  As soon as the treatment is over, the discomfort typically stops.

How long does shockwave therapy take?

A single treatment usually takes between 15 to 20 minutes. Depending on the injury, a patient will usually receive three to five treatments over a period of several weeks.

References:

  1. Auersperg V, Trieb K. Extracorporeal shock wave therapy: an update. EFORT Open Rev. 2020 Oct 26;5(10):584-592. doi: 10.1302/2058-5241.5.190067. PMID: 33204500; PMCID: PMC7608508.
  2. Burton, Ian1; Cooper, Kay1,2,3; Alexander, Lyndsay1,2; Swinton, Paul Alan1. Effectiveness of combined shockwave therapy and plantar fascia stretching interventions in treating plantar heel pain: a systematic review and meta-analysis protocol. JBI Evidence Synthesis 19(5):p 1186-1192, May 2021. | DOI: 10.11124/JBIES-20-00186
  3. El Molla, S.S., Fahmy, A.M., Gamil, A.M. et al.Evaluation of plantar fasciitis improvement after shock wave therapy in calcaneal spur patients by musculoskeletal ultrasonography. Egypt Rheumatol Rehabil 48, 43 (2021). https://doi.org/10.1186/s43166-021-00085-y
  4. Dedes V, Stergioulas A, Kipreos G, Dede AM, Mitseas A, Panoutsopoulos GI. Effectiveness and Safety of Shockwave Therapy in Tendinopathies. Mater Sociomed. 2018 Jun;30(2):131-146. doi: 10.5455/msm.2018.30.141-146. PMID: 30061805; PMCID: PMC6029898.
  5. Circi E, Okur SC, Aksu O, Mumcuoglu E, Tuzuner T, Caglar N. The effectiveness of extracorporeal shockwave treatment in subacromial impingement syndrome and its relation with acromion morphology. Acta Orthop Traumatol Turc. 2018 Jan;52(1):17-21. doi: 10.1016/j.aott.2017.10.007. Epub 2017 Nov 16. PMID: 29153594; PMCID: PMC6136340.
  6. Notarnicola A, Ladisa I, Lanzilotta P, Bizzoca D, Covelli I, Bianchi FP, Maccagnano G, Farì G, Moretti B. Shock Waves and Therapeutic Exercise in Greater Trochanteric Pain Syndrome: A Prospective Randomized Clinical Trial with Cross-Over. J Pers Med. 2023 Jun 10;13(6):976. doi: 10.3390/jpm13060976. PMID: 37373965; PMCID: PMC10301141.
  7. Vahdatpour B, Taheri P, Zwre Zade A, Moradian S. Efficacy of Extracorporeal Shockwave Therapy in Frozen Shoulder. International Journal of Preventive Medicine 2014; 5(7): 875-88
  8. Wang CJ, Ko JY, Weng LH, Wang JW, Chen JM, Sun YC, Yang YJ. Extracorporeal Shockwave Shows Regression of Osteoarthritis of the Knee in Rats. J Surg Res. 2011; 171(2): 601-608.
  9. Choi IJ, Jeon JH, Choi WH, Yang HE. Effects of extracorporeal shockwave therapy for mild knee osteoarthritis: A pilot study. Medicine (Baltimore). 2023 Nov 17;102(46):e36117. doi: 10.1097/MD.0000000000036117. PMID: 37986308; PMCID: PMC10659666.
  10. Vahdatpour B, Taheri P, Zade AZ, Moradian S. Efficacy of extracorporeal shockwave therapy in frozen shoulder. Int J Prev Med. 2014 Jul;5(7):875-81. PMID: 25104999; PMCID: PMC4124565.
  11. Forogh, Bijan MDa; Karimzad, Yousef MDb; Babaei-Ghazani, Arash MDc; Janbazi, Lobaneh MDd; Bagherzadeh Cham, Masumeh PhDa,e; Abdolghaderi, Siavash MDb. Effect of extracorporeal shockwave therapy on medial tibial stress syndrome: a systematic review. Current Orthopaedic Practice 33(4):p 384-392, July/August 2022. | DOI: 10.1097/BCO.0000000000001127
  12. An S, Li J, Xie W, Yin N, Li Y, Hu Y. Extracorporeal shockwave treatment in knee osteoarthritis: therapeutic effects and possible mechanism. Biosci Rep. 2020 Nov 27;40(11):BSR20200926. doi: 10.1042/BSR20200926. PMID: 33074309; PMCID: PMC7670564.
  13. Unlocking the Power of ESWT for Athletes: A Game-Changer in Sports Medicine.” Published in the British Journal of Sports Medicine. Epub ahead of print: [01 Feb 2023]. doi:10.1136/bjsports-2023-107567.
  14. Schroeder AN, Tenforde AS, Jelsing EJ. Extracorporeal Shockwave Therapy in the Management of Sports Medicine Injuries. Curr Sports Med Rep. 2021 Jun 1;20(6):298-305. doi: 10.1249/JSR.0000000000000851. PMID: 34099607.
  15. Rhim HC, Borg-Stein J, Sampson S, Tenforde AS. Utilizing Extracorporeal Shockwave Therapy for in-Season Athletes. Healthcare (Basel). 2023 Apr 1;11(7):1006. doi: 10.3390/healthcare11071006. PMID: 37046934; PMCID: PMC10093829.

    15. Rhim HC, Shin J, Kang J, Dyrek P, Crockett Z, Galido P, Wade C, Hollander K, Borg-Stein J, Sampson S, Tenforde AS. Use of extracorporeal shockwave therapies for athletes and physically active individuals: a systematic review. Br J Sports Med. 2024 Feb 7;58(3):154-163. doi: 10.1136/bjsports-2023-107567. PMID: 38228375.

  16. Beling A, Saxena A, Hollander K, Tenforde AS. Outcomes Using Focused Shockwave for Treatment of Bone Stress Injury in Runners. Bioengineering (Basel). 2023 Jul 25;10(8):885. doi: 10.3390/bioengineering10080885. PMID: 37627770; PMCID: PMC10451564.
  17. Fatima A, Ahmad A, Gilani SA, Darain H, Kazmi S, Hanif K. Effects of High-Energy Extracorporeal Shockwave Therapy on Pain, Functional Disability, Quality of Life, and Ultrasonographic Changes in Patients with Calcified Rotator Cuff Tendinopathy. Biomed Res Int. 2022 Mar 4;2022:1230857. doi: 10.1155/2022/1230857. PMID: 35281612; PMCID: PMC8916860.