Shockwave therapy is a non-invasive (non-surgical) treatment that uses high energy sound waves to transmit energy into a body tissue. First developed in the 1970s for the treatment of painful Kidney stones. More recently, Radial Shockwave or Extracorporeal Shockwave Therapy (ESWT) treatment have been shown to be effective in the treatment of delayed fracture healing and chronic (more than three months onset of symptoms) muscle-tendon problems.
Shockwave is particularly effective for stubborn patellar, achilles, shoulder (rotator cuff), calcific tendonitis, tennis elbow, golfers elbow, gluteal tendinopathy (lateral hip pain) and plantar fasciitis conditions.
How does it work?
Shockwave has both chemical and physical effects to the tissue it is applied to. There are 4 main actions that offer patients therapeutic benefit:
- Pain relief. Through a process called hyperstimulation analgesia. Shockwave excites the sensory nerves so much that it causes the pain signals to eventually become blocked. This pain relief usually lasts 1 to 3 days post treatment.
- Release of chemicals. After a shockwave treatment session there are numerous helpful chemicals released by cells within the body that helps improve blood flow, controls inflammation and helps with pain relief.
- Cellular activity is increased promoting healing of injured tendon tissue.
- Cavitation. When shockwaves pass through tissue, it causes small bubbles to form, which then collapse. This process helps to break down stubborn scar tissue.
Most tendon problems can be related back to a sudden increase in activity for example walking, attempting 5, 10 or 15 miles when you sit most of the day and aren’t a regular miles walker. Attempting a local 10km or half marathon without appropriate training or conditioning, a week of painting and decorating often aggravates shoulder and elbow tendons. Some conditions are a result of long-term postural positions that causes tendons to be compressed onto hard bone such as when sitting, lying or standing for sustained periods.
In all these conditions there is a similar disease process of tendon overuse/overloading which causes micro-tears in the tendon tissue structure and an increased infiltration of nerve endings around the injured tissue. Blood supply is subsequently reduced which reduces the tensile structure of the tendon and therefore its ability to tolerate the load placed on it through activity. The added nerve endings, poor blood supply and reduced load transfer ability all conspire to cause the pain felt with the condition. The problem can often be quite stubborn and take a long time to recover, despite ongoing treatment.
Research suggests that shockwave therapy is effective as an adjunct to appropriate stretching/strengthening of the tissue, with a 60 to 80 % success rate for patients who undertake the treatment. It has been proven to be safe and has less side effects than other treatments such as steroid injections or surgery.
TreatmentTreatment duration and dosage is individualised by the clinician. Duration is dependent on levels of pain and longevity of symptoms so that discomfort can be minimised. The treatment can be painful and the treatment area could be sore for a few hours after. A period of relative rest up to 48 hours is often recommended.
It has cleared by National Institute for Health and Care Excellence (NICE) for clinical use in the UK as there are no major safety concerns (see NICE guidance for more information)
There are specific contra-indications for shockwave therapy and our clinician will go through these with you on your initial assessment.
Most clinical studies recommend 3-4 sessions, which is usually between one and two a week. In certain cases, additional sessions might be required, based on the clinical judgment of the therapist.