Extracorporeal shockwave therapy (ESWT) uses acoustic pulses to help to improve tissue healing and reduce pain. Pressure waves inside the shockwave unit are generated inside the unit balistically.   Compressed air rapidly speeds up a projectile in the transmitter of the unit.  The projectile is abruptly stopped by hitting the transducer head and the pressure wave is transmitted into the tissue using a water based gel.  Within the target tissue the mechanical energy is converted to chemical energy.

How does Shockwave help?

The common treatment sites treated by shockwave are the tendons.  In several areas of the body including the hips, knees, ankles, shoulders and elbows, these tendons do not have a good local blood supply.  Over time micro trauma, small injuries without proper healing, can create a situation where the accumulated failed healing can result in pain.  Research has shown that these tendinopathies areas do not respond well to techniques such as cortisone and anti inflammatory medication.  When the target tissue is the tendon research has shown that energy produced by the shockwave unit during a treatment session affects the tendon at the cellular level.  Through a chain of events at the cellular level, there is an increase in production of structural protein of the connective tissue known as collagen.   Circulatory changes also occur resulting in improved blood flow to the area.  This is dependent on the frequency used during the session as well as the intensity of the treatment waves.

What can I expect from a shockwave session?

Your physiotherapist will localize the area to be treated using a thorough assessment to determine if it is appropriate for you.  A water based gel is used to conduct the pressure wave into the tissue and is not moved around to the same extent as an ultrasound head.  Once the shockwave treatment has begun you will hear the noise of the projectile striking the transducer at a frequency determined by your therapist to maximize benefits and minimize discomfort.  Since pressure waves are being used there can be mild discomfort that is felt during the treatment session however this is usually temporary.  Your physiotherapist may increase the intensity of the shockwave slightly if the session is being tolerated well but will ask you before this is done.  The shockwave treatment is generally complete after a few minutes after which your physiotherapist will utilize other techniques to address movement or strength imbalances that may have contributed to the pain.  You may notice a slight discomfort or occasional reddening of the areas treated after the shockwave session.  You will be able to return to work and even continue with sports after the session, however for a few conditions you may be asked to refrain from certain aggravating movements.  Most conditions require between 3 to 8 treatment sessions usually spaced five to ten days apart.  There can be immediate changes in pain after the session; however tissue regeneration will take time.

Conditions that can benefit from Shockwave

Studies have shown shockwave to be a beneficial treatment approach for a variety of orthopaedic conditions including:

• Tennis elbow
• Calcific tendinitis of the rotator cuff
• Achilles pain
• Hip pain
• Patellar tendinitis
• Achilles Tendinopathy
• Plantar fasciitis
• Muscle pain
• Myofascial pain and more

For more information or to determine if shockwave is appropriate for your condition talk to one of the physiotherapists at Family Physiotherapy.

References

Mani-Babu S., Morrissey D., Waugh C., Screen H., Barton C. “The Effectiveness of Extracorporeal Shock Wave Therapy in Lower Limb Tendinopathy” The American Journal of Sports Medicine 43 2014

Speed, C.  “A systematic review of shockwave therapies in soft tissue conditions: focusing on the evidence” British Journal of Sports Medicine 48 2014

Dreisilker, U. “Enthesopathies” Shockwave Therapy in Practice 2010