What is Shockwave Therapy?

In the medical world, shockwaves have been used since 1908 to disintegrate kidney stones. When used on muscular injuries though, it promotes tissue repair and regeneration⁷.  Shockwave is high-energy acoustic waves which target the affected area to produce a therapeutic effect^{8, 7}. Success rate of SW therapy ranges from 65% – 91% with very low side effects⁸.

HOW DOES SHOCKWAVE THERAPY WORK?

Before I get into the jargon of things, I’ll talk a little on what the tendon does in the body. A tendon is a tough band made of connective tissues that connects muscles to bone and has the ability to withstand tension. Unfortunately, due to overuse, direct injuries and repeated mechanical loading, the tendon continues to be re-aggravated leading to recurring injury, inflammation and chronic pain¹. Recent studies have shown that it can increase the number of new blood vessels in the tendon by releasing growth factors and other active substances which is vital in tendon repair¹. So basically, the quicker we can get the repairing happening, the better chance we have at getting the tendon to heal.

WHAT KIND OF CONDITIONS WOULD BE EFFECTIVE WITH SHOCKWAVE THERAPY

Research is still ongoing on the effectiveness of SW on different types of tendon conditions however there has been good evidence shown on musculoskeletal conditions such as:

1. Plantar Fasciitis

A trial conducted in 2003 on 172 patients who suffered from plantar fasciitis showed a significant reduction in heel pain in the first 3 months of treatment and continued to have reduction in pain in a 1 year follow up³. If you are suffering from ongoing heel pain that has been unresponsive to conservative treatment, from a research perspective, SW therapy might be able to help⁵.

2. Calcific Tendinopathies of the Shoulder

Calcific tendonitis happens when calcium deposits build up in your muscles or tendon. It can happen anywhere in the body but it has a high tendency of affecting the shoulder tendons. This causing a great deal of shoulder pain and leading to a frozen shoulder. Like plantar fasciitis, there is proven research on the positive effectiveness of SWT in treating this condition. A report in improvement of shoulder function, decrease in pain and better resorption rate of calcium deposit within the tendon has been positive^{1, 6}. It has also been pointed out that a high energy SW should be applied to achieve good results for this condition as it did not seem to be as effective when a low energy SW was utilised.

3. Knee Osteoarthritis/ Knee Degenerative Joint Disease

Shockwave therapy has also been compared to the efficacy of other non-invasive modalities. 120 patients with moderate knee osteoarthritis were treated with ultrasound and SW therapy on top of rehabilitation for 6- 8 weeks⁴. The SW therapy group had better improvement in range and strength compared to the group who received ultrasound.

IF IT IS SO GOOD, WHY ISNT IT USED MORE FREQUENTLY?

One of the primary reasons why SWT has not been used as often is because of the generalised unfamiliarity with the technique. Most of the current systemic reviews support the safety and helpfulness in some conditions but not many have investigated the protocols, treatment parameters and application technique which would be most beneficial for patients therefore making it difficult for practitioners to determine the “best practice” approach⁷.

TAKE HOME MESSAGE

Despite the positives, negatives, and further questioning on SWT as a treatment option for musculoskeletal disorder, we can safely say SWT is a safe modality that can be helpful if combined with sound clinical reasoning. To help decide on whether SW therapy would be a suitable option for your condition, speak to one of our practitioners for further guidance. Book online or call us on 07 3398 7022.

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666498/
2. https://www.jfas.org/article/S1067-2516(02)80005-9/pdf
3. https://www.jfas.org/article/S1067-2516(06)00143-8/fulltext
4. https://www.sciencedirect.com/science/article/pii/S1607551X1400076X
5. https://www.ncbi.nlm.nih.gov/pubmed/23552334
6. https://www.sciencedirect.com/science/article/pii/S1356689X11000397?via%3Dihub
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674007/
8. https://www.ncbi.nlm.nih.gov/pubmed/22433113