Shockwave Therapy: How physiotherapists are improving pain and healing with technology

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Shockwave Therapy: How physiotherapists are improving pain and healing with technology

Extracorporeal Shockwave Therapy (ESWT) is definitely one of the more eyebrow raising treatments to see advertised by highly trained musculoskeletal physiotherapists and Specialist Sports and Exercise physiotherapists. It’s not as dramatic as it sounds. A technology that has been in use since the 1980’s, Shockwave Therapy technology has been studied and refined by scientists and physiotherapists and has been expanded to treat more conditions, more efficiently over the years.[1] First used to disintegrate kidney stones,[2] it wasn’t until the 90’s that the high-energy acoustic pulses produced by Extracorporeal Shockwave Therapy were applied to musculoskeletal disorders and tendinopathies.[3] Since then it’s been used successfully to treat a growing list of musculoskeletal issues, and research is ongoing. Lane Cove Physio can provide you with an accurate assessment of your candidacy for Shockwave Therapy and the likelihood you will see an improvement in your condition.

How does Shockwave Therapy promote healing and reduce pain?

Shockwave therapy is probably underused because of unfamiliarity over what it is and exactly how it works.[4] Luckily, there are hundreds of studies and decades of treatment guidelines outlining exactly how the technology works and how it can be applied to specific conditions. Shockwaves are high energy acoustic pulses (pressure waves) delivered by an Extracorporeal Shockwave unit. These shock waves cause the activation of small fibers that promote the body’s serotoninergic system, diminishing nerve pain signals to the brain and accelerating healing through a localised metabolic reaction due to increased vascularity.[5] Put simply, the shock waves break down calcifications, stimulate the body’s pain management system and promote blood flow and natural healing.

What conditions can Shockwave Therapy treat?

Shockwave therapy promotes pain relief, mobility restoration, scar tissue breakdown and bone density improvement,[6]making it a great non-invasive and non-surgical treatment option for a large variety of conditions.

  • Plantar fasciitis

Plantar fasciitis is one of the most common causes of foot pain in adults, usually treated conservatively by physiotherapists with a combination of rest and icing for pain relief. Studies have shown that Shockwave Therapy positively affects pain and improvement in functional ability immediately following it and these benefits continued through 3, 6 and 12 months.[7]

  • Achilles tendonitis

Achilles tendinopathy is consistently reported as the top overuse injury seen by sports and musculoskeletal physiotherapists.[8] Shockwave Therapy treatment has been shown in small sample groups to improve pain and movement scores of Achilles tendinopathy patients and is recommended as a positive area of future study.[9]

  • Chronic shoulder injuries

Conditions affecting the shoulder such as chronic rotator cuff tendonitis and calcific tendinopathies are among the most common treated by musculoskeletal physiotherapists.[10] While shockwave therapy has been studied more in depth on Rotator Cuff calcifications, promising results have been reported on other shoulder pathologies and is considered to be an effective choice over surgical procedures in some cases.[11]

  • Tennis Elbow

Tennis elbow or lateral epicondylitis is a common and growing in number issue faced by tennis players and many other professions alike. When diagnosed early, shockwave therapy has been shown to be effective in reducing the severity and length of pain while improving movement and daily activity.[12]

  • Myofascial Pain

Myofascial pain has been known to cause localised muscle tenderness, referred pain and muscular twitching primarily in the cervical and lumbar vertebral region, areas of the neck and shoulder. A recent study showed ESWT’s ability to reduce pain and improve neck range of motion as well as trigger point therapy and TENS in patients with trapezius muscle pain.[13]

What happens in a Shockwave Therapy session?

One of the most important factors for success is being able to identify and select which patients and conditions are most likely to benefit from this technology and Lane Cove physio will undertake an in depth assessment of your candidacy for Shockwave Therapy after we have made our diagnosis of your specific condition.

First of all, despite the sound of the name, Shockwave Therapy doesn’t hurt. Some of the earliest machines used to cause that much pain a local anaesthetic was required, but thankfully the science has progressed. The shockwave technology Lane Cove Physio utilizes does not generally cause any significant discomfort and there is NO local anaesthetic required.

Each treatment session only takes around 5-10 minutes. Your physiotherapist will apply the shockwave therapy hand piece onto the injured area to allow the unit to gently and extensively transmit shock waves to that region. The feedback you provide helps the physiotherapist fine tune the position of the applicator and the intensity of the treatment.

Extracorporeal Shockwave Therapy is not a straightforward topic and there are no one size fits all treatment options. There are positives, negatives and further studies that need to be undertaken to confirm the efficacy of the treatment on other issues such as temporomandibular joint/jaw pain, Hamstring and Quadriceps Tendinopathies and forms of arthritis. Don’t let Shockwave Therapy remain a mystery, just ask your physio if it can be applied to your condition and just how effective it could be.

 

[1] Ioppolo F, Rompe JD, Furia JP et al. Clinical application of shock wave therapy (SWT) in musculoskeletal disorders. Eur J Phys Rehabil Med 2014;50:217–30.

[2] Chaussy C, Brendel W, Schmiedt E. Extracorporeally induced destruction of kidney stones by shock waves. Lancet. 1980;2:1265–1268.

[3] Loew M, Jurgowski W. Initial experiences with extracorporeal shockwave lithotripsy (ESWL) in treatment of tendinosis calcarea of the shoulder. Z Orthop Ihre Grenzgeb. 1993;131(5):470–473

[4] Schmitz, Christoph et al. “Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database.” British medical bulletin vol. 116,1 (2015): 115-38. doi:10.1093/bmb/ldv047

[5] Dedes, Vasileios et al. “Effectiveness and Safety of Shockwave Therapy in Tendinopathies.” Materia socio-medica vol. 30,2 (2018): 131-146. doi:10.5455/msm.2018.30.141-146

[6] Wölfl, Christoph et al. “Influence of extracorporeal shock wave therapy (ESWT) on bone turnover markers in organisms with normal and low bone mineral density during fracture healing: a randomized clinical trial.” GMS Interdisciplinary plastic and reconstructive surgery DGPW vol. 6 Doc17. 18 Dec. 2017, doi:10.3205/iprs000119

[7] Vahdatpour, Babak et al. “Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebo-controlled trial with ultrasonographic and subjective outcome assessments.” Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences vol. 17,9 (2012): 834-8.

[8] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/achilles-tendonitis

[9] Vahdatpour, Babak et al. “Effectiveness of extracorporeal shockwave therapy for chronic Achilles tendinopathy: A randomized clinical trial.” Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences vol. 23 37. 26 Apr. 2018, doi:10.4103/jrms.JRMS_413_16

[10] R.J. Murphy, A.J. Carr Shoulder pain Clin. Evid. (2010), p. 1107 (Online) 2010 Jul 22

[11] Daniel Moya, Silvia Ramón, Leonardo Guiloff, Ludger Gerdesmeyer, Current knowledge on evidence-based shockwave treatments for shoulder pathology, International Journal of Surgery, Volume 24, Part B,2015, Pages 171-178,

[12] Razavipour M, Azar MS, Kariminasab MH, Gaffari S, Fazli M. The Short Term Effects of Shock-Wave Therapy for Tennis Elbow: a Clinical Trial Study. Acta Inform Med. 2018;26(1):54–56. doi:10.5455/aim.2018.26.54-56

[13] Jeon JH, Jung YJ, Lee JY, et al. The effect of extracorporeal shock wave therapy on myofascial pain syndrome. Ann Rehabil Med. 2012;36(5):665–674. doi:10.5535/arm.2012.36.5.665