What is shockwave therapy?
Shockwave therapy is non-invasive pro-inflammatory treatment used in clinical practice. The hand-held device allows acoustic shockwaves to travel through to the affected soft tissue to allow two things
- Stimulate the body’s healing process at cellular level
- Desensitise the efferent nerve endings to help with reduction of pain.
What can shockwave be used to treat?
Shockwave can be used to treat a variety of conditions; it was first used into the medical practice 30 years ago for the treatment of urology stones. However, this is slightly out of scope of practice at Physio On The Green.
In a clinical setting, we use shockwave therapy for soft tissue injuries such as tendinopathies or fasciopathies; such as supraspinatus calcific tendinopathies, plantar fasciopathy (commonly known as plantar fasciitis). There have been studies that show moderate amounts of evidence for the use of shockwave in hamstring tendinopathies. (Korakakis et al., 2018
Shockwave therapy is thought to aid the breakdown of scar tissue allowing the body to restart the tissue repair process, with this in mind shockwave therapy is typically used in chronic conditions; injuries that have failed to recover in months-to-years of conservative treatment. However, there is more research being brought to light to show successful outcomes for shockwave therapy in the acutely injured patient, (Zissler et al., 2018).
How many sessions do you need
The medical research suggests between is 3-6 to sessions. However, treatment varies with different conditions, and individual tolerance. A study completed in 2015 looking at the efficiency and safety of shockwave therapy in orthopedic conditions highlighted the optimum shockwave dosage is from 3 weeks, at 11-week intervals (Schmitz et al., 2015)
Does it hurt?
The name ‘shockwave’ can alone be daunting, and a common question we get asked is “does it hurt?”. To promote healing at a cellular level, the acoustic sound waves are thought to cause microtrauma at the soft tissue. This therefore means there is an essence of discomfort, however your therapist will ease you through this process
It is common after the first session a ‘numbing’ type sensation around the targeted area, this is thought to be due to the sound waves bombarding those nerve endings, allowing the area to become desensitized.
The National Institute for Health and Care Excellence (NICE), set the gold standards of healthcare across the nation. NICE has highlighted there are no major short term or long-term safety concerns with the administration of shockwave therapy (NICE 2016).
Can anyone have shockwave therapy?
Not quite, like other treatments in clinical practice, there are conditions that are contraindicated. Below is a list of contraindicated medical conditions:
- Anti–coagulation medication
- Anti-platelet medication
- History of cancer
- Bleeding/clotting disorder
- Infection in the area or nearby joint
- Steroid injection in the last 12 weeks
- History of ligament/tendon rupture
- Cardiac pacemaker or implanted device
- Polyneuropathy with diabetics / Nerve disorder at treatment site
- Over a joint replacement
- Over open wound
- Severe circulatory disorder
- Under 18 years old
References
Schmitz, C. et al. (2015) Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: A systematic review on studies listed in the pedro database, British medical bulletin. U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674007/ (Accessed: February 6, 2023).
Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N. The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction. Br J Sports Med. 2018 Mar;52(6):387-407. doi: 10.1136/bjsports-2016-097347. Epub 2017 Sep 27. PMID: 28954794. (Accessed: February 6, 2023).
Zissler A, Stoiber W, Pittner S, Sänger AM. Extracorporeal Shock Wave Therapy in Acute Injury Care: A Systematic Review. Rehabilitation Process and Outcome. 2018;7. doi:10.1177/1179572718765138 (Accessed: February 6, 2023).
NICE, 2016. What has nice said?: Information for the public: Extracorporeal shockwave therapy for achilles tendinopathy: Guidance (no date) NICE. Available at: https://www.nice.org.uk/guidance/ipg571/ifp/chapter/what-has-nice-said (Accessed: February 6, 2023).