Shockwave therapy and how it could be the right treatment for you.

Before we start here are 5 things you need to know about shockwave therapy before you read any further.

  1. Shockwave is a safe and effective treatment for pain relief in tendon based injuries.

  2. Shockwave therapy has been shown to have excellent results with heel pain, plantar fascitis, achillies tendon injuries.

  3. Shockwave has shown to be very effective with rotator cuff and hip tendon calcification.

  4. Shockwave therapy can be a little uncomfortable but should not be painful.

  5. Its is rarely a stand alone treatment but used with other treatments for the best results.

What is Radial Shockwave Therapy?

Radial Shockwave Therapy (RSWT) is a low-cost, safe and effective therapy that can be used to treat a range of musculoskeletal injuries.

Initially used in the treatment of gallstones and renal calculi in the 1970’s. As with most discoveries it was found to have beneficial effects with musculoskeletal disorders such as tendon and plantar fascia problems. Treatment of these orthopaedic conditions started in the 1980’s/90’s in Europe.

Since then it has developed to more accessible and effective technology.

How does shockwave therapy work ?

Shockwave therapy is a form of mechanical pressure applied to the tissue. This mechanical pressure then does the ollowing to the target tissue;

  1. Shockwave helps "Kick start" a stalled repair process in the injured tissue by stimulation of the cells that make it up.

  2. It has been shown to increase the local release of essential growth factors required for tissue repair in tendon. These growth factors increase the type 1 collagen production which is an essential ingredient in healthy strong tendon.

  3. Shockwave has the ability to breakdown calcium deposits in tissue at higher energy levels. This has been observed to occur within 1 session.

  4. Helps to reduce pain through an analgesic effect on the nerves at the sensitized tissue.

What can we treat with shockwave therapy ?

plantar fascitis / heel pain and shockwave therapy.

There have been very encouraging results in treating plantar fasciopathy and heel pain with shockwave.

The great news is that studies have shown that up to 75% -88% of patients have either very good results or are pain fee after 1 year. Chen (2003), Rompe et al (2002).

Current treatment of plantar fascia and achillies tendons has improved markedly in past few years with specific exercise programs.

Surprisingly no studies have been done yet looking at a combination of exercise and shockwave with plantar fascia but we would suspect that the two combined approaches will give an even better effect. Especially when looking at the results of a combined approach with achillies tendon injuries.

Achillies tendonopathy and shockwave treatment.

For both midportion and insertional achillies tendon injuries a combination of shockwave therapy with a strength protocol had superior results than just doing exercise alone, ( Rompe 2009). This was seen in both mid body and insertional achillies tendon problems.

It's even better when you add strengthening !

Importantly the treatment effect after 12 weeks of shockwave and exerise therapy was superior to just using exercise alone, Rassmussen (2008).

Lateral hip tendonitis or bursitis.

Another condition that responds well to exercise as well as using shockwave therapy is lateral hip pain. Researchers have found shockwave plus exercise lead to a significant improvement in symptoms at 1 month post treatment in chronic lateral hip pain. There has also been research to show that by combining shockwave with exercise therapy individuals returned to sport and activity quicker.

Calcification in the shoulder and shockwave therapy.

Another condition that we commonly see in th eclinic is calcification of tendons in the hip and shoulder. The use of shockwave in shoulder calcification has shown evidence on X-ray of destruction of calcific deposit after 1 session Spindler (1998), Constantino (2003).

From a symptom and function perspective the following results have been observed;

•31-40% reduction in calcification in supraspinatous tendon with a concurrent decrease in pain and increase in function, (Consentino 2003).

• Up to 60% of patients had full resolution and a further 30% had significant improvement which was maintained at the 2 year follow up. Thats 90% of individuals with a significant response.

•Evidence on Xray of destruction of calcific deposit after 1 session Spindler (1998), Constantino (2003).

How shockwave therapy fits in with your treatment, It's part of the solution.

At Arana hIlls physiotherapy we don't use many machines but we do like shockwave for the conditions mentioned above. Very rarely do we do see this as a MAGIC bullet treatment for you and it is used in conjunction with other techniques and practices in management of your injury.

These other factors are;

•Education, its important to understand what keeps the problem going and what you need to change or alter to get better.

•Load management, we need to get the tissue fitter and stronger to cope with what life throws at it.

•Soft tissue and joint manual therapy play a role in improving the biomechanics of the affected regions.

•We need to keep progressing the exercises as you improve to avoid plateauing or having recurrent problems.

Hope you found that useful , if you have any questions about shockwave therapy please feel free to get in touch or book in to see us.

Cheers Dave

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