What is Shockwave Therapy?
Extracorporeal shockwave therapy (ESWT), or Shockwave as it can be called, is a non-invasive, out-patient alternative to surgery or injections, for those with joint and tendon disorders.
ESWT sends high pressure acoustic shock waves into the affected structures. It activates the healing process by provoking an acute phase of healing and stimulating enzymes involved in reducing pain.
The application of ESWT is an evidence-based, effective treatment for:
- Plantar fasciitis
- Most tendon conditions
- Achilles tendon issues
- Patellar tendinopathies
- Gluteal tendinopathies
- Tennis elbow tendinopathies
- Hip pain
- Shoulder pain
- Knee pain
- Shin splints
The treatment is given alongside physiotherapy, exercise, and advice.
What can you expect at your treatment?
The physiotherapist will assess you thoroughly and determine, with your input, if ESWT is appropriate for you.
You will be asked to sign a consent form before your ESWT
Approximately 2000-3000 shocks are administered per treatment area (the duration of which is approximately 5 minutes). Some patients and/or conditions require more shocks and duration, depending on severity and chronicity (how long the condition or injury has existed).
It is a short treatment (usually five to twenty minutes) that may be a little uncomfortable. However, most people can easily tolerate it. However, if you cannot tolerate it, adjustments on the machine can decrease the pressure you feel.
Many conditions resolve withing 1-3 sessions, however some conditions may take up to 5 sessions.
Do you have private health insurance?
Most private health insurance companies cover the cost of ESWT. Please contact your insurer prior to your appointment to check that you are covered and obtain an authorisation code for our records.
If you would like more information, please talk to your treating physiotherapist, or call us on 01642 205975.
The science of ESWT
Shockwaves are transient pressure disturbances that propagate rapidly in three-dimensional space. They are associated with a sudden rise from ambient pressure to their maximum pressure. Significant tissue effects include cavitation, which are consequent to the negative phase of the wave propagation.
Direct shockwave and indirect cavitation effects cause hematoma formation and focal cell death, which then stimulate new bone or tissue formation .
The effects of ESWT treatment are not completely known. However, the proposed mechanisms of action for ESWT include the following:
- Promote neovascularization at the tendon-bone junction Stimulate proliferation of tenocytes and osteoprogenitor differentiation
- Increase leukocyte infiltration Amplify growth factor and protein synthesis to stimulate collagen synthesis and tissue remodelling
History of ESWT
ESWT was first introduced into clinical medical use in the early 80s, to treat urological issues such as kidney stones and crystal formation. The high-pressure sound waves helped break up the crystals and stones non-invasively and effectively without much discomfort or need for anaesthetic.
It was soon utilised in orthopaedics to help with removal of the prothesis in revision replacement surgeries such as Total Hip and Total Knee. The shockwaves helped to break up the bony growth and the cement around the prosthesis and thus make it easier to remove during the revision surgery.
Incidentally, during these surgeries, it was noted that the ESWT seemed to influence the surrounding soft tissues also.
Further, animal studies conducted in the 1980s revealed that ESWT could augment the bone-cement interface, enhance osteogenic response, and improve fracture healing. While shockwave therapy has been shown to be beneficial in fracture healing, most orthopaedic research has focused on upper and lower extremity tendinopathies, fasciopathies, and soft tissue conditions. It is currently endorsed by NICE Guidelines in the treatment of chronic or persistent tendinopathies such as Plantar Fasciopathy.