Shockwave Therapy

What is shockwave therapy?

‘Shockwave’ therapy or ‘Radial Shock wave’ is a proven and researched therapy’

 

There is scientific evidence to show that:

 

  • It is as effective as 3 months of eccentric strengthening for Achilles’ tendinopathy.
  • It is an effective treatment for proximal hamstring tendinopathy in professional athletes.
  • It is an effective treatment for plantar fascia dysfunction (fasciitis) and has been FDA approved for this condition.
  • It is effective for treating trochanteric pain.
  • Can be used to treat tennis and golfers’ elbow (tendinopathy affecting the common extensor and flexor tendons at the elbow)

 

It has found to be an effective adjunct to muscular injuries as well as acute and chronic tendon issues. Shockwave increases the blood flow to the injured area, breaks down scar tissue and helps de-sensitive the nervous system therefore reducing the amount of pain you experience. It is recommended to receive a total of 3-6 sessions, which is applied by your physiotherapist once to twice a week.

In conjunction with an exercise-based rehabilitation programme, it has seen to accelerate the healing process of muscular and tendon issues. Shockwave can be mildly uncomfortable on administering but the settings on the machine can be adjusted to suit your needs. It is especially good for kickstarting the healing process in conjunction with other modalities your Physio precises.

How Does it Work?

Shockwave therapy is a non-invasive treatment that involves applying a series of low-energy acoustic waves via a gel medium to an injured area of your body. Radial Shock wave causes initial ‘hyperstimulation anaesthesia’ to the injury site decreasing pain signals to such an extent that their activity diminishes, thereby decreasing or eliminating pain.

Radial Shockwave also alters the release of the pain mediator and growth factor substance P which over time leads to a depletion in substance P from the nerve endings. Less substance P in the tissue results in reduced pain and causes so-called neurogenic inflammation to decline.

A regeneration or tissue-repairing effect in musculoskeletal tissue is also produced by Shockwave. They appear to stimulate the release of growth factors and an improvement in blood supply leading to repair of tendon and bone. These are the mechanisms by which long-term improvement in symptoms occur.

In conjunction with Shock wave specific rehabilitation for that pathology is prescribed to give the optimum outcome.

  1. Your Physiotherapist will locate the area of pain through palpation.  This area will then be marked, and some ultrasound gel applied.
  2. The shock wave impulses are delivered using a handpiece.  It takes about five minutes to
    deliver a single treatment. This is generally said to be uncomfortable (rather than painful) and is well tolerated by most patients.
  3. This process is repeated a total of three times – with a week between treatments. Some patients note an immediate improvement in their pain; however, the best results occur 12 weeks after the initial treatment.

HOW MANY TREATMENTS DO I NEED?

Treatment can be uncomfortable but tolerable (less than 10 minutes) with initial anaesthesia benefits but long-term effects and best results occur up to 3 months post therapy.

Three treatments are given a week apart and cost is dependent of ACC/Insurance or private pathologies.

ACC has started to recognise the researched benefits of Shock wave for some musculoskeletal conditions and an application for funding can be made where it has been advised by specialist to be the optimum treatment for that condition. To optimize the benefits of Shock wave therapy it is imperative the patient is following the correct rehab and graduated loading program to coincide with the ‘rebooting’ of the repair mechanism of the tissue involved.

Time will be taken here as part of the therapy to make sure this is the correct program is being undertaken.

WHAT DOES THE RESEARCH SAY ABOUT SHOCKWAVE THERAPY?

Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis.

Pubmed Link: https://www.ncbi.nlm.nih.gov/pubmed/26834345 Product Tested: STORZ

MASTERPULS Radial extracorporeal shockwave therapy compared with manual therapy in runners with iliotibial band syndrome.

Pubmed Link: https://www.ncbi.nlm.nih.gov/pubmed/26406193 Product Tested: STORZ

MASTERPULS MP100 Radial extracorporeal shock-wave therapy in rotator cuff calcific tendinosis

Pubmed Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004453/ Product Tested: STORZ

MASTERPULS MP200 Extracorporeal Shock Wave Therapy for Patients Suffering from Recalcitrant Osgood-Schlatter Disease.

Pubmed Link: https://www.ncbi.nlm.nih.gov/pubmed/23047459 Product Tested: STORZ DUOLITH

SD-1 Extra-corporeal pulsed-activated therapy (“EPAT” sound wave) for Achilles’ tendinopathy: a prospective study.

Pubmed Link: https://www.ncbi.nlm.nih.gov/pubmed/21406328 Product Tested: STORZ

MASTERPULS MP200 Radial Soundwave for Sesamoidopathy in Athletes: A Pilot Study

Pubmed Link: https://pubmed.ncbi.nlm.nih.gov/27618711/ Product Tested: STORZ MASTERPUL

What is important to remember?

 

Most of these conditions occur initially because the load was too great for the tissue that it was placed on (you have a lack of capacity). This can be for several reasons such as::

 

  • Started a new sport, type of exercise or work.
  • Change surfaces suddenly that you exercise on.
  • You had just returned to exercise after a period of time off i.e after a different injury.
  • Age, gender, hormones, and other health conditions play a part.

 

As a result of this it is important to remember that while shockwave may help improve or resolve your condition, you need to complete your full rehabilitation, or the pain will come back as the tissue has not built up its capacity to cope with load yet, which was the original cause of the injury.

 

Contraindications

Shock wave therapy is not suitable if you have the following:

  • Haemophilia or other coagulation disorders
  • Acute inflammation
  • Disturbed sensory and nervous function, eg. Diabetes
  • Corticosteroid injections – wait minimum of 6 weeks after local injections
  • Malignancy
  • Prostheses and implants fascia dysfunction (fasciitis)
  • Trochanteric bursitis pain
  • Pregnancy