Extra-corporeal shock wave therapy (ESWT) is a treatment used to treat tendon pathology – as well as other musculoskeletal pain. Shockwave is an acoustic wave which carries high energy to painful spots and musculoskeletal tissues with subacute, subchronic and chronic conditions. The energy promotes regeneration and reparative processes of the bones, tendons and other soft tissues.
How does it work?
Shockwave initially reduces pain through what is known as ‘hyperstimulation anesthesia’. The nerves sending pain signals to the brain are stimulated to such an extent that their activity diminishes, thereby decreasing or eliminating pain.
Shockwave alters the release of the pain mediator and growth factor Substance P. Substance P is responsible for causing slight discomfort during and after shockwave treatment. Over time the shockwaves lead to the depletion of substance P from nerve endings. Less substance P in the tissue results in reduced pain.
Extracorporeal shockwaves also produce a regenerative or tissue-repairing effect in musculoskeletal tissues. They appear to stimulate the release of growth factors and an improve blood supply leading to repair of tendon and bone. These are the mechanisms by which a long-term improvement in symptoms occurs.What conditions does it work for?
Shockwave therapy has been used in sports medicine clinics worldwide for a number of years. It is not a new treatment. There is scientific evidence to show that:
- It is as effective as 3 months of eccentric strengthening for Achilles tendinopathy
- It is superior to eccentric strengthening and more ‘traditional’ rehabilitation techniques for insertional achilles tendinopathy
- It is an effective treatment for proximal hamstring tendinopathy
- It is an effective treatment for plantar fascia dysfunction (fasciitis)
- It is effective for treating trochanteric (hip, gluteal) pain
- Can be used to treat tennis and golfers elbow (tendinopathy affecting the common extensor and flexor tendons at the elbow)
What to expect at the appointment:
If you have been referred for shockwave, you will attend a shockwave specific appointment, of which the treating physiotherapist maybe different from your ‘normal’ one. The treating physiotherapist will have a good understanding of your injury prior to the appointment.
The physiotherapist will locate the area of pain through palpation. Ultrasound gel is applied and shockwave impulses are delivered using a hand-piece, which is moved continuously over the painful area/structure with mild-moderate pressure.
It takes about five to ten minutes to deliver a single treatment. This is generally said to be uncomfortable (rather than painful) and is well tolerated by the vast majority of patients.
How many sessions of Shockwave do I need?
For maximum benefits, research suggests 3 treatments, 1 week apart.
Some patients may require 1-2 additional treatments, but this will be guided by your physiotherapist.
Shockwave is unsuitable in the following circumstances:
If you are pregnant
If you have a blood clotting disorder (including thrombosis)
If you are taking oral anti-coagulants
If you have received a steroid injection within 6 weeks
If you have a pacemaker fitted
If tumours are present at the treatment site
If you have an infection or skin abrasion at the treatment site
Is it painful?
It is more uncomfortable than truly painful. The level of discomfort can vary from patient to patient, and is dependant on injury location and severity.
Can the treatment be stopped I find it too painful?
Yes, of course. This would limit the effect of treatment, but it can be ceased if needed (although highly unlikely).
Will I feel pain afterwards?
Usually patients report a reduction in pain immediately afterwards, however there may be an ache or an increase in pain in the hours after treatment due to the mechanism of the shockwave acting on your injury. The best results occur 12 weeks after the initial treatment.
Are there any side effects?
Following the treatment, you may experience more pain, redness, bruising, swelling and numbness to the area at first. These side effects should resolve within a week, before your next treatment.
Are there any restrictions after treatment?
We would advise no specific loading of that area/injury for up to 48 hours after treatment.