In this article, you will find out everything you need to know about shockwave and the most effective alternatives, including an advanced treatment called Prolotherapy.

Shockwave therapy

Shockwave Therapy also called Extracorporeal Shockwave Therapy (ESWT), is a technique or device that is used in many healthcare departments for patient therapy and patient care. (1) It is used not only in the portfolio of orthopaedics, but also in physiotherapy, and sports medicine. Some healthcare setups have also found their use in urology and veterinary medicine. The aim of shockwave therapy is to revive the mobility of the patient who has restricted motions due to some injury or other health condition. The technique has the potential of decreasing severe pain and giving relief to the patient in comparatively a shorter time.

History of the Technique

ESWT is a therapy that was found for improved the treatment of patients who suffer from urological conditions. It has been used actively in pain treatment and the healing process since the year 1982. (2) The initial use in clinical practice was for the breakdown of urologic crystals in the urinary tract. Its health and clinical excellence, in the beginning, convinced the healthcare professionals to utilize this process for more health conditions. The technique was successfully introduced for pain relief in orthopaedic and sports medicine as it tends to loosen the hip cement and treat hip pain which is one of the most complicated pain to treat. With the passage of time, the technique has proven to be helpful in fasciopathies, tendinopathies, and also many soft tissue conditions.

Technique of Shockwave Therapy

As it is a non-invasive treatment, it involves a non-invasive probe that is applied to the skin. The electric charge produces an energy wave that is directed to the concerned area.  A force is created on the tissues by the shock waves that may induce healing. This approach to healing works for some people, but this is still not clear, but it may be that shock waves as they cause inflammation and improve the blood circulation and flow to help the body to repair and heal itself. (3)

Principle

Shockwaves are short-lived pressure distortions that proliferate rapidly in three-dimensional space. They are linked with a rapid rise from medium pressure to maximum pressure through the generation of sound waves. The energy sound is produced, which is usually in the form of radial shockwave therapy. Tissues that are consequent of the negative phase of the wave propagation most importantly include tissue effects like cavitation. Both direct shockwave and indirect shockwave cavitation effects may also result in significant reduction in hematoma formation and central cell death. This can also proceed to stimulate new tissue or bone formation. The main physics behind shock waves and physical parameters included evaluating the amount of energy transferred to the target tissue and comparing the different high-energy and low-energy devices being assessed for the effective treatment of musculoskeletal problems.

Mechanism of Action

Shockwave therapy is an outpatient procedure. In this procedure, the probe is applied topically on the skin and then a gel is applied to oblige and conduct the shock waves. High-energy or low-energy waves can be used. High-energy waves are liable to cause pain and need a local or regional anesthetic. No anesthesia is required for Low-energy shock wave therapy so it is not used for it. This radial shock wave therapy is more effective with the participation of an active patient where the patient communicates with the therapist and tells whether the probe is in the right area of pain or not. This treatment does not end up in a single session so one needs to take more than one session.

The therapy involves three steps, which start with locating the treated area so that the waves can be generated over the correct site. This conservative treatment is done by sensing the palpations using the right steps and procedures so that radial shock waves from the therapy can be delivered accurately. Just like the radiological scans, there is a gel that is applied first to the affected area. The gels serve as a transparent agent that lets the shockwaves transmit into the body in a smooth and aligned way. Then the handheld applicator is used by the healthcare professional and placed against the area to be treated followed by pressing the power button to start the operation.

Conditions requiring Shockwave Therapy

There are multiple disease conditions that require shockwave therapy. Some of them are preferentially treated with ESWT, others can only be treated effectively with this method in order to avoid adverse effects and choose the safest treatment. The conditions include chronic plantar fasciitis,, (4) plantar fascia, Achilles tendinopathy, and lateral epicondylitis. Other conditions like jumper’s knee, golfer’s elbow, tennis elbow, and calcific tendonitis are also treated with this therapy. There are multiple ways to treat tendinitis, but hamstring tendinopathy, patellar tendinopathy, and tendonitis of the shoulder are effectively treated with Shockwave Therapy. According to the National Institute of Health and Care Excellence (NICE), the use of this therapy is encouraged for the treatment of Achilles tendon, greater trochanteric pain syndrome, and medial tibial stress syndrome.

Who Should Avoid Shockwave Therapy?

There are some major contraindications that need to be considered before recommending a patient the ESWT technique. This is because it involves waves that can be harmful in a certain condition and can even aggravate some other health conditions. (5) Pregnant and lactating mothers should totally avoid the shockwave therapy work. If a person has a bone marrow condition or a bone tumor, or other infections, he or she is also ineligible to receive this therapy. Since the technique involves waves, it can interfere with any electronic devices that are implanted in the patient’s body. This means that people with heart pacemakers and neurological electric devices cannot get Shockwave Therapy either. Any injured tissues, joints in a post-surgical condition, cancer, and blood vessel disorders also are major contraindications, so any person who can survive without getting this treatment session should totally avoid it.

Why Prefer Shockwave Therapy?

Conditions like rotator cuff and other related shoulder pains often require only a mild treatment. So, shockwave therapy forms a very reliable basis for rapid healing along with physio exercises instructed by physiotherapists. According to the clinical trials, the shockwave therapy suitable also serves as a treatment option for Tendinitis of the shoulder (6) and adhesive capsulitis. Calcifications have been one of the earliest health issues managed with this technique, so patients with calcific tendonitis are prescribed this therapy very often.

Success Rate of Shockwave Therapy

Shockwave therapy has a very high success rate because of its easy-to-manage application system. The treatment does not hurt much and does not hinder any patient’s daily activities which makes it a favorable option for therapy. On the physician’s and the healthcare professional’s part, it is again preferred because it requires the least time, cost, and energy consumption non surgical treatment. It also eliminates the need for steroid injection in many cases, keeping the safety profile of the patient above all other requirements by avoiding serious side effects. (7) The success rate of the ESWT in treating kidney stones is very high, same is the case with calcific conditions. Currently, there is a great interest in the application of the shockwave treatment and in making better use of the mechanisms of action in tendon pathologies. The success rate of this modality has been recorded to be nearly 80% in plantar fasciitis, epicondylitis, calcific tendinitis, Achilles tendinitis or jumper’s knee, and heel pain. Also, recent studies have shown treatment success rates ranging from 78% to 91% recently, depending upon the area treated, treatment protocol, and the device used.

Other treatment options

Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat pain and increase mobility.

Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to repair the damage and help treat pain.

As prolotherapy is helping to treat the root cause of pain, it is deemed to be a permanent fix, preventing the symptoms from returning.

Frequently Asked Questions

How long does it take for shockwave therapy to work?

The shockwave therapy shows a significant decrease in pain and therapeutic effect within a period of 6 to 8 weeks after the first treatment and receival of the therapy.

Who should not get shockwave therapy?

Patients who have open wounds, blood disorders, cancer, and bone disorders and recommended to avoid this shockwave therapy significantly reduced it. Moreover, pregnant and lactating mothers are also advised to avoid shockwave therapy.

What should you not do after a shockwave?

Running and very high-impact exercises like jogging should be avoided after the Shockwave Therapy. This can hinder the success of the treatment and in return harm the patient. However, the patient can begin the rehabilitation exercise doing gentle physical activity after a period of 48 hours.

What is the success rate of shockwave therapy?

The use of shockwave therapy is found to be 60% to 80% effective in most disease conditions which makes it a very renowned option among healthcare professionals as well as patients.

Is shockwave therapy good for arthritis?

Shockwave Therapy is also known for fighting inflammation along with pain reduction. So, yes the treatment is also effective for knee arthritis.

How often can you get shockwave therapy?

Mostly, three to five sessions of ESWT are recommended. These sessions are to be delivered with a spacing of 3-10 days in between each session.

References

1. 1. 1. Shrivastava, S. K., & Kailash. (2005). Shock wave treatment in medicine. Journal of Biosciences, 30(2), 269–275. https://doi.org/10.1007/bf02703708
      2. Vincent, K. C. S., & d’Agostino, M. C. (2018). History of Shockwave Treatment and Its Basic Principles. Shockwave Medicine, 6, 1–16. https://doi.org/10.1159/000485050
      3. Auersperg, V., & Trieb, K. (2020). Extracorporeal shock wave therapy: an update. EFORT Open Reviews, 5(10), 584–592. https://doi.org/10.1302/2058-5241.5.190067
      4. Kudo, P., Dainty, K., Clarfield, M., Coughlin, L., Lavoie, P., & Lebrun, C. (2006). Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: A North American confirmatory study. Journal of Orthopaedic Research, 24(2), 115–123. https://doi.org/10.1002/jor.20008
      5. van der Worp, H., van den Akker-Scheek, I., van Schie, H., & Zwerver, J. (2013). ESWT for tendinopathy: technology and clinical implications. Knee Surgery, Sports Traumatology, Arthroscopy, 21(6), 1451–1458. https://doi.org/10.1007/s00167-012-2009-3
      6. Notarnicola, A., & Moretti, B. (2012). The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles, Ligaments and Tendons Journal, 2(1), 33–37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666498/
      7. Mittermayr, R., Antonic, V., Hartinger, J., Kaufmann, H., Redl, H., Téot, L., Stojadinovic, A., & Schaden, W. (2012b). Extracorporeal shock wave therapy (ESWT) for wound healing: Technology, mechanisms, and clinical efficacy. Wound Repair and Regeneration, 20(4), n/a-n/a. https://doi.org/10.1111/j.1524-475x.2012.00796.x