How Effective is Shockwave Therapy?

A simple, yet effective solution to reducing pain in the feet, legs and back

Shockwave therapy is a safe, non-invasive, and innovative treatment for various musculoskeletal conditions. It uses acoustic sound waves, “shockwaves” to reduce inflammation, stimulate tissue repair, reduce pain, and promote healing. Extracorporeal shockwave therapy is used in sports medicine to treat a myriad of conditions including but not limited to:

  • Plantar fasciitis
  • Achilles tendinopathy
  • Cellulite
  • Muscle tightness and tears
  • Greater trochanteric bursitis
  • Long bone non-union fractures
  • Osteoarthritis
  • Shin splints
  • Jumpers knee
  • Osgood-Schlatters
  • Avascular necrosis
  • Tennis elbow
  • Calcific or non-calcific tendonitis of the shoulder
  • Myofascial pain syndrome

What does shockwave therapy do?

The mechanism of action of extracorporeal shockwave therapy consists of a biphasic pulsed acoustic sound wave (shockwaves) that carry energy through tissues to induce a rapid increase in both positive and negative pressures. The positive and negative pressures induce physical/mechanical effects on treated tissues to initiate a variety of molecular and biological effects on both bone and soft tissues. These response to these effects results in the development of new blood vessels and an increase in growth factors and signalling pathways resulting in tissue repair, healing, and regeneration.

In addition to the regenerative effects of extracorporeal shockwave therapy, shockwave therapy also provides analgesic effects through several mechanisms, encompassing degeneration of small sensory unmyelinated nerve fibres, reduction of pain-related neuropeptides, hyperstimulation of nociceptors, alteration of pain neurotransmission, and a reduction in inflammation, all working to reduce pain levels. 

How long does it take for shockwave therapy to work?

One of the effects of extracorporeal shockwave therapy is increased healing rates, however the exact timeframes for increased recovery can vary depending on the injury being treated and associated injury specific treatment program. In some instances, pain relief can be almost immediate, however this does not indicate injury recovery, rather an analgesic effect due to the response of nociceptors (nerves that signal pain). Shockwave therapy can reduce pain due to the temporary inhibition of the nerve fibres that signal pain.

In conditions such as plantar fasciitis, treatment times are around 6-8 weeks in conjunction with home exercises. Whereas the recovery time for midportional Achilles tendinopathy varies depending on patient compliancy with home tissue-loading exercises.

The treatment time for cellulite therapy can vary based on frequency of treatment; two sessions per week for five weeks or one session per week over ten weeks. In both cases, improvements continue for the three months following treatment.

For long bone non-union fractures improved healing continues for over six months following treatment.

It is important to note that shockwave therapy is not recommended as a sole therapy, rather an adjunct to treatment that may include, off-loading, orthotics, home exercises, and even diet depending on desired outcome.

Additionally, a growing body of evidence demonstrates that long-term analgesia, lasting between several months and years, occurs following a couple of extracorporeal shockwave therapy sessions.

What conditions can shockwave therapy treat?

Approved standard indications for the use of extracorporeal shockwave therapy include:

Chronic tendinopathies

  •     Calcifying tendinopathy of the shoulder
  •     Lateral epicondylopathy of the elbow or tennis elbow
  •     Greater trochanter pain syndrome
  •     Patellar tendinopathy
  •     Achilles tendinopathy
  •     Plantar fasciitis with or without heel spur

Bone pathologies

  • Delayed bone healing
  • Bone non-unions or pseudoarthroses
  • Stress fracture
  • Avascular bone necrosis without articular derangement
  • Osteochondritis dissecans without articular derangement

 Skin pathologies

  • Delayed or non-healing wounds
  • Skin ulcers
  • Non-circumferential burn wounds

Common empirically tested clinical uses include:

Tendinopathies

  • Rotator cuff tendinopathy without calcification
  • Medial epicondylopathy of the elbow
  • Adductor tendinopathy syndrome
  • Pes anserinus tendinopathy syndrome
  • Peroneal tendinopathy
  • Foot and ankle tendinopathies

Bone pathologies

  • Bone marrow edema
  • Osgood-Schlatter disease or apophysitis of the anterior tibial tubercle
  • Tibial stress syndrome

Muscle pathologies

  • Myofascial syndrome (such as myofascial pain syndrome of trapezius)
  • Muscle sprain without discontinuity

Skin pathologies

  • Cellulite

What are the side effects of shockwave therapy?

There are no long-term complications associated with the use of extracorporeal shockwave therapy in populations that fit the criteria for treatment. Shockwave therapy is unsuitable in the following circumstances:

  • Pregnancy
  • Blood clotting disorders (including thrombosis)
  • Oral anti-coagulant medications
  • Within 6 weeks of a steroid injection
  • Pacemaker fitted
  • Tumours present at the treatment site
  • Infection or skin abrasion present at the treatment site
  • Bone lithotripsy
  • Bone infection or infected pseudarthrosis
  • Active growth plates in children and young adults (except in the treatment of Osgood-Schlatter disease)

How does shockwave therapy affect nerves?

Although the precise molecular mechanisms underlying extracorporeal shockwave therapy mediated analgesic effects are not yet fully understood, a mounting body of evidence demonstrates that shockwave therapy is a safe and effective treatment modality in causing pain reduction and functional recovery in subjects with different musculoskeletal disorders including nerve lesions.

The application of extracorporeal shockwave therapy activates nervous tissue regeneration involving numerous endogenous biochemical and cellular events that lead to decreased neuronal loss, and temporary loss of sensory unmyelinated nerve fibres, inducing long-lasting analgesia.

Shockwave therapy is used to improve vascularization, the local release of growth factors, and local anti-inflammatory effects to promote neural regeneration. However, clinicians avoid treating major nerves directly, rather focusing shockwave therapy on the areas around the major nerves avoiding major nerves themselves.

Is shockwave therapy good for knee osteoarthritis?

Extracorporeal shockwave therapy has significant effects on pain reduction, global function restoration, and disease inflammation reduction in people suffering from knee osteoarthritis. The application of shockwave therapy as a sole treatment significantly improves pain levels, function, and inflammation. However, better results are seen when combining shockwave therapy with conventional physical therapy techniques such as muscle strength and conditioning.

Where can I get shockwave therapy?

Bespoke Health and Performance offers shockwave therapy in Sydney CBD and Narwee. Both locations offer the latest extracorporeal radial shockwave therapy technology, applied by experienced podiatrists that have been effectively using shockwave therapy as an adjunct therapy for years.

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