Clinical Corner - Shockwave Therapy

In our clinical corner this quarter we take a look at shockwave therapy, one of the treatments available via our physiotherapy team and used to treat a variety of musculoskeletal problems. It is particularly helpful for those conditions where the muscle tissue attaches to bone.

Therapeutic shockwaves were introduced over twenty years ago as a medical treatment for eliminating kidney stones without causing skin injury. Some of the beneficial side effects on areas submitted to shockwave treatment were found to be bone healing and also accelerated tissue healing.

Today the use of radial shockwaves or Radial Pressures Waves (RPW) has been successfully extended to other therapeutic and wellness applications.

How does it work?

The mechanism of action is thought to be:

- Mechanical stimulation

- Producing increased local blood flow in the damaged tissue

- Increase in activity of cells responsible for healing

- Transient analgesic (pain killing) effect on nerves

- Breaking down calcific deposits (primarily, but not exclusively in tendon)

Common conditions suitable to treat

- Heel pain - Plantar fasciopathy

- Achilles, patellar and high hamstring tendinopathy

- Medial Tibial Stress Syndrome (shin splints)

- Lateral hip pain - Greater Trochanteric Pain Syndrome including gluteal medius tendinopathy, trochanteric bursitis

- Tennis Elbow 

- Golfer’s Elbow

- Calcific tendinitis of the shoulder – an acutely painful condition of the shoulder (rotator cuff) tendons where calcium forms in the tendon

It can also be used to treat:

- Muscle trigger points

- Tight muscle and connective tissue bands

- Lymphatic drainage

Advantages over other procedures

- Shockwave therapy is non-invasive - no needles or surgery are required

- Quick to administer- approximately 15-20 minutes per session, 4-6 sessions usually required

- Well tolerated and few complications

- Reported side effects are minimal

- Significant benefit can often be seen 6-8 weeks after treatment

Cautions and contraindications

There are certain situations where Shockwave therapy is not appropriate.

- If there is infection in the local area

- Over the lungs

- In bleeding disorders like Haemophilia or people taking anticoagulant therapy e.g. warfarin

- Tumours                                                                

- Implanted cardiac stents, pacemakers and implanted heart valves

- Joint replacement (only in the area to be treated)

- Children – it is not used over active growth plates in bones

- Pregnancy

- Cortisone therapy up to 6 weeks before 1st treatment

The last point may influence the choice of treatment for conditions where shockwave and injection may be appropriate.

If you have shockwave therapy first, you can proceed to injection treatment if it does not work adequately, but you would need to wait six weeks after an injection before starting shockwave therapy.

Possible side effects

You should be aware that there may be some transient side effects to this treatment that should resolve in a few days. These are:

- Reddening

- Swelling

- Mild pain

- Haematoma (bruising) or Petechiae (red spots)

- Skin bruising may be more pronounced if you have had previous cortisone (steroid) treatment

- Tingling and numbness

​How many sessions are required?

Normally at least three treatment sessions at about weekly intervals, and a minimum of five days between treatments. If good effect is being seen then additional sessions may be required.