Extracorporeal shockwave therapy treats common MSK conditions such as Achilles tendonitis, plantar fasciitis, tennis elbow, and stress fractures. In addition, there is good scientific evidence that shock wave therapy reduces pain. But what is shockwave treatment, and how does it work?
What is extracorporeal shockwave therapy?
It’s a simple pressure wave that creates a sudden change in pressure. There are different ways to produce a shockwave. For example, we make radial shock waves using high-pressure air to force a collision of a ball bearing onto a metal tip. This collision creates a sound wave that moves outwards. Alternatively, focused shock wave produces a sound wave fixed to one point with increased energy. We don’t know whether radial or focused shock wave is better. However, we suspect that focussed shockwave may be better for deeper structures such as the hamstring tendons.
What does shock wave therapy do?
Surprisingly, we don’t know exactly. However, we think that shockwave pressures change the properties of cells, causing healing and remodeling. Alternatively, we believe that sound waves stun the small nerves that transmit pain messages to the brain. Also, shockwave may break up calcium deposits in tendons, reducing pain.
Most people experience immediate pain relief after every session, but the best effects are felt after 3-5 sessions.
What conditions respond best to extracorporeal shockwave therapy?
Generally, we think that certain musculoskeletal conditions respond better to shockwave than others.
Common conditions that have shown positive effects in studies on shockwave include Achilles tendonitis, hamstring tendonitis, tennis elbow, plantar fasciitis, shin splints, and stress fractures.
Recent evidence suggests a good effect of shockwave in lower limb tendons. We are not sure if radial or focussed shockwave is better. However, we suspect that focussed shockwave is better for pathology that needs more energy, such as stress fractures or large deeper tendons such as hamstring or hip tendons.
How long does the treatment take?
Generally, we suggest one session every seven days for up to 5 sessions. Each session directs about 3000 sound waves over 5-10 minutes.
If there is no response after five sessions, we recommend stopping this treatment.
Does shockwave therapy hurt?
Both focussed and radial shockwave is uncomfortable but should not be intensely painful. Power can be adjusted depending on how painful the procedure is. However, we don’t suggest local anaesthetic for patients. Studies indicate that shockwave is more effective without local anaesthetic.
Do you need to modify exercise during shockwave therapy?
Generally no. You do not need to change or stop your exercise program during shockwave treatment. Results are better if you combine shockwave and exercise. However, we advise you to avoid anti-inflammatory medicines such as ibuprofen tablets or ice packs as we think these treatments can blunt the positive effects of shockwave.
Will private insurance cover the cost of shockwave therapy?
Yes, most insurance plans will cover the cost of a series of shockwave sessions in central London. However, you should check with insurance coverage before starting treatment.
Other frequently asked questions about shockwave therapy?
What is the shockwave therapy recovery time?
It takes time to see a benefit from shockwave therapy. Generally, maximal benefit occurs 4-6 weeks after the last session.
Can shock wave therapy cause damage?
If used correctly at the proper settings, it is unlikely to cause damage. It is one of the reasons we use it for tendonitis, as the risks are less than other interventions, such as tendon injections.
Shockwave treatment side effects: what are they?
Generally, shockwave therapy is well tolerated. However, possible side effects include increased pain and skin damage.
Does exercise therapy help improve the effects of shockwave?
Yes. Recent studies suggest that exercise can help improve the effects of shockwave therapy. For example, a recent paper reviewing combining exercise with shockwave has found excellent results with Achilles tendonitis, tennis elbow, plantar fasciitis, and calcific rotator cuff tendonitis.
Final word from Sportdoctorlondon
Overall, shockwave therapy is an excellent addition to tendonitis and stress fractures treatment. In particular, shockwave therapy is helpful for plantar fasciitis, hamstring origin tendinopathy, and problematic tennis elbow. However, we don’t know whether a focussed or radial shockwave is better.
On a torn shoulder tendon, that I have anterior and posterior, my second MRI in a year with no surgery shows that the tear is calcifying, so my question is is the calcium buildup superficial? Can it be scraped off upon surgery? And how typically do they repair this type of problem? I heard they can use tendons from a pig is that true? Do they use tendons from a cadaver also I would like to know!!!!
If the tendon needs repair, then it is easier enough to remove the calcification before repair. Surgeons can use cadaver tendons if needed.