Shockwave Therapy

What is shockwave therapy?

Extracorporeal shockwave therapy (ESWT) or shockwave therapy is a non-invasive (1), conservative treatment which is effective for treating many tendon conditions (4,10). Multiple studies have found shockwave therapy to be up to 80% effective, with improvements found in pain level and function at the affected area (5,6). Shockwave therapy is considered for individuals when their pain is not settling with conventional physiotherapy alone. Evidence suggests that shockwave therapy can be most effective when combined with an exercise programme and conventional physiotherapy (4).

Who can shockwave help?

Shockwave therapy has been used for many years(1) to treat both acute and chronic pain, with most of the recent evidence suggesting it is particularly effective for individuals with chronic, nagging issues (5) including:

  • Plantar fasciitis (1; 3)
  • Achilles tendinopathy (itis) (2)
  • Patellar Tendinopathy (Jumper’s knee) (2)
  • Calcific and non-calcific shoulder tendinopathy (itis, 2).
  • Tennis Elbow (lateral epicondylitis; 2).
  • Greater trochanteric pain syndrome (2)
  • Proximal hamstring tendinopathy (itis; 7)

How shockwave therapy works

Shockwave therapy is delivered through a hand-held probe which pulses high energy sound waves to the skin and underlying tissue through a water-based gel medium. There are many theories as to why ESWT can be effective, but some of the latest theories we have about shockwave therapy about the underlying treatment effect is that it can decrease local tissue sensitivity and pain; increase tissue repair, support the body’s natural healing processes and reduce inflammation (4).

Shockwave at Balanced

If shockwave therapy is an appropriate intervention for you, you will see an experienced physiotherapist who will deliver 3-5 initial sessions of shockwave therapy (7). Appointments generally last 25-40 minutes.

Alongside your shockwave treatments, you will also be following an individualised exercise programme.

After your initial block of shockwave sessions, we will monitor your progress with the exercise programme and assess whether further treatment is indicated based on how you're feeling and functioning.

Are there any side effects?

Shockwave is regarded as a safe therapy (8). However, as with many physiotherapy treatments, there are some potential side effects. These side effects include pain (primarily during application of shockwave therapy), skin redness, swelling and bruising. To help mitigate any potential side effects, your therapist will adjust your treatment to suit your needs and comfort level.

Who can’t have shockwave therapy

There are relatively few contraindications to shockwave, however you cannot have shockwave therapy if (9):

You are pregnant or trying to conceive

You are undergoing cancer treatment

You have had a steroid injection in the last 6 weeks

You have an infect or wound at the treatment site

You are under 18 years old

If you are taking anticoagulants

You have a blood clotting disorder

You have a viral infection

The tendon question has previously ruptured

Next steps - Booking your Treatment.

If shockwave therapy sounds right for you, you can give us a call on 0131 315 3105 or enquire via email at info@balancededinburgh.co.uk.

References.

1.Sun J, Gao F, Wang Y, Sun W, Jiang B, Li Z. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: A meta-analysis of RCTs. Medicine (Baltimore). 2017. 96(15):e6621. doi: 10.1097/MD.0000000000006621. PMID: 28403111; PMCID: PMC5403108.

2.Al-Abbad H, Allen S, Morris, S. et al. The effects of shockwave therapy on musculoskeletal conditions based on changes in imaging: a systematic review and meta-analysis with meta-regression. BMC Musculoskelet Disord. 2020. 21(275). https://doi.org/10.1186/s12891-020-03270-w

3. Hirschmüller A, Weidermann F. Plantar Fasciopathy - Pathophysiology Diagnostics and Therapy - A Clinical Guideline. Therapeutische Umschau. Revue Therapeutique. 2022. 79(7):325-332. DOI: 10.1024/0040-5930/a001369. PMID: 35983940.

4. Paantjens MA, Helmhout PH, Backx FJG, van Etten-Jamaludin FS, Bakker EWP. Extracorporeal Shockwave Therapy for Mid-portion and Insertional Achilles Tendinopathy: A Systematic Review of Randomized Controlled Trials. Sports Med Open. 2022. 8(1):68. doi: 10.1186/s40798-022-00456-5. PMID: 35552903; PMCID: PMC9106789.

5. Dedes V, Stergioulas A, Kipreos G, Dede AM, Mitseas A, Panoutsopoulos GI. Effectiveness and Safety of Shockwave Therapy in Tendinopathies. Mater Sociomed. 2018. 30(2):131-146. doi: 10.5455/msm.2018.30.141-146. PMID: 30061805; PMCID: PMC6029898.

6. Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles Ligaments Tendons J. 2012. 2(1). PMID: 23738271; PMCID: PMC3666498.

7. Tenforde AS, Borgstrom HE, DeLuca S, McCormack M, Singh M, Hoo JS, Yun PH. Best practices for extracorporeal shockwave therapy in musculoskeletal medicine: Clinical application and training consideration. PM R. 2022. 14(5), pp.611-619. doi: 10.1002/pmrj.12790. Epub 2022 Apr 14. PMID: 35187851; PMCID: PMC9321712.

8. Schroeder AN. Tenforde AS,  Jelsing EJ. Extracorporeal Shockwave Therapy in the Management of Sports Medicine Injuries. Current Sports Medicine Reports. 2021. 20(6), pp. 298-305. DOI: 10.1249/JSR.0000000000000851

9. ISMST Guidelines : https://www.shockwavetherapy.org/fileadmin/user_upload/ISMST_Guidelines.pdf

10. (10)Reilly JM, Bluman E, Tenforde AS. Effect of shockwave treatment for Management of Upper and Lower Extremity Musculoskeletal Conditions: a narrative review. PM R. 2018. 10(12). pp. 1385‐1403. doi: 10.1016/j.pmrj.2018.05.007

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