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Shockwave Therapy

Updated: May 1, 2023


What is shockwave therapy?

It is a non invasive treatment that uses shockwaves in damaged tissue by increasing blood circulation and metabolism which stimulates regeneration and healing. It can be used on tendons, ligaments and other soft tissue injuries such as achilles tendinopathies, plantar fasciitis and tennis elbow, to name just a few.



Physical Effects of Shockwave

Radial pressure waves (RPW) offer a non invasive treatment solution to long term insertion and soft tissue pathologies. Local treatment in the affected area will support and reset the healing pattern. Today there are several working hypothesis for the physical effects of radial pressure waves:

•Pain reduction: The patient experiences a reduction of pain, explained by the Gate Control Theory. Intensive pulses from the transmitter into the tissues create a strong nociceptor activation of the A-β fibers, which affect interneurons that inhibit the transmission of the pain signals.

•Increased metabolism: Shockwaves influence the tissues on a cellular level. The chemical environment of the cells is affected by free radicals promoting the release of pain and inflammatory inhibiting substances.

•Revascularization: Repeated shockwaves to the affected area create a revascularization effect, with the new blood flow in the area promoting tissue healing and regeneration.

•Reduced muscle tone: The “vicious circle”, as well as the strong pathological association between pain and muscle tone, will be broken and lead to restoring a normalized muscular tone. (1)


Background

Therapeutic shockwaves were introduced as a medical treatment for eliminating kidney stones 20 years ago. One of the side effects discovered during treatment was the effect on bone healing (bone density increase), as well as accelerated tissue healing in the area. In nature, shockwaves are caused by a high energy wave. This wave has an extremely short build up time and high amplitude, similar to an explosion. (1)


What to expect

The area of pain is located through palpation. This area will then be marked and some ultrasound gel applied. The shock wave impulses are delivered using a hand-piece. It takes about five minutes to deliver a single treatment. This is generally said to be uncomfortable (rather than painful) and is well tolerated by the vast majority of patients. This process is usually repeated a total of three times - with a week between treatments.

Some patients note an immediate improvement in their pain, for others the best results may take a bit longer.


What conditions can shockwave be used for?

* The majority of the treatment programs are for what we commonly refer to as “insertional tendinopathies”.

* Soft/connective tissue/muscles with trigger points or / and increased tension are also targets for treatment.

* In many cases shockwave treatment gives excellent results in order to dissolve calcifications.


For example:


• Plantar fasciitis

• Achillodynia

• Shin splints

• Muscle sprain

• Jumpers knee

• Runners knee

• Trigger point therapy

• Trochanteric insertion tendonitis

• Piriformis syndrome (1)


What are the benefits of shockwave?

• Short treatment time (minutes)

• Precise & targeted application

• Deep tissues can be reached

• Non-invasive

• Alternative to medication

• Results usually 2-6 weeks after final treatment


Radial Pressure Waves

Radial pressure waves are pulses generated by compressed air. The compressed air is used to drive a projectile in a cylinder, located inside the hand piece, to a shock transmitter. The kinetic energy generated by the motion and weight of the projectile, converts into acoustic energy when the projectile hits the shock transmitter. The acoustic pulses then spread into the underlying tissue, treating a larger area than the focused shockwave shown on the previous page. The highest energy level of the pressure waves will be at the tip of the transmitter (max 0, 63 mJ/mm² at 5 Bar) right on the skin over the treatment point and 4 Bar on the Mobile RPW. The energy level will then gradually decrease as the penetration depth increases. The penetration depths are normally 0-6 cm (0-2.3”). Apart from providing focused shockwaves, a treatment with radial pressure waves needs no additional pre examinations or treatments such as ultrasound imaging, local anesthesia, MRT or X-ray. With a correct handling, RPW is an excellent non invasive treatment method with very few negative side effects, for indications that normally are very difficult to treat. For these indications we now know that radial pressure waves is a treatment method that reduces pain as well as improves function and quality of life. (1)

Scientific Background

Radial shockwave therapy is a modality which is successfully used by doctors, practitioners and physiotherapists in both sport medicine and rehabilitation. Radial shockwave therapy has recently been the subject of clinical evidence in several medical papers. The research is progressing continuously with a steadily increasing volume of publications.


What can be the side effects of shockwave therapy?

Occasionally patients may experience mild side effects after a treatment The majority will appear within 1-2 days of treatment.

• Reddening

• Swelling

• Pain

• Haematoma (bruising)

• Petechia (red spots) / Redness


Speak to your therapist if you are taking any pain relief (2)


As with everything, Shockwave therapy has contraindications, so you should always discuss treatment with your practitioner first so they can advise you.



References:

1) Chattanooga RPW Shockwave Therapy, Clinic Guide

2) Chattanooga RPW Shockwave Therapy, Patient Guide



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