EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT) FOR MUSCULOSKELETAL CONDITIONS29 July 2019
What is shockwave therapy?
Extracorporeal shockwave therapy (ESWT – and more commonly known as shockwave therapy) is a type of treatment used by physiotherapists, orthopaedists, urologists and cardiologists. It’s an effective treatment option that results in no injury to the actual skin. Many studies exist on the efficacy of shockwave therapy that have been reviewed and accepted by NICE (UK National Institute for Health and Clinical Excellence) and the FDA (Food and Drug Administration).
How does shockwave therapy work?
With shockwave therapy being a multidisciplinary device, it can work and be used in a variety of ways depending on the practitioner. A shockwave itself can be defined as a sharp change of non-periodic pressure, which forms the basis of this method of treatment.
Shockwave therapy works by sending shockwaves – an acoustic wave which carries high frequencies of energy to areas of injury such as myoskeletal tissue, subchronic and chronic conditions. The waves are said to promote the body’s natural regeneration process of bones and soft tissues through the kinetic energy of the device which is created by compressed air, the frequencies can be transferred from the end of the applicator into the patient’s tissue.
Medical Indications of Shockwave therapy:
The following types of medical indications are the most commonly sought after for shockwave therapy treatment:
Medial tibial stress syndrome
Advantages of shockwave therapy
Patients tend to have trouble facing the thought of invasive surgery, especially when they hear about the risks involved. By correcting factors that have caused injury in the first place, you can make the most out of shockwave therapy due to its advanced medical investigations and safety.
Advantages of shockwave therapy include:
No risk of tendon rupture
NICE and FDA approval
Complication risks are extremely low
Studies on shockwave therapy
Numerous studies have been undertaken to prove the efficacy of shockwave therapy as a form of treatment – including non-reoccurrence, complete elimination of pain, elimination of ailments in relation to Achilles tendinopathy and plantar fasciitis. Studies on how to cure plantar fasciitis in particular has formed the basis of how effective shockwave therapy is for patients, especially for aiding the regeneration of chronic plantar fasciitis and severe plantar fasciitis.
We’ve collated some of the most notable studies that have proved how effective shockwave therapy is as a form of treatment:
After 9 studies reviewed:
The systematic review by NICE had reported evidence from a case-control study of 68 patients:
The study involved comparing shockwave therapy with conservative treatment including rest, footwear modification, anti-inflammatory medication, and gastrocnemius-soleus stretching and strengthening. They found that shockwave therapy was statistically significantly better in improving pain and functional outcomes at 3–month follow‑up
Side effects reported: transient pain, reddening of the skin, numbness and headaches
In conclusion there were no major safety concerns
106 studies reviewed
The studies involved investigation the safety of shockwave therapy and was supported by cumulative data.
Shockwave therapy was evaluated to be “effective and safe”. An optimum treatment protocol for shockwave therapy appears to be three treatment sessions at 1-week intervals, with 2000 impulses per session and the highest energy flux density the patient can tolerate.
In terms of data - the efficacy of shockwave therapy is clearly supported: 88.5% (23 out of 26) of all RCTs (randomised control trials), on (radial) rESWT and 81.5% (66 out of 81) of all RCTs on focused shockwave therapy in PEDro had positive outcomes (i.e. randomised shockwave therapy or focused shockwave therapy is significantly better statistically than either placebo or alternative treatment modalities).
No reports of serious adverse events in any of the studies performed.
A total of 39 studies included were included in this systematic review due to its common occurrence in middle-aged people, athletes and soldiers.
Treatment for plantar fasciitis gneraly involves resting the affectied area, taking NSAIDs, physiotherapy, tenex or injections – the last two in particular are invasive treatments with risks of developing a ruptured plantar fascia. Due to the risks involved, shockwave therapy became a highly researched method of treatment.
11/39 was a single session treatment (28%)
19 studies (49%) had weekly intervals between sessions
Two more studies had daily intervals
Another had 3-day intervals
Two studies had two-week intervals, three studies had four weeks to three months intervals, and for one study intervals are unknown.
Peak incidents occur between ages 40-60
Up to 94% success rate
The most common side effects reported: reddening of the skin, numbness, transient pain, bruising and headache
Evaluated ESWT as being a safe treatment for Plantar Fasciitis.
No complications expected at one-year follow-up. Shockwave therapy machines contribute to the healing and pain reduction in plantar fasciitis as a result.
Other studies of shockwave therapy on various conditions
Studies of Shockwave Therapy on various other conditions
Each condition to follow this order: No. of patients involved, time period of the study, objectives and conclusions
Commonly asked questions
Will Shockwave Therapy definitely help me?
Slight discomfort is normal. Treatment is over within minutes and patients report being able to tolerate discomfort due to the short period.
How many treatments will I need?
This depends on the tissue response, and with the treatment being cumulative you’ll typically need anywhere between 3-5 rounds of treatment. Patients report significant relief after their first treatment.
How often will I need treatment?
This depends on your tissue response and tolerance. Anywhere between 3-5 treatments are needed and are performed between 3-10 days apart.
Will I feel pain after the treatment?
Patients report immediate pain relief after their first treatment. However within a few hours of treatment, you may experience slight soreness. It’s been reported tolerable and will not hinder any day-to-day activity
Are there any restrictions after the treatment?
We highly recommend refraining from physical activity, especially if it involves the treated area for 48 hours after your session.