Definition & Overview

Shockwave therapy, also referred to as extracorporeal shockwave therapy (ESWT), is a non-invasive procedure in which pressure waves are introduced into the body to treat various musculoskeletal conditions. As suggested by its name, it involves acoustic shock waves passed through the skin and targeted towards injured areas using a special hand piece or device. It helps treat chronic pain in affected areas such as the heel and elbows.

In shockwave therapy, mechanical, audible, and low-energy shockwaves (and not electric in nature) are used. These are intense and made of short energy waves that travel faster than the speed of sound. The procedure works by enhancing blood flow to the injured area, thereby accelerating the natural healing process. The exact scientific reason for its effectiveness in alleviating pain and inflammation is yet to be fully understood, but experts believe that ESWT does have a direct effect on nerves.

The concept behind shockwave therapy is similar to that of lithotripsy, a technology that uses shockwave to break apart kidney stones and has been in use for decades as a standard procedure for the said condition without the need for surgery. Medical experts have built up on this technology and have found that shock waves can also accelerate the healing process.

Who Should Undergo and Expected Results

ESWT is used to treat various musculoskeletal pain, diseases, and conditions, specifically those that involve connective tissues attached to the bone. It is a more advanced treatment option considered if conservative treatments such as rest, ice therapy, painkillers, steroid injections, and physiotherapy fail to offer patients adequate relief. It can treat various conditions including:

  • Plantar fascitis or fasciosis – A condition characterised by stabbing pain in the heel due to the inflammation of plantar fascia, which connects the bones to the toes.

  • Achilles tendonitis – A condition caused by overuse of the Achilles' tendon, found between the calf muscles and the hind lower leg

  • Calcific tendonitis – This refers to pain caused by calcium buildup in the tendon, leading to pressure and irritation

  • Lateral epicondylitis or “tennis elbow” – A condition characterised by the inflammation and pain in the tendons of the elbow due to overuse of the forearm, arm, and the hand muscles

  • Morton’s neuromas – This refers to heel pain caused by thickening of connective tissues surrounding the nerve between the bases of the toes (common in women, usually due to long-term use of high heels or tight shoes)

  • Heel spur – This refers to the pain due to calcium deposit protrusion on the underside of the heel bone
    Those suffering from the conditions above as well as other connective tissue related diseases are candidates for this treatment. Although generally safe, shock wave therapy is not recommended for:

  • Children

  • Pregnant women
  • Patients taking blood clot inhibiting medications (anticoagulants) and antiplatelet drugs
  • Patients with bone tumours and certain metabolic bone conditions
  • Patients with nerve and circulation disorders
  • Those with cardiac pacemaker or other device installed
  • Those with foot infection
  • Patients who had steroid injection in the past three months

How is the Procedure Performed?

After a full evaluation of medical history, the procedure is pre-planned by marking the trigger point and actual sore area, where a special gel is then applied. The ESWT hand piece is then positioned strategically to start transmitting shockwaves in marked areas. The handpiece delivers slow and gentle compressed air impulses through the ultrasonic gel. The entire procedure lasts only about 15 minutes.

During the procedure, patients usually feel some degree of pain. While the shock waves are being released, the orthopaedic specialist may adjust treatment to ensure that the pain is manageable and tolerable for the patient.

Energy pulsations of ultrasonic waves sent into the body in ESWT simulate the body’s innate self-healing process, making the procedure effective in inducing healing.

After the session, patients are usually able to stand up and walk normally. Pain medications, anti-inflammatory medication, or ice therapy are NOT recommended as these might interfere with the proper healing process. While normal activities can be resumed right away, strenuous activities must be avoided 48 hours after the ESWT session.

Most patients notice significant improvement after just one session. Success rates are about 80%, and increases to 90% with a second treatment.

Possible Risks and Complications

With shockwave therapy, there is no need for surgery, anaesthesia, or medications. As such, the procedure is free of side effects, assuming proper preparations were conducted. However, some patients report slight tingling sensation, hypersensitivity, redness, bruising or swelling, numbness, and warmth – all of which go away within a few days.

There may be a small risk for tendon or ligament to rupture as well as soft tissue damage. However, this complication can be easily avoided by hiring the services of a highly experienced medical consultant.

References:

  • Waugh CM, Morrissey D, Jones E, Riley GP, Langberg H, Screen HR (2015). "In vivo biological response to extracorporeal shockwave therapy in human tendinopathy." European Cells & Materials 29: 268–80; discussion 280.

  • Zuoziene G, Leibowitz D, Celutkiene J, Burneikaite G, Ivaskeviciene L, Kalinauskas G, Maneikiene VV, Palionis D, Janusauskas V, Valeviciene N, Laucevicius A (2015). "Multimodality imaging of myocardial revascularization using cardiac shock wave therapy". International Journal of Cardiology 187: 229–30.

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