Shockwave therapy is the most cutting edge non-surgical technology currently available for treating joint, tendon, ligament and muscle problems. It has been shown to be highly successful with over 70% of patients reporting significant pain reduction or being pain free. This blog aims to inform and answer any questions you might have on this new line of physiotherapy treatment.
What is shockwave therapy?
Shockwaves are audible high-energy sound waves. These sound waves deliver a sudden high pressure to a targeted area, followed by a negative pressure. They occur naturally in the atmosphere, for example during lightning strokes. In medical treatment, shockwave energy is conducted from a shockwave generator to the painful body regions, where it has its effect.
Therapeutic shock waves were first introduced as a medical treatment to eliminate kidney stones in the 1980s. During these treatments, an accelerated tissue healing response was reported as a side effect. Some 30 years later, further research led to the development of Extracorporeal Radial Shock Wave Therapy (RSWT), a modern and highly effective treatment.
What are the physiological effects? (What effect does it have?)
RSWT reduces pain and accelerates the healing process by controlled reinjuring of tissue, which activates the body’s self-healing powers to regenerate new healthy tissue. Its main effects are as follows;
1) Reduces pain – it changes the way the nerves signal pain (interfering with pain signals in a positive way).
2) Increases tissue healing – radial shockwaves help to release chemicals in the cells which can control inflammation and pain.
3) Breaks up tissue scarring – dissolves the calcification deposits that have penetrated tendons and ligaments.
4) Improves blood flow – repeated shockwaves create microtrauma, resulting in new blood vessel formation, which promotes tissue healing and regeneration.
5) Reduces muscle tone – shock waves act on trigger points. These are the tender spots in muscles, which often result in pain and dysfunction.
What can it be used to treat?
It has been found to be effective in treating various conditions in multiple areas of the body such as:
- Chronic neck and back pain
- Shoulder calcifications, tendonitis, frozen shoulder and biceps tendinopathy
- Elbow – Lateral and medial epicondylalgia (tennis/golfer’s elbow)
- Hip – Trochanteric bursitis, iliotibial band syndrome
- Knee – Patellar tendinopathy (jumper’s knee)
- Shin – Medial tibial stress syndrome (shin splints)
- Ankle and heel – achilles tendinopathy, heel pain
- Foot – plantar fasciitis
What are the benefits?
Benefits of RSWT include:
- No down time – you can return to normal activities immediately
- No anaesthesia required
- Non-invasive treatment
- No ultrasound guidance needed
- Safe technique with no risk of infection
- Faster and easier healing
- Improved outcomes
- Reduced expenses in the long term
Why is it different to other treatment methods?
What sets RSWT apart from traditional treatments is that it treats the musculoskeletal pathology instead of just offering symptomatic relief.
This is why clinical studies have shown it to have such a high success rate, even in cases like chronic conditions that have failed to respond to conventional approaches. In such chronic cases, it’s thought that RSWT has the ability to stimulate an acute inflammatory response in a chronic inflammatory environment, which can promote healing.
What can I expect during treatment?
The application takes between 5 and 15 minutes, and is integrated into a regular physiotherapy session. In general, averages of 3 to 6 therapy sessions are necessary, at weekly intervals. However, some patients notice a difference after just one session.
The physiotherapist will find the painful region by palpation and discusses the findings with you. A skin gel is then applied to the treatment area. The shockwaves are generated using compressed air from the shockwave device. These shockwaves are then released as the hand piece is moved over the painful region in a circular motion. You will feel a pulsing sensation at the treatment site and may feel some mild discomfort, but this is normally tolerable as the treatment only lasts a few minutes. The pulses you can hear and feel spread into your underlying tissue to a depth of up to 6cm.
What can I expect after treatment?
Many clients experience a decrease in pain immediately after treatment. Normally, RSWT is well tolerated with few side effects. Bruising, slight swelling and discomfort over the treatment area may occur. There may also be some soreness, particularly in the first 1-2 hours afterwards due to the body’s inflammatory response, which is triggered by the shockwaves. This is normal and is your body’s way of healing itself and regenerating the targeted tissue. This discomfort usually subsides after 1-2 days.
Will it work for everyone?
Quite simply, no. We find significant improvements in approximately 70% of patients, but still a percentage of people do not respond. RSWT is not used as a sole method of treatment but will be used as an adjunct to overall management. Patients will also be given some ‘homework’ that they will be expected to continue with, such as stretching and strengthening exercises.
What are the precautions/contraindications?
General precautions/contraindications include:
- Haemophiliacs or those on blood-thinning medication
- Heart or circulatory problems
- Nerve disorders
- History of cancer in or around treatment area
- Metal implants
- History of joint replacement
- Cortisone injection in the local area (within last six weeks)
- Infection in the local area
- Open wound over site of treatment
- Over growth plates in children
PhysioActive is one of the few private physiotherapy practices in Singapore who offer this new, advanced technology known as Extracorporeal Radial Shock Wave Therapy (RSWT).
Suffering from pain?
Thanks for reading!
This post has been written by physiotherapist Liam Mc Ginley.