Shockwave Therapy: evidence, indications and patient information.

Shockwave therapy (also called radial pressure wave or extra-corporal shock wave therapy) is a fast and effective non-invasive method of eliminating or reducing many painful conditions of the musculoskeletal system.

Shockwave therapy uses high-energy pressure waves in the treatment of tendinopathy and soft tissue disorders of the shoulder, elbow, hip, knee and ankle. The mechanical stimulus of shockwaves is a trigger that activates a series of cellular events that have a positive effect on cell metabolism and cell cycle. Basic science has shown that shockwaves induce proliferation, migration and differentiation of stem cells, which significantly contribute to tissue healing and regeneration (Int J Surg. 2015).

As we are a sports injury and musculoskeletal rehabilitation clinic, we focus on treating primarily tendinopathies and myofascial pain. Tendinopathies are notoriously tricky to treat and can often linger on for months and even years, often with flare ups and setbacks. The current recommendation for treating tendon pain in the initial 3 months of onset is graded tendon loading, however if this approach initially fails, shockwave therapy is now recommended as safe and effective treatment option. 

What are the benefits? 

-       Non invasive.

-       Fast, safe and effective.

-       Decreases pain and increases function.

-       No incision, therefore no risk of infection or scarring. 

-       Future treatment options are not limited. 

Evidence based indications for shockwave (radial pressure wave) therapy: infographic by Kristen Page Chiropractic

What to expect?

Your therapist will recommend a number of 1 x weekly sessions (usually between 6-10) depending on your individual presentation. The goal of therapy is to reduce pain, promote tendon healing and improve function.

Initially, it is important to get an accurate diagnosis and you may be referred for a scan (ultrasound). For this reason, your initial appointment may take a little longer. Treatment itself only takes 5-10 mins depending on the area involved. 

You may feel pressure or an ache over the injured site while the therapy is being applied, this will be modulated to suit your tolerance level, and should decrease over time. 

Adverse events are uncommon and only mild if they do occur. The majority will appear after 1-2 days and usually abate after 5-10 days. Side effects include: 

-       Reddening

-       Swelling

-       Pain

-       Haematoma (bruising) 

-       Petechia (red spots)

How to get the most out of your treatment? 

Shockwave should be used in conjunction with individualised tendon loading and exercise program for optimum benefits. So, you actually need to do your exercises!

Avoid taking NSAIDs (ibuprofen etc.) during your therapy as these have apposing affects and may mitigate response. 

If you have recently had a steroid injection in the affected area you will need to wait about 6-8 weeks after if you want to begin shockwave therapy.