Shockwave Therapy: A Not So New Tool In Physiotherapy
More accurately referred to as extracorporeal shockwave therapy (ESWT in short) shockwave therapy in 2022 is now commonplace as a treatment modality provided in physiotherapy clinics across Sydney and Australia wide. The word “extracorporeal” refers to any procedure performed outside the body and with ESWT shockwaves they can be likened to acoustic waves occurring in the atmosphere following an explosive event such as a lightning strike or sonic boom. Therapeutic shockwaves are simply acoustic waves with an extremely high energy peak harnessed for medical benefit. The specific type of shockwave treatment provided in our Sydney and Randwick Physio practices is called “Radial Shockwave Therapy” another type of shockwave treatment used in physiotherapy and Western medicine is “Focused Shockwave Treatment”. There are differences between these two forms of shockwave treatment, differences which will be discussed at a later date however when referring to shockwave therapy in this blog I will specifically be referencing what is the most common form of shockwave treatment used in physiotherapy across Australia and that is radial shockwave treatment. The use of shockwave therapy in medicine and allied health (as physiotherapy is referred to) is a relatively modern treatment tool. However, given the rate medicine can move these days with technological advances and academic learning these high-energy sound waves have quickly become accepted as common place is the physio world due to their researched backed and significant wide spread positive therapeutic benefits. The use of high-energy sound waves being introduced into the body was first used in the 1980’s, when they were used to disintegrate kidney stones and this discovery started the evolution to what we have today in physiotherapeutic shockwave treatment.
It’s Like Ultrasound Therapy On Steroids
In physiotherapy the use of shockwave therapy treatment differs from ultrasound therapy which historically is another common treatment modality used in some physiotherapy practices. There are several differences between shockwave treatment and ultrasound treatment one of the major differences is in the extremely large pressure amplitudes with shockwave therapy when compared to ultrasound therapy. It is not a medically accurate description of the therapy by any means, but I will often describe shockwave therapy by saying that “shockwave therapy is like ultrasound on steroids” to some of my patients who have previously had ultrasound therapy and question if it is similar to this machine wanting to understand what shockwave treatment is like and its effects.
The Therapeutic Effects Of Shockwave Treatment
During shockwave therapy high-intensity sound waves interact with the tissues of the body leading to several potentially beneficial effects including:
- neovascularisation ingrowth
- reversal of chronic inflammation
- stimulation of collagen and tissue regeneration
- and dissolution of calcium build-up
Ideally shockwave therapy creates an optimal healing environment by causing stimulation of one, or several of these listed biological effects. Basically shockwave treatment can help trigger your biology to start healing affected tissue.
Indications For Application Of Shockwave Therapy
Shockwave treatment is frequently used in physiotherapy, podiatry, orthopaedics, and sports medicine. With regard to the use of the treatment in physiotherapy circles is it often used to treat a variety of chronic tendinopathies including achilles tendon complaints, rotator cuff issues in the shoulder and “tennis elbow” to name a few. Shockwave therapy is also very effective in the management of heel pain arising from the plantar fascia and is widely used to treat this painful disorder by physiotherapist and podiatrists alike.
Shockwave therapy is a great option for management of soft tissue disorders when:
- pain has been present for 3-6 months (or longer)
- and where previous conservative treatment such as targeted exercises, biomechanical and ergonomic changes including other manual, or electrotherapy treatment has failed to provide significant relief
Precautions Regarding The Use Of Radial Shockwave
There are however precautions and contraindications regarding the application of shockwave therapy. Simply having tendon or soft tissue pain does not mean you qualify for the safe application of shockwave. When used correctly it is a very safe and frequently effective treatment approach for management of chronic soft tissue complaints, however there are some situations where this therapy should not be used such as:
- if there is a tear constituting 50% or greater in the target tissue then it would be contraindicated
- if there is a tumor in the area then again the use of shockwave therapy is contraindicated
- during pregnancy the use of shockwave therapy is not advised
- or, if the target area has had a cortisone injection in the previous 6 weeks.
More precautions and contraindications exist and therefore as a result it is crucial to have a clear understanding of what is going on both medically as a whole and locally at the site of application prior to using shockwave. Henceforth, although not necessary it is often seen as advisable prior to receiving shockwave therapy that a patient has some form of imaging (such as an ultrasound, MRI and X-ray) of the area are carried out prior to starting the treatment process.
Typically How Many Sessions Are Necessary To Have A Positive Impact?
Frustratingly for patients in pain and wanting relief as with most medicine there is no strict recipe when it comes to the application, and results associated with ESWT. Every individual will respond differently depending on their individual medical circumstances and injury situation. Each case will be unique and must be treated as such, however there are typical shockwave treatment guidelines and this is that
- sessions are provided around 1-2 weeks apart
- and a course of treatment often consists of three sessions with a maximum of six sessions
however these are not hard and fast rules. I am aware of some practitioners providing multiple sessions well beyond these guidelines. As previously stated in the medical world it is still a relatively new form of therapy and much of the research centres around these numbers and as the body of research grows I am sure guidelines will change accordingly. My standard approach is that if someone is not responding to the treatment after a few sessions then I am reluctant to continue. I usually find those who respond well will normally show signs after only 1-2 sessions and therefore anyone not improving following a few sessions is less likely to find shockwave treatment the right approach for them. The old adage of “doing the same thing and expecting a different result…” applies here for me.
Physiotherapy And Shockwave Therapy In Summary
In brief, shockwave therapy is relatively new safe and non-invasive therapy harnessing the powers of acoustic waves. It is used by physiotherapists around the world for treating soft tissues disorders of the musculoskeletal system. As a treatment when applied on the right candidate it is frequently very effective in providing relief in chronic situations where other conservative treatments may have failed. Relief that is ideally reported by patients as a relatively rapid change for the positive. Where beneficial and lasting effects are frequently experienced after as little as just 2-3 sessions with your physio.
Disclaimer: This information is provided as an educational service and is not intended to serve as a substitute for personalized medical advice. Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned in this post. Anyone seeking specific advice, or assistance regarding “shockwave therapy” should consult his, or her physiotherapist, orthopaedic surgeon, general practitioner, sports medicine specialist, or otherwise appropriately skilled medical practitioner.