Shockwave therapy in a nutshell, helping heal sports and overuse injuries.

Introduction

Shockwave therapy is a non-invasive treatment option that has gained popularity in recent years for its effectiveness in healing sports and overuse injuries. This innovative therapy uses shockwaves to stimulate the body's natural healing process and promote tissue repair.

Injuries to the soft tissues, such as muscles, tendons, and ligaments, are quite common in athletes and individuals who engage in repetitive physical activities. These injuries can result in pain, limited mobility, and a significant impact on daily activities. Shockwave therapy offers a promising solution for those seeking pain relief and a quick recovery.

The acoustic shockwaves generated during a shockwave therapy treatment session help break up calcifications or calcium build-ups in the soft tissues. This process promotes the resorption of these potentially harmful deposits, allowing the injured tissue to heal properly. Additionally, shockwave therapy enhances collagen synthesis, which is crucial for the repair and regeneration of damaged tissues.

Furthermore, shockwave therapy releases growth factors, which are essential components for tissue healing and repair. These growth factors promote the recruitment of cells to the injured area, increasing blood flow and accelerating the healing process. By improving blood circulation, shockwave therapy helps deliver vital nutrients and oxygen to the affected area, aiding in the reduction of pain and down regulating inflammatory cytokines.

Whether it's plantar fasciitis, tennis elbow, or patellar tendinopathy, shockwave therapy offers an effective treatment option for various musculoskeletal conditions. With its ability to stimulate the body's healing response, this type of therapy can help individuals get back to their normal activities with minimal downtime.

How ESWT Works

Extracorporeal Shockwave Therapy (ESWT) is a non-invasive treatment that utilises pressure waves to promote healing in soft & hard tissues. This innovative therapy has shown promising results in the treatment of various musculoskeletal conditions, including: plantar fasciitis, patellar tendinopathy, tennis elbow, and trochanteric pain syndrome.

During an ESWT treatment session, a handheld device is used to deliver acoustic pressure waves to the injured tissue. These pressure waves stimulate blood flow and metabolism in the affected area, promoting the regeneration of damaged cells and tissues. By increasing blood supply, enhancing collagen production and the release of glycoproteins like lubricin (a joint lubricant) ESWT helps to reduce pain, inflammation, and the formation of scar tissue.

An ESWT machine consists of three main components: a generator, an applicator, and a control unit. The generator produces the acoustic pressure waves, which are then transmitted through the applicator to the patient's body. The control unit allows the healthcare professional to adjust the intensity and frequency of the waves according to the patient's specific needs.

ESWT has several benefits over traditional treatment options. It is a non-invasive procedure that avoids the need for some surgery and eliminates the risks associated with anaesthesia. ESWT is a non-invasive alternative to repeated steroid injections, provides long-lasting pain relief by addressing the root cause of the problem. Moreover, ESWT has shown potential in treating non-union fractures, where traditional methods have proven to be ineffective.

In conclusion, ESWT is a promising therapy for various musculoskeletal conditions. By delivering pressure waves to the affected tissues, it stimulates blood flow and metabolism, promoting healing and reducing pain.

Cavitation Bubbles and shockwaves

It hurts so good…a little

Shockwave therapy, is a non-invasive treatment option used for a variety of musculoskeletal conditions. But, does it hurt?

When it comes to discomfort during shockwave therapy, it can vary from person to person. However, most patients describe the sensation as a little uncomfortable rather than outright painful. The level of discomfort experienced may also be influenced by the location of the treatment area.

It's important to note that everyone's pain tolerance is different, so what one person considers a mild discomfort may be perceived differently by another. Additionally, pain can be subjective and difficult to measure accurately. Some healthcare professionals may use a pain scale to assess the level of discomfort experienced during treatment.

In conclusion, while shockwave therapy may cause some discomfort, it is generally not described as extremely painful. The discomfort varies from person to person and may be influenced by the treatment area. It's important to discuss any concerns with a healthcare professional who can provide a better understanding of what to expect during the treatment session.

What conditions can Shockwave Therapy (ESWT) treat?

Depending on the injury, patients can avoid invasive treatments such as steroid injections or surgery. ESWT requires no incisions or downtime. Most patients see long-term results after only three treatments, which take about 15 minutes each.

Achilles tendinopathy
“Bursitis” or tendinopathy in the hip
Stress fracture
Fracture non-union – a broken bone that hasn’t healed

Frozen shoulder
Osteoarthritis in the knees, hips, or shoulders
Plantar fasciitis
Rotator cuff injuries

Strained calves and hamstrings
Tendonitis in the foot and ankle, hip, or shoulder
Tennis or golfer’s elbow

More on the science

Fast pain relief and long-lasting healing - how does the body react to shock waves

How is the sensation of pain generated in the human body? First, it is detected as sensory information by nociceptors located on free nerve endings; then, it is carried then via A-delta and group C nerve fibers from the periphery to the dorsal horn of the spinal cord. This transmission of pain information is mediated by a number of neurotransmitters. Here, we will focus on one of them: substance P.

During the shockwave therapy, an increased level of substance P is also what is responsible for any discomfort or unpleasant sensations. Substance P and other neuropeptides are released from the peripheral ends of sensory nerve fibers and lead to a slight sensation of pain. Herein lies the answer! The longer the C-fibers are activated with shockwaves, the lower the concentration of this neuropeptide within the treated area. As a result, the nociceptors are no longer sufficiently stimulated. Less substance P in the tissue leads to pain relief (because the transmission between injury and brain is ineffective) and inhibits the neurogenic inflammation process.

Shockwave therapy acts on the musculoskeletal system via molecular and cellular mechanisms. First of all, it lowers the concentration of substance P and brings about pain relief. Secondly, it blocks the development of neurogenic inflammation, which plays an important role in the pathogenesis of tendinopathies such as tennis elbow or plantar fasciopathy. Thirdly, it activates the formation of pri- mary muscle cells to repair damaged muscle fibers and increases expression of the following growth factors:

VEGF (Vascular Endothelial Growth Factor), which plays an important role in angiogenesis (formation of blood vessels). In this way, new blood vessels are formed to accelerate tissue healing.
PCNA (Proliferating Cell Nuclear Antigen) and eNOS (Endothelial Nitric Oxide Synthase), which are growth factors responsible for stimulating blood circulation. A better flow of oxygenated blood promotes tissue regeneration.

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Shockwave Therapy Side Effects

While shockwave therapy is generally considered safe and well-tolerated, there are a few potential side effects to be aware of.

Common side effects of shockwave therapy include:

Redness, bruising, and tenderness at the treatment site. These effects are generally mild and temporary, resolving on their own within a few days. Some patients may also experience a temporary increase in pain immediately after the treatment session, but this usually subsides within 24 to 48 hours.

Rare side effects of shockwave therapy are very uncommon but can occur. In rare cases, temporary damage to the skin or underlying tissues may occur, leading to more intense pain and a longer recovery period. Additionally, there have been extremely rare reports of tendon tears or ruptures associated with shockwave therapy. However, it's important to note that these cases are extremely uncommon and are often attributed to a combination of factors, such as the severity of the underlying condition or improper use of the treatment.

Overall, shockwave therapy is a safe and effective treatment option for many musculoskeletal conditions, offering pain relief, improved function, and reduced healing time. It is important to consult with a healthcare professional who can assess your specific condition and determine if shockwave therapy is a suitable treatment option for you.

Who Should Not Undergo Shockwave Therapy?

Shockwave therapy, also known as extracorporeal shockwave therapy, is a non-invasive treatment option for various musculoskeletal conditions. It utilizes high-energy acoustic waves to target injured tissue and promote healing. However, there are certain individuals who should not undergo shockwave therapy due to contraindications and specific medical conditions.

Exclusion Criteria / Contraindications:

Steroid injection in the past month
Tendency to haemorrhage
Patients taking anti-coagulant therapy
Haemophiliac patients
Tumour at the treatment site
Infection of the treatment area
Pregnancy
Severe circulatory disorder
Nerve disorder at treatment site
Open wound at the treatment site
Prosthesis

While shockwave therapy offers significant benefits for many patients with musculoskeletal disorders, there are certain individuals who should not undergo this treatment. Pregnant women, those undergoing cancer treatment, individuals with implanted cardiac pacemakers, those who have recently received corticosteroid injections (within 6 weeks), and individuals with blood clot disorders or taking anticoagulants should explore alternative treatment options to ensure their safety and well-being. Always consult with a healthcare professional to determine the best course of action for your specific needs.