By Guy Oldring – Sports and Injury Specialist
Over the past decade, the use of shockwave therapy has become more and more common in both the NHS, professional sport and private practice. This is due to it being the most researched form of electrotherapy on the planet and also that all the controlled trials show that it is effective in treating certain issues. However, there are still quite a lot of myths about what it is and how it works.
Due to the above I thought it would be useful to answer a lot of those questions and dispel some myths about how everything works. I have tried not to ” geek out” too much, but forgive me for a bit of geeking!
What is radial shockwave therapy?
Shockwave therapy is an effective, safe and non-invasive treatment that uses a series of sound energy waves to promote the healing of injured soft tissue. These shockwaves are passed into the body by using various specialist applicators that are specifically designed for targeting different soft tissues.
Shockwave treatment works by activating the healing process and stimulating pain-reducing enzymes. It targets the injured tissue with specially calibrated shockwaves that stimulate blood circulation and metabolism, accelerating the body’s own healing processes. The application of shockwaves gives pain relief after treatment and stimulates long-term tissue normalisation and regeneration.
What can I expect from the treatment?
During the initial shockwave therapy consultation your practitioner will take a full clinical assessment of your condition to ensure shockwave therapy is the most appropriate intervention. If we feel this treatment is appropriate, we’ll discuss a course of treatment, typically weekly for three to six weeks. To complement this, your practitioner will design a series of rehabilitation exercises to maximise the effectiveness of the treatment.
To start, we’ll apply a contact gel to the skin over the area to be treated. The shockwave applicator will be applied to the area, whereby the shockwaves will begin to excite the injured tissue. This will stimulate your body to respond by increasing blood circulation in the soft tissues and triggering stem cell activation and enzyme production in the injured tissue. This, in turn, will promote and accelerate the healing process and reduce pain in the area. The process takes approximately 10 minutes.
The best results are achieved after six to twelve weeks from the final treatment with a continuing exercise programme alongside the shockwave therapy.
How does Shockwave work?
Based on research from over 6000 scientific papers, it is now agreed that radial shockwaves’ physical energy cause a biological response with increased metabolic activity around the site of the tissue damage and pain. The sound waves from Radial Shockwave therapy microscopically cause interstitial and extracellular responses which induce a healing effect. Specifically, the shockwaves were shown to stimulate the early expression of angiogenesis related growth factors including eNOS (endothelial nitric oxide synthase), VEGF (vessel endothelial growth factor) and PCNA (proliferating cell nuclear antigen), which then induces the ingrowth of neovascularization. This may sound complex, but essentially, this improves blood supply and increases cell proliferation and eventual tissue regeneration to repair the tendon or soft tissues.
The treatment also induces an analgesic effect. This mechanism is theorized to occur as a result of an initial rise in concentration of substance P in the zone of the shockwave with a subsequent prolonged reduction in its total concentration. This may explain the initial pain response followed by prolonged pain relief.
Does Shockwave Hurt?
Shockwave treatment is administered using the patients own pain experience to modify the treatment. Due to this, whilst you may feel discomfort with the treatment, the pain should never be over a 5/10.
As shockwave is used to help shake the tissue to help promote healing, if pain levels are higher than 5/10, then it is suggested that the effectiveness of the treatment will be reduced.
What can Shockwave Treat?
Over the last 30 years, over 6000 papers have been written on the use of Shockwave. Over this time it has been shown that shockwave can significantly improve the recovery of the following injuries:
Plantar Fasciitis – foot pain
Plantar fasciitis is the inflammation of the fibrous tissue of the sole, resulting in pain in the heel and over the bottom of the foot. This condition may be caused by over-use such as an increase in running and walking, standing for long periods, or after wearing shoes that do not support the foot arch or cushion the feet correctly. Shockwave therapy has been proven as an effective and non-invasive treatment for this painful condition.
Patellar Tendinopathy – knee pain
Patellar tendinopathy is an injury to the tendon that connects the kneecap (patella) to the shin bone. Also known as ‘jumper’s knee’, it causes pain in the front of the knee and is most common in, but not exclusive to, athletes whose sports activity involves frequent jumping. Shockwave therapy can successfully treat this condition by stimulating the body’s natural healing process, particularly when used in conjunction with rehabilitation exercises.
Achilles Tendinopathy – ankle pain
Achilles tendinopathy can be caused by repetitive activity and running or walking faster and on steeper ground. It can be experienced as pain and swelling of the tissue on the back of the heel and calf. Shockwave therapy and exercises to increase the loading tolerance of the achilles tendon can give excellent results in reduction of pain and return to normal activity.
Tennis or Golfers Elbow Tendinopathy – elbow pain
Tennis elbow can be caused by the repeated strain of gripping or twisting the hand or wrist. Symptoms are tenderness and pain on the outside of the elbow when gripping or lifting objects. Golfers elbow affects the tendons on the inside of the elbow. Shockwave therapy and rehabilitation exercises have proven to be effective in the treatment of symptoms for these conditions, stimulating blood flow, cell regeneration and healing, decreasing pain and restoring normal movement and function.
Gluteal Tendinopathy – hip pain
Gluteal tendinopathy often presents as severe pain in the side of the hip. The tendons are the fibres that connect the gluteal muscles to the hip bone. Shockwave therapy treatment together with rehabilitation exercises will help the tendon tolerate load with less pain and can result in normal pain-free activity.
Hamstring Tendinopathies – leg pain
Hamstring Tendinopathy is where the soft tissues that connect the muscles of the back of the thigh to the pelvis or lower legs become damaged. Shockwave therapy, in conjunction with a personalised programme of rehabilitation exercises, can help to resolve the symptoms.
Shoulder Tendinopathy – shoulder pain
Shoulder tendinopathy is damage to the shoulder tendons which can cause severe pain in the neck, arm or shoulder, restrict range of movement and make lifting or lying on the arm painful. Damage to the tendons can occur due to overloading, repetitive use or injury, or can be due to postural issues or poor movement patterns. Shockwave therapy and rehabilitation exercise is an effective, non-surgical and non-invasive treatment for this condition.
If you feel like shockwave could be beneficial then why not book in for a shockwave initial consultation with one of our practitioners at The Thornbury Clinic by booking online or calling 01454 838366