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Shockwave physiotherapy

What is shockwave therapy?

Shockwave therapy is a non-invasive treatment that involves creating a series of low-energy sound waves pulses that are applied directly to the injury. Shockwave therapy is the ideal treatment to speed up recovery and treat various conditions that cause acute or chronic pain.

Shockwave therapy device mechanism of action:

The Shock Wave therapy device is used as a method of physical therapy.Shock wave therapy device is a multidisciplinary device used in orthopedics, physical therapy, sports medicine, urology, and veterinary medicine. Shockwave therapy is mainly used to relieve pain and restore mobility quickly, along with being a non-surgical treatment and without the need for painkillers. Shockwave is an acoustic wave which carries high energy to painful spots and myoskeletal tissues with subacute, subchronic, and chronic conditions. The energy promotes regeneration and reparative processes of the bones, tendons, and other soft tissues. 

Shockwaves are characterized by jump change in pressure, high amplitude, and non-periodicity. The kinetic energy of the projectile, created by compressed air, is transferred to the transmitter at the end of the applicator and further into the tissue.

 

Medical Effects of Shockwave Therapy:

Acoustic waves with high energy peaks used in Shockwave therapy interact with tissue causing overall medical effects of accelerated tissue repair and cell growth, analgesia, and mobility restoration. All the processes mentioned in this section are typically employed simultaneously and are used to treat chronic, sub-acute, and acute (advanced users only) conditions.

 

  • New Blood Vessel Formation:

Nutrient blood flow is necessary to start and maintain the repair processes of the damaged tissue structure. The application of acoustic waves creates capillary micro ruptures in tendons and bone. Due to micro ruptures, the expression of growth factors such as ENOS, VEGF, PCNS, and BMP is significantly increased.

As a result of these processes, arterioles are remodeled, stimulated to grow and new ones are formed. The new blood vessels improve blood supply and oxygenation of the treated area and support faster healing of both the tendon and the bone.

  • Reversal of Chronic Inflammation:

Chronic inflammation occurs when the inflammatory response is not completely halted. It can damage healthy tissue and results in chronic pain. Mast cells are one of the key components of the inflammatory process. Their activity may increase by using pervasive acoustic waves.

Mast cell activation followed by the production of chemokines and cytokines. These pro-inflammatory compounds first enhance the inflammatory process and in the next step, help restore normal healing and regenerative processes.

  • Stimulation of Collagen Production with Shockwave Therapy:

The production of a sufficient amount of collagen is a necessary precondition for the repair processes of the damaged myoskeletal and ligamentous structures. Shockwave therapy accelerates procollagen synthesis. The therapy forces the newly created collagen fibers into a longitudinal structure which makes the newly formed tendon fibers more dense and stiff and creates a firmer structure.

  • Dissolution of Calcified Fibroblasts:

Calcium build-up is most often a result of micro-tears or other trauma to a tendon. Acoustic waves break up the existing calcifications. Shockwave therapy starts the biochemical decalcification of the calcium build-up of a toothpaste-like consistency and treats the tendon. The granular particles of calcium are then removed by the lymphatic system.

  • Dispersion of Pain Mediator “Substance P”:

Substance P is a neurotransmitter that mediates pain information through C-fibers. This neuropeptide is generally associated with intense, persistent, and .chronic pain It relays pain messages to the central nervous system. Lowering the concentration of Substance P reduces the stimulation of afferent nociceptive fibers and thus reduces the pain. Decreasing Substance P, histamines, and other nociceptive metabolites also help inhibit the development of inflammatory edemas. Acoustic waves generated by Shockwave therapy lower the Substance P concentration and trigger pain relief. 

 

  • Release of Trigger Points:

Trigger points are the main cause of pain in the back; neck, shoulder, and extremities, and they are well associated with nodules in tight gangs of muscle fibers and contain many sarcomeres. Dysfunctional sarcomas shrink so severely that they begin to cut off their blood supply causing the formation of waste, and the accumulation of these waste causes irritation of the sensory nerve endings that leads to further contraction. This vicious circle is referred to as a “metabolic crisis“. The supposed mechanism of action is that the acoustic energy unleashes a calcium pump and thus the metabolic crisis reflected in the muscle strands and releases the trigger points.

Indications for using Shockwave Therapy:

Jumper’s Knee, Painful Shoulder, Tennis Elbow, Heel Spur, Insertional Pain, Chronic, Tendinopathy, Medial Tibial Stress Syndromes, Calcifications, and Hip Pain.

  • Jumper’s Knee

  • Painful Shoulder

  • Tennis Elbow

  • Heel Spur

  • Insertional Pain

  • Chronic

  • Tendinopathy

  • Medial Tibial Stress Syndrome

  • Calcifications

  • Hip Pain

  • Jumper’s Knee:

Jumper’s knee is an inflammation or injury of the patellar tendon felt as pain, tenderness, and functional deficit. This condition may interfere with or even end your patient’s sporting career regardless of their age and is difficult to treat. Shockwave therapy offers a simple and immediate solution. The patient feels relief right after the first session and in several treatments, the cause and the pain vanish.

  • Painful Shoulder:

The pain of the shoulder caused by e.g. calcifications, impingement syndrome, or frozen shoulder. All the indications are a source of dull to severe pain and limit the patients in their daily life.  In calcific tendonitis of the shoulder treated by the Shockwave, the calcification disappears completely in more than 85% of the cases. Significant reduction in pain and improvement in shoulder function observed after 4 weeks. Solution for many cases is surgery or injections to which Shockwave therapy is a fitting substitute. 

  • Tennis Elbow:

Tennis elbow is a frequent condition occurring in up to 10% of the general population. Unfortunately, the conservative treatment of epicondylitis is lengthy (rest), includes medication (painkillers, steroid injections), and often needs repetition. Shockwave therapy on the other hand offers rather prompt pain relief and cure with the efficiency of over 70% in just a maximum of 5 treatments.

  • Heel Spur:

Calcium deposit on the underside of the heel bone (heel spur) is closely associated with scarring or inflammation of the plantar fascia (plantar fasciitis). Either of the indications or combined, limit patients in their daily activities. Shockwave treats both of the problems simultaneously. Acoustic waves are responsible for fast recovery, return to the daily routine, and long-lasting effects in up to 88% of the patients.

  • Insertional Pain:

Pain in the muscle insertions typically occurs due to repetitive or prolonged activities placing strain on a particular tendon. Through the process of neovascularization Shockwave, therapy encourages more blood flow to the area and hence faster healing without the need for addictive pain medication.

  • Chronic Tendinopathy:

Cumulated micro-traumas from repetitive overloading can result in chronic Tendinopathy (tendinitis or tendinosis). Tendinopathy in various areas of the body is a widespread diagnosis of both the active persons and the general population.  Both inflammation of the tendon and damage on the cellular level successfully treated with Shockwave. The number of sessions is typically 3–5 with 5–10 days in-between sessions.

  • Medial Tibial Stress Syndrome:

Medial Tibial stress syndrome typically occurs due to activities placing large amounts of stress through the tibialis anterior muscle. These activities may include fast walking or running (especially up or downhill or on hard or uneven surfaces) or sporting activity (such as kicking sports). Patients are usually restricted from such activities for prolonged periods. When treated with Shockwave therapy the passive period is significantly shorter and the recovery time cuts back by at least a half.

  •  Calcifications:

Calcifying tendinitis is a chronic pain disorder that is characterized by calcifications in rotator cuff tendons. Such a condition causes pain and a range of motion limitations. Shockwave therapy is one of the most effective treatments of calcifications. Acoustic waves cause disruption of the calcified entities and support their resorption and elimination by the body. SWT significantly decreases treatment length and offers fast relief in chronic stages.

  •  Hip Pain:

With age and use, the cartilage can wear off or damage and it may happen due to excessive use of the muscles and tendons in the hip, or because of the fracture of the thigh bone itself during a fall or other injury. Any of these causes can lead to pain or damage to the hip area. Shockwave therapy promotes the healing process, fights inflammation, removes pain and tenderness, and can prevent hip replacement surgery. 79 % of patients with necrosis are also helped by shockwave therapy by improving femoral head necrosis. 

Therapy sequence:

Shockwave therapy is a non-invasive treatment. The application is simple and easy. Initiate therapy in 3 steps:

  1. Location of the area to be treated: The area to be treated is located using palpation in order to deliver the therapy precisely.
  2. Gel application: Sufficient amount of gel is applied to the area located in step 1. The use of gel is necessary to transfer the acoustic waves efficiently and smoothly. 
  3. Therapy initiation: The Shockwave applicator is slightly pushed against the area to be treated and the start button is pressed.

FAQ

  • Will Shockwave therapy help me?

Most patients with chronic pain problems have been through various unsuccessful types of treatments. Up to 80% of the same patient’s worldwide report that Shockwave therapy has helped them eliminate their problem.

  • Does the treatment hurt?

There may be a slight feeling of discomfort during the treatment, depending on the level of pain the patient is already experiencing in the area. However, since the treatment lasts only about five minutes, most patients are able to tolerate this discomfort. Additionally, the intensity of the treatment adjusted throughout the session.

  • How many treatments will I need?

The number of treatments varies depending on the indication and tissue response. The effect of the treatment is cumulative, so you will typically need more than one (3–5) treatment. Very often though, you will experience relief right after the first treatment.

  • How often will I need the treatment?

Most indications require 3–5 treatments, which are done 3–10 days apart, depending on the patient’s tolerance and their tissue response.

  • Will I feel any pain after the treatment?

Most patients will experience immediate pain relief following the treatment. However, within 2–4 hours after the treatment, they may experience some soreness in the treated area. This soreness is reported as tolerable and not limiting.

  • Are there any restrictions after the treatment?

It is recommended that patients refrain from physical activity, especially one that would involve the treated region, for about 48 hours following each treatment session with shock wave therapy.

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