What is it?
This therapeutic device Shockwave therapy is a non-invasive treatment that uses acoustic sound waves to produce a pro-inflammatory and inflammatory response within body tissue. The device performs vibration like impulses onto the affected area that are generated through air compression within the handheld device. This action causes increased blood flow to the area as well as stimulating tissue at a cellular level leading to improved tissue regeneration. This helps to kickstart a stalled healing process whilst producing an analgesic effect leading to reduced pain which can last up to four weeks post treatment.
How It Works?
A probe is pressed on to the affected area and the shockwaves are delivered through the skin. The impulses are delivered through the skin as a shockwave that spreads inside the injured tissue as a radial sound wave. These radial shockwaves initiate an inflammation-like response in the injured tissue that is being treated, and prompts the body to respond naturally by increasing blood circulation which helps to restart the healing process.
The device will produce fast repetitive pulses over the effected area, which will feel like vigorous tapping. Typically, your first treatment will start with a low level of intensity and increase to a point where you feel comfortable. The aim is to stimulate the area, meaning a minor level of discomfort may be felt when receiving treatment, however this will be monitored by the therapist throughout application.
Evidence within research suggests that a minimum of three sessions must be completed in order to provide effective stimulation to the effected area with the optimum of six sessions. It is recommended that duration between treatment should not exceed 10 days to ensure the treatment effect is not lost between sessions.
Who Can It Help?
This treatment is great for patients with both chronic and acute issues that are not progressing as quickly to hands on techniques. Research suggests that problems relating to tendons and muscles can be effectively treated via shockwave therapy. Due to the analgesic affect this is an effective treatment for people struggling with long term pain. Through restarting the healing process patients can become more mobile without the restriction of pain. This ensures that accompanying treatments such as mobilisation and strengthening exercises can be completed without triggering high levels of pain.
Main Research Findings
Evidence suggests that Radial shockwave therapy is effective when treating lower limb conditions such as Achilles tendinopathy, plantar fasciitis, greater trochanteric pain syndrome and medial tibial stress syndrome within all phases of rehabilitation. (Korakakis, 2018)
Radial shockwave was found to be superior to ultrasound therapy when treating upper limb tendon injuries where pain levels were considerably lower after ultrasound therapy. (Kubot, 2017).
Likelihood of overall improvement has been reported for many common conditions, percentage likelihood across all conditions range from 60% to 80% improvement from pre to post treatment. (NICE Guidelines).
What Can Be Treated With Shockwave Therapy?
This form of treatment will be recommended to patients presenting with a number of conditions such as:
- Achilles tendon pain
- Plantar fasciitis (pain under the foot or heel)
- Patellar tendinopathy (pain under the knee bone)
- Iliotibial band syndrome (pain along the side of your leg from hip to knee)
- Medial tibial stress syndrome (shin splints)
- Hamstring and gluteal tendinopathies
- Shoulder pain, rotator cuff tendinopathy, impingement or frozen shoulder
- Lateral epicondylitis (tennis elbow)
Treatment options will be discussed within initial assessment based on specific tests for the area of pain or irritation.
Contraindications For Treatment
One of the most positive aspects of shockwave therapy is that because this is a non-invasive form of treatment there are only a small number of reasons preventing the use of this therapy. The international society for medical shockwave treatment indicates the following contraindications for radial shockwave:
- Malignant tumour in the treatment area
- Pregnancy (only when treating the area surrounding the fetus)
Precautions for treatment will be reviewed before treatment, these will only prevent use of shockwave if the area corresponds to the injury site:
- Infection within the surrounding area
- Blood clotting
- Electronic implants
- Local infection
- Metal implants
- Recent radiotherapy
- Severely impaired circulation
Why Shockwave May Be Right For You
When there is irritation to muscle or tendon tissue fibres. Typically, the body will initiate a natural healing process within the affected area and start to rebuild the fibres. However, in some cases this healing process is halted, often due to insufficient rest and appropriate stimulation of the injured area. In these cases, the issue may not heal back to normal and remain irritated and painful. This is where shockwave is very effective, this treatment helps to stimulate the effected area and restart the healing process by triggering an inflammatory response within tissue.
What To Expect During Shockwave Treatment
Shockwave therapy is administered through a handheld device operated by your therapist, it is important to arrive for your appointment appropriately dressed as the device must be placed directly onto skin (i.e shorts or vest top depending on the area to be treated). The intensity and duration of treatment will be explained before treatment begins. It is normal to feel some mild discomfort during treatment. Your therapist will monitor your symptoms throughout your treatment. As the treatment goes on, your tolerance increases due to the pain dampening effects allowing your therapist to increase the intensity which in turn increases the positive treatment effects.
At Physio-logical we will perform two types of treatment approaches during the session, we first aim at targeting the effected tendon, performing a cross friction technique to stimulate the fibres within the tendon. We also treat the associated musculature using massage like motions to release trigger points within the muscle. These two approaches help to ensure the entire effected areas are treated together which maximises positive treatment effects.
Evidence within research suggests that a minimum of three sessions must be completed in order to provide effective stimulation to the affected area with the optimum of six sessions. It is recommended that duration between treatment should be 5- 10 days to ensure the treatment effect is not lost between sessions.
What To Expect After Shockwave Treatment
Treatment effects vary based on the individual and also the area treated. Common reports following treatment are a dampening of pain within the area which will allow improvement in range of movement. We encourage people receiving this treatment to refrain from moderate and vigorous physical activity for two days post treatment, as this may lead to overloading the effected area whilst it is healing.
There is medical evidence to support the treatments inclusion in the NICE guidelines. Improvements which have been reported;
77% for Tennis Elbow
90% improvement in Plantar Fascia symptoms
75% for Achilles and Patellar Tendinopathy
91% improvement for Calcific Tendinitis
This treatment is great for patients who have a niggling pain in a tendon or muscle which is not improving with hands on techniques.