A Better Understanding
Extracorporeal shock wave treatment (ESWT) is a non-invasive method that utilises pressure waves to treat a variety of musculoskeletal conditions. ESWT produces high-energy acoustic waves (shockwaves) which then delivers a mechanical force into the body’s tissues.
Shockwave therapy may treat chronic conditions such as degenerated tendons such as Achilles tendonitis, heel pain such as plantar fasciitis and elbow pain such as tennis elbow or lateral epicondylitis.
Degenerative tendons and ESWT
Tendons have a poor blood supply which inhibits their healing processes. So, when a tendon has been damaged from excessive load or individual errors, the tendons may become reactive. If this continues without altering the load or training regime, the tendon enters into a state of reactive tendinopathy and dysrepair. Hence once the tendon enters this stage it is harder to return the tendon to normal function, which descends the tendon further into a state of chronicity and it becomes a degenerative tendon.
It is at this stage where ESWT is most effective and is believed to be the only way the tendon can be returned to normal. The shockwaves essentially stimulate the mechanoreceptors in the tendon to allow inflammation and remodeling to occur. They also mechanically help break scar tissue formed to allow for proper tissue realignment. Both processes help increase local inflammation via pro-inflammatory neuropeptides such as substance P and CGRP (Calcitonin gene-related peptides). This increased inflammation allows the tendon to attempt to heal at a cellular level. Combining ESWT with progressive loading/exercise that is aimed to eventually reach 70% of the client’s max effort will return the chronicity of the tendon to normal function.
ESWT is well known for its pain relief benefits. Through research, we now know that ESWT has a role in returning degenerative tendons into reactive tendons. However, shockwave does provide an analgesic effect in the area. This is best achieved when the machine uses a noxious stimulus via the pain gate theory. This means for this to occur the shockwave session must be uncomfortable or involve a low-mid level of pain.
ESWT is a pro-inflammatory treatment modality. The reason behind this is that it can change the cells of a degenerative tendon into a more acute, reactive tendon thus increasing blood flow and stimulating the body’s natural healing process.
Indications for shockwave
• Achilles tendinopathy
• Plantar fasciitis with or without heel spur
• Lateral epicondylitis (tennis elbow)
• Medial epicondylitis (golfer’s elbow)
• Greater trochanteric pain syndrome (GTPS)
• Rotator cuff tendinopathy
• Tibialis posterior tendinopathy
• Tibial stress syndrome
• Myofascial pain with trigger points
• Muscle sprain
What Should I Expect?
A narrow rod connected to the machine is used on the affected area. It sounds and feels like a small pulsating jack hammer. The settings can be adjusted to suit the patient’s tolerance but over time tolerance raises and settings are modulated to this. You may experience a sensation of mild discomfort while the pulses help stimulate and remodel the tissue. Local redness can be produced at the area and in some rare cases bruising might occur. For the next 24 hours after the treatment there can be increased soreness as this is a healing response from the increased blood flow to the area, but this usually subsides in a day or two. The entire healing process can take up to 10 to 12 weeks but by the end of the treatment regimen the affected tissue will be stronger and rejuvenated which allows you to better go about your sport and/or activities.
For More Information
For more information, get in touch with our team.