Evidence

Shockwave Therapy – An Effective Treatment Option

Therapeutic shock waves were introduced as a medical treatment for eliminating kidney stones without causing skin injury over 20 years ago.

Today the use of radial shock waves or Radial Pressure Waves (RPW) has been successfully extended to other therapeutic and wellness applications. Although especially popular in Europe it is still a relatively new technology for musculoskeletal intervention in the UK.

The effectiveness of the treatment modality for specific conditions has however been reviewed accepted by both NICE (UK National Institute for Health and Clinical Excellence) and FDA (US Food and Drug Administration).

Shockwave Therapy Explained

The treatment goes by several names, the most popular being SHOCK WAVE THERAPY or EXTRACORPORAL SHOCKWAVE THERAPY (ESWT). It has been suggested that the therapy version of shockwave therapy might be usefully called RADIAL SHOCKWAVE THERAPY (RSWT) to distinguish the nature of the wave from the high energy, focused versions, employed elsewhere in medical practice.

Radial shockwaves are also referred to as Radial Pressure Waves. They are pulses generated by compressed air which converts into acoustic energy. The acoustic pulses are then transmitted via a dispersive wave into the tissue of the affected area.

Principles of production

There are basically four different way to produce the ‘shock wave’, which in simple terms are: spark discharge; piezoelectric; electromagnetic and pneumatic (or electrohydraulic). The wave that is generated will vary in its energy content and also will have different penetration characteristics in human tissue. In therapy the most commonly employed generation method is based on the pneumatic system, and the key reason for this is that a radial (dispersive) wave results. The focused waves are essential for ‘surgical’ interventions, but given their destructive nature, they are less appropriate for therapeutic uses. Focused waves are sometimes also referred to as ‘hard’ shockwaves, and the radial or dispersive wave termed a ‘soft’ shockwave.

RPW Hypotheses of mode of action

Pain reduction: the intensive pulses transmitted from the hand piece to the tissue help inhibit the transmission of the pain signal (Gate Control theory)
Increased metabolism: shock waves influence the tissue on a cellular level, promoting the release of pain inhibiting and inflammatory inhibiting substances
Revascularisation: repeated shock waves influence the blood flow, promoting tissue healing and regeneration
Reduced muscle tone: shock waves help restore a normalized muscular tone by reducing the impact of pain on muscle tone

Safety

The basic technology involved in extracorporeal shockwave therapy has been used for decades to treat millions of people. The technology has been used most extensively in Europe and during all this time, ESWT of the musculoskeletal system has been found to have virtually no serious side-effects when used by trained physicians. In fact, even mild side-effects such as tingling, aching, redness, or bruising are relatively rare, mild, and transient.

Evidence for Shockwave technology

There is good clinical research into the effectiveness of shockwave therapy. Physiocare has been very encouraged by such evidence and has invested in shockwave technology to help treat patients quickly and effectively.

Prof. Tim Watson, Professor of Physiotherapy in the School of Health & Social Work at The University of Hertfordshire has produced an impartial and useful review of shockwave therapy. A link to the relevant section of his website can be found here: https://www.electrotherapy.org/modality/shockwave-therapies-.

NICE (National Institute for Health and Clinical Excellence) has reviewed ESWT and has approved guidelines for its application.

Chattanooga, the manufacturer of our Shockwave device has created an overview of the clinical evidence in the scientific literature regarding the use of RPW Shockwave therapy: Chattanooga Clinical Evidence Overview

The use of Shockwave Therapy for specific conditions

We have collected together a series of links relating to the use of Shockwave Therapy in specific conditions:

Shoulder

Plantar Fasciitis

Jumpers Knee

Achilles Tendinopathy

Trochanteric Bursitis

Tennis Elbow

Stress Fractures

International Society for Medical Shockwave Treatment: https://www.ismst.com/abstracts_9congress/abstracts_9_53.htm

And for those wanting more rigorous scientific evidence…

A Daily Mail Report: https://www.dailymail.co.uk/health/article-2242517/Shockwaves-fired-foot-cured-crippling-pain–got-heels.html

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