SHOCKWAVE
Extracorporeal Shockwave Therapy (ESWT/Shockwave)
WHAT IS SHOCKWAVE?
Shockwave therapy, also known as Extracorporeal shockwave therapy (or ESWT), is a non-invasive treatment that administers high-intensity sound waves. A shockwave is a form of acoustic energy, and though often compared to ultrasound, the two waveforms are fundamentally different. From a physics standpoint, a shockwave is defined as an acoustic wave with a high positive peak pressure, a fast rise time, and a negative pressure period, all within a very short time.
For more details see our dedicated shockwave website.
WHAT CAN IT HELP?
Shockwave therapy can help treat many chronic conditions arising from overuse that are often challenging to manage with other methods. It is typically used for tendinopathy (such as tennis or golfer's elbow, biceps tendonitis, plantar fasciitis, and heel pain). It may also aid in the treatment of myofascial pain syndromes, intractable trigger points, and chronic muscle pain.
DOES IT WORK?
For most conditions, the reported rate of clinical success worldwide is between 75 and 91 per cent, although some respond better than others (such as plantar fasciitis and heel spurs). During the assessment, the underlying contributing causes of the problem are identified and addressed to prevent a recurrence. The treatment is cumulative, and results are usually felt after 3 to 5 sessions, with most benefits typically seen four to six weeks following care.
ARE ALL SHOCKWAVE UNITS THE SAME?
The DolorClast® Radial Shock Waves stands out due to delivering up to 200% more energy density than competing devices at 15 Hz and above frequencies and maximum pressure. Other shockwave units on the market provide less energy, requiring 8-10 sessions, but the higher energy delivered by DolorClast® Radial Shock Waves device results in shorter treatment times.
WHAT ARE THE ADVANTAGES?
Shockwave therapy is a non-invasive treatment with very few side effects or complications:
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A safe procedure, confirmed by NICE* guidelines
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Strong clinical results/evidence-based*
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May prevent the need to have surgery
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No need for anaesthesia
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Short treatment sessions lasting just 10-20 minutes
* National Institute of Clinical Excellence (NICE) Guidelines IPG376 (Greater trochanteric pain syndrome), IPG312 and IPG571 (Achilles tendinopathy), IPG311 (plantar fascitis), IPG21 (calcific tendonitis) and PG313 (tennis elbow )
WHAT ARE THE RISKS?
Treatment with shockwave therapy has few disadvantages or side effects, but some of these may include the following:
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Discomfort during treatment, (however, the intensity is moderated for each client to their individual tolerance).
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Pain or discomfort for a few days following treatment due to the body’s inflammatory response.
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Treatment may not always be successful, and in this case, surgery or referral may be an option. Despite a very good success rate with shockwave, we cannot guarantee results.
WHEN IS IT NOT SUITABLE?
Shockwave therapy is suitable for most people, but not if any of the following apply:
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Pregnancy
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Tumours (at/near the site of treatment)
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Infection at the site of treatment
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Taking anticoagulants ("blood thinner")
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Pacemaker fitted
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Recent steroid injection (within the last 8 weeks)
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Under 18 years of age (except treating Osgood-Schlatters)
HOW LONG WILL IT TAKE?
Typically, shorter term injuries will require around 3 applications, whereas long term, difficult to shift conditions may require 5 or 6 sessions. Each application last just a few minutes.
FOR THE SCIENCE GEEKS
How Shockwave Works:
The exact mechanisms leading to shockwave therapy's success, especially for tendinopathy, still need to be completely understood. Evidence suggests a complex interplay exists among mechanical, biochemical, and pain relief mechanisms. The mechanical effects are likely brought about by the cavitation phenomenon, which induces subsequent cell membrane vibrations through mechanotransduction.
Mechanotransduction triggers the following cellular responses:
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A significant increase in vascular endothelial growth factor, endothelial nitric oxide synthase, and proliferating cell nuclear antigen leads to angiogenesis.
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Immediate elevation of Interleukin-6 and Interleukin-8 and a five-fold increase in matrix metalloproteinase-2 and 5. These substances are closely linked with tendon homeostasis, fibroblast activity, and pathological tissue destruction, suggesting that shockwave therapy may have a pro-inflammatory action.
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Positive effects on bone health through the reduction of osteoclast activity and the stimulation of osteoblast activity.
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Immediate pain relief through hyper-stimulation mechanisms, reduction in substance-P, and reduced calcitonin gene-related peptide, also known as regulating neurogenic inflammation.
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Long-term pain relief through the selective destruction of unmyelinated nerve fibres.
