Shockwave Therapy

Shockwave therapy also known as Extracorporeal Shock Wave Therapy (ESWT), is a non-invasive treatment (meaning no cutting of the skin and no introduction of any medical device into the body) that stimulates the body’s natural healing process. It is used to relieve pain and promote healing of injured ligaments, tendons, and other soft-tissue structures. It accomplishes this by passing shockwaves through the skin using a small, handheld device like an ultrasound wand. The shockwaves are mechanical, high-energy sound waves, which function by stimulating and improving blood flow to the inflamed or injured area to speed up the healing process.

Indications

Shockwave therapy is usually recommended for the treatment of a variety of musculoskeletal conditions and sports injuries, particularly those affecting soft tissues such as ligaments and tendons, when other conservative treatments such as physical therapy, medications, or injection therapy, have failed to provide satisfactory results. Some of the common musculoskeletal conditions treated with shockwave therapy include:

• Foot pain: Plantar fasciitis and Achilles tendinopathy
• Knee pain: Patella tendinopathy (jumper’s knee)
• Leg pain: Hamstring injuries
• Shoulder pain: Rotator cuff injuries, calcific tendinitis
• Elbow pain: Tennis elbow, golfer’s elbow, and little league elbow
• Hip pain: Rectus femoris and lateral hip pain with gluteal tendinopathies
• Spinal pain: Acute and chronic muscular pain in cervical and lumbar spine regions

Shockwave therapy is also commonly used as a treatment option for kidney stones, and more recently, erectile dysfunction (ED).

Contraindications

Shockwave therapy is not approved for certain patients, such as those with the following:

• Open wounds, skin rashes, swollen, inflamed, or infected areas
• Tumors
• Ruptured tendon
• Joint replacements
• Implanted devices
• Pacemakers
• Pregnancy
• Nerve or circulation disorder
• Coagulation disorder, or if taking anticoagulant/antiplatelet medications

Preparation

Preparation for shockwave therapy will involve the following steps:

• A review of your medical history and a physical examination to determine if the procedure is appropriate for you
• Routine diagnostic tests such as blood work and imaging
• Disclosing to the medical staff any recent illnesses or other medical conditions you have
• Informing your doctor of current medications or supplements you are taking
• Your doctor may also advise you to stop taking certain medications, such as anti-inflammatories, at least a few days prior to the procedure
• You should not consume heavy meals before the session, and you will be asked to wear loose-fitting clothes
• You will be asked to sign an informed consent form

Procedure

Shockwave therapy is performed on an outpatient basis, meaning you can go home the same day of the procedure without the need for an overnight hospital stay. You may require at least 2 to 3 sessions of shockwave therapy based on the severity of your condition. In general, the procedure involves the following:

• Based on the area of treatment, you will be asked to either sit or lie down on the procedure table.
• Ultrasound gel is applied to the treatment area to help transmit the shockwaves through the skin.
• The shockwaves are then delivered through a special handheld probe or device attached to a shockwave machine that turns compressed air into low-energy sound or acoustic waves.
• The probe is moved over the treatment area to deliver shockwaves in a systematic manner through the gel.
• The shock waves penetrate the skin of the treatment area and help to:
  • increase circulation around injured soft tissues
  • stimulate cells that generate new bone tissue and connective tissue
  • reduce pain by overstimulating nerve endings in the affected area
  • break down scar tissue, if any, in the affected area. Scar tissue is thick, fibrous tissue that may cause pain and immobility in the surrounding tissues. Breaking it down helps to improve mobility and reduce discomfort.
• You may feel slight discomfort during the procedure. However, each treatment session will only last a few minutes, so most patients are able to tolerate the level of discomfort caused by the therapy.

Post-procedure care

Following shockwave therapy, you will be able to walk and return to your normal activities right away, including a return to work. You may experience redness and swelling in the treated area, but this is indicative of the healing process. It is totally normal and will subside in a day or two. In general, your doctor may advise you of the following:

• You should rest the treatment area for a day or two to promote healing.
• Refrain from any strenuous or high-impact exercises, such as running, for at least 2 days.
• Refrain from taking any anti-inflammatory pain medications, such as ibuprofen as they can counteract the treatment.
• Adhere to scheduled follow-up appointments to monitor your progress.

Risks and Complications

Shockwave therapy is a relatively safe procedure; however, as with any procedure, there are risks and complications that may occur, such as:

• Pain
• Swelling
• Skin reddening
• Bruising
• Numbness

Summary

Shockwave therapy is a non-surgical medical treatment that promotes tissue healing and provides considerable or total relief from pain in the majority of patients with musculoskeletal conditions. It is an outpatient procedure that requires no incisions or downtime. Most patients see long-term results after only two to three sessions, each lasting about 15 to 20 minutes.