new technology aka “the jackhammer for tendons”..
The effect of shock waves (acoustic energy waves) on the human body has been of interest since it was noticed that underwater bombs damaged human lungs of castaways during WWII. After some years of research in 1971 Haeusler and Kiefer in Germany made the first disintegration of kidney stones via shock waves without direct contact which led to the development of the first Lithotripsy machine in 1974. Today Lithotripsy/ extracorporeal shock waves is the treatment of the first choice for kidney and ureteral stones successfully healing millions of people.
In 1988 the first successful shock wave therapy treatment (SWT) of a non-united fracture in a human was successfully performed in Germany. In the early 1990’s SWT was also used successfully for calcific tendon pain in shoulders and then for a variety of problems in tendon, ligaments and other soft tissue disorders. Since this time there has been a large and growing body of research demonstrating positive treatment effects for a number of conditions as listed below:
- Tendon pain disorders
- Plantar facsciitis/ fasciopathy, heel spur
- Gluteus medius tendonopathy/ bursitis (lateral hip pain)
- Achilles tendinopathy Shin Splints (medial tibial stress syndrome)
- Patellar tendinopathy
- Tennis and golfers elbow (medial and lateral epicondylalgia)
- Biceps tendinopathy
- Rotator cuff tendinopathy
How does it work?
The basic premise of SWT is a stimulation of healing responses in conditions where healing has been slow, stalled or incomplete.
With a radial shockwave therapy device the ballistic principle is utilised which consists of a handpiece with a projectile which is pneumatically accelerated towards an applicator transmitter. Upon impact, a wave is produced which propagates in radial direction from the applicator into the tissues.
As the energy wave is transmitted into targeted tissues there has been demonstrated increased local blood flow, increased cellular metabolism (activity/ release of chemicals), modulation of inflammation, an analgesic effect from stimulation of nerves and break down of calcific deposits (an abnormal healing response in tendons). There have been no demonstration of detrimental effects at clinical treatment levels.
What to expect from treatment
- Improvement of blood and lymphatic circulation
- Pain reduction, analgesic effect
- Reduction of muscle tension
- Reduction of calcification and fibrotic changes (long term)
- Better range of motion
- Strengthening of connective tissue
- Increased cell regeneration process
Possible minimal side effects of SWT reported are some short term pain and discomfort, minor skin irritation and sometimes numbness which all resolve within a short period of time.
From clinical research the number of sessions required typically involve 3-5 sessions in most instances, sometimes up to 7 in slower cases and these are usually delivered around 1 week apart.
Importantly SWT has been found to be much more effective when combined with other treatment modalities particularly an appropriate exercise/ controlled loading program and stretches in some instances under the guidance of your physiotherapist.
Who we wouldn’t use SWT for:
Haemophiliacs, people taking strong anticoagulants, cancer/ malignancy, local infection, osteoporosis, metal implants, near froth plates in children, pregnancy
The Authors experience..
We first came across SWT a few years ago via professional conferences and trade demonstrations. As in initial skeptic I investigated the emerging literature which appeared to show some promising results and we then trialled a few machines in our clinic for a few months. We were pleased to find excellent customer feedback from our initial trials which mirrored the clinical studies results. After this we purchased a quality SWT machine which we have now used in our clinic for the past 2 years with many success stories.