Shock Wave Therapy
I would like to share some exciting news with you about a new addition to our clinic. We now have a shock wave machine in our clinic and I think this might be a good opportunity to explain a little more to you what shock wave therapy is, as well as highlight who could benefit from the treatment.
First things first, what exactly is shock wave therapy? Shock wave therapy or extracorporeal shock wave therapy (ESWT) is a non-invasive therapy that is used by many disciplines (i.e. chiropractic, physiotherapy, orthopaedics, sports medicine etc.) to speed up healing in various acute and/or chronic pain conditions. The main benefit of shock wave therapy is its ability to quickly reduce pain (within minutes) and promote healing.
Shock wave therapy utilises a device that creates shock waves (acoustic pressure pulses) generated by compressed air, which accelerates a small projectile in a handpiece. The handpiece is strategically placed and held on the body of a recipient by a trained professional after a thorough assessment and diagnosis. The treatment generally takes 5-10 minutes but can require longer if there are multiple areas or a large area to be treated.
Shock wave therapy is a relatively new therapy despite having come on the market 30 years ago. Like many new technologies it takes time for the evidence of a devices effectiveness and safety to accumulate, however, now for EWST there is evidence of for both. A meta-analysis (which sits at the top of the evidence hierarchy) published by Liao et al. (BMC Musculoskeletal Disorders 2018) had the following conclusion: “Out of 19 randomised controlled trials and 1189 patients – no adverse events, side effects, or complications were reported after ESWT.” Currently more and more professionals in medical and allied health industries are adopting the therapy due to its demonstrated efficacy and safety.
How does it work?
A projectile in the handpiece is accelerated at high speed by means of precisely controlled bursts of compressed air. When the projectile strikes the applicator inside the handpiece, its kinetic energy is converted into a mechanical energy. The energy that is produced is then transmitted through soft tissues of the body resulting in physiological changes to the treated area. This aids with reduction of pain, and tissue repair and regeneration.
Medical Effects of shock wave therapy
Acoustic waves used in shock wave therapy interact with tissues causing biochemical and physiological effects including faster tissue repair, angiogenesis (new formation of blood vessels), cell growth, analgesia and mobility restoration.
New Blood Vessel Formation (Angiogenesis)
Blood contains nutrients which are necessary for repair and remodelling of damaged soft tissues. The application of shock waves creates micro-ruptures of tiny blood vessels (capillaries) in soft tissues. Due to micro-ruptures the expression of growth factors is significantly increased, which leads to the formation of new blood vessels.
The new blood vessels improve blood supply to the treated area, which in turn improves the body’s ability to heal and eliminate waste products.
Reversal of Chronic Inflammation
The human body normally has a certain amount of inflammation even in the healthiest of individuals. Inflammation is a necessary response for healing, when a tissue is damaged the tissues release chemicals that trigger a localised inflammatory response, which in turn attract leukocytes (white blood cells that protect the body against infections) to the site of inflammation. Once the leukocytes have completed their work (laid down new tissues and removed the old damaged tissues) the inflammation in the area should return to normal levels. However, for some individuals the body will maintain a high inflammation rate in the area of injury, and the repair job never gets completed. This is what we call ‘chronic inflammation’, which is an undesirable state. This is because with chronic inflammation the injured area remains swollen and painful for an excessive period of time. This results in damage to healthy tissue and chronic pain due to central sensitisation. Mast cells (a form of leukocyte) are one of the key components of the inflammatory process. Their activity may be increased with shock wave therapy.
Stimulation of Collagen Production
The production of a sufficient amount of collagen in the body is necessary for the repair and remodelling processes of damaged soft tissues. Shock wave therapy stimulates procollagen production. The treatment forces the newly created collagen fibres into alignment which makes the newly formed tendon fibres denser and stiffer, thus creating a more resilient tissue.
Breaks Down Calcium Build-up in Tissues
Calcium build-up is often due to micro-tears or other such trauma to a tendon. Shock waves can break up existing calcifications within soft tissues of the body. Shock wave therapy triggers a biochemical process in calcified tissues that leads to the breakdown of calcium and restoration of normal function and elasticity of the treated tissue. The granular particles of calcium are then removed by the lymphatic system and excreted by the body.
Dispersion of Pain Mediator “Substance P”
Substance P is a neuropeptide that mediates pain information through pain sensitive nerves (C-fibres). Substance P is generally associated with intense, persistent and chronic pain. It relays pain messages to the central nervous system. Lowering the concentration of Substance P reduces the stimulation of C-fibres and hence reduces pain. Decreasing Substance P, histamines and other pain metabolites also helps reduce inflammatory oedema (swelling). Shock wave therapy helps to lower Substance P concentration in the treatment area and results in a local pain relieving effect.
Release of Trigger Points
Trigger points are a main cause of musculoskeletal pain in the back, neck, and limbs. Trigger points are palpable nodules in taut bands of muscle fibres (feels like a marble under the skin). The dysfunctional muscle fibre (sarcomeres) contract so tightly that they begin to cut off their own blood supply. This causes local waste products to build up. Waste product build-up irritates the sensory nerve endings which then causes further contraction. This vicious cycle is referred to as “metabolic crisis”. The theory is that the delivered energy unblocks the calcium pump and thus reverses the metabolic crisis in the muscle fibre and releases the trigger points.
shock wave Indications:
Tension Headaches
Trigger point pain
Osteoarthritis
Tendinopathy/Tendinitis (Jumper’s knee, Golfer’s elbow, Swimmer’s shoulder, Tennis elbow)
Medial tibial stress syndrome
Heel spurs
Lymphedema
Calcifications
Fracture non-union
Osgood Schlatter’s
Wound management
shock wave Contraindications:
Air filled tissues: lung, gut, heart
Pregnant women
Local tumours / cancers
Bleeding disorders (haemophilia)
Patients taking prescription blood thinners (Warfarin)
Local cortisone injections (Ok 6 weeks post injection)
Patients under the age of 18 (except Osgood Schlatter's)
Pre-ruptured tendons
If you have any questions regarding shock wave therapy or would like to talk to us to see if it could benefit you, please don’t hesitate to contact us.
Take care,
Your Back to Function Team