Shock Wave Therapy - No pain, no gain?

Extracorporeal shock wave therapy (ESWT) has been around for a long time. In the hospital setting it has an established history for managing Renal Calculi (kidney stones).  In the veterinary setting it is used for a number of orthopaedic conditions in horses. From a sports medicine perspective it has now been used for some time to manage a number of musculoskeletal pain conditions and tendon pathologies.  

ESWT is postulated to work through two main methods. The first is through producing a regenerative or tissue-repairing effect in musculoskeletal tissues as a direct result of the treatment over the site of pain or pathology. It appears to stimulate the release of growth factors and an improvement in blood supply leading to repair of tendon and bone. These are the likely mechanisms by which a long-term improvement in symptoms is achieved. The second response primarily produces a reduction in pain through “hyper-stimulation anaesthesia” where by the nerves sending pain signals to the brain are stimulated to such an extent that their activity diminishes, thereby decreasing or eliminating pain.

There have been a number of clinical trials which have examined the efficacy of ESWT in tendinopathy, and found marginal improvements over placebo. Systematic reviews have also reached mixed conclusions about the effectiveness of ESWT for treating tendinopathy. However, a 2015 systematic review concluded that there is moderate evidence for the effectiveness of ESWT for the treatment of three greater trochanteric pain syndrome, patellar tendinopathy, and Achilles tendinopathy, both mid-portion and insertional. There is also evidence showing it is an effective treatment for plantar fascia dysfunction (fasciitis) and has been FDA approved for this condition.  

Our experienced Sport and Exercise physicians certainly feel that if appropriate first line treatment has failed, there is benefit in particular for the treatment of Plantar fasciitis, Achilles tendonopathy and Cacific tendonopathy of the Supraspinatus.

How do patients get referred for this treatment?

In order to be referred for this procedure patients need an initial consultation by one of the Axis clinicians, who will then decide if it is the right treatment for them. Patients will be provided with further information and some of the pros and cons discussed alongside the common expected outcomes and side effects.

At the ESWT appointment the doctor will locate the area of pain through palpation. This area will then be marked and some ultrasound gel applied. The shock wave impulses are delivered using a hand-piece. It takes about five minutes to deliver a single treatment. This is generally said to be uncomfortable but can be painful. It is well tolerated by the vast majority of patients. This process is repeated a total of three times - with a week between treatments. Some patients note an immediate improvement in their pain, and one of the benefits of this procedure is you are often able to return to work or activity soon after the procedure on the same day.

They will then be reviewed four weeks after the last treatment. The best results typically occur 12 weeks after the initial treatment.