Shockwave Therapy

What is Extracorporeal Shockwave Therapy (ESWT)?

In 1997 EMS, a prominent European manufacturer of medical equipment patented the first extracorporeal shock wave machine, Swiss Doloclast, to be used in Medicine for the treatment of kidney stones. It was called Lithotripsy. It was also found to be helpful in treatment of orthopaedic and sports medicine conditions, particularly chronic conditions such as plantar fasciitis and achilles tendonitis. Success in treating these conditions meant that surgical options were avoided.

EMS has continued over 21 years to develop ESWT. There current machine is the Radial Swiss Dolorclast. It delivers high pressurized, low frequency acoustic kinetic energy from a handpiece in a short period of time and is converted into a radial shockwave which travels through gel into tissues, stimulating pain relief and tissue repair. The radial shockwave produces a compressive and tensile phase which creates cavitation bubbles. The cavitation bubbles creates metabolic tissue reactions including the production of substance P. The more energy delivered into the tissues the better the therapeutic outcome.

What are the Benefits of Shockwave Therapy?

The benefits of shockwave therapy include:

1. Reduced pain and inflammation with a depletion of substance P, so neurogenic inflammation declines
2. Increased blood flow in tissues with the proliferation of new blood vessels – useful in chronic conditions which persist despite physical interventions
3. Stimulating the healing process – triggered by Stem cells in acute and chronic musculoskeletal conditions
4. Proliferation of cells (e.g.tenocytes) in collagen tissue (collagen synthesis) – so creating repair of chronic tendinopathy conditions e.g. achilles tendinopathy and posterior tibialis tendinopathy with improved tendon gliding and tendon re-modelling
5. Being non-invasive compared to surgery or injections
6. Helps to dissolve calcium build ups
7. Can avoid the need for surgery
8. Can be given without anaesthesia
9. Only requires 3-4 treatments on average
10. New bone formation with the proliferation of osteoblasts
11. Relaxation of spastic muscles

What sort of conditions are treated by ESWT?

Shockwave therapy is used to treat superficial musculoskeletal conditions – subacute and chronic affecting muscle, tendons, tendon insertions, fascial conditions

Conditions commonly treated by ESWT include:

1. Tendinopathies – achilles tendinopathy, de Quervains, dupuytrens hand contracture, gluteal tendinopathy, tibialis posterior tendinopathy
2. Fasciopathies – plantar fasciitis/heel spur/calcaneal spur, iliotibial band runner’s knee
3. Myotendinous tears – shoulder rotator cuff injuries, proximal hamstring tendinopathy, quadriceps jumper’s knee, pes anserinus insertion strains
4. Muscle strains – hypertonic/spastic muscle tissue, shin splints, calcified haematomas “corkies”
5. Shoulder Rotator cuff tendinopathies/impingement, calcific tendinopathy
6. Patella tendinopathies
7. Back pain
8. Tennis elbow (lateral epicondylitis) and golfer’s elbow
9. Osteitis pubis
10. Tigger points
11. Tendon insertion problems -calcaneal/Haglunds, Osgood Schlatter’s Disease,
12. Sever’s Disease – shock wave therapy can help with bone regeneration at the growth plate achilles tendon junction with results of 80-90% improvement over 3 treatments
13. Osteoarthritic knees

Shockwave therapy is used in conjunction with other physiotherapy management for tendinopathies, fasciopathies and may include

1. home exercise programs to load the tissue so it can sustain the forces of activities of daily life and sport,
2. taping
3. acupuncture/dry needling.

Achilles Tendonitis

How many treatments are necessary?

Most patients will feel an immediate reduction of pain on re-testing. However, as a guideline a course of 3-6 treatments maybe needed to produce significant reduction of pain in chronic conditions. The average is 3-4 treatments.

How much does it cost to have a course of Shockwave Therapy?

There is a surcharge of $30 per session on top of the consultation fee for ESWT at focus on physio.

You do not need a referral to focus on physio for Shockwave Therapy. We accept Private Health funds (gap payment), Medicare EPCs (we do not bulk bill – there is a gap payment), DVA patient, Compensable groups – Workcover and Third party, NDIS

At the Initial Consultation you will be assessed to ensure Shockwave therapy is suitable for you or not. If not, you will be offered other physiotherapy treatment or we will happily refer you to your Doctor for follow up investigations, if indicated.

At focus on physio your initial consultation is longer (45mins) to allow us to conduct a thorough examination (include medical screening), to discuss with you a recommended treatment plan and to deliver treatment on you first appointment.

Frequently asked Questions

Can’t I just have a hydrocortisone injection?

Hydrocortisone is a steroid injection and whilst effective a patient can only have 3 injections of steroids. Steroids actually weaken collagen tissue which makes up tendons and insertions so ultimately the tendon loses its strength and is vulnerable to tear. Shockwave therapy does not have any of these harmful effects on the collagen tissue of tendons or their insertions into bone.

Are there any dangers with using ESWT?

Shock wave therapy is FDA and TGA approved and is considered safe. It is non-invasive and is delivered by a handpiece through special gel for penetration into the body. There may be some discomfort which is regulated by the machine and the physiotherapist.

ESWT is not used:

• over areas close to lung tissue or gut or close to sensitive tissues
• if you are under the age of 18 years except for Osgood Schlater’s disease and Sever’s disease (parental consent necessary)
• over a pacemaker
• if you are taking anti-coagulants or have other blood clotting disorders or thrombosis
• over infection
• over areas of poor nerve sensation/irritation
• over areas of poor circulation
• if you are undergoing current treatment for cancer, local tumors or undiagnosed lumps
• in pregnancy
• if the area has had a corticosteroid injection – 6 weeks must lapse before shockwave treatment is given
• for known tendon rupture

Are there any side effect of shock wave therapy?

Following treatment most people feel immediate pain relief. Sometimes aching may be felt in the treatment area like a bruised sensation which dissipates over a couple of days leaving the original pain from the condition treated much reduced. It is important to remember that the treatment effects on tissues (cellular regeneration) are continuing over several days after the treatment. This is why it is recommended to treat weekly and best results occur over a course of treatment sessions.

What is the Research Evidence to support the use of shockwave therapy?

Shock wave therapy does work and has been proven in numerous clinical studies to be a beneficial treatment in chronic problems for which it is suitable. You can read some below and there are many more articles:

Achilles tendonitis:

• Rompe et al: Eccentric loading compared shockwave treatment for chronic insertional Achilles tendinopathy, Journal of Bone and Joint Surgery 2008;90:52-61
• Han et al 2009: Effect of Extracorporeal Shockwave Therapy on cultured tenocytes , Foot and Ankle International, 30:93-98
• Dedes et al, Effectiveness and Safety of Shockwave Therapy in Tendinopathies, Mater Sociomed, 2018, Jun;30 (2)131-146

Plantar fasciitis

• Furia et al: Extracorporeal Shockwave Therapy treatment of chronic planta fasciitis and achilles tendinopathy, Current Opinion in Orthopaedics, 2007 :101-111
• Wand et al Long term results of extracorporeal shockwave treatment for plantar fasciitis. American Journal of Sports Medicine.2006; 34 (4):592-596
• Otham et al. Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of planta fasciitis. Archives Orthopaedic Trauma & Sugery. 2010;130 (11):1343-1347
• Gerdesmyer et al, Radial Extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis, The American Journal of Sports Medicine, 2008,Vol 10 (10), 1-10

Rotator cuff and calcific tendinitis

• Rompe et al.Shoulder function after Extracorporeal shock wave therapy for calcific tendinitis. Journal of Shoulder Elbow Surgery, 1998;7(5):505-509
• Wang et al. Shock wave therapy for calcific tendinitis of the shoulder: a prospective clinical study with two-year follow-up. Ammerican Journal of Sports Medicine, 2003; 3193):425-430
• Cacchio et al, Effectiveness of radial shockwave therapy for calcific tendinitis of the shoulder: single blinded, randomized clinical study, Physical therapy, 2006, Vol 86(5), 672-682

Patella Tendinitis

Wang et al, Extracorporeal shockwave for chronic patellar tendinopathy, American Journal of Sports Medicine, 2007, Vol 35 (6), 972-979

Lateral Epicondylitis (tennis elbow) and Golf’s elbow

• Pettrone et al Extracoporeal shock wave therapy without local anaesthesia for chronic lateral epicondylitis. Journal Bone and Joint Surgery 2005;87(6):1297-1304
• Collins et al A clinical study of extracorporeal shock waves (ESW) for treatment of chronic lateral epicondylitis. Current Orthopaedic Practice2011; 22(@):185-192
• Melikyan et al Extracorporeal shock wave treatment for tennis elbow: a randomized double-blind study. 2003; 85 (6): 852-855
• Ilieva et al, Radial shock wave therapy in patients with lateral epicondylitis, Folia med (Plovdiv) 2012; 54(3): 35-41