Shock wave therapy is a non-invasive therapeutic procedure. It involves applying a single-impulse transient acoustic wave, lasting 1 microsecond, to various target body regions. This treatment aims to induce analgesia and facilitate healing through a mechanism known as mechanotransduction . Shock waves are recognised as an effective, non-invasive, and cost- and time-efficient treatment. Shockwave therapy was initially introduced into clinical practice in 1982 for managing urologic conditions. Its success in treating urinary stones rapidly established it as a first-line, noninvasive, and effective method . Later, shockwave therapy was investigated in orthopedics, revealing its potential to loosen cement in total hip arthroplasty revisions. Subsequently, orthopedic research has concentrated on tendinopathies, fasciopathies, and soft tissue conditions affecting both upper and lower extremities. Plantar fasciitis was the first orthopedic condition to receive FDA (Food and Drug Administration) approval for shock wave management, paving the way for numerous other indications to follow. 

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Physiology

Shockwaves are sound waves characterised by specific physical attributes, including nonlinearity, high peak pressure followed by low tensile amplitude, short rise time, and short duration (10 ms). They consist of a single pulse with a wide frequency range (0-20 MHz) and a high pressure amplitude (0-120 MPa).

These characteristics give rise to both a positive and negative phase of shockwave. The positive phase exerts direct mechanical forces, while the negative phase generates cavitation and gas bubbles that subsequently implode at high speeds, generating a second wave of shockwaves.

In comparison to ultrasound waves, the peak pressure of shockwaves is approximately 1000 times greater than that of an ultrasound wave.”

Mechanism

ESWT works by promoting the growth of new blood vessels where tendons and bones connect. It also encourages the growth and specialisation of tendon cells and bone-forming cells. Additionally, it increases the number of certain types of white blood cells and boosts the production of growth factors and proteins, which help in making collagen and remodeling tissues. Additionally, shockwave therapy is thought to disrupt the transmission of pain signals and break down calcifications or scar tissue in the affected area, promoting tissue remodeling and healing.

Indication 

Shockwave therapy, also known as extracorporeal shockwave therapy (ESWT), is a non-invasive treatment method utilised for various musculoskeletal conditions. Primarily, it finds application in alleviating pain and promoting healing in conditions like plantar fasciitis, tennis elbow (lateral epicondylitis), golfer’s elbow (medial epicondylitis), and Achilles tendinopathy. Additionally, it’s effective in addressing shoulder pain issues such as calcific tendonitis and rotator cuff tendinopathy. Beyond these specific ailments, shockwave therapy can also be beneficial for chronic musculoskeletal pain management, targeting areas like the knees, hips, and back. Moreover, it has been explored for its potential in promoting bone healing, particularly in cases of non-union or delayed union fractures. Furthermore, shockwave therapy has shown promise in treating trigger points and has even been investigated as a potential treatment for erectile dysfunction, especially when related to insufficient blood flow to the penis. However, it’s crucial to consult with a healthcare professional to determine the suitability of shockwave therapy for an individual’s specific condition and medical history

Contraindication

Shock wave treatment isn’t advised for people on blood-thinning medication or those prone to bleeding, as high-intensity shock waves can cause bleeding. It’s also not recommended for those with acute infections, during pregnancy, or directly over growth plates. Care should be taken to avoid nerves and major blood vessels during treatment. It is also not suitable for complete tendon ruptures.

Side effect

ESWT is generally safe, with most side effects occurring at the application site, such as pain during treatment, temporary skin irritation (like redness, bruising, and swelling), or brief nerve irritation causing tingling sensations. No serious adverse events have been reported. Patients often find ESWT uncomfortable but bearable. If necessary, the energy level can be adjusted to improve tolerance. It’s crucial to be prescribed this treatment by a licensed professional and receive shockwave therapy only from a qualified clinician

Procedure 

Shockwave therapy sessions typically last between 10 to 20 minutes, varying depending on the treated condition and the size of the treatment area. The number of sessions needed can range from 4 to 8, tailored to individual requirements. Before the procedure, a conductive gel is applied to the treatment area by the healthcare provider to facilitate the penetration of shockwaves through the skin. To ensure accurate targeting, the area may be marked. Using a handheld applicator or probe, the provider administers shockwaves in intermittent bursts, adjusting intensity and frequency according to the patient’s needs and the specific condition being treated. Patients might feel a mild to moderate tapping or vibrating sensation during the treatment. While some individuals may experience mild discomfort or soreness afterward, it typically subsides within a few hours. Post-treatment instructions, including recommendations to avoid strenuous activities and applying ice to the treated area, are provided to patients.

Similarities of Shockwave Therapy with Therapeutic Ultrasound 

Shockwave therapy and therapeutic ultrasound, while distinct modalities in physiotherapy, share several similarities in their therapeutic applications. Both treatments harness mechanical energy to elicit healing responses within the body. Shockwave therapy utilises high-energy acoustic waves, while therapeutic ultrasound employs high-frequency sound waves. This mechanical energy enables both modalities to penetrate tissues, albeit to varying depths. While shockwave therapy typically reaches deeper structures due to its higher energy levels, therapeutic ultrasound is effective at targeting superficial and deeper tissues alike.

Biologically, both treatments exert similar effects, promoting tissue healing and regeneration, increasing blood flow, reducing inflammation, and alleviating pain. However, the specific mechanisms of action may differ slightly between the two modalities. Despite these variances, they are both non-invasive procedures, offering safer alternatives to surgical interventions for various musculoskeletal conditions.

In terms of clinical applications, shockwave therapy is often used to treat specific conditions such as plantar fasciitis, tendinopathies, and musculoskeletal pain. In contrast, therapeutic ultrasound has a broader range of applications, encompassing soft tissue injuries, muscle strains, joint stiffness, and scar tissue management, among others. Additionally, both modalities typically require multiple treatment sessions to achieve optimal therapeutic outcomes, with the number and frequency of sessions tailored to the individual patient’s needs and response to treatment.

While shockwave therapy and therapeutic ultrasound share similarities, it’s essential to recognise their unique characteristics and applications. The choice between the two modalities depends on factors such as the patient’s diagnosis, treatment goals, and individual response to therapy. Therefore, a thorough assessment by a healthcare professional is crucial in determining the most suitable treatment approach for each patient.

Differences of Shockwave Therapy with Therapeutic Ultrasound 

Shockwave therapy and ultrasound therapy have distinct mechanisms of action and clinical applications.

Extracorporeal Shockwave Therapy (ESWT) utilises high-energy mechanical sound waves, known as therapeutic shockwaves, to stimulate healing in injured areas of bones, tendons, and soft tissues. These shockwaves cause physical disruption or stimulation in the tissue, leading to increased blood flow and tissue regeneration. ESWT is particularly effective for chronic pains or injuries such as plantar fasciitis, tennis elbow, shoulder tendinopathies, and certain slow-healing fractures.

In contrast, ultrasound therapy employs sound waves at a much higher frequency than audible to generate heat deep within the body’s tissues. This thermal effect increases blood flow, speeds up healing, decreases pain, reduces inflammation, and improves tissue elasticity. Ultrasound therapy is versatile, working well in both post-acute and chronic pain scenarios, including strains, sprains, tendon strains, and fractures.

In summary, while shockwave therapy and ultrasound therapy both promote healing and alleviate pain, they do so through different mechanisms and are suited to different types of conditions. Shockwave therapy is ideal for chronic pains and injuries, while ultrasound therapy is effective across various stages of recovery and in treating a broader range of musculoskeletal issues.