Shock wave therapy

Extracorporeal shock waves are high-pressure acoustic pulses generated by a mechanism; the method of shock wave generation can be of different nature:

  • piezoelectric (property of some substances that deform when electric current flows through them;
  • electromagnetic;
  • radial;
  • pneumatic-hydroelectric.

Shock wave therapy is often used in physiotherapy, orthopedics and sports medicine.
The application is only indicated for a few problems, but there it shows great effect.


How does shock wave therapy work?

The shock wave device emits a single high-energy sound wave. This is directed to a small area using target systems that indicate the current area of action, similar to ultrasound of the musculoskeletal system.
Shock waves must not be confused with ultrasound, which consists of a continuous emission of sound waves imperceptible to the human ear

Shock waves develop a pressure 1000 times higher than that of ultrasonic waves: 500 bar versus 0.5 bar.
When the shock wave passes through the blood, it creates vapor bubbles, which is called cavitation.
After the wave passes, an implosion occurs, which enhances the effect of the therapy because more energy is released.

The applications in physiotherapy are mostly in connection with the treatment of:

  1. chronic muscle and tendon diseases,
  2. Neck
  3. Trigger points.

The orthopedic application of shock waves, on the other hand, focuses on the treatment of:

  • Calcifications
  • painful exostoses,
  • Tendonitis with or without calcification – the cure rate is between 60% and 80% (Seil et al.- 2006),
  • bursitis (Khosrawi et al. – 2017),
  • healing problems with fractures (delayed consolidation and pseudoarthrosis),
  • osteochondrosis dissecans,
  • Necrosis of the femur head.

Shock waves can be a real alternative in many cases when a surgical solution seems unavoidable.

The main indications are:

  1. shoulder stiffness,
  2. heel spur,
  3. Arthrosis
  4. Osgood-Schlatter’s disease,
  5. periosteal inflammation (Moen et al. – 2012),
  6. Tendinitis of the Achilles tendon, whereby 76% of patients are cured long-term (Vulpiani et al. – 2009),
  7. Epicondylitis, with a success rate of 60% (Ho – 2007), and medial epicondylitis
  8. Plantar fasciitis, with a success rate of 81% (Metzner et al. – 2010), in this case shock waves are more effective than conservative treatments and surgical interventions (Cole – 2005).

It should be noted that in case of a heel spur, the spur does not disappear (Yalcin – 2012).
This means the pain can be relieved, but the spur remains.

The shock wave is very often used in sports medicine because of its healing promotion and its regeneration effect on soft tissue. As a result, healing after a lesion can be reduced to the maximum. The most common indications are:

  • Pubalgia
  • Achilles tendon disease
  • Muscle contracture
  • Tendonitis on quadriceps and kneecap
  • Tennis elbow
  • Tendonitis of the shoulder (Schmitz – 2015)
  • Handling trigger points

The latest results show that shock waves are very effective in treating muscular injuries by drastically reducing healing time.

Frequently asked questions about shock wave therapy

Does the treatment hurt?
During treatment, depending on the problem the patient has, pain may occur. However, since a treatment lasts only eight minutes, most patients are able to tolerate this sensation well. In addition, it is possible to adjust the intensity of treatment at the beginning of each session to reduce pain.

Will you feel pain after the treatment?
Within 2-4 hours after treatment, pain may occur in the treated area. However, this pain is very bearable and can last from a few hours to a few days.

Do you have to spare yourself during shock wave therapy?
Patients are advised to avoid physical activities affecting the affected area of the body until 48 hours after treatment.

How many treatments are required and at what intervals?
Each session lasts 5-10 minutes. In most cases, 3-5 sessions are required. Treatments are performed every 3-10 days, depending on patient tolerance and tissue response.

Side effects and contraindications of shock wave therapy

The most common side effects include minor pain during and immediately after treatment and reddening of the treated area. These typical side effects are short-lived and pass over the course of 24-48 hours.
Before undergoing shock wave therapy, a physiotherapist or doctor should be consulted.

Contraindications to shockwave therapy:

  • Coagulation disorders and taking anticoagulants such as coumarin and heparin
  • Cancer
  • Pregnancy (Maren C. Kiessling et al. – 2015)
  • Infections
  • Cortisone – do not take cortisone for six weeks before treatment

Is the effect of radial shock wave therapy scientifically proven?

Radial shock waves have been subjected to scientific studies more than other types of physical medicine.
The results have been published in numerous prestigious medical journals: PubMed.

Today, radial shock wave therapy is widely accepted and shows similar results to focused shockwave therapy for superficial disorders of the musculoskeletal system.
Even if the attached energy decreases in depth, this method has clearly shown its effectiveness in soft tissue injuries.

Results of shock wave therapy based on reliable sources

Here are some examples:

  1. The success rate for tendon calcification of the shoulder is 2003%, according to the 91 Journal of American Medical Association.
  2. The success rate in the treatment of plantar fasciitis is 90%, quoted by the Journal of Orthopaedic Research 2005.
  3. The success rate in the treatment of tennis elbow is 2005%, according to the Journal of Orthopaedics of 77.

Are all devices for the application of shock waves the same?

Not all shockwave therapy devices are created equal.
Currently, devices are marketed that do not produce real shock waves, but a ballistic or radial wave.
This type of wave is completely different from a real shock wave. Ballistic or radial waves are created by driving a projectile from a compressor against the head at high speed (similar to a small jackhammer).
Since the shaft is not focused in this type of device, the entire vicinity of the treatment point is hit.

Currently, devices with strongly focusing shock waves are also in circulation, which have a large penetration depth into the tissue.
The penetration depth of the “bombardment” can be regulated depending on the treatment point and the energy can be concentrated with extreme accuracy.
With these devices, the energy output is so concentrated that there is a risk of injury to the underlying tissues.
In addition, the strong focus increases the likelihood of missing the target area, which would make the treatment ineffective and even harmful.

Description of treatment

With an interval of one week, 3-4 sessions are carried out, lasting 10-15 minutes. The treatment must be carried out by qualified personnel under medical supervision. The therapy is quite painful, but patients are usually able to endure the session to the end.

Related articles:

  1. Effect of shock waves
  2. Ultrasound therapy

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