Extracorporeal shockwave therapy or simply shockwave therapy can be a useful physiotherapy treatment for chronic soft tissue pathologies and injuries. The treatment is non-invasive and involves sending shockwaves into chronic inflamed tissue to reduce pain and improve function. This has been found to be particularly useful in treating conditions which may not have responded to other therapies. Shockwave can be beneficial in the following ways:

  • Chronic inflammation is when the inflammatory process associated with tissue repair does not fully conclude in expected healing times. This can result is changes in the tissue and long term pain. The shockwaves are thought to increase the activation of mast cells, which are important in inflammation. This has a pro-inflammatory effect which kick starts the healing process and regeneration of healthy tissue.
  • In chronic soft tissue injuries which have not experienced normal healing there is a loose weave of collagen fibres with cross link formation, which are unable to take normal load. Shockwave therapy accelerates the production of collagen into a highly organised longitudinal pattern required for normal function.
  • The shockwaves generated during the treatment can induce pain relief by reducing Substance P. Substance P is a neurotransmitter which is involved in sending pain signals through the nervous system to the brain and is considered prevalent in chronic pain. In addition to reducing Substance P, shockwave therapy can reduce histamines and other painful metabolic substances which in turn can decrease inflammatory swelling or oedema.
  • Shockwave therapy creates microtrauma to soft tissues and bone which stimulates the production of new blood vessels, bringing oxygen and nutrients to the tissues and promoting the healing process.
  • Shockwaves can be effective in breaking down calcification within tendons. Calcium build up in tendons is the result of trauma to the tissue which does not fully heal. Calcification can be treated without the need for surgical intervention using shockwave therapy.

Some common long-term conditions that may be benefit from shockwave therapy include:

  • Plantar fasciitis
  • Achilles tendinopathy
  • Tennis elbow (lateral epicondylitis)
  • Golfer’s elbow (medial epicondylitis)
  • Jumper’s knee (patella tendon)
  • Rotator cuff tendinopathies involving calcification

Evidence references

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