Extra-Corporal Shock Wave Therapy (ESWT)

What is Extra-Corporal Shock Wave Therapy (ESWT)

Extra-Corporeal Shockwave Therapy (ESWT) is a treatment used to treat tendon pathology - as well as other musculoskeletal pain. Initially developed to obliterate Renal Calculi (kidney stones) via lithotripsy, physicians noted improvements in bone density of patients who underwent this treatment, and later this was developed to treat an array of musculoskeletal pathologies.

At movementLAB we currently use this technology to treat conditions including plantar fasciitis, Achilles tendinopathy (tendinitis / tendinosus), Tennis Elbow & Golfer’s Elbow (lateral epichonditis & medial epichonditis) , greater trochanteric bursitis and patellar tendinopathy.

Unlike current cortisone and PRP (Platelet-Rich-Plasma) treatments which uses injection directly into the painful tendons or area, ESWT is a non-invasive treatment and does not require anaesthesia, and does not does carry infection risks such as with more invasive treatments. It is quick and easy to perform with no downtime following treatment.

How is treatment performed?

  1. Your physio will locate the area of pain by palpating the area. This area will then be marked and some ultrasound gel applied.

  2. The acoustic shock wave impulses are delivered using a hand-piece directly to the affected tendon, and surrounding muscle tissue. It takes about ten to fifteen minutes to deliver a single treatment to one area, although in cases of bilateral pathology expect twice as long to perform both affected areas. The treatment is well tolerated and although not completely pain free is said to be uncomfortable rather than painful. Your physio can modify the treatment to accomodate you should you experience any undue discomfort.

  3. This process is repeated a total of three to six times - with a week between each consecutive treatment. Some patients note an immediate improvement in their pain, while others may report a local sensitisation of the area. Side effects are uncommon however do sometimes occur, and these will be discussed with you prior to treatment. Best results usually occur up to 12 weeks after the initial treatment.

How does it work?

  • ESWT initially reduces pain through what is known as 'hyperstimulation anesthesia'. The nerves sending pain signals to the brain are stimulated to such an extent that their activity diminishes, thereby decreasing or eliminating pain.

  • ESWT alters the release of the pain mediator and growth factor Substance P. Substance P is responsible for causing slight discomfort during and after shock wave treatment. Over time the shock waves lead to the depletion of substance P from free nerve endings. Less substance P in the tissue results in reduced pain. Less substance P also causes so-called neurogenic inflammation to decline.

  • Extracorporeal Shockwaves also produce a regenerative or tissue-repairing effect in musculoskeletal tissues. They appear to stimulate the release of growth factors and an improvement in blood supply leading to repair of tendon and bone. These are the mechanisms by which a long-term improvement in symptoms occurs.

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 greater trochanteric pain syndrome, patellar tendinopathy, and Achilles tendinopathy, (both mid-portion and insertional tendinopathies). There is also evidence showing it is an effective treatment for plantar fasciitis and has been FDA approved for this condition.

What conditions does it work for?

ESWT has been used in clinics Worldwide for a number of years, it is not a new treatment. However, in recent years the technology has become more accessible due to decrease in cost of the machines. There is scientific evidence to show that:

  • It is as effective as 12 months of eccentric strengthening for Achilles tendinopathy (but requires a fraction of the time for a treatment to be completed versus the time to perform the tiresome and often painful exercises)

  • It is superior to eccentric strengthening and more 'traditional' rehabilitation techniques for insertional achilles tendinopathy

  • It is an effective treatment for plantar fasciitis and has been FDA approved for this condition

  • It is effective for the treatment of greater trochanteric bursitis

  • Can be used to treat tennis and golfers elbow (tendinopathy affecting the common extensor and flexor tendons at the elbow)

How do I get referred for treatment or find out if ESWT is right for me?

If your injury has been long-standing (6 months or longer), and first line treatment has failed (either conservative management, or more invasive medical treatment) either a referral from you GP or specialist will suffice, or you can also simply make an appointment with one of our physiotherapists to find out if ESWT is right for you.

In your initial consultation you will be provided with further information including the pros and cons of treatment discussed alongside the common expected outcomes and side effects. Eligibility will be ascertained as there are some contraindications for treatment, such as:

  • recent corticosteroid injection (within the past 12 weeks)

  • pregnancy

  • malignancy

  • acute inflammation

  • diabetes

  • pacemakers

  • metalware or other implants

  • you have haemophilia or other coagulation issues

Patients are then reviewed approximately four weeks after the last treatment. The best results typically occur 12 weeks after the initial treatment.

If you would like to learn more about ESWT, or whether you are a suitable candidate for treatment please, feel free to arrange an appointment with one of our physiotherapists.

You can email inquiries to physio@movementlab.co.nz or call us on 09-360-0008 to schedule an appointment.

Jianni FelpasComment