Have you tried Extracorporeal Shockwave Therapy?
By now, most people reading this probably know of someone who has had, or is currently undergoing, Extracorporeal Shockwave Therapy (ESWT) to treat their recent or persisting muscle sprain, tendonitis/nosis, scar tissue or even bone fracture?
Either way, if you have one of these conditions or know of someone who does… then you are probably interested, like myself, in the mechanism of action and possible therapeutic benefits that this modern treatment modality carries.
Maybe you are a practitioner and are thinking of getting one for your practice? In my experience, I am realizing one important outcome… It’s working!
So far, I have had positive patient results using ESWT when treating tibial stress syndrome, ITB syndrome, ankle inversion sprains and myofascial trigger points. In all cases, the patients have experienced immediate relief and reported significant improvements in functionality and pain with continued treatment.
So what is ESWT?
An electric current can be turned into electro-magnetic energy. The energy is transmitted in waves, and the waves can be of various lengths. Accumulating clinical evidence indicates that various energy waves preferentially treat various conditions. Four energy waves are now being used in clinical pain practice:
ESWT falls under the ‘ultrasound’ category because it forms a powerful acoustic wave. However, it is more focussed and far more intense in pressure and amplitude than conventional ultrasound treatment modalities.
Conventional ultrasound uses a piezoelectric crystal that vibrates within the casing of a transducer and causes a conversion from electrical to mechanical energy. This high frequency wave has a ‘micro-massaging’ effect that is said to increase fluid resorption and breakdown adhesive tissue in athrofibotic conditions and cheloid scarring. There is also a thermal effect resulting from the waves colliding with tissues. Ultrasound of this nature is used to break down kidney stones, stimulate bone growth and prevent sclerosis.
ESWT, however, is primarily used to treat chronic, enthesopathic conditions (ligaments and tendons) by increasing blood supply to an area and breaking up calcific lesions in the tissues.
This makes sense!
Immunohistologic studies have identified specific proteins associated with hypoxic tissue. The abundance of these proteins is directly proportional to the amount of tissue degeneration. Therefore, by increasing blood and subsequent oxygen/nutrient supply to an area, ESWT could increase tissue regeneration.
ESWT has only been around since 2000, and clinical data is lacking compared to other treatment methods. However, the anecdotal ‘wave’ of empirical data showing the benefits of ESWT for chronic, recalcitrate, enthosopathic conditions is growing (+ 1600 citations) and as machine manufacturers increase, the use of it will increase and thus, the scientific evidence will increase.
An interesting study that I found by Cacchio et al., (2009) compared surgical therapy to shockwave treatment for pseudarthrosis of long bones proved that:
ESWT and surgery show practically the same success rates
Recovery was significantly accelerated in the patients receiving ESWT
Complications were significantly reduced in the patients receiving ESWT
A similar study compared ESWT to screw-fixation surgery in patients suffering from a non-union of their fifth metatarsal bone (Jone´s fracture) which occurs frequently in physically active patients and high profile athletes and found that both are effective, yet screw fixation is more often associated with complications (Furia et al., 2010).
Rompe et al., (2009) compared clinical results in two groups of patients with greater trochanteric pain syndrome who underwent either shockwave therapy, home-training or local corticosteroid injections. They found that both shockwave and home training were more beneficial than corticosteroid use in treating hip pain and dysfunction.
As mentioned earlier, I have had fantastic patient results so far and will continue to incorporate shockwave into my chiropractic treatment protocols when I feel that a chronic, enthesopathic condition is not responding to my usual management strategies.
Thank you for reading. If you have a chronic muscle/tendon strain, ligament sprain or even a bone fracture and feel like you’d like to try something extra to speed up the healing process, feel free to contact us or visit The Chiropractic Health Centre for a check up.
Chat to one of our friendly receptionists to make a booking or follow the link to learn more about our services: www.chiropractor.co.za/our-services
Phone: 021 683 2996 (Claremont) or 021 439 8898 (Sea Point)
- Cacchio, A., Giordano, L., Colafarina, O., Rompe, J., Tavernese, E., Ioppolo, F., Flamini, S., Spacca, G. and Santilli, V. 2009. Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions. J Bone Joint Surg Am. 91:2589–97.
- Furia, J., Juliano, P., Wade, A., Schaden, W. and Mittermayr, R. 2010. Shock Wave Therapy Compared with Intramedullary Screw Fixation for Nonunion of Proximal Fifth Metatarsal Metaphyseal-Diaphyseal Fractures. J Bone Joint Surg Am. 92:846-854.
- Rompe, J.D., Segal, N.A., Cacchio, A., Furia, J.P., Morral, A., Maffulli, N. 2009. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med. 37(10):1981-90.
- Tiziano Marovino. 2016. High Potency Ultrasound for the Treatment of Connective Tissue Disorders.