Extracorporeal Shockwave Therapy
What is it?
Extracorporeal Shockwave Therapy (ESWT) is a non-invasive treatment in which a device is used to pass acoustic shockwaves at a set frequency through the skin to the affected area. It is purely a mechanical wave- not an electric one. Shockwave is an accepted intervention in the UK and treatment may provide pain relief for chronic tendinopathies.
How does it work?
The treatment initiates a pro inflammatory response in the affected tissue that is being treated. The body responds by increasing the blood circulation and metabolism in the affected area which accelerates the body's own healing processes. The shockwaves can break down injured tissues and calcifications. As a result of cellular tissue micro-trauma, it can provide a temporary analgesic effect on afferent nerves providing immediate pain relief, known as ‘hyper-stimulation anaesthesia'.
How is the shockwave delivered?
The painful area is located by palpation. The treatment is delivered via a compressed air impulse through a hand held piece attached to the shockwave machine. The shockwave radiates out through the head into the affected area. Contact gel will be applied to the skin to improve the transmission of the shockwave.
Why chose ESWT?
Shockwave therapy stimulates and supports the body's self-healing mechanisms. ESWT is a non-invasive treatment modality- there are no medications such as cortisone or surgery involved. There are no major safety concerns associated with ESWT. It is common to have some immediate pain relief and studies have shown positive outcomes in approx. 70% of cases. It is included in the NICE guidelines for the management of refractory (chronic) tendinopathies involving conditions such as plantar fasciitis, Achilles tendinopathy and tennis elbow but can be used for most common tendinopathies.
Frequently Asked Questions:
How long does the treatment session last?
The ESWT application lasts 3-4 minutes to deliver the set 2500 impulses of shockwave energy and you must attend for 5 sessions over 5 consecutive weeks.
Is the shockwave treatment painful?
The treatment itself can be painful during the application of the ESWT. The treatment is delivered according to patient response, if a patient is unable to tolerate the pain levels the settings will adjusted to reduce the discomfort. A mild ache may occur later that day but should pass after a day. A patient may therefore take analgesic pain relief afterwards if required or before attending their next session.
What are the criteria for referral for ESWT?
All patients must have had some imaging to confirm diagnosis prior to ESWT. Patients must have an on-going tendinopathy for more than 6 months and have failed at least one course of conservative treatment such as physiotherapy, injection therapy or orthotics.
Are there any Contraindications or Precautions to be aware off?
ESWT is not allowed if you are pregnant.
ESWT application is also not indicated if the following criteria apply:
• Lung tissue in direction of sound fields
• Presence of a Cardiac pacemaker
• Has had a Cortico-Steroid injection in the area in past 3 months
• Over or near bone growth centers until bone growth is complete
• Malignancy is known to be present in or near the treatment area
• Treatment site has open wounds, skin rashes, swollen, inflamed, or infected areas
• Over ischemic tissues in individuals with vascular disease
• Coagulation disorder or taking anticoagulant/antiplatelet medications
• Infection at the treatment site to avoid the risk of spreading
• History of latex allergy or allergy to coupling solution
What to do following the treatment?
There are no restrictions after the treatment session- you may continue with your normal activities. You may use simple painkillers if still in pain. Do not use anti-inflammatory medication such as Ibuprofen/Voltarol or use ICE on the treated area as both will affect the body's inflammatory and healing process stimulated by the shockwave treatment.
Pain relief may be felt immediately but long term effects are normally seen after 3 months. All patients should be reviewed after 6-12 weeks by their referring clinician after having completed the course of shockwave treatment.
