Extracorporeal Shockwave Therapy (SWT) is a modality used for the treatment of a variety of musculoskeletal conditions, primarily applied to chronic conditions, particularly those affecting medium to large sized tendons and their insertions on bone such as:
SWT has been available in Canada since the mid-90s but has recently been popularized with the advent of low energy SWT. SWT is an intervention that stimulates the body’s natural healing process. Additionally, SWT has been shown to have a direct effect on local nerve endings resulting in a decrease in pain. It is important to understand the difference between low energy and high energy SWT when considering whether you are an appropriate candidate for SWT and which type of SWT is most likely to yield positive results in the treatment of your condition.
A study recently published in the Journal of Bone and Joint Surgery described how shockwave could be used to treat plantar fasciitis, Achilles tendinopathy, stress fractures, non-unions, jumper’s knee, hamstring tendinopathy, rotator cuff tendinopathy, and calcific tendinopathies. Other indications include fascial release, pain reduction, acupuncture points, trigger point therapy, tennis elbow, shin splints, Osgood-Schlatter, Morton’s neuroma, Hallux Rigidus, and chronic pelvic pain syndrome.
A study published in Clinical Orthopaedics and Related Research (2001) showed that SWT created a biologic response in the Achilles tendon tissue that increased Bone Morphogenetic Proteins (BMP), nitric oxide synthase (NOS), vascular endothelial growth factor (VEGF), and proliferating cell nuclear antigen (PCNA). This lead to improved blood flow to the effected area and resulted in tissue regeneration. Shockwave therapy has also shown to have analgesic effects by affecting substance “P.”
The contraindications for shockwave therapy include: existing cancer, those with pacemakers, and pregnancy. Patients are also asked to refrain from taking anti-inflammatory medications as it will block the pathway shockwave uses to promote tissue healing. However, patients who require blood thinners do not have to stop their medication because it improves the effectiveness of the treatment.