The Origins of Shockwave Therapy
Shockwave, an up-and-coming treatment modality that has been around for decades, was first employed for a very specific treatment: lithotripsy. The machine, developed over 7 years, allowed a patient to avoid surgical removal of kidney stones by focusing acoustic waves on the stones, to break them into smaller pieces so they could be passed naturally.1 The original machine required anaesthetic and was first used on February 7, 1980.1,2
During initial use of the first lithotripters, researchers were concerned about the unknown effect of shockwaves on bones, specifically the hips.2 If shockwaves could break up kidney stones, what might they do to bone? This question led to detailed studies that determined that not only were bones not damaged, the shockwaves actually stimulated osteogenesis, or bone formation.2 This discovery was quickly applied to bone fractures classified as non-union, that is, fractured bones that don’t heal and remain broken.2 The first successful treatment of non-union was performed in 1988.2
Focused Extracorporeal Shockwave Therapy (fESWT)
Focused shockwaves can be made by either reflecting waves so they converge on a single point, or by creating multiple waves that travel to a single point.3 The purpose of focused shockwaves is to create a wave of large amplitude, thus having a large effect deep within the body at a very specific site.3 This is why lithotripsy only breaks up kidney stones and not the cells that the shockwaves pass through.
Radial Extracorporeal Shockwave Therapy (rESWT)
Radial shockwave therapy has a single source of acoustic waves. These are typically generated by a projectile traveling down a tube and hitting a metal plate, the applicator or emitter, pressed against a patient’s skin.3 This impact causes a wave that propagates through tissue away from the applicator in every direction possible, much like the ripples in water that move away from a stone thrown into a lake.3 Unlike focused shockwave, the deeper into the body the radial shockwave travels, the less energy it has.
Shockwave Therapy Used in Physiotherapy
Currently, radial shockwave therapy is used by physiotherapists in the treatment of several conditions alongside a comprehensive treatment plan consisting of strengthening, neuromuscular control, stretching, individually tailored for return to sport or activity.
Radial shockwaves assist in the treatment of tendinopathy such as tennis elbow or jumpers knee by stimulating new blood vessel formation for improved nutrition to tissue and new collagen production used as the building blocks for new tissue.6 Radial shockwave is the preferred modality to treat calcific tendonitis, typically of the rotator cuff, by breaking up calculus (calcium deposits) to improve pain free shoulder movement and to speed up the reabsorption of those deposits.6 Finally, for people with long-standing muscle tension, or those who simply aren’t comfortable with a needling technique like IMS, radial shockwave can be used to release tight muscles all over the body.6
Shockwave is not a stand-alone treatment. Proper physiotherapy care involves identifying the reasons a patient has tennis elbow, calcification or other conditions and treating their cause to reduce the chance of reinjury or recurrence. Typical shockwave treatment consists of 3 to 5 shockwave sessions approximately one week apart, followed by physiotherapy sessions to treat the cause of injury by retraining body mechanics, building strength and balance, stretching and ensuring safe return to sport or activity.
If you have golfer’s elbow, tennis elbow, achilles tendinopathy, jumper’s knee, plantar fasciitis, heel spurs, or even calcific tendonitis, book an assessment to learn if radial shockwave therapy is appropriate for you!
Stephen Baker graduated from Western University with a Masters of Physical Therapy. He has a passion for helping those with neck, hand or knee injuries return to their daily adventures. Book with Stephen today.
Chaussy C.G. (2018) The History of Shockwave Lithotripsy. In: Patel S., Moran M., Nakada S. (eds) The History of Technologic Advancements in Urology. Springer, Cham. doi:10.1007/978-3-319-61691-9_11
The International Society for Medical Shockwave Treatment. Shockwave History. https://www.shockwavetherapy.org/about-eswt/shockwave-history/. Accessed April 14, 2019.
The International Society for Medical Shockwave Treatment. Shockwave History. https://www.shockwavetherapy.org/about-eswt/physical-principles-of-eswt/. Accessed April 14, 2019.
Kertzman P, Császár NBM, Furia JP, Schmitz C. Radial extracorporeal shock wave therapy is efficient and safe in the treatment of fracture nonunions of superficial bones: a retrospective case series. J Orthop Surg Res. 2017;12(1):164. Published 2017 Nov 6. doi:10.1186/s13018-017-0667-z
The International Society for Medical Shockwave Treatment. Shockwave History. https://www.shockwavetherapy.org/about-eswt/indications/. Accessed April 14, 2019.
BTL. Medical Effects. https://www.shockwavetherapy.eu/subpage#medical-effects. Accessed April 14, 2019.