What can shock wave therapy be used to treat?

Focused shock wave (F-SW) therapy and radial pressure wave (RPW) therapy have been shown to stimulate the body’s natural healing process, with positive effects on bone and tendon repair, as well as tissue regeneration26. But how can these effects be applied practically to treat patients?

COMMON INDICATIONS FOR SHOCK WAVE THERAPY

Tendon pathologies – hamstrings, Achilles tendon, patellar tendon, shoulder ‘rotator cuff’

Tendon pathologies – hamstrings, Achilles tendon, patellar tendon, shoulder ‘rotator cuff’

F-SW and RPW While it was a long-held belief that chronic tendons were not capable of repair, studies have shown that F-SW is effective in significantly stimulating the growth indicators associated with tendon, bone, and tendon-bone interface1,2. Positive outcomes have also been recorded with RPW treatment3.  

Frozen shoulder

F-SW and RPW Frozen shoulder is an idiopathic and progressive disease, identified by pain and decreased range of motion (ROM) of the shoulder and shoulder joint capsule fibrosis. The use of F-SW seems to have positive effects on treatment, quicker return to daily activities, and quality-of-life improvement on frozen shoulder4. RPW has also been shown to be effective5.

Calcifications F-SW and RPW Both F-SW and RPW can provide positive results in reducing calcification, with improvements recorded in shoulder pain, range of motion, and function, while combining the two has been shown to provide even better results6.  

Tennis elbow

F-SW and RPW  Tennis elbow, or lateral epicondylitis, is a common source of pain among manual workers. It has been demonstrated that F-SW was more effective than ultrasound therapy for improving pain and grip strength when treating tennis elbow, and also yielded better subjective evaluation7. Additionally, RPW therapy has been shown to yield higher improvements than steroid injections in treating lateral epicondylitis8.

Carpal Tunnel Syndrome F-SW and RPW Positive outcomes have been observed for pain symptoms, functional outcomes, and median nerve activity9.  

Chronic neck pain F-SW and RPW F-SW is more effective than ultrasound for improvement of myofascial pain syndrome, and equally effective as dry needling and laser therapy. It is also less invasive and less prone to adverse effects or allergic reactions than those conventional therapies10. Trigger point treatment with RPW used in combination with physical therapy has also been shown to relieve neck and shoulder pains11. However, it is important to mention that the anterior cervical area is contraindicated for localized shock wave therapy, and that only experienced clinicians should consider such treatments, as care must be taken to avoid neurovascular bundles.

Low back pain

F-SW and RPW Studies have shown that RPW added to conventional physiotherapy and core stability exercises has a significant effect on the reduction of chronic low back pain and the improvement of functional condition compared to a conventional physiotherapy program12. F-SW has also proven effective13.

Muscle hypertonia F-SW and RPW It has been demonstrated that both F-SW and RPW are effective in reducing muscle spasticity and improving motor recovery after stroke14, while RPW has also shown positive results in reducing pain and muscle tone in multiple sclerosis patients as part of a rehabilitation program15.  

Hip pain

F-SW and RPW While low-energy shock wave interventions cannot be used to treat hip conditions such as avascular necrosis or intracapsular pathology, RPW has been shown to be effective in treating greater trochanter hip pain16,17. F-SW appears to be effective for aiding in pain relief and functional recovery in patients with osteonecrosis of the hip18.

Knee osteoarthritis

F-SW F-SW has been proven effective for improving pain and function in knee OA, with medium energy values having significantly greater effect than low energy19,20.  

Shin pain (‘splints’) F-SW and RPW Traditional treatment of medial tibial stress syndrome (MTSS) is generally lengthy, associated with frequent recurrences, and in some cases, an unacceptable degree of improvement. In one study, a single application of F-SW treatment in combination with a specific exercise programme accelerated clinical and functional recovery from MTSS21. Adding RPW to standard home exercise therapy has been shown to offer significantly more improvement of pain, degree of recovery, and return to sports22.

Plantar fasciitis

F-SW and RPW F-SW has been shown effective in reducing heel pain associated with chronic plantar fasciitis23. RPW therapy has been demonstrated to improve pain, function, and quality of life in patients with recalcitrant plantar fasciitis24.  

Erectile dysfunction F-SW The number of studies of low-intensity focused shock wave therapy for erectile dysfunction (ED) have increased dramatically in recent years, with results indicating F-SW significantly improves ED and the efficacy can last up to 3 months and more. Furthermore, it may have the potential to be the first-choice non-invasive treatment for patients with ED25.  

Wound healing F-SW It has been well established that, through the principle of ‘mechanotransduction’ (the process by which a mechanical stimulus is converted into a set of biochemical reactions and a cellular response), F-SW can positively influence the chain of biological reactions that lead to tissue regeneration and healing26.  

Diabetic foot F-SW As with wound healing in general, F-SW as an adjunct to standard wound care has been shown to significantly reduce the size and the healing time for wounds associated with chronic diabetic foot ulcers27.  

Cellulite RPW RPW therapy is well established in the aesthetics market, having been shown to be an effective treatment for improving the appearance of cellulite, with significant improvement recorded in skin firmness and structure28.   [INSERT CALL TO ACTION HERE]  

REFERENCES

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Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis. Eur Urol. 2017 Feb;71(2):223-233. 26. d’Agostino MC, Craig K, Tibalt E, Respizzi S. Shock wave as biological therapeutic tool: From mechanical stimulation to recovery and healing, through mechanotransduction. Int J Surg. 2015 Dec;24(Pt B):147-53. 27. Omar MT, Alghadir A, Al-Wahhabi KK, Al-Askar AB. Efficacy of shock wave therapy on chronic diabetic foot ulcer: a single-blinded randomized controlled clinical trial. Diabetes Res Clin Pract. 2014 Dec;106(3):548-54. 28. Russe-Wilflingseder K, Russe E, Vester JC, Haller G, Novak P, Krotz A. Placebo controlled, prospectively randomized, double-blinded study for the investigation of the effectiveness and safety of the acoustic wave therapy (AWT(®)) for cellulite treatment. J Cosmet Laser Ther. 2013 Jun;15(3):155-62.