Using Shockwave Therapy to Treat Pain

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What is Shockwave Therapy?

Shockwave is applied to the body by a hand piece that vibrates transmitting high intensity energy to the tissues in waves, and in doing so, causes direct mechanical vibration of the tissue.

How does it work?

There are a few different mechanisms as to how shockwave therapy may work.

Shockwave may work by changing biochemicals in the tendon that may be responsible for pain, but there is little evidence to support this.

A more likely theory is that shockwave may produce a conditioned pain modulation effect. When a painful input (shockwave) enters the body this may lead to a pain inhibitory response for some time after the application of shockwave. Basically what this means is that we are using pain to fight pain.

The short term pain relief effect may also result in a window of opportunity that facilitates greater activity. 

The other potential mechanism is placebo. In simple terms, a placebo is anything that seems to be a "real" medical treatment, but isn't. However, although this may be part of it, placebo is unlikely to explain all the benefits of shockwave therapy.

Is it effective?

Shockwave can have a short term effect on pain and can be a very useful adjunct to exercise. The scientific literature is varied with some studies reporting that shockwave is more effective than a placebo (a sham machine) while others do not. The important thing to note is that these studies tend to look at the longer term effect over weeks and do not take into consideration the potent short term effects on pain of shockwave.

Who would be the ideal candidate for shockwave therapy?

People who have tendinopathy pain and their treatment has plateaued or exercises and other treatments are having less effect on pain. Shockwave therapy in addition to a progressive exercise program can be very helpful in these types of scenarios.

Is shockwave therapy safe?

Yes but treatment is not permitted in the following cases:

• Coagulation disorders
• Use of anticoagulants 
• Thrombosis 
• Tumour diseases
• Pregnancy
• Children in growth 
• Cortisone therapy up to 6 weeks before first treatment 

How many sessions would I need?

Generally, between 3-5 is the standard, but this depends on pain response.

Pain during activities that you find irritating such as hopping (Achilles tendon) should be assessed prior and after the shockwave. If pain on these tests is not immediately and dramatically reduced by shockwave, we would be less likely to offer a follow up session.

Can I continue to run and exercise when having shockwave?

Yes, you can. Shockwave is a powerful pain modulator, so harnessing the window of  pain free period seems sensible. Many patients continue to run or play sports during shockwave treatment.

The bottom line

• There is some evidence it is useful
• It is NOT a miracle cure
• It most likely works as a pain modulator to allow greater activity
• Shockwave is an adjunct to GOOD management – and this should include exercise

Credit: http://www.completesportscare.com.au/2016/04/shockwave-therapy-tendinopathy-save-money/