Shockwave Therapy

Intra-muscular Stimulation

What is Shockwave Therapy?

Shockwave Therapy has nothing to do with electrical shocks; it is a bit of an unfortunate name for the technology!  Shockwave was introduced as a form of non –surgical treatment for kidney stones.  Two of the fortuitous side effects were accelerated bone healing and improvements in damaged or degenerative soft tissues.

Therapeutic grade radial shock waves are generated by compressed air, which then pushes on a metal projectile in the hand piece that is held by the physiotherapist against the patient’s skin. The projectile in the hand piece hits up against a shock transmitter at the end of the hand piece.  At that point the energy is converted into acoustic energy pulses, or radial “shock waves”.  These shock waves travel into the underlying tissues (skin and muscle) up to 5 cm deep. 

For optimal results, it is usually necessary to receive 3 to 5 sessions of the shockwave therapy and maintain any recommended exercises given to you by your therapist.

How Does Shockwave work? What are the Proposed Mechanisms of Action?

  1. Pain reduction: The strong impulses from the shockwave activate certain neurons in the pain pathway to our brain. This results in inhibition of the pain signal from your sore body part, such as your shoulder. The signals you are receiving from the shockwave can effectively “block” the pain that you were earlier feeling in your shoulder. You may be aware of the “Gate Control Theory of Pain”. This is it in action!
  2. Increased metabolism: The environment of the cells and nerves is altered, resulting in a “flushing out” of the pain and inflammatory substances and increasing the amount of oxygen in the area.
  3. New blood vessel formation: Over time and repeated treatments, new blood vessels form in the area (neovascularization) and the existing vessels may increase in diameter. This increases blood flow to the injured area which promotes healing.
  4. Reduced muscle tone (tightness): Pain often causes protective “bracing”, or tightening of the muscles in the area. We often see this as people not being able to relax their back muscles to allow them to bend over comfortably or lift their arms easily. The shockwaves relax the muscles by breaking the pain / spasm cycle, allowing more normal movement to return. This, in turn, helps reduce pain.
  5. Dissolving of calcification: Research has shown that it is possible for shockwave therapy to be effective in dissolving calcium deposits in tendons. This occurs is calcific tendinosis of the rotator cuff and Achilles tendon.

What Does Shockwave Feel Like?

Once the physiotherapist completes your assessment, he/she may propose trying shockwave. Some people may find it mildly painful, but most people find it fairly comfortable. The sensation is a firm, fast tapping feeling that gives a deep vibration into the area being treated. Afterwards, there may be some mild, transient, reddening of the skin. You may feel much less pain, or a mild short term increase in pain. Often times, when we re- assess someone afterwards, their flexibility and range of motion has improved due to the reduction in pain and muscle tension. A dull or diffuse ache may occur for a few hours, up to a day, afterwards.

Does shockwave work?

The research evidence is very promising for this treatment for the following conditions:

  1. Lateral elbow tendinopathy ( “tendinitis”)
  2. Plantar fasciitis and heel pain
    Achilles tendinitis or tendinopathy
  3. Calcific and non-calcific shoulder tendinopathy and rotator cuff tendinitis
  4. Knee tendinopathy
  5. Pain in and around the hip joint
  6. Shin splints, and medial tibial stress syndrome
  7. Low back pain and tightness

Some research results:

In one study of 42 people with tennis elbow, patients each received 3-5 weeks sessions of shockwave therapy. Six months later, 64% of the patients had no pain, 24% were significantly better and 5 % were slightly better.

In another study, 245 people with chronic plantar fasciitis (arch and foot pain) were placed in a Randomized Controlled Trial. Placebo treatment and shockwave therapy were compared. They had three treatment sessions and were re- assessed at 12 weeks. After 12 weeks, the shockwave group had a 61% success rate, compared to 41 % in the control group. The results were even better when they were re- assessed one year later.

See below for more research evidence for Shockwave Therapy.

Research Evidence

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