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Shockwave is a modality that can be used to treat chronic tendinopathy, help with the breakup of calcification and to release muscles.1 It does this by creating an acoustic wave that propagates outward from the emitter and through tissue, creating micro trauma and inducing an inflammatory response.2 The inflammatory response is one of the first steps in the stages of healing.3
For more information regarding the history and mechanism of shockwave, see the blog post Everything You Need to Know About Shockwave Therapy.
Indications
Shockwave is indicated for treatment of chronic tendinopathy, calcific tendinopathy and muscle release.1 This includes conditions such as plantar fasciitis, Achilles tendinopathy, patellar tendinopathy, lateral epicondylopathy (tennis elbow) and calficic tendinopathy (most commonly rotator cuff calcification).1
While there is no standard definition for the term ‘chronic,’ many definitions include a phrase analogous to ‘lasting longer than three months.’4,5 When considering shockwave for a chronic condition, symptoms should generally be gradual in onset, caused by a repetitive task or stress and persist beyond three months.
Contraindications
Shockwave is not appropriate if it would be performed over an epiphyseal plate (growth plate), over lung, brain or nerve tissue, if the patient is pregnant, has a history of cancer or a history of a blood/bleeding disorder, or if there is a history of steroid injections near the treatment area. 6
Treatment
Shockwave is not a one stop shop. When treating any condition, the person with the condition and the treating professional must identify what caused the condition to come about in the first place.
Modifying the cause of symptoms (e.g. repetitive load) and avoiding pain are the first steps of treatment. Conservative management consisting of exercise and manual therapy should be attempted before shockwave is considered. If conservative management is unsuccessful, then shockwave may be appropriate to facilitate healing.
Treatment of a tendinopathy with shockwave typically consists of three sessions, 7-10 days apart.6 Exercise and manual therapy should accompany shockwave therapy and continue after shockwave therapy is complete.
Chronic tendinopathy can take 3-12 months to resolve, with a longer course of treatment for longstanding tendinopathies that have been ignored. For persistent tendinopathies, a second course of shockwave treatment can be considered.
In my practice, I measure the success of shockwave by its ability to reduce the intensity of symptoms and provide relief between treatments. Book with me today to discuss whether shockwave is appropriate for you.
Stephen Baker graduated from Western University with a Masters of Physical Therapy. He has a passion for helping people recovering from orthopaedic trauma and surgery reach their full potential and return to their daily adventures.
References
1. The International Society for Medical Shockwave Treatment. Indications. https://www.shockwavetherapy.org/about-eswt/indications/. Accessed April 25, 2021.
2. BTL. https://www.shockwavetherapy.eu/subpage#top. Accessed April 25, 2021.
3. Wallace HA, Basehore BM, Zito PM. Wound Healing Phases. [Updated 2020 Sep 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470443/. Accessed April 25, 2021.
4. Bernell S, Howard SW. Use Your Words Carefully: What Is a Chronic Disease?. Front Public Health. 2016;4:159. Published 2016 Aug 2. doi:10.3389/fpubh.2016.00159
5. Kaux JF, Forthomme B, Goff CL, Crielaard JM, Croisier JL. Current opinions on tendinopathy. J Sports Sci Med. 2011;10(2):238-253. Published 2011 Jun 1.
6. The International Society for Medical Shockwave Treatment. DIGEST Guidelines for Extracorporeal Shock Wave Therapy. https://www.shockwavetherapy.org/fileadmin/user_upload/ISMST_Guidelines.pdf. Accessed April 25, 2021
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