Shock wave Therapy

In medicine, shock wave therapy (SWT) is a non-invasive treatment that uses high-energy acoustic waves to relieve pain and promote healing in various musculoskeletal and tissue conditions. The therapy is technically known as extracorporeal shock wave therapy (ESWT) because the shock waves are generated outside the body.

Mechanisms of action

While the exact physiological mechanisms of SWT are not fully understood, research indicates that it uses a process called mechanotransduction to stimulate the body’s natural healing responses.

The therapeutic effects of SWT include:

1. Analgesic effect: Reduces pain by affecting nerve endings and neurotransmitters like Substance P.
2. Tissue regeneration: Stimulates cell proliferation, angiogenesis (formation of new blood vessels), and production of growth factors like VEGF and BMP-2.
3. Dissolution of calcifications: Breaks down painful calcium deposits in tendons.
4. Anti-inflammatory effects: Helps modulate the inflammatory process at the cellular level.

Types of SWT

There are two primary types of SWT, which differ in how they generate and deliver the acoustic waves:

1. Focused Shockwave Therapy: Delivers high-energy waves that converge on a targeted area deep within the tissue. This method is often used for bone-related issues, such as stress fractures, osteonecrosis, and chronic fractures.
2. Radial Shockwave Therapy: Also called acoustic wave therapy or radial pressure wave therapy, this method delivers lower-energy pressure waves that spread out over a broader, more superficial area. RSWT is effective for a wide range of soft tissue conditions.

Common applications

Since its initial use for breaking up kidney stones (lithotripsy) in the 1980s, SWT has expanded to treat numerous musculoskeletal and other conditions:

• Tendinopathies: Includes conditions like plantar fasciitis, Achilles tendinopathy, patellar tendinopathy (“jumper’s knee”), and tennis or golfer’s elbow.
• Calcific tendinitis: Particularly in the rotator cuff of the shoulder.
• Bone injuries: Such as fracture non-unions, stress fractures, and early-stage osteonecrosis.
• Myofascial pain syndrome: For addressing painful trigger points in muscles.
• Nerve entrapment: For conditions like carpal tunnel syndrome.
• Erectile dysfunction: Low-intensity ESWT is used to promote neovascularisation.
• Chronic injuries: This therapy can be used for any musculoskeletal area that is not responding to other therapies.