Extracorporeal Shockwave therapy (ESWT)

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Published
Jan 15, 2020
Updated
Jan 15, 2020

What is it?

Extracorporeal Shockwave therapy (ESWT)

The newest and most exciting technological advancement in evidence based medical treatment!

Sound waves are delivered at high velocity with air pressure which causes minor physical tissue damage and so creates a pro-inflammatory healing response.

Formerly only seen in private medical hospitals and the NHS, here at Regeneration Physiotherapy we are excited to bring this new technology to you!

What does it do?

• Forms new blood vessels in areas with poor circulation such as tendons,
• Increases collagen and proteoglycan production,
• Improves bone healing,
• Improves the immune system with increased Leukocyte infiltration,
• Amplifies growth factor and protein synthesis during tissue remodelling.
• Gold standard NICE Guideline treatment for:
      • Tendinitis/ tendinopathy with a 60-80% success rate
      • Achilles,
      • Patella,
      • Rotator cuff,
      • Tennis elbow
      • Golfers Elbow
      • Plantar fasciitis
      • Medial Tibial Stress Syndrome
      • Significantly improves pain and function
      • Greater Trochanteric pain syndrome
      • Calcific tendinitis.
      • Osgood-Schlatters syndrome
      • Osteoarthritis

Below we have summarised some of the evidence for each condition and even attached a reference list should you wish to have a further read.

This is the very best treatment option when combined with a suitable treatment and rehabilitation plan for the below conditions.

Stop using complementary or unproven techniques / substances and start your road to recovery with evidence based treatments, backed by research and delivered by practitioners with a three year full time degree in Physiotherapy.

Shockwave can treat:

Achilles Tendionpathy:

“82% greater success rate when combined with eccentric loading program vs loading alone".
(Rompe, Furia and Maffulli, 2009).

Grater trochanteric pain syndrome (GTPS):

Both radial shockwave therapy and home training were significantly more effective than was the single corticosteroid injection. Better results were achieved earlier after shock wave therapy than with the home training protocol. Corticosteroid injections offered only short term benefits.
(Rompe et al., 2009).

Medial tibial stress syndrome:

The degree of recovery, pain reduction and return to sports was twice as high in the RPW group versus the control group.
(Rompe et al., 2010).

Osgood-Schlatters Syndrome:

”75% of patients became free of symptoms following Shockwave treatment”.
(Lohrer et al., 2012)

Patella Tendinopathy:

3 sessions of Shockwave produced significant improvement of symptoms in 65%-75% of patients at 14 weeks follow-up.
(van der Worp et al., 2013).

Plantar Fasciitis:

“Significantly improves pain, function and quality of life”.
(Gerdesmeyer et al., 2008)

Shoulder/rotator cuff tenidonpathies:

“Shockwave effectively reduces pain and increases shoulder function without device-related adverse effects. The results seen after the treatment were maintained over the following 6 months. Moreover, Radial Shockwave therapy (RSWT) was unexpectedly better in dissolving calcifications of the shoulder than focussed shock wave therapy in the literature: all patients showed partial to full resorption of calcifications”.

“The use of RSWT for the management of calcific tendinitis of the shoulder is safe and effective, leading to a significant reduction in pain and improvement of shoulder function after 4 weeks, without adverse effects”.
(Cacchio, 2006).

Tennis Elbow:

The use of radial shock wave therapy allowed a decrease of pain and functional impairment, and an increase of the pain-free grip strength test.
(Spacca, 2005).

Soft Tissue:

ESWT has also been show to reduce spasticity and has low level evidence for improving wound healing.
By Curtis Taylor and Jason Beaumont

References:
Aqil, A., Siddiqui, M., Solan, M., Redfern, D., Gulati, V. and Cobb, J. (2013). Extracorporeal Shock Wave Therapy Is Effective In Treating Chronic Plantar Fasciitis: A Meta-analysis of RCTs. Clinical Orthopaedics and Related Research®, 471(11), pp.3645-3652.

Cacchio A, Paoloni M, Barile A, Don R, de Paulis F, Calvisi V, Ranavolo A, Frascarelli M, Santilli V, Spacca G. Phys Ther. 2006 May;86(5):672-82.

Cacchio, A., Rompe, J., Furia, J., Susi, P., Santilli, V. and De Paulis, F. (2010). Shockwave Therapy for the Treatment of Chronic Proximal Hamstring Tendinopathy in Professional Athletes. The American Journal of Sports Medicine, 39(1), pp.146-153.

Chang, K., Chen, S., Chen, W., Tu, Y. and Chien, K. (2012). Comparative Effectiveness of Focused Shock Wave Therapy of Different Intensity Levels and Radial Shock Wave Therapy for Treating Plantar Fasciitis: A Systematic Review and Network Meta-Analysis. Archives of Physical Medicine and Rehabilitation, 93(7), pp.1259-1268.

Gerdesmeyer, L., Frey, C., Vester, J., Maier, M., Lowell, W., Weil, L., Russlies, M., Stienstra, J., Scurran, B., Fedder, K., Diehl, P., Lohrer, H., Henne, M. and Gollwitzer, H. (2008). Radial Extracorporeal Shock Wave Therapy is Safe and Effective in the Treatment of Chronic Recalcitrant Plantar Fasciitis. The American Journal of Sports Medicine, 36(11), pp.2100-2109.

Furia, J., Rompe, J., Cacchio, A., Del Buono, A. and Maffulli, N. (2012). A single application of low-energy radial extracorporeal shock wave therapy is effective for the management of chronic patellar tendinopathy. Knee Surgery, Sports Traumatology, Arthroscopy, 21(2), pp.346-350.

Ioppolo, F., Tattoli, M., Di Sante, L., Venditto, T., Tognolo, L., Delicata, M., Rizzo, R., Di Tanna, G. and Santilli, V. (2013). Clinical Improvement and Resorption of Calcifications in Calcific Tendinitis of the Shoulder After Shock Wave Therapy at 6 Months' Follow-Up: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation, 94(9), pp.1699-1706.

Korakakis, V., Whiteley, R., Tzavara, A. and Malliaropoulos, N. (2017). The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction. British Journal of Sports Medicine, pp.bjsports-2016-097347.

Li, X., Zhang, L., Gu, S., Sun, J., Qin, Z., Yue, J., Zhong, Y., Ding, N. and Gao, R. (2018). Comparative effectiveness of extracorporeal shock wave, ultrasound, low-level laser therapy, noninvasive interactive neurostimulation, and pulsed radiofrequency treatment for treating plantar fasciitis. Medicine, 97(43), p.e12819.

Rompe, J., Cacchio, A., Furia, J. and Maffulli, N. (2010). Low-Energy Extracorporeal Shock Wave Therapy as a Treatment for Medial Tibial Stress Syndrome. The American Journal of Sports Medicine, 38(1), pp.125-132.

Rompe, J., Furia, J. and Maffulli, N. (2009). Eccentric Loading versus Eccentric Loading plus Shock-Wave Treatment for Midportion Achilles Tendinopathy. The American Journal of Sports Medicine, 37(3), pp.463-470.

Rompe, J., Nafe, B., Furia, J. and Maffulli, N. (2007). Eccentric Loading, Shock-Wave Treatment, or a Wait- and-See Policy for Tendinopathy of the Main Body of Tendo Achillis. The American Journal of Sports Medicine, 35(3), pp.374-383.

Rompe, J., Segal, N., Cacchio, A., Furia, J., Morral, A. and Maffulli, N. (2009). Home Training, Local Corticosteroid Injection, or Radial Shock Wave Therapy for Greater Trochanter Pain Syndrome. The American Journal of Sports Medicine, 37(10), pp.1981-1990.

Saxena, A., Ramdath, S., O’Halloran, P., Gerdesmeyer, L. and Gollwitzer, H. (2011). Extracorporeal Pulsed-activated Therapy (“EPAT” Sound Wave) for Achilles Tendinopathy: A Prospective Study. The Journal of Foot and Ankle Surgery, 50(3), pp.315-319.

Spacca G, Necozione S, Cacchio A. Eura Medicophys. 2005 Mar;41(1):17-25.

Ioppolo, F., Tattoli, M., Di Sante, L., Venditto, T., Tognolo, L., Delicata, M., Rizzo, R., Di Tanna, G. and Santilli, V. (2013). Clinical Improvement and Resorption of Calcifications in Calcific Tendinitis of the Shoulder After Shock Wave Therapy at 6 Months' Follow-Up: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation, 94(9), pp.1699-1706.

van der Worp, H., Zwerver, J., Hamstra, M., van den Akker-Scheek, I. and Diercks, R. (2013). No difference in effectiveness between focused and radial shockwave therapy for treating patellar tendinopathy: a randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy, 22(9), pp.2026-2032.

C.J. Wang, H.Y. Huang, C.H. Pai Shockwave-enhanced neovascularization at the tendon-bone junction: An experiment in dogs J Foot Ankle Surg, 41 (2002), pp. 16-22

Jason Beaumont BSc Hons, PG Cert, MCSP, HCPC

As a CEO and a clinical director of Regen Physio, Jason has a passion for helping people achieve their goals, whether that is sporting success or leading a happy, healthy and pain free life style. Jason has undergone multiple knee and ankle reconstructions himself and yet is attempting the challenge of completing an IRONMAN triathlon.

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