Shockwave therapy for the treatment of tendon injuries originates from a treatment called Lithotripsy. Lithotripsy uses sound waves to break up stones in the kidneys and gall bladder. As many kidney stones have calcium in them, it was thought that lithotripsy could be used to break up the calcium we see in a dysfunctional tendon. Shockwave has been found to be effective for treating tendon problems, but ironically it is most effective in mild to moderate tendon injuries (proliferative phase) rather than severe calcific tendinopathies
The name “Shockwave” doesn’t really promote a sense of calm, however it is a non-invasive, relatively pain free procedure that can be easily titrated by the patient to deliver the maximal dose, while minimising any pain. Lakeside Sports Medicine uses a Dolocast radial shockwave. This style of shockwave has the most published scientific evidence about its utility and effect. You can find a list of references below with links to their abstracts if you are interested in reading the technical detail.
RSWT® for the treatment of Achilles tendinopathy
Rompe et al., Am J Sports Med 2009;37:463-470
Rompe et al., J Bone Joint Surg Am 2008;90:52-61
Rompe et al., Am J Sports Med 2007;35:374-383
RSWT® for the treatment of plantar fasciitis
Ibrahim Ibrahim et al., submitted for publication
Gerdesmeyer et al., Am J Sports Med 2008;36:2100-2109
RSWT® for the treatment of tendinosis calcarea of the shoulder
Engebretsen et al., Brit Med J: in press
RSWT® for the treatment of medial tibial stress syndrome
Rompe et al., Am J Sports Med: in press
RSWT® for the treatment of greater trochanteric pain syndrome
Rompe et al., Am J Sports Med 2009 May 14 [Epub ahead of print]
Furia et al., Am J Sports Med 2009 May 13 [Epub ahead of print]
The exact way shockwave works is still a matter of debate. It is believed that it stimulates tendon cells to lay down more collagen. This essentially amounts to “healing”. In addition, it is believed that is alters nerve function in the area to decrease the release of factors from local nerves that may be driving any ongoing neuro inflammatory processes.
For those patients that are going to respond to shockwave the response is almost immediate, but initially short lived. After the 1st treatment most patients have a decrease in their pain that lasts 2-3 days. By the time they return for the second treatment their symptoms are generally back to the pre-treatment level. The second treatment provides a longer benefit of up to 7 days, and the 3rd treatment generally has a longer lasting effect. Some of the scientific studies published have shown that people get additional benefit up to 9 weeks after treatment.
Shockwave is not a cure. It helps settle pain and promote healing, but it has its best effect when it is done in conjunction with a rehabilitation program. For treating tendon problems, at Lakeside we suggest combining an appropriate strength program, addressing the underlying risk factors to tendon overload, prescribing nitrate patches, and a modified exercise load.
