Focused shockwave (FSW) therapy was pioneered in Europe and has been around since the early 1990s. It was initially used to break up kidney stones (lithotripsy). Since then it has been refined to treat acute and chronic musculoskeletal disorders. 60% of the time it is used to treat tendon, ligament and fascia-related problems like rotator cuff injuries, calcifications and bursitis, golfers and tennis elbow, patellar and Achilles tendinopathy and plantar fasciitis. It is also useful for fracture healing, bone bruises, sprained ligaments, and trigger points.
Shockwave adds the following therapeutic benefits to our treatment protocols:
FSW works on several levels. The sound waves pass through the cells, making their membranes more permeable, causing them to excrete vesicles of exosomes (sacs of fluid containing some of the cell’s proteins and DNA), initiating an immune response without damaging the cells. In the short term, inflammation is flushed from the area, levels of substance P are reduced desensitising the area to pain and muscle relaxation is achieved.
In the long term, the immune response attracts macrophages and phagocytes (white blood cells) to clean up dead and damaged cells. Mesenchymal stem cells, which can self-renew and differentiate into whatever cells are required, are attracted to the treated area where they transform into the required cells to replace the damaged tissues. The underlying process involves growing new blood and lymph vessels to nurture the regenerative process. If damaged bones are treated, you get bone repair. If damaged connective tissue is treated the stem cells turn into fibroblasts and tenocytes, which produce collagen for tendon, ligament and fascia repair. If calcific deposits are treated lymphatic vessels grow into the area causing the elimination of the calcifications. This is regenerative medicine without the need for platelet or stem cell injections.
What to expect during your appointment
A history will be taken and you will be examined to determine the problem area and diagnosis. If you are a candidate for FSW the process will be explained in more detail and, with your consent, it will be applied to the damaged tissue. In the initial part of the treatment we map the area, looking for your feedback, to identify where you feel the shockwave. FSW therapy is unique. You only feel the sensation produced by the acoustic shockwave on damaged or unhealthy tissue. When we move the applicator over healthy tissue you don’t feel anything. This makes it easy to find and treat the problematic tissue, you only feel it where you need it. We quickly identify the damaged tissues and focus on treating them rather than randomly treating the area.
The average treatment utilizes 2000 shocks over 10 minutes. Avoiding strenuous activity for the 48 hours after treatment is recommended. Also avoid applying ICE and taking Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) like aspirin (such as Disprin), ibuprofen (such as Nurofen), naproxen (such as Naprosyn), diclofenac (such as Voltaren) and celecoxib (such as Celebrex) so that you don’t decrease the pro-inflammatory response.
After the treatment immediate benefits are typically noticed, like experiencing less pain and being able to move the damaged area better. 85-95% of patients experience very good outcomes after 3-4 weekly treatments. If your problem started 30-40 years ago, however, you may require 6-10 treatments. The benefits of each treatment are cumulative. The area tends to feel better and better after each treatment. The symptoms and function of the area continue to improve with time. The maximum benefits of FSW are noticed 3-4 months after the treatment when new blood vessels have grown into the area and the tissues have regenerated. Booster treatments can be applied if required. For most conditions, FSW is not a stand-alone therapy. The best results are achieved when it is incorporated into a care plan including manual care (adjustments/manipulations), dry needling, and exercises. The better you feel the easier it is to do rehab exercises, enjoy life and stay healthy.
Contradictions
There are a few contradictions to shockwave therapy: we wait for 6 weeks before treating joints that have had corticosteroid injections. We ask you to stop taking NSAIDs, like Voltaren, for 2 weeks before and after treatments as they interfere with the pro-inflammatory response required to regenerate the damaged tissue. We don’t treat people who bruise easily due to taking blood thinners/anticoagulant drugs. We can treat patients with metal implants as long as the shockwave is not pointed directly at the metal. We can treat the lower back and legs if you have a pacemaker. We don’t treat over the bone growth plates in children. We wait until they are 16. We don’t treat over the lungs, known cancer sites, skin infections or near the foetus in a pregnant woman.
Why we use only Focused Shockwave, a true sound wave
There are two types of shockwave used in Australia, focused shockwave and radial pressure wave (RPW). RPW was called shockwave until 2 years ago when there was a name change because it is not a true shockwave. RPW is more like a high-velocity supercharged massage gun. It has therapeutic benefits but is not the best for many of the conditions we treat because it has a shallow penetration (2cm), it causes superficial bruising (damages tissue) and hurts more. RPW devices are more common in Australia because of their low cost, ¼ to ½ the price of a FSW device.
FSW, an acoustic wave, is a true supersonic shockwave. It penetrates through the skin to a depth of (6.5cm). This is essential for treating deeper structures of the spine, buttocks, shoulders, hamstrings and calves without bruising or causing tissue damage. It is less painful, better tolerated by patients. FSW is the treatment of choice for bone healing and eliminating calcifications, like calcific tendinopathy in the rotator cuff muscles. In Europe, Latin America and Asia FSW devices are more common. Our device is one of the few FSW devices in Queensland.
Calcific Tendinopathy
This condition is a common cause of moderate to severe chronic tendon pain. The area circled in blue on the left side of the image below is an example of a calcific deposit in the rotator cuff muscles. On the right is an image of the same shoulder after it was treated with FSW. Boom, no calcification, no risk of infection, no downtime.
FSW is the easiest, safest, most efficient and cost-effective procedure used to eliminate tendon calcifications. The before and after photos show what FSW can do after three treatments. The calcification was reabsorbed and the damaged tissue was repaired, allowing the individual to get on with their life. On average, the calcium is reabsorbed 1-3 months after receiving 3 weekly treatments of 4000 shocks at 6Hz. Each treatment takes 10-15 minutes. Mild to moderate pain, 5/10, is experienced during the treatment and most patients experience decreased pain and an improvement in their shoulder’s range of motion immediately after the treatment. In a study of 23 patients, at follow-up, 82.6% of cases showed complete resorption of the calcium deposit and 8.7% showed partial resorption. The remaining 8.7% showed no significant change in radiographic imaging.
Knee pain and Osteoarthritis (OA)
The risks of developing knee pain and OA include: traumatic injuries, heavy manual work, and overuse with poor movement patterns, older age, genetics and excess weight. Knee injuries constitute 35% of overuse injuries and are a common cause of disability. According to the study by Liao C. et al. (2018), FSW significantly reduces knee pain, improves functional recovery, and increases the overall treatment success rate. In a clinical case, the morning knee pain of a of 28 years old professional runner dropped from 8/10 to 0/10 after 5 sessions of FSW in 8 weeks together with a personalized strengthening program. Ultrasound images, after the treatment as compared to the pre-treatment images showed increased collagen alignment and decreased tendon thickness/swelling. Pain management with FSW allows patients to do their rehab exercises. The stronger you are the easier it is to align your knees, move better, get fitter, manage weight and reduce the risk of developing OA.
Getting OA treated with FSW may mean being able to participate in your desired activities and avoid an expensive joint replacement. Even knees with a bit of bone on bone are worth treating but they may require a booster dose every 6-8 weeks. Keep up your rehab exercises and you may experience relief for decades.
