What Is Shockwave Therapy?

Therapeutic shockwaves were introduced as a medical treatment for eliminating kidney stones without causing skin injury over 20 years ago. In recent years the technique has become popular in the treatment of a number of recalcitrant musculoskeletal conditions.

There are several theories about how this treatment works but the most accepted theory is that the micro-trauma caused by the repeated shock waves increases the blood flow to the area and this promotes healing. The treatment is simple, quick and non-invasive.

Does it work?

Fortunately there’s been a significant amount of research on shockwave therapy (SWT), and while the results are quite mixed for other regions of the body several recent studies have generally shown significant benefits for musculoskeletal conditions in the lower-limb. The over-arching opinion is that SWT alone is unlikely to provide a positive outcome, but provides improved outcomes when used in combination with other physical therapies and proper load management.

Plantar Heel Pain (Plantar Fasciitis)

SWT has been used for the treatment of recalcitrant heel pain syndrome as an alternative to surgery for decades. It is widely used because it enables fast recovery without the necessity of reduced weight bearing or immobilization.

Good quality research is supportive of the SWT, particularly in recalcitrant plantar fasciitis (1,2,3). The authors of a systematic review of seven randomised control trials found “the results of the present review showed strong statistical evidence for the efficacy of SWT in the treatment of chronic, recalcitrant plantar fasciitis over a midterm follow-up period.” (2) The authors of this and another two studies agree that in the short term, pain relief and functional outcomes are satisfactory when using SWT for chronic plantar fasciitis and superior than placebo (1,2,3).

In summary, from research perspective we can give thumbs-up to the use of SWT in patients struggling to recover from plantar fasciitis that does not want to go away.

Achilles Tendinopathy

A high quality paper published in 2015 (4) has investigated the available evidence behind SWT in different lower limb conditions. After a thorough review the authors concluded that there is moderate evidence supporting the use of SWT in Achilles Insertional tendinopathy when compared to eccentric loading training in the short term. It is important to highlight Achilles Tendinopathy is a multifactorial condition and is clinically subdivided into insertional or mid-portion type. When looking into the mid-portion group, SWT is as effective as eccentric loading programs; however, combining eccentric loading with SWT seems to yield superior outcomes according to research.

Others have a different opinion (1). In this Systematic Review, the author found the evidence in favour of the SWT to be limited when addressing Achilles Tendinopathies. Despite acknowledging there is some research in support of the therapy, it is their opinion more high quality research must be done before deciding on the value of adding SWT in the management of Achilles Tendinopathy.

Conclusion

Considering the conflicting evidence in the literature, patients are encouraged to seek professional advice in trying to decide the best course of action when contemplating SWT for lower limb conditions. It certainly isn’t suitable for everyone, but can be a useful ‘circuit-breaker’ for Achilles and plantar heel pain not responding to other therapies.

For more information on shockwave therapy head to https://subiacofootclinic.com.au/conditions/shockwave/

References

(1) Speed C. A systematic review of shockwave therapies in soft tissue conditions: focusing on the evidence. British Journal of Sports Medicine Br J Sports Med. 2013May;48(21):1538–42.

(2) Yin M-C, Ye J, Yao M, Cui X-J, Xia Y, Shen Q-X, et al. Is Extracorporeal Shock Wave Therapy Clinical Efficacy for Relief of Chronic, Recalcitrant Plantar Fasciitis? A Systematic Review and Meta-Analysis of Randomized Placebo or Active-Treatment Controlled Trials. Archives of Physical Medicine and Rehabilitation. 2014;95(8):1585–93.

(3) Dizon JNC, Gonzalez-Suarez C, Zamora MTG, Gambito ED. Effectiveness of Extracorporeal Shock Wave Therapy in Chronic Plantar Fasciitis. American Journal of Physical Medicine & Rehabilitation. 2013;92(7):606–20

(4) Mani-Babu S, Morrissey D, Waugh C, Screen H, Barton C. The Effectiveness of Extracorporeal Shock Wave Therapy in Lower Limb Tendinopathy: A Systematic Review. The American Journal of Sports Medicine. 2014Sep;43(3):752–61.