Extracorporeal shock wave therapy (ESWT) is a noninvasive treatment that involves delivery of shock waves to injured soft tissue to reduce pain and promote healing. ESWT is a relatively new technology in the field of musculoskeletal medicine, having evolved over the past few decades to its current advanced state of efficacy.
ESWT can benefit both athletes and non-athletes. Often difficult to treat, chronic tendinopathy/tendonitis is characterised by localised pain and pathological changes to a tendon. ESWT is a viable option to consider for many patients who haven’t responded to more-conservative treatments.
Why consider extracorporeal shock wave therapy?
ESWT uses a series of low-energy acoustic waves and transmits these waves to the patient’s skin via a transducer. A topical gel is used on your skin and it is completely non-invasive. This procedure does not require anaesthesia or any pain medication. The shock waves trigger the body’s innate healing mechanisms to stimulate tissue repair and reduce pain. Many patients report significant pain reduction after a single treatment session.
As ESWT triggers an inflammatory response, which is the body’s mechanism for healing, patients may experience temporary swelling and tenderness at the area of treatment. This is in fact a positive healing response and can be treated with anti-inflammatory medications. Shock wave therapy is especially effective at treating tendonitis/tendinopathies that are slow to heal and for treating tendinosis, the degenerative condition of injured tendons.
Types of extracorporeal shock wave therapy
There are three types of shock waves: radial, focused and defocused. Each has its own advantages and disadvantages.
1. Radial Shockwave
Uses a series of pressure waves to stimulate the healing of damaged tissues providing moderate regenerative effect on superficial tissues. Good for repairing superficial muscle tissue and goes well with focused and defocused shock wave therapy.
2. Focus Shockwave
Estimated to be 70% more effective than radial shockwaves and 50% more effective than defocused shockwaves, these are the most regenerative of the three types of shockwaves. The depth of penetration can vary as required and the focused waves are able to reach tissues deep below the surface of the skin. Focus shockwaves allow up to a single millimetre on targeted tissue for greater precision.
3. Defocused shockwave
Also known as softwaves or planar shockwaves, they are more dispersed than focused shockwaves and do not penetrate as deeply. Defocused shockwave therapy complements focused shockwaves and are useful in conditions that cover a large area, such as for deep gluteal pain syndrome.
Conditions that can benefit from extracorporeal shock wave therapy
1. Tendon disorders
Extracorporeal shock wave therapy is particularly effective in treating disorders of tendon, including patellar tendonitis, achilles tendinopathy, elbow tendinopathy, shoulder tendinopathy, and plantar fasciitis. In addition to its regenerative effects, ESWT stimulates the production of lubricin, a mucinous glycoprotein that aids tendon gliding.
Joint pain and stiffness is a resultant of the breakdown of joint cartilage and its underlying bone over time. Shock wave therapy is effective for pain relief in the early stages of osteoarthritis.
3. Sciatica and Back Pain
A combination of radial and focused shock wave therapy produces excellent results in treating sciatic nerve pain. It also has a positive effect on the facet joints of the spine, and is effective in relieving myofascial trigger points that often contributes to back pain.
Conditions like pelvic pain, tibial stress syndrome, ligament injuries and stress fractures can also benefit from shock wave therapy.
Extracorporeal Shock Wave Therapy Specialist Treatment
Consult with a sports injury doctor or orthopaedic specialist to understand further about extracorporeal shock wave therapy and your suitability for it. Dr Gowreeson Thevendran is an experienced orthopaedic surgeon in Singapore with a specialist interest and surgical expertise in lower limb conditions. He is skilled in surgical techniques to treat foot and ankle conditions, as well as knee, hip and thigh conditions. Dr Gowreeson has a keen interest in surgical and medical advancements including extracorporeal shock wave therapy.