Shockwave Therapy
What is shockwave therapy?
Originally developed to treat kidney stones and gallstones, extracorporeal shock wave therapy (ESWT) has been used for more than two decades to treat an increasing number of musculoskeletal conditions, such as tennis elbow, rotator cuff tendinitis, patellar tendinopathy, Achilles tendinopathy, plantar fasciitis, and bony non-unions.
ESWT is a non-invasive procedure in which a series of high- or low-energy shockwaves are directed at the site of injury, and is commonly used in patients who have not responded to more conservative treatment modalities. ESWT induces tissue regeneration and neovascularization, induces pain relief via hyperstimulation analgesia, and in the case of tendinopathies, disintegrates calcified deposits.
The term extracorporeal shockwave therapy has sometimes been used to describe treatment delivered by two different types of devices. One emits focused shock waves, the other emits radial pressure waves.
Focused shockwaves are high energy acoustic waves that converge to achieve maximal energy at the target site – the energy of focused shockwaves is not diminished upon skin penetration. Focused shockwaves are generated in water via electrohydraulic, electromagnetic, or piezoelectric techniques.
In contrast, radial shockwaves (or radial pressure waves) diverge as soon as they are discharged – the energy of radial pressure waves diminish upon skin penetration and result in low energy diffuse waves at the target site. Radial pressure waves are generated by pneumatic techniques.
ESWT has been in use for many years and appears to be able to direct high energy shockwaves at deeper tissue sites. The therapeutic impact of focused ESWT remains unclear, as the relationship between shockwave characteristics and mechanism of action has not been elucidated.