By: Malika Richards, Student Physiotherapist, Queen's University, Ontario, Canada
Co-Author: Matthew Craig, Principal Physiotherapist, Director bounceREHAB
bounceREHAB is proud to announce we now have the world’s most clinically proven Shockwave Therapy device! Check out our webpage!
Shockwave Therapy is a major advance in safe and effective physiotherapy treatment. The beneficial effects of Shockwave Therapy on pain and mobility are often experienced from the very first treatment session and the long-term healing benefits continue after your last treatment, helping to avoid pain medications, injections and surgery.
WHAT IS SHOCKWAVE THERAPY?
Shockwave Therapy is an innovative cost-effective therapy that can target specific pain in the bones, joints, muscles, tendons, and ligaments. It is a non-invasive and safe treatment that gives significant or total relief of pain in 90% of patients suffering from musculoskeletal disorders. Shockwave Therapy is the application of compressed airwaves to the area of concern which activates fibers responsible for the transmission of uncomfortable stimuli, called C nerve fibers. The prolonged activation of the C nerve fibers results in a decrease in the release of substance P in the tissues and spinal cord which decreases pain signaling and reduces neurogenic inflammatory processes. Shockwaves also stimulate fibroblast proliferation which allows for the formation of collagen and the extracellular matrix to form the structural framework and repair the tissue. Furthermore, shockwave therapy allows for the release of growth factors and activation of stem cells within the treated tissue to create an environment of optimal healing for the tissue.
WHAT ARE THE BENEFITS?
One of the major benefits of Shockwave Therapy is that you can heal quickly as shockwaves stimulate the body’s natural healing processes. When shockwaves are applied to injured tissues, they increase blood circulation and trigger stem cell activation, while also reducing the pain felt by nerve fibers. Another benefit is that shockwaves pass through the body without breaking the skin, unlike an injection which can cause damage to the tissue treated over time. This makes it an ideal treatment for many acute conditions, athletic injuries, and for anyone suffering from chronic pain.
Experience the same treatment that many Olympians and professional athletes including well known AFL and NRL teams use so they can heal and go back to play quickly!
WHAT CONDITIONS CAN BE TREATED?
The main benefits of Shockwave Therapy are pain relief and restoration of function. Here at bounceREHAB we offer Shockwave Therapy using the EMS DolorClast® Radial Shockwave, which has been shown to be an effective treatment modality for 90% of Musculoskeletal disorders including:
- Hamstring Tendinopathy and Tears
- Frozen Shoulder / Adhesive Capsulitis
- Trochanteric Bursitis & Gluteal Tendinopathy
- Meniscal Injuries
- Bone spurs
- Arthritis
WHAT CAN I EXPECT AT bounceREHAB?
When you’re treated with Shockwave Therapy at bounceREHAB, your practitioner will undertake a thorough assessment, then use a hand-held device connected to a machine that turns compressed air into shock waves. Gel is applied to the skin beforehand to help transmit the shock waves through the skin. They will apply some light pressure and move the device over the area that requires treatment. Shockwave delivery is short in time, and usually takes 5 minutes to treat one area and can be coupled with other therapies in your treatment session. Typical treatment involves 3-6 sessions at weekly intervals.
IS THERE CLINICAL EVIDENCE SUPPORTING THE USE OF SHOCKWAVE THERAPY?
The EMS DolorClast® Radial device used at bounceREHAB is the most clinically researched Shockwave device. Most of the clinical studies demonstrating the efficacy and safety of Shockwave Therapy have been performed on a DolorClast® device. The results speak for themselves as for over 23 years, more than 100 million patients have been treated with DolorClast® Shockwave Therapy.
A common injury seen at bounceREHAB is plantar fasciitis, which is a pain in the heel of the foot. The plantar fascia is the band on tissue that connects the heel bone to the base of the toes and it can become inflamed from repeated stretching and tearing of the fascia. It is the most common cause of chronic inferior heel pain.
Treatment of plantar fasciitis
A study by Dizon et al. (2013) evaluated the effectiveness of shockwave therapy in treating chronic plantar fasciitis. This meta-analysis examined eleven high-quality randomized controlled trials and concluded that shockwave was more effective in decreasing overall activity pain and functional outcomes. Shockwave therapy was also more effective in decreasing morning pain experienced with plantar fasciitis compared to placebo/control groups. This analysis also determined that high and moderate intensity shockwave therapy was more effective than low intensity shockwave in the management of chronic plantar fasciitis.
In a study examining the long-term benefit of shockwave therapy by Malinoski et al. (2010), it was concluded that shockwave therapy was highly effective in treating chronic plantar fasciitis, as early as three months following treatment. This study was a nine-year follow up with patients who were treated with shockwave therapy for plantar fasciitis in the early 2000s. It was found that shockwave had a significant effect on decreasing pain and increasing functioning, and there were no long-term complications.
Tendinopathies are another injury frequently seen at bounceREHAB. Tendinopathy is pain and dysfunction in a tendon from failed healing, usually caused by overuse. Tendinopathy is usually seen in the knee (patellar tendon), Achilles, rotator cuff, and the elbow (Tennis elbow/Golfers elbow).
Treatment of Achilles Tendinopathy
A study by Rompe et al. (2008), found that for Achilles tendinitis treatment, shockwave treatment combined with eccentric loading was more effective than an eccentric loading protocol alone. The patients in the shockwave group completed an eccentric loading protocol along with the EMS DolorClast® Radial device. The conclusions were that the likelihood of recovery after 4 months was higher after a combined approach of eccentric loading and shockwave.
In a study examining knee soft tissue disorders, Liao et al. (2018), found shockwave to be a successful treatment. This study examined randomized controlled trials reporting the efficacy of shockwave therapy for tendon injuries in the knee, including patellar tendinopathies and pes anserine tendinopathies. It was found that shockwave therapy had a significant effect on pain reduction, patient-reported functional outcomes, and range of motion restoration.
Another common concern that shockwave has been proven effective for is osteoarthritis. Osteoarthritis is a degenerative joint disease where the cartilage in a joint breaks down and can cause damage to the underlying bone. There is currently no cure for osteoarthritis, and it is a leading cause of disability and pain.
Treatment of knee osteoarthritis
In a randomized controlled trail by Zhang et al. (2021), it was found that shockwave therapy was effective at alleviating pain in knee osteoarthritis. This study primarily measured pain intensity on the visual analogue scale (VAS) and the secondary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. The EMS DolorClast® Radial device was used, and patients received 4 sessions of shockwave therapy one week apart with shock frequency of 8 Hz per session. Patients were assigned to 1 of 4 treatment groups and received different shock densities. It was found that VAS and WOMAC scores decreased with shockwave therapy and scores decreased more at higher shock densities. The findings of this study indicate that shockwave therapy using the EMS DolorClast® Radial device is effective at treating knee osteoarthritis and is more effective at higher shock densities.
FUN FACT
There is research supporting the use of shockwave for frozen shoulder, also known as adhesive capsulitis. Adhesive capsulitis is a progressive stiffness and pain in the shoulder joint. There are three stages involved:
1) Freezing stage: movement becomes limited and painful.
2) Frozen stage: shoulder becomes stiff, and movement is difficult.
3) Thawing stage: ability to move begins to improve and pain lessens.
Each stage of frozen shoulder can last anywhere from 4-12 months. There has been no consensus regarding the best treatment for adhesive capsulitis. However, a study by Hussein & Donatelli (2016), found that shockwave therapy using the EMS DolorClast® Radial device is a safe and effective treatment option. This study was a randomized, double-blind clinical trial that assigned patients with primary adhesive capsulitis to the experimental or control group. All patients received four applications of shockwave therapy one week apart, and the control group had a clasp blocking the transmission of the shockwave. The outcome measures used where the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), pain using the visual analogue scale (VAS), and shoulder active and passive abduction and external rotation using a goniometer. This study concluded that the experimental group had significant improvement in all outcome measures at 4-week and 24-week intervals. This study indicates the effectiveness of shockwave therapy on functional outcomes, pain, and shoulder range of motion associated with adhesive capsulitis.
Treatment of frozen shoulder
UNIQUE APPLICATION
Shockwave therapy has been shown to be effective for reducing cellulite. Cellulite occurs when there is an accumulation of fat cells between the fibrous connective cords attaching the skin to the underlying muscle. The fat cells push up against the skin, while the fibrous cords pull down which results in dimples and uneven skin. It is proposed that shockwave therapy is beneficial in improving skin elasticity and weakening fibrous components to revitalize and smooth the skin. A meta-analysis by Knobloch & Kraemer (2015), found that radial shockwave therapy is able to improve the degree of cellulite. One of the studies included used the EMS DolorClast® Radial device, and found that 2 weekly treatments for 4 weeks improved cellulite grade based on clinical examination, photographic documentation, and patient satisfaction questionnaires. This analysis looked at five randomised controlled trials and concluded that there is growing evidence that shockwave therapy is effective improving the degree of cellulite in terms of appearance and ultrasound improvement of subcutaneous fat. Here at bounceREHAB, we have the EMS DolorClast® Radial device with the "skin" setting to help target cellulite!
WANT TO KNOW MORE?
To learn more or make an appointment, call bounceREHAB on (02) 9571 7606 or book Shockwave with our Principal Physiotherapist online.
REFERENCES
Dizon, J. N. C., Gonzalez-Suarez, C., Zamora, M. T. G., & Gambito, E. D. V. (2013). Effectiveness of Extracorporeal Shock Wave Therapy in Chronic Plantar Fasciitis: A Meta-analysis. American Journal of Physical Medicine & Rehabilitation, 92(7), 606–620. https://doi.org/10.1097/PHM.0b013e31828cd42b
Frairia, R., & Berta, L. (2011). Biological effects of extracorporeal shock waves on fibroblasts. A review. Muscles, ligaments and tendons journal, 1(4), 138. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666484/
Grecco, M. V., Brech, G. C., & Greve, J. M. D. A. (2013). One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy. Clinics, 68, 1089-1095.
Hussein, A. Z., & Donatelli, R. A. (2016). The efficacy of radial extracorporeal shockwave therapy in shoulder adhesive capsulitis: a prospective, randomised, double-blind, placebo-controlled, clinical study. European Journal of Physiotherapy, 18(1), 63–76. https://doi.org/10.3109/21679169.2015.1119887
Knobloch, K., & Kraemer, R. (2015). Extracorporeal shock wave therapy (ESWT) for the treatment of cellulite–A current metaanalysis. International journal of surgery, 24, 210-217. https://doi.org/10.1016/j.ijsu.2015.07.644
Liao, C. D., Xie, G. M., Tsauo, J. Y., Chen, H. C., & Liou, T. H. (2018). Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: a meta-analysis of randomized controlled trials. BMC musculoskeletal disorders, 19, 1-26. https://doi.org/10.1186/s12891-018-2204-6
Malinoski, K. A., Weil Jr, D. L., Weil Sr, L. S., Borrelli, A. H., & Benton-Weil, W. ESWT for the Treatment of Plantar Fasciitis: A Nine-Year Follow-Up. https://ems-dolorclast.s3.ap-southeast-2.amazonaws.com/download-centre/scientific-evidence/ESWT+for+the+Treatment+of+Plantar+Fasciitis+-+A+Nine-Year+Follow-Up.pdf
Rompe, J.D., Furia, J., & Maffuli, N. (2009). Eccentric Loading Versus Eccentric Loading Plus Shock-Wave Treatment for Midportion Achilles Tendinopathy: A Randomised Controlled Trial. The American Journal of Sports Medicine, 37(3). https://www.spnorwest.com.au/images/shockwave-papers/rompe_jd_et_al_2009_-_eccentric_loading_versus_eccentric_loa.pdf
Schmitz, C., Császár, N. B., Milz, S., Schieker, M., Maffulli, N., Rompe, J. D., & Furia, J. P. (2015). Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. British medical bulletin, 116(1), 115–138. https://doi.org/10.1093/bmb/ldv047
Schmitz, C. (2021). Improving extracorporeal shock wave therapy with 904 or 905 nm pulsed, high power laser pretreatment. Preprints. https://doi.org/10.20944/preprints202101.0138.v1
Zhang, Y. F., Liu, Y., Chou, S. W., & Weng, H. (2021). Dose-related effects of radial extracorporeal shock wave therapy for knee osteoarthritis: A randomized controlled trial. Journal of rehabilitation medicine, 53(1), jrm00144. https://doi.org/10.2340/16501977-2782