Extracorporeal Shockwave Therapy for Musculoskeletal Conditions
Extracorporeal Shockwave Therapy (ESWT) has been successfully used for the management of a variety of musculoskeletal conditions for over 20 years. It is now available at North Light Physiotherapy!
In Urology, shockwaves are used to disintegrate kidney stones, whereas in Musculoskeletal medicine, its use is to induce tissue repair and regeneration on a cellular level. The mechanism by which this takes place is not fully understood, despite many studies showing positive outcomes in a variety of conditions.
Principle of Treatment
Shockwave patterns differ from Ultrasound waves, in that ESWT generates significantly higher pressure. Primarily, this generates a mechanical force focussed on the target tissue. This generates a response within the target cells, and in areas around the target tissue. Many patients we treat with ESWT present with tendon pain- commonly in the Achilles, knee-cap (Patellar) tendon, the Plantar Fascia, and at the elbow (so called “tennis elbow”, or lateral epicondylitis), or shoulder.
Problems with tendons seem to occur more frequently with a big and relatively sudden increase in physical workload. Examples include suddenly running much further than usual, suddenly lifting more heavily in the gym or other physical activity, such as CrossFit.
When people are new to physical exercise, problems can occur during the time it takes for the body to develop the robustness to tolerate more physical work. For this reason, ESWT will only ever form part of the overall treatment, because sensible management of physical workload, in view of individual physical capacity, is the key to success.
If you believe ESWT may be appropriate to help manage your problem, we will always consider this as a management option as part of a comprehensive assessment. ESWT as a standalone treatment, is likely to be less effective than when combined with comprehensive Physiotherapy care.
Plantar Fasciopathy (Fasciitis)
Many studies have shown ESWT to be effective in the treatment of Plantar Fasciopathy. Success rates vary between 34% to 88%. This may depend on severity of the problem, and how long the condition has been present before treatment. Good quality evidence suggests that treatment must incorporate a suitable loading programme (Physiotherapy-type exercise). This ensures the Plantar Fascia retains/improves its ability to tolerate the force required for exercise.
Achilles Tendinopathy (Tendonitis)
A common problem with runners, the Achilles tendon may generate symptoms in the mid-portion (half way up), or at its insertion into the heel bone (calcaneus). The insertional Achilles pains tend to be more stubborn to settle. However, studies have shown that both insertional and mid-portion Achilles problems are responsive to ESWT. In many cases, runners will present to our specialist running clinic, during which we may discuss and suggest modifications to running gait, and recommend modifications to running workload (distance, intensity).
Patellar Tendinopathy (Tendonitis)
Another frequent problem with running athletes, powerlifters and CrossFit-ers. Success rates have been reported to be as high as 74-88% with ESWT. Commonly, knee and hip control issues can play a part in the onset of problems, and will need addressing as part of a comprehensive treatment regime. Our specialist Running Clinic often identifies related areas to improve on, to modify and improve on pain and control of the knee.
Shin Splints (Medial Tibial Stress Syndrome- MTSS)
Often seen in running athletes, and more frequently in females- sufferers will experience pain at the inner side of the shin. Particularly evident on landing, during running. Modifications can often be made to the ankle and foot, in respect of strength and control of the rear part of the foot during landing. Sometimes orthoses (in-soles in the trainers) can make a difference. ESWT has been shown in some studies to make a positive contribution to symptoms of MTSS, and others not so much. Again, ESWT will be considered as part of a course of Physiotherapy, which will address any contributing factors.
(Calcifying) Tendonitis of the Shoulder
Success rates for treatment with ESWT have been reported in the 78-91% range, in studies, with ongoing relief beyond 2 years. The benefits include improved joint movement, and therefore improved ability to use the arm, particularly in overhead activities. Swimmers and other overhead athletes, such as racket-sport players, and bowlers (cricket) can tend to be affected. The effectiveness of ESWT is again supplemented by a good course of Physiotherapy rehab, and workload modification principles.
If you are affected by a problem for which ESWT may be useful, please do get in touch – North Light Physiotherapy will be pleased to support you. You can get in touch via our Contact page, or on 01484 660663. See you soon!
Chris Liversidge (MSc, BSc (Hons) MCSP, SRP) is Practice Principal at North Light Physiotherapy Associates, Huddersfield HD4 7NR. Visit www.northlightphysio.co.uk or call 01484 660663
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Now don’t get me wrong- there were dark times-I did doubt myself- pain messes with your head in that way-, and I did come in for some criticism too (“you’re a Physio, you shouldn’t have problems like this-what hope is there for the rest of us?”). This was hard to take, but I had to reassure myself I could sort the problem. The thing is, I’m made of the same stuff as everyone else, so there’s no reason I shouldn’t develop back pain. The measure of me was, whether I was good enough to solve the problem? The answer was a resounding yes!