Burlington Sports Therapy recently added Shockwave Therapy to our treatment offerings. Although it has been around for about 20 years, it is a relatively newer approach to treating various musculoskeletal injuries. It has primarily shown benefit in the treatment of certain tendon disorders including but not limited to rotator cuff tendinopathy, calcific tendinopathy, elbow tendinopathy (such as tennis elbow) plantar fasciopathy (commonly called plantar fasciitis) and Achilles tendinopathy.
Results of a Large Systemic Review
A large 2015 systematic review investigating the efficacy and safety of extracorporeal shockwave therapy for orthopaedic conditions is perhaps one of the most recent and thorough reviews of the shockwave literature. The review arrived at ten pertinent findings or recommendations based on a thorough analysis of the published literature. They are as follows…
- Shockwave Therapy is effective. 88.5% (23 out of 26) of all randomized controlled trials reviewed in this study showed statistically significant better outcomes than placebo or alternative treatment approaches.
- Shockwave Therapy is safe. No adverse effects were reported in the reviewed literature.
- For certain conditions, Shockwave Therapy shows better evidence than other treatment modalities. In particular, this applies to plantar fasciopathy, non-calcific supraspinatus tendinopathy and calcifying tendonitis of the shoulder, Achilles tendinopathy and lateral epicondylitis (tennis elbow).
- All of the reviewed studies were good quality studies, whether the results of the research showed positive or negative results.
- The findings of this review suggest that the use of local anesthesia during Shockwave Therapy treatment has a negative effect on the outcome.
- If the settings are too low, the outcome won’t be as good. So yes, in this case, more is better.
- There are two types of shockwave therapy devices, radial and focused. At Burlington Sports Therapy, we use the Swiss Dolorclast Radial Shockwave device. Focused shockwave devices are rarer to find in general practice. It is usually performed by a medical professional and is done under guided imaging. This is because all of the shockwave force is directed to a single point as illustrated in the below diagram. The results of this systematic review conclude that neither approach is better than the other; both radial and focused shockwave devices are great treatment options for various musculoskeletal conditions.
- In the past, some people were under the impression that radial shockwave devices were ‘lower energy’ and focused shockwave produces ‘higher energy.’ This is not true.
- It seems there may have been disagreements in the field as to which focused shockwave device is better since there are different ways that focused shockwave devices can apply force. It turns out all of the different types of focused shockwave devices are the same in terms of treatment outcome. I suppose this doesn’t really matter since radial is as effective as focused, and most clinics (including ours) use radial shockwave therapy devices.
- According to this review, generally speaking, the best protocol for treatment is three sessions, once a week, using 2000 impulses each session at the highest setting the patient can tolerate.
In summary, Shockwave Therapy has emerged as a very good treatment option for certain musculoskeletal conditions with scientific evidence supporting it. Although it may be a little uncomfortable for patients it has been found to be very safe with no adverse events reported in this literature review. Treatments don’t take very long and not too many appointments are needed. At Burlington Sports Therapy, we are proud to offer Shockwave using the Swiss Dolorclast device. Treatments can be performed by either our chiropractors or our physiotherapists, so the appropriate insurance coverage may be applied if you have funding through your extended health benefits. For more information, please refer to our Shockwave Therapy page under our services tab on this website or contact us directly at firstname.lastname@example.org or 905-220-7858.
By Dr. Kevin McIntyre
Schmitz C, Csaszar NBM, Milz S, Schieker M, Maffulli N, Rompe J-D, et al. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. Br Med Bull. 2015 Nov 18;50:ldv047–24.