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Considering Shockwave?

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What is Shockwave Therapy?

Shockwave was originally known as a treatment of Tendinopathies, in some cases, calcific build ups, but recent research from around the world is showing success in areas of regenerative medicine like spinal cord injuries and vascular & nerve regeneration.

These can sometimes be difficult to label appropriately and looking at Shockwave as a treatment for chronic pain that has failed to respond to other interventions, is a good way to identify conditions that Shockwave can treat, especially as an alternative to surgery. Unfortunately, in the UK, we still lack a broad awareness of Shockwave in the GP community and some people are left with pain that they are asked to manage.

Depending on your condition, symptoms can manifest themselves in a number of different ways, however the typical treatment protocol is similar and many people will recognise the following example.

You’ve had a niggling pain for some time but it isn’t too bad and rubbing it better often takes the edge off and you forget about it. Over time the pain becomes more frequent or lasts longer. It may even have got to the stage of asking for painkillers or anti-inflammatories at the local chemist. Then one day at the beginning of summer, a day in the garden or the first round of golf will result in a pain that is too uncomfortable to ignore.

At this point, a trip to the doctors results in the pain being treated acutely. There is an interest in dealing with the immediate symptoms but not necessarily the cause. Once the immediate pain subsides you may be recommended acupuncture Physiotherapy or to an Osteopath. If the pain is still present you may be given an Orthopaedic referral or sent for an Ultrasound. Finally, an acute strain which should have settled down or a degenerative condition in a tendon is identified, and in many cases surgery is the only option given. We know only too well that this type of tendon deterioration does not do well with surgery! The common thought is that the condition is described as a newly found tendinopathy. Later you will find words like tendinitis and other names relating to tendon types of injury rather than deterioration.

By this point you have lived with the pain for 6-8 months and you’re willing to go under the knife but for those conditions that are persistent and failing to respond to other treatment, Shockwave could well be the answer.

In Europe there is a greater focus on promoting Shockwave earlier in the process and it will typically be suggested after three months. Their attitude is why wait? Though the UK guidelines say it shouldn’t be an option before six months, you can still investigate your options earlier. The most important element is to get an accurate diagnosis of the problem as early as possible. You should always attend appointments for scans to avoid delays and, if your GP is reluctant to refer you to a hospital you can consider seeking your own investigation from a sports Osteopath.

So, now you have a general understanding of the types of pain that could indicate Shockwave as a solution, let’s quickly look at a few specific symptoms you may be suffering from.

Many people suffer from Achilles problems, symptoms typically include morning stiffness in the ankles and lower calf and is often accompanied by difficulty walking down the stairs. The affected area often gets better with activity but then, when you sit down again, it stiffens up and the pain returns. To many, this may not be something they have diagnosed, but any long term, ongoing pain should be investigated.

If you suffer from ongoing shoulder pain that has again failed to respond to treatment, it could be caused by a calcific tendinopathy. This is where a build-up of calcium in the supraspinatus tendon leads to pressure, pain and in some cases, severely limited movements as the arm is abducted and mechanically it impinges on the acromion under the ACJ, the joint on the outside of the clavicle where the shoulder blade and the clavicle meet. As with the Achilles, in the early stages symptoms may include mild pain and stiffness which is rather widespread, this time caused by the body trying to protect the affected area. Soon though, the symptoms become more persistent and your range of motion reduces as the calcified area becomes more apparent. It’s as if the calcification has grown in a short period of time, in reality this process like all the others has taken place over a considerable period of time.

This is thought to be one of the worst pains possible in the shoulder with the growth reaching a considerable size if left untreated. It's a bit like a kidney stone in the shoulder and, as with kidney stones, it is easier to treat the sooner it is diagnosed. For many, leaving it too long means that surgery is the only option as the larger the growth, the more power is needed for Shockwave to have an effect and this can simply be too painful. This is a strong case for Focused Shockwave, as it’s easier to tolerate from the patients’ perspective, however it is often patient dependent and I have done a good number of these with Radial with considerable success.

Caught earlier though, Shockwave is a great solution. We’ve treated many people in the practice, with a series of treatments breaking down the growth and patients start feeling some relief after just a few sessions.

With tennis elbow you may be experiencing pain in the forearm. Often occurring after an increase in use, it can be misdiagnosed as an acute injury and the condition is treated as such. If the injury fails to respond to initial treatments (anti-inflammatories or non-steroidal injections) it may be a sign of tendon damage and investigating Shockwave could be the way to go.

Unfortunately, and all too often, the initial treatment is an injection given for pain relief that helps immediately but actually inhibits any healing. Injections have often been found to injure the tendon, often causing an interstitial tear and needs Shockwave to restart the healing process (neoangiogenesis).

The last set of symptoms I want to mention are slightly different. Though not one of the 6 conditions with NICE guidelines, Shockwave has a great track record helping in the recovery of joint replacements. Often the process involved in a hip, knee or shoulder replacement can create symptoms similar to that of a tendinopathy. You may have had surgery in the last year and still experience pain, stiffness or tenderness in the area around the new joint. Often patients will need a second surgical review procedure to address the damage caused by the first. We often find that the joint capsule has issues and, for instance in the hip, presents rather like a rotator tendinopathy. Smart surgeons have found that in the presence of skilled hands Shockwave can save review surgery.

This is another very successful area in which Shockwave can and does really help. Because the therapy is designed to stimulate the areas natural healing process, this can be beneficial post-surgery where encouraging the tendons to heal around the new joint can help avoid a further procedure.

If you’ve ever said something like ‘I’ve had a new hip but I’m still not right’, then Shockwave may be worth investigating.

Shockwave is not for every condition, but for many it can be the answer to long standing pain and discomfort.