A clinical shockwave is nothing
more than a controlled explosion that creates a sonic pulse, much like
an airplane breaking the sound barrier. The primary effect of a shockwave
is a direct mechanical force. The exact mechanism by which shockwave therapy
acts to treat tendon pathology is not known. The leading explanation is
based on the inflammatory healing response. It is felt the shockwaves
cause microtrauma to the diseased tendon tissue. This results in inflammation,
which allows the body to send healing cells and increase the blood flow
to the injured site.
Shockwaves are used to treat
many orthopedic conditions, including plantar fasciitis (heel spurs),
patellar tendinitis (jumper’s knee), lateral epicondylitis (tennis
elbow), medial epicondylitis (golfer’s elbow) and shoulder tendinitis.
Multiple studies have been conducted to assess the efficacy of shockwave
therapy. Many have shown a positive response versus placebo treatment
and others have shown no benefit over placebo. No studies have reported
any significant side effects when utilized for orthopedic conditions.
Contraindications to shockwave therapy include bleeding disorders and
pregnancy.
There are two main types of
shockwave machines, low and high energy. High-energy treatments are administered
in the operating room with regional or general anesthesia. Low-energy
treatments are administered in the clinic and do not require anesthesia
or injections. AASTHA currently uses a low-energy machine. A technician
places the probe on the area of greatest tenderness and the shockwaves
are delivered over 10-20 minutes. Occasionally, patients will relate mild
transient discomfort at the treatment site. Patients are usually treated
with 3-5 sessions separated by a week. Between treatments, patients are
able to perform all normal daily activities. Some patients report immediate
pain relief but the healing response usually requires 6-8 weeks. Early
results are encouraging and research continues at multiple sites around
the country. |
