Shockwaves: how they work and when they should be applied

Shock waves began to be used in 1980 to treat urinary tract stones (“stones” in the kidney and ureters). On follow-up X-rays of patients, urologists observed that, if the stone was located in the ureter, there was an increase in the density of the pelvic bone. The shock waves destroyed the stones and, at the same time, promoted bone regeneration in the areas near the treatment site.

This effect quickly attracted the attention of orthopedic surgeons and traumatologists. In the early 1990s, the first patients suffering from delayed bone healing and chronic tendinopathies were treated.

A shock wave is an acoustic pulse that generates a high compression and decompression of the tissues in a very short time. These shock waves produce a mechanical stimulation of the cells, which recognize and respond to the stimulation producing different biological responses. In general terms, the benefits of shock waves are threefold:

  • Tissue regeneration
  • Formation of new blood vessels
  • Strong analgesic effect

This is a process of converting mechanical stimuli into biochemical responses. For example, if we stimulate the cells of a tendon with shock waves, collagen synthesis will increase. Collagen is an essential protein for recovering the biomechanical functions of injured tendons.

In what type of injuries can they be applied?

Scientific studies have shown that shock waves are effective in treating the following pathologies:

  • Calcific tendinitis of the shoulder
  • Plantar fasciitis with or without calcific spur
  • Epicondylitis or “tennis elbow”.
  • Trochanteric Bursitis or trochanteritis
  • Patellar tendinitis
  • Achilles tendonitis
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Why choose shock waves and not another treatment?

Chronic tendinopathies are a great challenge for any physician or specialist in Physical Therapy. They affect a large number of patients in occupational and sports settings. Available treatments include pharmacology, physiotherapy, infiltrations, platelet-rich plasma, surgery… There is no scientific consensus on the best treatment to resolve a chronic tendinopathy. However, any treatment should include a good diagnosis, detection and prevention of risk factors and a comprehensive exercise program to control the forces acting on the tendon. On the other hand, shock waves can complement a global rehabilitation program, helping tendon regeneration without drugs or infiltrations and with minimal side effects.

Can all patients undergo this treatment?

The Scientific Societies of shockwave: International Society for Medical Shockwave Treatment (ISMST) and the Spanish Society of Shockwave Treatments (SETOC) recommend shockwave therapy for the treatment of chronic tendinopathies (tendinitis of more than 3 months of evolution). There are some contraindications such as, for example, patients with blood coagulation disorders and patients during pregnancy.

How many sessions will be necessary and how are the results?

Treatment protocols consist of 3 to 5 sessions. The interval between sessions is 1-2 weeks. Although positive results can be experienced after the first session, the assessment of the effectiveness of shock waves is made approximately 2 months after the end of the treatment. The therapy includes an exercise program that the patient must perform at home and a control of risk factors. The success rate of shock waves in the treatment of chronic tendinopathies is about 80%.