Introduction to Shockwave Therapy

Neil Rossi Extended Scope Practitioner

Who am I?

• Graduated from UH with 1st class Honours in Physiotherapy

• Awarded UH prize for ‘best student’

• Worked at the Commonwealth Games as a field of play physio for track and field athletics

• Member of NWL MSK clinical network

• Currently studying MSc

• Work at Hillingdon Hospital as MSK

outpatient lead / Extended scope practitioner

Introduction

• History

• What is shockwave?

• Effects

• Contraindications

• Conditions treated

History of Shockwave

History (1)

• Effects of shockwaves on the Human body became apparent during WWII

• Explosions near human beings led to injuries -despite no signs of outer trauma

• Scientists discovered the shockwave experienced - even at a distance – affected the tissues

History (2)

• 1950s saw studies into shockwave for medical purposes

• Lab experiments showed that shockwaves could disintegrate ceramic when shot through water

• First non-direct contact disintegration of a kidney stone described in 1971

(Haeusler & Kiefer, 1971)

History (3)

• 1980’s - Shockwave was trialled in orthopaedic disorders

– Non-union fractures

– Pseudo-arthroses

– Osteochondrosis

– Tendinopathies

(Haupt, 1997)

• 1990’s research into heel spurs and epicondylitis led to the development of new shockwave devices – no longer required water

• The Shockwave machine at Hillingdon Hospital is one of only a very small number in the NHS

What is Shockwave?

What is Shockwave? (1)

• Non-invasive treatment

• Lower frequency than other acoustic waves

• When a shockwave enters living tissue it will either be reflected, refracted, transmitted or dissipated

• Therapeutic ECSWT energy is released at the tissue interfaces (between muscle, tendon, bone, skin)

What is Shockwave?(2)

• 2 fundamentally different types

– Focused also called lithotripsy

• Hard Shockwave

• Used for kidney stones

– Non-Focused also called Radial

• Soft Shockwave

• Used for MSK conditions

What is Shockwave?(3)

• Radial Shockwaves generated in 2 main ways

– Electromagnetic

– Air compressed

• As per Hillingdon Hospital

• Bullet in barrel is accelerated using compressed air

• Strikes an end plate – generating the shockwave

What is Shockwave?(4)

• Radial Shockwave

– Energy declines rapidly in proportion to the distance from the site of generation

– Shockwaves lose power the deeper they go into body

What is Shockwave?(5)

Effects of Shockwave

Effects of Shockwave (1)

• Radial Shockwave effects

– Destruction of tissue

– Increased Healing

– Decrease pain

Effects of Shockwave (2)

• High Levels

– Destruction + healing + pain relief

• Middle Levels

– Healing + pain relief

• Low Levels

– Pain relief only

Effects of Shockwave (3)

• All shockwave effects beyond the scope of this presentation

• Biological effects – http://www.shockwavetherapy.education/index.php/t

heory/biological-effects

• Treatment effects – http://www.shockwavetherapy.education/index.php/t

heory/tissue-effects

Contraindications

Contraindications (1)

• Absolute

– Lungs

– Eyes

– Brain

– Major blood vessels

– Major nerves

– Implanted devices or hormones

Contraindications (2)

• Relative

– Epiphysis – open growth plates in children

– Open wounds / post surgical wounds

– Pregnancy

– Clotting disorders / anti-coagulants

– Joint replacements – may cause loosening

– Infection

– Cancer

– Corticosteroid – wait 1 month

Conditions Treated

Conditions Treated (1)

• Shoulder Calcific Tendonitis

• Lateral Epicondylitis

• Gluteal Tendinopathy

• Adductor Tendinopathy

• Hamstring Tendinopathy

• Patella Tendinopathy

• Achilles Tendinopathy

• Plantar Fasciitis

Conditions Treated (2)

• However

– Not a passive modality

– The patient still needs to load the tendon through exercise

– Good evidence for ECSWT use in tendinopathy with exercise

Questions?