The Incredible Improvements I’m Seeing Using Shockwave Therapy
- Treatment Options • October 23, 2019
By Dr. Richard Thompson
significant proportion of my clinical practice over the past 13 years has focused on treating acute and chronic soft-tissue injuries. Acute injuries, or injuries that occur suddenly and within the past 14 days, require careful attention to inflammation and pain management, followed by functional rehabilitation to restore full mobility and strength. Chronic conditions, or injuries that have been ongoing for over 3 months, are often more complex injuries to treat, involving physiological changes to the primary injury site. There are also secondary areas of dysfunction that develop due to compensation and abnormal movement patterns that have been brought on from the original injury. Many of the chronic injuries I see in clinical practice have become chronic for a number of reasons – either a concise diagnosis was never made, a patient-specific treatment plan with the appropriate treatment options was never rendered, or the patient has pushed through pain without addressing the problem. In any case, chronic injuries, as a rule, tend to lead to longer recovery times, require more treatment over an extended period of time, and are often associated with a less favourable prognosis for a full recovery.
Earlier this year, I selected a dozen patients that had been dealing with chronic soft-tissue injuries that had been plaguing them for as little as several months to as long as 3+ years. Their injuries included upper hamstring tendinopathies, lateral epicondylitis (elbow pain), plantar fasciitis (heel pain), Achilles tendinosis (lower calf pain), and longstanding myofascial adhesions in the upper back – those stubborn knots just above the shoulder blade. Almost all of these cases had seen very good to excellent improvements in their condition using our typical conservative treatment options (soft-tissue therapy, laser therapy, and/or acupuncture), but their conditions had plateaued at around the 70-80% range of full recovery. No matter how intensely or how frequently treatment was rendered, the conditions had hit a standstill. This was not only frustrating for the patient, but also for myself as a healthcare practitioner dedicated to delivering results!
For the past few years, I had been researching the clinical benefits of extracorporeal shockwave therapy and I was seeing very favourable outcomes being published in the literature. I decided it was time to bring the technology into the clinic to see the results for myself.
For those of you that have not heard of the technology, shockwave therapy (SWT) is a therapeutic modality used in physical therapy and sports medicine for the treatment of common musculoskeletal (MSK) conditions. Acoustic waves generated by the shockwave are driven into chronically injured tissues to trigger biological effects that lead to faster, long-term healing and tissue regeneration. For many chronic injuries, the tissues have undergone cellular changes, where the body has laid down fibrotic cells over a period of time to mend the injury site. This process of fibrosis leads to thickening of the tissue and forms adhesions not only within the damaged tissue but as well with the tissues adjacent to the injury site. If left untreated, these adhesions become extremely dense, large, and resistant to movement, otherwise known as scar tissue. Many of my chronic injury patients often try to stretch out the area of pain for relief, only to either cause a worsening in pain or find that stretching provided little to no benefit at all.
In my clinical opinion, shockwave therapy is not a viable therapeutic option for certain conditions. There are a select few criteria that I use after diagnosing a condition to determine if the patient is a suitable candidate for the treatment. Firstly, because we are using high powered acoustic (sound) waves to manipulate and ultimately ‘break-up’ fibrotic, unhealthy tissue, the condition must involve some component of cellular fibrosis and/or adhesion/scarring. Secondly, the application of these sound waves is quite powerful, so if the tissues are actively inflamed, the therapy can actually increase the inflammation in the tissue, and as a result, increase pain. As such, SWT should be applied to tissues that are not actively inflamed, which is most commonly found in chronic versus acute injuries. Lastly, SWT helps break down cellular adhesion/scars to help restore normal movement in the structure (i.e., muscle, tendon, ligament, etc.), but the treatment itself does not create the movement in the tissue. As such, shockwave therapy should always be immediately followed with some form of manual soft-tissue therapy protocol to help lengthen and ‘stretch’ the tissue the treatment is targeting. In my case, I always implement Active Release Techniques® or Graston Technique® immediately following shockwave therapy to induce movement and regain normal mobility in the tissue.
Let’s go back to the 12 patients in my shockwave therapy trial. They were each put on a treatment plan that consisted of SWT in conjunction with manual soft-tissue therapy and home care protocols, such as stretching, icing and/or heat. Treatment was rendered once or twice a week for a trial period of 3 weeks. I was not surprised to see that patients were reporting an improvement in their mobility in the injured tissue – they were able to move more and with less discomfort. What I was not expecting to see was the immediate improvement in both pain levels as well as the rapid tissue changes only after the first one or two sessions! What’s important to note with chronic, fibrotic changes in tissue is that these adhesions or scars are very palpable. You can feel the hard, rigid texture of these abnormal tissues compared to healthy tissues, so part of my diagnostic assessment of the injury is to assess the size, firmness, and location of the fibrotic tissues. To my amazement, the injuries I was treating in the trial were showing drastic reductions in the magnitude and density of the adhesions/scars, often after the very first treatment. Patients were reporting immediate decreases in pain levels and when palpating the injury location, patients also reported significant improvements in tenderness. By the second or third week of treatment, patients were reporting greater improvements in their injury than they had ever seen previously and we were reintroducing them to exercises and daily activities that they were previously unable to perform without pain.
I can truly attest to the therapeutic effectiveness of shockwave therapy (under the right clinical circumstances) and I am beyond pleased with the clinical outcomes I am now achieving for chronic soft-tissue injuries. Patients are returning to their sport or activity and are able to resume their normal activities of daily living without the worry of experiencing pain. If you or anyone you know are dealing with a chronic injury or longstanding pain, I encourage you to seek out the advice of a healthcare professional who can properly diagnose the problem and provide shockwave therapy as a treatment option for your condition.