All Your Questions About Shockwave Therapy Answered

What Is Shockwave Therapy?

Extracorporeal Shockwave therapy (ESWT) is an effective non-surgical treatment for painful musculoskeletal injuries. 

There are several mechanisms of action from Shockwave therapy that aids in short term and long term pain relief as well as increased mobility through promoting muscle/tendon/ fascia repair. It was originally invented and used for the treatment of Kidney stones

There are two types of Extracorporeal shockwave – Focal and Radial. Where musculoskeletal injuries are present, radial  shockwave therapy is typically used.  This allows for the dispersion of a singular acoustic pressure to a larger area, ensuring all the affected tissue is targeted. 

The Positive Medical Effects

New Blood Vessel Formation

Shockwave therapy increases the amount of blood flow to the tissue area that is being treated.  It does this by the use of acoustic waves which causes capillary micro-tears in the tendon, muscle, fascia. Due to these micro tears it allows for different naturally occurring growth factors in the body to be increased. This results in blood vessels remodelling and the formation of new ones. The new blood vessels improve blood supply and oxygen uptake to the treated area, leading to improved healing of the injury. 

Reversal of Chronic Inflammation

Extracorporeal Shockwave therapy works to reverse chronic inflammation which happens in many pathologies (achilles tendon pathology, Plantar Fasciitis pathology). Chronic inflammation happens due to the inflammatory response being disrupted. Chronic inflammation can damage healthy tissue and results in more persistent pain. A cell known as the mast cells are the foundation of the inflammatory response. Through Shockwave therapy, mast cells are increased which allows for the reactivation of the anti-inflammatory process.  This leads to the production of Chemokines and Cytokines. These two compounds allow for healing of tissue and regeneration of tissue. 

Further to the Shockwave inhibits an enzyme known as COX II. Shockwave inhibits this inflammatory marker, allowing for anti-inflammatory response to occur. 

Stimulation of Collagen Production

In order for tissue to heal, we need collagen production. Extracorporeal Shock Wave  helps to accelerate the collagen regeneration process. It does this through forcing the newly created collagen fibres into a longitudinal structure which creates a firmer structure at the site that was injured. This allows for less chance of reinjury to the site. 

Dispersion of Pain Mediator “Substance P”

Substance P is a naturally occurring neurotransmitter within the body. It allows for pain signals to be sent throughout the body. Substance P mediates pain information and growth factor. Shockwave increases the release of Substance P which produces an analgesic effect by sending an anti pain message to the Central nervous system (brain).   Blood circulation increases and contributes to the formation of new tissue. 

Release of Trigger Points 

Trigger points, or what a lot of individuals refer typically to as knots within the muscle can cause significant pain.. Trigger points are  palpable nodules within the taut band of muscle.  When trigger points become tight it causes the nerve endings to become more sensitive and causes the muscle to further contract. Radial Shockwave therapy works by sending the acoustic signals towards the trigger point to release the tight contraction allowing for looser muscles leading to less pain. 

Therapy Sequence

What kind of lower limb aliments does shockwave therapy treat

Shockwave therapy can treat an array of different musculoskeletal pathologies this includes the following 

  • Chronic tendinopathies and enthesopathies: plantar fasciitis, heel spurs, peroneal tendon pathology, tibialis anterior and tibialis posterior tendon pathology.
  • Sports indications: Medial tibial stress syndrome, Osgood-Schlatter, soft tissue tears, achilles tendinopathy.
  • Muscular disorders: Muscle pain, hypertonia, spasms, cramps, muscle hardening, and fibrosis

Location of the area to be treated

At the beginning of each session of shockwave therapy, your treating podiatrist will locate the area to be treated; this is done through palpation of the site and includes bony landmarks and muscle to ensure the right spot will be targeted. 

Gel application

After the correct area is located and found, the podiatrist will apply a transduction gel to the area. The gel is used to ensure the acoustic wave forms are transmitted through to the skin to the area. 

Therapy initiation

Lastly, the treating Podiatrist will place the Shockwave applicator on to the gelled area and begin the treatment. During this phase it is normal to hear a loud thudding noise (imagine a jack hammer like sound) this is the stage where the radial acoustic wave forms are being transmitted and the process for regeneration of the tissue is occurring. 


Will Shockwave therapy help me?

It is imperative that before any treatment is commenced that you are assessed and diagnosed properly. Extracorporeal shockwave therapy will help most individuals with Plantar fasciitis, heel pain, achilles pain, shin pain as well as numerous other musculoskeletal injuries. It can assist with decreasing your pain and increase the healing of any injured tissue. We always recommend strength and conditioning in conjunction with Shockwave therapy to ensure your tendon/fascia/ muscle becomes stronger and less prone to reinjury. 

Does the treatment hurt?

While Shockwave sounds painful, we find that most of our clients can handle the treatment. Most clients report feeling a slight discomfort during treatment. The treatment itself doesn’t go for a long period of time so most individuals are able to tolerate the small discomfort. 

The treating Podiatrist will start off slowly and build up to the desired level as tolerated by each client. During treatment it is recommended that pain is around a 6-7/10 for best outcomes.  During a Shockwave session your Podiatrist will set the pulses to anywhere from 2000-4000 shocks per area. 

How many treatments will I need?

Most clients benefit from between 4-6 sessions of shockwave therapy for their injury, as the effect of radial shockwave is cumulative. Some clients may find that they get immediate relief.  It is best to discuss with your Podiatrist how many sessions may be needed for your particular injury.

How often will I need the treatment?

Based on research and evidence, in order for shockwave therapy to be effective it is recommended that it is performed every 7-10 days. This allows for the body to start the natural healing process.

Will I feel any pain after the treatment?

Most individuals do not feel any pain after treatment. In fact most individuals feel that they have less pain and are able to walk easier the days following.

Are there any restrictions after the treatment?

While we do not recommend no activity, we ask that you refrain from strenuous exercise. We are more than happy for you to go for a walk, cycle or swim or any other low impact activities. 

Podiatrists are experts in treating acute and chronic soft tissue injuries. We would love to be part of your journey to rid you of your lower limb pain. You can book in to see a Podiatrist who will be able to provide shockwave therapy and a structure management plan. 

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03 9553 0044 or make an appointment HERE for your orthotic assessment with one of our team!

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