At Walnut Grove we have invested in a Radial Shockwave machine because it has been shown in numerous studies to help with persistent tendon problems such as Plantar fasciopathy (previously called fasciitis) Plus many other tendinopathies, achilles, knee, hip, shoulder and elbow.
The ‘shock’ part of the treatment is generated ballistically using compressors to accelerate a projectile down a barrel to strike a transmitter that converts the kinetic energy into an acoustic pressure wave. The shape, size and material of the transmitter affects the amount, spread + depth of energy emitted and that can be altered depending on the tissue being treated. The sensation is like a mini jack hammer pulsing against your skin – it will be and should be uncomfortable but not painful.
The mechanism of action is well known:
- Initiates Acute inflammatory response
- Initial analgesia through: Hyperstimulation of the nerves in the short term
- Improves blood vessel repair and cell health
- Stimulates Collagen production to help repair of tendon
- Alleviates Myofascial Trigger Points
- The main biological effect of ESWT is via Mechanotransduction. Cells convert mechanical energy into biochemical processes. Evidence that after shockwave exposure there is a correlative change in stem cell activation, osteoblastic activity, endothelial cell production, Nitric oxide production, fibroblastic proliferation.
NICE has approved its use on the NHS – but don’t hold your breath – as yet we haven’t seen anyone actually have treatment on the NHS!
It works particularly well in those chronic long-term cases where nothing else has worked and healing has stalled.
Shockwave effectively takes a tissue from a chronic to an acute state and in doing so provides a stimulus for repair.
Shockwave is safe and effective with few side effects such as soreness and bruising for 1 day after treatment and occasionally short-term skin irritation. There are some contraindications for using shockwave but these are very few and your therapist will have a full case history and discuss any issues with you.
Shockwave works best when combined with a full programme of individualised treatment and a tissue specific stretching regime. Many clinics use shockwave in isolation but this does not give the best results. Shockwave should be part of a treatment package of care. Imaging, such as ultrasound or MRI is not very useful in these types of conditions as tendon structure is NOT related to symptom severity and cannot be used as a predictor of clinical outcome.
Tendinopathies are difficult conditions to treat – they are often long term and people come to us having had months or sometimes years of pain BUT do not despair because the right approach really can make a difference.
Medical knowledge is very clear about some aspects:
- Rest is bad for tendons – they get weaker.
- Exercise is the best intervention.
- Graded loading is essential to make sure the tendon heals with the right structure for future strength.
- There is a very poor link with imaging and pain.
- Pain is ok during exercise as long as it is 3-5/10 whilst doing the exercise and returns to baseline in 36 hours.
- Tendon recovery will take 3-6 months minimum.
Recently the practitioners at Walnut Grove who use Shockwave, both physiotherapists and osteopaths have been on a weekend update with James Woledge, working with Venn healthcare the providers of our machine. They are innovative educators and very proactive in updating and educating practitioners as new research becomes available.
If you are suffering with long term Musculo-skeletal pain – please talk to us, we can advise as to whether this approach or other treatment modalities could help your recovery. Don’t continue to suffer – help is here!
