Shockwave Therapy: The Ultimate Guide to Reclaim Your Active Lifestyle for Those Who Want to Know if Shockwave Therapy is for Them
Have you been wondering if shockwave therapy is a fit for you?
Have you been told that shockwave therapy may be a solution for the chronic symptoms that you’ve been experiencing?
Maybe you just want to know if you have a chronic or degenerative condition that shockwave therapy may help with.
Shockwave therapy is becoming more well-known in the health and wellness space, but with that comes more questions from those who may be told they need something more than exercise to heal their pain or injury.
In this guide, I’m going to break down everything you need to know about shockwave therapy so that you can decide if you’d like to reach out to a shockwave therapy provider near you (and how to go about doing so!)
We’re going to go over:
What is shockwave therapy?
What’s in a Name? The Lingo of Shockwave Therapy
Who Can Benefit From Shockwave Therapy
Diagnoses Treated With Shockwave Therapy
Which Is Better - Focused Shockwave Therapy or Radial Pressure Wave Therapy?
What to Expect During a Shockwave Therapy Session
What are the Benefits of Shockwave Therapy?
How to Find a Qualified Shockwave Therapy Provider
Incorporating Shockwave Therapy Into Your Recovery Plan
FAQs
Introduction
Chronic pain and injuries can be debilitating, preventing you from enjoying your favorite activities and maintaining an active lifestyle. Enter shockwave therapy, a revolutionary treatment that has been gaining popularity for its effectiveness in treating chronic injuries and promoting rapid recovery. In this guide, we'll explore the ins and outs of shockwave therapy, providing you with everything you need to know to decide if this treatment is right for you.
What is Shockwave Therapy?
Shockwave therapy is a non-invasive treatment that uses high-energy sound waves to stimulate the body's natural healing processes. Originally developed to treat kidney stones, it has since been adapted for a variety of musculoskeletal conditions.
History of Shockwave Therapy
The first medical use of shockwave therapy was in the 1980s for lithotripsy, a procedure to break up kidney stones. By the 1990s, researchers began exploring its potential for treating soft tissue injuries and chronic pain, leading to the development of extracorporeal shockwave therapy (ESWT) and radial pressure wave therapy (RPWT).
The Science Behind Shockwave Therapy
The Body’s Inflammatory Process
Our body is equipped with an innate natural healing process. This process is kicked into gear the moment our body detects injury. While thought of as a linear progression, many of us who have ever suffered an injury know that is not always the case.
Sometimes it feels like we move one step forward, to only take two steps back. We’re feeling really good and push our activities levels a bit only to feel sore the next few days or weeks. This is where shockwave therapy comes in.
Most of us stall out in our healing, if we are going to, in the Proliferative Stage. This is the part of healing where our body is laying down tissue, “patching the holes of injury” so to say, and rebuilding the structures and integrity of the tissue.
This prevents the body from entering the Remodeling Stage, which can take months to years after an injury, to help the tissue finally lay down along lines of stress that we can use, rather than distress, disorganization, and degeneration that comes with injury.
This stalling out of our healing can happen for many reasons:
We continue to overload the tissue by not giving it the rest and decreasing in volume/load that it needs to recover.
We continue doing the thing the way we did that caused the injury - think faulty mechanics in a golf swing, or our general health and constitution are compromised.
If our body is already an inflamed system from other things -
Autoimmune disorder, chronic disease/illness, or inflammatory lifestyle - poor sleep habits, inflammatory/poor diet/undernourishment, dehydration, lack of exercise and stimulus, over stressed, our energy is going to be put towards maintaining the ship and trying to stay afloat amongst the rocking seas of inflammation and a poor lifestyle, than divert efforts to tending a strained muscle or tendon.
- Enter Shockwave Therapy –
Shockwave therapy works by delivering acoustic sound waves to the affected area. These waves create microtrauma, which stimulates blood flow and promotes tissue regeneration, essentially “restarting” the body’s natural inflammatory process and continuing progress toward healing and pain relief.
As you can see in the figure to the left inflammation is a natural part of our body’s tissue repair system. Without it, our body would never get the signal that
something is wrong and send down the necessary cell responders to move things along to the proliferative growth and remodeling stages to get us back to a functional state.
Often, inflammation gets a bad rap. It’s not the inflammation that is bad, it's when it is overabundant and our body cannot keep it in check, or we are not equipped to address it, that it becomes a problem. With shockwave therapy micro-inflammation is introduced at a level that stimulates your body to respond, and with a specificity that is limited to the injured tissue. This allows patients to continue with their normal everyday activities as well as controlled exercise and movement, while the body is healing.
This is also why it is important to heed the instruction of your shockwave therapy provider to avoid the use of ice and NSAIDS (Ibuprofen, etc.) after treatment. We want the body to respond to the micro-inflammation that was introduced with the therapy, we do not want to slow or negate your body’s response to a session.
Therapeutic shockwave devices impart energy levels (Energy Flux Density) that are significantly lower than lithotripsy devices used to treat kidney stones but are 1000x more powerful than standard therapeutic ultrasound waves used in many physical therapy clinics.¹ This makes them tolerable and effective to be used in clinics to treat injuries without the need for anesthesia or a numbing agent, or weeks and weeks of treatment to stimulate a response like ultrasound may need.
What’s In a Name? The Lingo of Shockwave Therapy
Extracorporeal Shockwave Therapy (ESWT): This is the umbrella term for shockwave therapy. It is broken down further into Focus Shockwave Therapy and Radial Pressure Wave Therapy.
Focused Shockwave Therapy (FSW): This method uses focused shockwaves that penetrate deep into the tissue- upwards of 12 cm in the body. It is often used for treating deep-seated conditions of the back and hips, or in larger individuals and elite athletes. It is still effective on superficial tissue.
Radial Pressure Wave Therapy (RPW): This method uses radial waves that are less intense and spread out over a larger area. It is typically used for superficial conditions and large muscle groups.
The device generates air pressure that drives a small object (like a piston) inside the hand-held tool. When this piston hits a transmitter, it creates energy in the form of sound waves. These sound waves spread into the tissue, covering a larger area compared to more focused treatments. The strongest energy is felt right at the surface of the skin where the treatment is applied, and the energy lessens as it goes deeper into the body, typically reaching up to about 2.3 inches (6 cm).
Comparison of focused shockwave and radial pressure wave waveform as it enters the tissue; depiction of maximum energy of the waveform.
Who Can Benefit from Shockwave Therapy
Target Demographic
Shockwave therapy is suitable for active adults of all ages who suffer from chronic pain and injuries. It is particularly beneficial for individuals involved in sports, fitness, and physically demanding activities. But, those that are looking to lead an active, pain free life can greatly benefit from the therapy.
Age and Fitness Levels
Young Athletes: Can use shockwave therapy to recover from sports-related injuries and enhance performance.
Middle-Aged Adults: Benefit from pain relief and improved mobility, helping them stay active and engaged in their hobbies.
Seniors: Experience reduced pain and increased function, promoting independence and a more active lifestyle.
Who is Shockwave Therapy Not For
Shockwave therapy is suitable for active adults of all ages who suffer from chronic pain and injuries, though some individuals are better off refraining from shockwave therapy due to their health history.
Contraindications
While shockwave therapy is safe for most people, it is not recommended for individuals with:
Blood clotting disorders
Active infections
Cancer in the treatment area
Pregnancy and treatment in the fetus area
Severe cardiovascular conditions
Consulting with a healthcare professional is crucial to determine if shockwave therapy is appropriate for your specific condition.
Diagnoses Treated with Shockwave Therapy:
Shockwave therapy is versatile and can treat a wide range of chronic injuries and conditions.¹ Here are some of the most common:
A. Plantar Fasciitis - This condition involves inflammation of the plantar fascia, a thick band of tissue that runs along the bottom of the foot. Shockwave therapy can reduce pain and promote healing by increasing blood flow to the area.
B. Tendinopathies - Conditions like Achilles tendinopathy, patellar tendinopathy (jumper's knee), and tennis elbow involve chronic inflammation of tendons. Shockwave therapy helps by stimulating new cell growth for damaged tissue.
C. Calcific Tendonitis - This condition occurs when calcium deposits build up in tendons, causing pain and limited movement. Shockwave therapy can facilitate the reabsorption of these deposits.
D. Medial Tibial Stress Syndrome (Shin Splints) - Shockwave therapy can be used to treat inflammation and pain along the shin bone, promoting faster recovery for athletes and active individuals.
E. Greater Trochanteric Pain Syndrome - This condition involves pain in the outer hip area. Shockwave therapy can reduce inflammation and stimulate healing of the gluteal tendons.
F. Low Back Pain - Shockwave therapy can reduce pain and improve function in patients with chronic low back pain when combined with an exercise program for up to 3 months or more.
G. Hamstring Injuries -Shockwave therapy can effectively reach and treat the deep hamstring muscle to facilitate healing where other modalities, nor practitioners’ hands, simply cannot reach.
H. Rotator Cuff Shoulder Injuries - Shockwave therapy can reduce pain, improve function, and allow the patient to rehabilitate this common shoulder injury.
I. Arthritis - Shockwave therapy slows down the structural changes in the bone reducing the progressive deterioration of the cartilage while creating a better environment for the joint with less inflammation. Research supports its use for knee osteoarthritis as well as many other joints.
J. Other Conditions - Shockwave Therapy is also effective for conditions like bursitis, stress fractures, calf injuries, neck pain, and more.
Outcomes - Which Is Better - Focused Shockwave Therapy or Radial Pressure Wave Therapy?
Schmitz et al. (2015) showed in their review of 106 shockwave papers that it is not the waveform (focused shockwave versus radial pressure wave) that dictates the success of a treatment, it is the dose that matters.
When following the dosing guidelines discovered by Rompe et al. (1998, 2009) and treatments are delivered in the medium energy range for the device, for the correct amount of pulses, delivered 1-2 times per week, for treatment of tendons and other pathologies of the musculoskeletal system outcomes for FSW and RPW are not found for one to be superior to the other.²
So if FSW and RPW Create the Same Outcomes, Why Choose One Over the Other?
Great question. When treating most tendinopathies and conditions of the musculoskeletal system, when dosed appropriately patients will receive the same improvements and reduction in pain and symptoms using FSW OR RPW.
Focused Shockwave: 81.5% effective
RPW: 88.5% effective
Both, create statistically stronger patient outcomes when compared to placebo, or other modalities.
However, there are times when a clinician would want to choose one device over the other.
Depth of the tissue to be treated/injury site
Comfort for the patient
Treatment area size
If they have all the RPW treatment heads
(The type of material and size of the RPW treatment head dictate the depth and energy that reaches the tissue to instill change)
Case Studies and Success Stories
Up until this point I have provided a very science based guide to shockwave therapy. Over my ten years of experience using shockwave therapy I have gathered many real-life examples of patients who have benefited from shockwave therapy. Here are just a few:
Case Study 1: Jeff, a lifelong runner and outdoor adventurist shared: “For a couple of years, I had a nagging hip/hamstring soreness that has kept me from running and other physical activities that demanded high leg strength. After a year of physical therapy and leg specific weight training, I showed some but marginal improvement. At the suggestion of my doctor I went to see Maria DelliVeneri at Remedy Sport Medicine. I was skeptical but within a couple of months of 5 sessions of her sonic shockwave treatments, I’m virtually pain free and back to running again. I’m now a believer. Thank you Maria”
Case Study 2: Carol, a photographer, improv artist, and active adult managing her history of back pain - “The shockwave therapy treatment I received from Maria was a game changer for me. I have had lower spine issues for years. And have done literally “everything” under the sun to remedy my pain. My wonderful orthopedic Dr. recommended I try this therapy before we discuss any surgical plan. I am SO glad he did and that I came to Maria. Her knowledge of the body is deep, and her ability to explain it is astounding. I had relief the first treatment, but she kept saying it will only get better. I could not be happier with the results, and my brain has “forgotten” the amount of pain I was in just a few short months ago. I could not be more pleased with this treatment, and so glad I found Maria in the ocean of pain management modalities out there.”
Case Study 3: Tyler, 28yo mountain biker, weight lifter, and concert-goer had his knee replaced 12 years ago and since had trouble getting enough range of motion to do everyday things.
“After my total knee replacement 12 years ago, I never thought I’d be able to bend past 90° let alone build strength in my leg again. After just 2 visits, I was bending past 100° and strength was starting to come back!! 6 visits later and I’m squatting like never before, bending further than I thought imaginable and even doing single leg exercises to really build on the muscle!!!”
What to Expect During a Shockwave Therapy Session
Initial Consultation
Your first session will typically involve a thorough evaluation of your condition. The clinician will:
Review your medical history
Conduct a physical examination to pinpoint the exact nature of your injury. Oftentimes when we are dealing with a chronic injury, something we’ve been dealing with for 6 weeks or greater, the body starts compensating. Be it to help us avoid a painful movement, or to complete a movement because the injury is limiting us, and leads up to compensations in the areas and joints surrounding the injury. Think neck pain from hiking a shoulder up to reach over head when it doesn’t want to go, hip/back pain from walking “funny” after a knee or ankle injury.
During the initial evaluation a full body examination is conducted to identify these potential compensatory patterns, as I would be remiss in your care if I treated just where it hurt, and didn’t help you be a fully functional human at the end of our time together.
Treatment Process
1. Preparation: The treatment area is assured to be clean(ed), and a gel is applied to allow efficient transmission of shockwaves into the target tissue.
2. Application: The clinician uses a handheld device to deliver shockwaves to the affected area. You might feel some discomfort, but the intensity can be adjusted to your comfort level.
It may take a treatment or two for your body to adjust and be treated at the necessary intensity needed to reach the depth of the tissue that’s injured.
Many studies have shown that treatment needs to be delivered at a medium energy level for that tissue in order to elicit the micro-inflammatory response that will initiate your body’s healing process. If you are treated below this threshold due to comfort, you may not experience the desired outcomes and healing you are looking for.³ Work with your clinician to find the treatment approach that’s best for you and your healing goals.
3. Duration: Each shockwave therapy session lasts about 15-20 minutes, depending on the condition being treated.
- The Remedy Sports Medicine Difference -
Staying true to the latest evidence and injury recovery best practices used by professional and collegiate sports, ALL shockwave therapy sessions are followed by Class IV Laser Therapy treatment. This combination has been shown to have a synergistic effect and superior outcomes to using either shockwave therapy, or laser therapy, alone to facilitate healing for painful conditions.
Shockwave therapy restarts the body’s healing process, and Class IV Laser therapy helps the cells and healing team get the job done faster.
Tips to Optimize Your Treatment
You will find after most shockwave therapy treatments you experience an immediate improvement in range of motion and reduction in pain. At Remedy Sports Medicine I capitalize on that therapeutic window with my patients by layering in additional manual therapy, therapeutic cupping, or exercise and movement training to repattern the movements that got you in that chronic state to begin with and begin loading the injured tissue. This gets patients back to doing the things they want to do faster, with lasting results between sessions.
Shockwave therapy is best utilized as a complement to an exercise or rehabilitation program. To optimize your results combine shockwave therapy with your physical therapy or exercise.
To set yourself up for success in your shockwave therapy session, have a good meal before treatment. Just like we fuel for performance, it is important to fuel for recovery and treatments. Having a light meal/snack before treatment may help you feel more comfortable during your session.
Frequency and Duration of Treatment
Most patients require a series of sessions to achieve optimal results. Typically, 3-6 sessions are scheduled 1-2 times per week. Some chronic conditions, or progressive degenerative (ie. arthritis) may need a higher number of sessions, or repeat series to get the results you are looking for. Your clinician will tailor the treatment plan to your specific needs and progress.
Post-Treatment Care
After the session, you may experience mild soreness or swelling, which usually subsides within a few days. There may be some redness that remains at the treatment site. It's important to follow your clinician's advice on activity levels and any post-treatment exercises to enhance recovery.
Potential Side Effects
While shockwave therapy is generally safe, some patients may experience temporary side effects such as:
Redness or bruising at the treatment site
Minor discomfort during or after the session
Swelling or numbness
These side effects are typically mild and resolve on their own.
Benefits of Shockwave Therapy
Advantages Over Traditional Treatment Methods
Non-Invasive: Unlike surgery, shockwave therapy does not require incisions or anesthesia. And, no needles!
Minimal Downtime: Most patients can resume normal activities shortly after treatment, or the same day.
Effective Pain Relief: Shockwave therapy targets the source of pain, providing long-lasting relief.
Stimulates Natural Healing: By creating new blood routes that enhance blood flow and tissue regeneration, shockwave therapy supports the body's own healing processes.
Faster Recovery and Return to Activity
Patients often experience significant improvements within a few weeks of starting shockwave therapy. This accelerated recovery allows for a quicker return to physical activities and sports. Studies show that shockwave therapy can continue to have a benefit and effect the remodeling on the injured tissue 6 months to one year after a treatment course.
Long-Term Benefits
Regular sessions can help maintain joint and muscle health, reducing the risk of future injuries. Additionally, the overall improvement in mobility and pain levels contributes to better quality of life.
Finding a Qualified Shockwave Therapy Provider
Researching Providers
When looking for a shockwave therapy provider, consider the following:
Credentials and Experience: Ensure the clinician is a licensed healthcare professional and has experience in administering shockwave therapy.
Specialization: Look for providers who specialize in treating your specific condition.
Reviews and Testimonials: Read reviews from previous patients to gauge the provider's reputation and success rates.
Choosing the Right Provider
Consultation: Schedule an initial consultation to discuss your condition and treatment options.
Facility: Visit the facility to ensure it is clean, well-equipped, and professionally staffed.
Communication: Choose a provider who communicates clearly, answers your questions, and makes you feel comfortable.
Remedy Sports Medicine has been utilizing Shockwave Therapy to treat chronic injuries, aches, and pains since 2014. With over 10 years of hands-on experience and 2 years as the Clinical Education Manager for the Chattanooga Shockwave Therapy device manufacturer, Maria DelliVeneri, is an expert in the science and clinical application of shockwave therapy.
How to Optimize your Time with your Shockwave Therapy Provider
Be honest about your medical history and current symptoms.
Ask about the provider's experience with shockwave therapy.
Discuss potential risks, benefits, and expected outcomes.
Discuss your current activity level, and what goals/activities you want to get back to.
Be an active participant in your care and ready to do your part in returning to life and sport with less pain and better movement.
Incorporating Shockwave Therapy into Your Recovery Plan
Integrating Shockwave Therapy
Combine shockwave therapy with other treatments and lifestyle changes for optimal recovery:
Physical Therapy: Complements shockwave therapy by improving strength and flexibility. Restores the body's natural function and movement patterns so you can get back to doing what you want to do, and prevent this injury from returning.
Massage Therapy: Helps reduce muscle tension and improve circulation.
Chiropractic Care: All of our muscles turn to tendons and attach to bones. We can’t have movement of one without influencing the other - if our foundation is off, it affects everything from the ground up.
Nutritional Support: A balanced diet supports overall healing and recovery. Addressing inflammatory foods, food sensitivities, and mineral and protein levels can have a significant impact on our pain levels, as well as our healing.
Sleep: We all need it, many of us struggle with it. If we’re not sleeping, we’re not healing.
Nervous System Support: It’s a no-brainer that stress is hard on the body. Reality is, stress cannot be avoided. But, it can be managed and supported. Work with your practitioner and learn some techniques to help you support your nervous system and provide moments of rest, relaxation, and restoration to both your body, and your mind.
Post-Treatment Recommendations
Follow your clinician's advice on:
Rest and activity levels - The cool thing about shockwave therapy is more often than not we do not need to completely shut it down. This is why professional sports teams choose shockwave therapy to treat their athletes in season, rather than cutting their season short and hopping straight to surgery.
Home exercises and stretches - Motion is lotion. Once shockwave therapy restarts the healing process, the body needs to keep the ball rolling. Typically there are 1-3 things that you can do most days of the week that will support your healing journey. No need for hours in the gym, or collecting a series of bands to get the job done.
Hydration and nutrition - “We are what we eat” they say. Plus, ~60% of our body is water. If you’ve ever experienced the symptoms of dehydration on a hot day - light headed/headache, stiffness or cramping in your muscles, you know what it’s like for the body to be low on water. If we’re chronically in that state, we’re chronically inhibiting our muscles and tissues from operating at full capacity. If we’re low on water or body is going to divert what we take in to the important stuff - our brain, heart, etc. Our injured, stiff, degenerated tissue is low on the totem pole of life. Optimize that hydration and you’ll be optimizing your healing!
Ongoing Support and Maintenance
Regular check-ins with your healthcare provider can help monitor progress and adjust the treatment plan as needed. Incorporating healthy habits and preventive measures can maintain your active lifestyle and reduce the risk of re-injury. Keeping you out in the world doing what you want to do, without worrying about pain or injury slowing you down.
Frequently Asked Questions About Shockwave Therapy
What Does Shockwave Therapy Do?
Shockwave therapy uses soundwaves to return the healing process for chronic injuries that are 6 weeks or older.
Shockwave therapy stimulates the body to:
Increase blood flow and create new blood routes (neoangiogenesis) to nourish the tissue.
Activate connective tissue.
Stimulate growth factors and cellular activity needed to repair/remodel degenerative tissue and help lay down new, healthy tissue in its place.
“Scramble” the pain signal so you feel less pain in the moment, and lasting pain relief over time.
Does Shockwave Therapy Hurt?
Most patients experience mild discomfort, but it is generally well-tolerated and limited to the duration of the treatment session. Some experience pain or soreness, like after a good workout, for 24-48 hours pots- treatment.
How Soon Will I See Results?
Many patients notice improvements within a few weeks, with full benefits typically seen after the complete treatment course, and go on to heal for the next 6-12 weeks.
Is Shockwave Therapy Covered by Insurance?
Typically in the United States shockwave therapy is not covered by commercial insurance programs or Medicare. However, many can use their HSA/FSA benefits for this service. Check with your provider. If we were in Canada or Europe, shockwave therapy is the standard of care for chronic injuries and tendinopathies.
Conclusion
Shockwave therapy is a non-invasive tool that can facilitate tissue and injury healing without the need for surgery, pharmaceutical drugs, or needles and injections. Pain relief and improvements in movement, sleep, and quality of life are experienced shortly after the beginning of treatment and continue all the way up to 6 months to one year post-treatment.
Through this guide, you learned the science and clinical application of shockwave therapy, as well as how to look for a provider to fit your treatment needs.
Shockwave therapy allows you to stay active with minimal downtime and is the reason it is in over 200 professional and collegiate athletic training rooms treating elite athletes and keeping them in the game. And, it is the reason why Remedy Sports Medicine has chosen to bring Shockwave Therapy to Central Oregon.
References
Introduction to Shockwave Therapy eBook. Chattanooga. djoglobal.com/shockwave. 2021
Rompe JD, Kirkpatrick CJ, Küllmer K, Schwitalle M, Krischek O. Dose-related effects of shock waves on rabbit tendo Achillis. A sonographic and histological study. J Bone Joint Surg Br. 1998 May;80(3):546-52. doi: 10.1302/0301-620x.80b3.8434. PMID: 9619954.
Schmitz C, Cs’sz’r NB, Milz S et al. (2015), “Efficacy and safety of extracorporeal shockwave therapy for orthopedic conditions: a systemic review on studies listed in the PEDro database,” British Medical Bulletin, vol. 116, no.1, pp115-138.
