What is shockwave treatment?
Extracorporeal shock waves are high-energy acoustic percussions. The body reacts by increasing metabolic activity in the painful area. This stimulates and accelerates the healing process. In Switzerland, shockwave therapy has been one of the ‘tools’ used to treat chronic tendonitis for more than a decade.
The aim of the treatment is to create a sharp increase in pressure at the heart of the tissue to be treated. This increase in pressure will trigger a series of physical and chemical transformations in the tendon itself and its attachment to the bone.
The shockwave is created by piezoelectric, electro-magnetic or electro-hydraulic phenomena. It is very powerful, reaching up to 1,000 bars, is very short-lived, lasting around 30 nanoseconds, and has a deep epicentre. Ultrasound detection can be used, but most often there is no detection. Radiographic identification was very rarely used on the first devices. ESWT should not be confused with radial shock waves, which are frequently used in physiotherapy practices. These radial shock waves also represent a therapeutic alternative, the effect of which can be compared to mechanical deep transverse massages.
The waves emitted are mechanical rather than acoustic, their scattering is radial rather than focal, and they have no negative phase (RSWT).
The radial shock wave is created by a mass propelled by compressed air. In this case, the increase in pressure is greatest at skin level (1 to 10 bars) and spreads conically in depth, gradually losing its intensity. If the intensity is lower, the duration of the wave is much longer, around 5 milliseconds. They are supposed to be less painful than ESWT. Ultrasound tracking is not necessary, and 6 to 10 sessions are required.
The increase in pressure has various effects:
1- It is likely to cause the calcifications in the cuff to burst, provided that they are ‘hard’; it may also have an effect on the micro-calcifications located in the area where the tendon is inserted into the bone.
2 – The wave saturates the pain receptors and causes a secretion of endorphins responsible for an analgesic effect in the hours that follow.
3 – By releasing NO (nitric oxide) and a vascular growth factor (VEGF) into the tissue, a new network of micro-vessels is created around the tendon and its attachment (neo-vascularisation). This new vascularisation will allow waste products to be evacuated and, above all, improve tissue nutrition.
4 – The pressure wave stimulates osteoblasts, the cells responsible for creating new bone, which extends the field of action of shock waves in pseudarthrosis (bone fractures that do not consolidate).
Indications:
We can thus respond to pathologies such as:
- Achilles tendinopathy (Achilles heel)
- Patellar tendinopathy (knee)
- Shoulder tendinopathies/calcifications
- Epicondylitis, epitrochleitis
- Muscle scars
- Calcaneal spurs (heel bone)
- Plantar fasciitis (inflammation of the tissues of the sole of the foot)
The frequency of treatment is generally once a week, to allow the treated tissue time to regenerate. At the start of treatment, it is necessary to leave 3 to 5 days between treatments. This should be done in accordance with the doctor’s prescription.
Coverage and insurance
Shockwave treatment is part of a conventional physiotherapy session. No extra charge is made.
