Description
Extracorporeal Shock Wave Therapy (ESWT) is one of the most modern, conservative, safe, and effective options in physical medicine, rehabilitation, and orthopedic treatment of musculoskeletal injuries. Its application is based on the medical method of extracorporeal lithotripsy, which involves the generation of mechanical waves through accelerated, controlled impact. Today, over 98% of all kidney stones are treated with extracorporeal lithotripsy.
The use of shock waves in treating painful tendinopathies began in the early 1990s. This therapy delivers energetic shock waves to targeted body tissues. The body responds with increased blood circulation and metabolism in the affected area.
Mechanism of Action of Shock Wave Therapy
The essence of this therapy lies in transforming a chronic inflammatory condition, such as tendinitis or fasciitis, into an acute inflammatory state—one that the body is capable of healing. Shock waves activate the body’s self-healing processes by:
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Increasing local blood flow and metabolism
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Breaking down tendon calcifications
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Stimulating tissue cell regeneration
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Enhancing the tissue’s resistance to mechanical stress
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Reducing pain
Advantages of Shock Wave Therapy
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No use of medications (e.g., corticosteroid injections) or local anesthesia
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Non-invasive, bloodless treatment (no needles or surgical incisions), performed in an outpatient setting
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Short treatment duration, typically around 10 minutes
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Immediate pain relief or improvement in joint movement is commonly reported after the first session
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Minimal side effects
Indications for Therapy
ESWT is indicated in tendinopathies of all joints, calcific tendinopathy (e.g., shoulder, heel spur), painful muscle spasms, skin inflammation (cellulitis), and wound healing (e.g., ulcers).
Most common indications include:
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Shoulder pain: Calcific tendinitis, rotator cuff tendinitis
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Elbow pain: Epicondylitis (tennis or golfer’s elbow)
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Hip pain: Trochanteric bursitis
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Knee pain: Patellar tendinitis, pes anserine tendinitis
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Shin pain: Anterior/posterior shin splints
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Achilles pain: Achilles tendinitis
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Heel spur: Plantar fasciitis
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Trigger points: Neck, shoulder blade, lower back, gluteal region
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Cellulitis
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Ulcer healing (e.g., diabetic foot)
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Non-unions, stress fractures
Frequently Asked Questions
How is the treatment performed?
Shock wave therapy (ESWT) is non-invasive and bloodless. A small amount of gel is applied with light pressure to the painful area of the skin, and the ultrasound applicator head is placed against the skin to deliver short bursts of shock waves. One session lasts approximately 5 minutes.
How many sessions are needed?
Typically, 3 to 5 sessions are recommended, with 5–7 days between each. Chronic or neglected conditions may require a longer treatment period, sometimes over several months, for maximum therapeutic benefit. Treatment is done on an outpatient basis, requires no anesthesia, and each session lasts 5 to 10 minutes.
Is the treatment painful?
Some mild stinging pain may be felt at the start of treatment, but this usually subsides as the session progresses, especially when the parameters are adjusted by a certified physician. After treatment, patients often describe a burning sensation similar to hot pepper, along with relief in the treated area.
Is it effective?
Numerous international clinical studies confirm the positive outcome and effectiveness of ESWT. Success rates can reach 80%, especially in cases where all other conservative treatments have failed. For optimal results, ESWT should be part of a comprehensive rehabilitation program, including therapeutic exercise.
Are there complications?
Serious complications are rare. Mild redness, temporary bruising, or a burning sensation in the treated area may occur. Tendon rupture (Achilles or supraspinatus) is a rare but possible complication if ESWT is applied to partially ruptured tendons rather than in cases of tendinitis. Therefore, ultrasound or MRI imaging is recommended before treatment, and therapy should be administered only by a certified physician.
What happens if there is no response to treatment?
ESWT is typically used in cases where other conservative methods (e.g., physiotherapy, injections) have failed. However, in some resistant cases, improvement may not be achieved. In such instances, it is advised to consult your attending orthopedic surgeon to explore alternative treatment options.
Cost and insurance coverage?
In most EU countries, insurance providers cover ESWT, especially for shoulder, elbow, and foot conditions. In Greece, this innovative procedure has not yet been priced officially. The cost of 3 sessions in the UK is approximately £600 (£200/session), while in Italy it is around €200 (€70/session).
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