Shockwave for Tendinopathy

Extracorporeal shockwave therapy, more simply known as ‘shockwave’, has become more prominent in the clinical treatment of tendinopathy. This blog will aim to outline how shockwave works, as well as who might benefit from this treatment.

What is Tendinopathy?

As a bit of background, tendinopathy is a painful overuse condition of a tendon (the tissue where muscle attaches to bone). This can happen to any tendon in the body, with common areas including the Achilles tendon (heel), patellar tendon (knee), and tendons of the elbow (aka ‘tennis elbow’). Tendinopathy will sometimes get better with simple activity modification and exercise, however in some cases it can persist for long periods of time. As tendinopathy becomes more chronic, changes in the tendon structure occur, such that an acute tendinopathy has different characteristics than a more chronic tendinopathy, and these different stages may respond differently to treatment interventions.

What is Shockwave?

A shockwave is a special type of pressure wave. It was first used to disintegrate kidney stones, before it was trialed for the treatment of tendinopathy.

How Does Shockwave Work?

Research on shockwave has investigated three prominent mechanisms through which shockwave is thought to work. These include the following:

• Pain Relief: Shockwave has several effects on the nervous system which reduce the perception of pain.
• Tissue Healing: Shockwave may stimulate cell responses important for tendon repair after injury.
• Destruction of Calcifications: Studies have shown that shockwave is effective in the desintegration of calcium deposits in tendons.

Is Shockwave Effective?

At this point in time, there is still some controversy surrounding shockwave for the treatment of tendinopathy. However, there is evidence that shockwave is most effective for more chronic tendinopathies (6+ months duration) rather than in the more acute stages. While more evidence is needed to support a particular shockwave protocol, research suggests that three treatment sessions at one-week intervals seems to be an effective dosage for shockwave therapy. It is important to note that shockwave should not be used as a stand-alone treatment, rather, it should be incorporated into a comprehensive rehabilitation program including education, exercise, and manual therapy. Additionally, the treated tendon benefits from rest from high-tendon loading activities for a short period of time immediately following shockwave in order to optimize healing.

If you are interested in trying shockwave therapy for chronic tendon pain, feel free to ask your physiotherapist about it. They are trained to provide comprehensive care, and if you are an appropriate candidate for shockwave therapy, they can integrate this into your treatment plan.

Written By: Reanna Montopoli, FCAMPT Physiotherapist