Benefits of Shockwave Therapy
Clinical Update: Integrating Shockwave Therapy into Our Physiotherapy Practice
At Perform Health Co, clinical progression is driven by objective evidence. While comprehensive data-driven assessments, targeted manual therapy, and progressive loading protocols remain the foundation of our injury management, we continuously look for evidence-based modalities to enhance patient outcomes.
To expand our capacity for managing complex and long-standing musculoskeletal conditions, we have introduced Extracorporeal Shockwave Therapy (ESWT) to our Edinburgh clinic.
Below is an overview of the physiological mechanisms behind shockwave therapy, the clinical indications it addresses, and how it is integrated into a complete rehabilitation framework.
The Physiology: How Shockwave Therapy Works
Despite its name, shockwave therapy involves no electrical current. Instead, a specialized handheld device generates focused acoustic energy (sound waves) that travel through a coupling gel into the underlying target tissue.
When these high-energy sound waves hit chronic or degenerated tissue, they initiate several key biological processes:
Cellular Stimulation (Mechanotransduction): The mechanical force of the sound waves creates controlled microscopic trauma in stagnant tissues. This cellular stress stimulates a localized healing response, essentially restarting the body's natural tissue-repair sequence.
Neovascularisation: The mechanical pulses prompt the release of growth factors that stimulate the formation of new micro-blood vessels. This increases localized blood flow, delivering oxygen and metabolic nutrients essential for tendon remodeling.
Nociceptive Inhibition: The therapy overstimulates local nerve fibers, which temporarily blocks the transmission of chronic pain signals. Additionally, it helps deplete Substance P (a neurotransmitter linked to persistent pain sensations), resulting in a reduction of localized discomfort.
Clinical Indications: What It Treats
Shockwave therapy is heavily backed by peer-reviewed research, particularly for conditions where a tissue has entered a state of failed healing (tendinopathy) or chronic stiffness. In our clinical practice, it is primarily utilized for:
Plantar Fasciopathy (Plantar Fasciitis): Stagnant degenerative tissue or micro-tearing along the dense band of tissue on the bottom of the foot.
Achilles Tendinopathy: Mid-portion or insertional chronic irritation of the Achilles tendon.
Patellar Tendinopathy (Jumper’s Knee): Chronic stress and pain localized just below the kneecap.
Epicondylalgia (Tennis or Golfer’s Elbow): Overuse injuries resulting in failed tendon healing on the lateral or medial aspects of the elbow.
Calcific Tendinitis of the Shoulder: Persistent shoulder impingement or limited range of motion exacerbated by calcium deposits within the rotator cuff tendons.
Integration with Rehabilitation
At Perform Health Co, shockwave therapy is never utilized as a standalone or passive treatment. While a mechanical modality can down-regulate pain and stimulate cell activity, it cannot correct underlying biomechanical issues, structural weakness, or load intolerance.
For optimal, long-term results, ESWT is integrated into an active recovery plan:
Objective Assessment: We utilize our clinical testing systems (including VALD equipment) to measure specific baseline force and strength deficits.
Pain Management: Shockwave therapy is used early in the treatment cycle to safely reduce localized pain and lower structural stiffness.
Progressive Loading: With the pain threshold lowered, patients can immediately engage more comfortably in the progressive exercise rehabilitation and functional loading plans required to permanently build tissue capacity.
A standard evidence-based protocol typically consists of 3 to 4 clinical applications, spaced roughly 7 to 10 days apart, tailored specifically to the patient’s diagnostic findings.
What a Session Feels Like
Because shockwave therapy uses mechanical energy to restart healing in already tender tissues, the treatment can feel uncomfortable, but it should never be unmanageable.
The Sensation: Most people describe it as a deep, rapid tapping or a dull, pulsing ache directly over the injured area.
Adjustable Intensity: The treatment starts at a very low setting so your tissues can adapt. Your physiotherapist will gradually increase the energy based entirely on your feedback, keeping the discomfort within a tolerable range.
Duration: The active discomfort lasts for only a very short time, as a typical shockwave application takes just 3 to 5 minutes per area.
Immediate After-Effects: Many patients experience a temporary "numbing" effect immediately after the session, resulting in a brief reduction in their original injury pain. You may notice mild redness, slight swelling, or a deep ache in the area for 24 to 48 hours afterward, which is a normal part of the body's inflammatory response.
