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Patients often have many questions about Shockwave. So on this page we aim to answer some of the top questions that we hear in clinic. We would never allow someone to book direct in for a shockwave appointment, so please don’t think you need to decide if it is the right treatment for you.
It is crucial that a thorough assessment is carried out first in clinic, so that one of our experienced podiatrists can put in place the correct treatment plan for you. Every person is different. Every treatment plan is bespoke.
What is shockwave therapy?
What are the different types of shockwave treatment?
What is the difference between radial and focused shoc kwave?
There are 2 types of shockwave:
This quick video shows focused shockwave in use.
Focused shockwave is where a piezo electric (electricity generated by pressure and latent heat) crystal is in a handheld piece of equipment creates a mechanical shockwave that is focused down to a central point via an applicator on to your skin. That shockwave then travels into the tissue at different frequencies and pressure to affect different types of structures.
Focused shockwave has a deeper penetration into the tissue than radial. It can travel up to 8 cm into soft tissue, which is what makes focused a good choice for joint issues.
In this short video Clinical Director, Ben Haythornthwaite explains how radial shockwave works.
Radial shockwave is a mechanical ball bearing inside a tube that impacts on an applicator at the end of the tube and creates a mechanical shockwave that ripples out like dropping a stone in a pond.
This has a slightly lesser reach into soft tissue than focused and is widely accepted as being the better choice for more superficial structures such as ligaments or tendons.
How does shockwave therapy work?
Both focused and radial are effectively pro-inflammatory.
Inflammation is part of healing and shockwave encourages all the cellular activity you need in what is called an acute inflammatory response.
The problem we have when people need shockwave is that they have a wound. Not a wound that you can see, but a wound inside their body, for example torn ligaments. Unlike a wound outside the body we can’t see what condition the internal wound is in accurately, even with modern ultrasound, mri or xray. The other problem we have in the lower limb (ie foot, leg and ankle) is that you have to put weight on it for day to day life. Putting weight on it effectively is like picking a scab on the skin, every time you do it, as it places pressure on the area. When you continually pick a scab it resets the healing process, of which it is largely accepted that there are 4 main stages of:
Stage 1 is hemostasis i.e. the stopping of bleeding.
Stage 2 is in the inflammatory stage which is problematic if it is prolonged or excessive.
Stage 3 is known as the proliferative phase. This third stage is where the wound starts to contract as you build new tissue, including a new network of blood vessels to allow granulation tissue to form.
Stage 4 is something called the maturation stage. This is where collagen is changed from one type to another to allow tensile strength to develop in the wound, very similar to the tissue around it.
Shockwave encourages the cellular response to help move through the healing process, whilst still bearing weight on the area (eg walking).
In a nutshell, they optimise the healing environment which allows a structure in the body to heal, whilst still under duress (ie whilst still being used such as standing or walking) in the most timely fashion possible.
When to use shockwave therapy and when not to …
There are certain occasions when it is not suitable. So, who should not get shockwave therapy?
- those suffering from a circulation or nerve disorder
- pregnancy under 18 year olds
- where infection or open wounds are present
- where there is a bone condition such as a tumour or osteomyelitis (infection of the bone)
- if anticoagulants or antiplatelets are being taken those suffering from severe circulatory disorders such as peripheral vascular disease
What to expect….
During treatment gel is applied to the skin and the handset is then placed over the skin and moved around the affected areas. Focused creates an aching sensation whereas radial is more like a fast repeated pressure (and is a bit more noisy).
Immediately after treatment, although everyone is different, patients tend to say the area feels quite free. However, the structure doesn’t repair immediately. The most optimal healing time for a soft tissue structure such as a tendon or ligament to heal is approximately 4 to 6 months. The shockwave just helps to bring along this process.
What is it a good alternative for?
At the clinic we don’t really see it as an alternative to anything, as there are benefits to all the different treatments available. It’s more a case of making sure the right treatment is assigned to the right individual and their particular case. In that sense we often see people who think they need to have injections or surgery, but shockwave if used as part of the right treatment plan, can put off or even negate the need for injections or surgery.
How do we use it in clinic? Is it part of a wider treatment programme or stand alone?
We rarely use shockwave as a standalone treatment as very few conditions are that simple. A full treatment programme tackling the different issues is often required to get a positive outcome.
Who performs shockwave therapy?
Shockwave is carried out by our experienced podiatrists, who all have a degree in podiatric medicine.
How many sessions will I need?
In clinic, on average, we see people needing up to 6 sessions.
Can shockwave therapy cause damage or make conditi ons such as plantar fasciitis worse?
Whilst it is technically always possible as an outside force is being applied to the body, it is not something we have ever seen in clinic and there is no clinical research to suggest that shockwave therapy causes damage. In fact the research points to the exact opposite, citing it as away to improve damaged structures inside the body.
Is it painful to have shockwave?
In this short 20 second video, our patient Dan explains what it feels like
Is shockwave therapy good?
Yes it can be brilliant but it all depends on the condition that it is treating and is why it is essential that a thorough assessment is carried out first, to ensure the right treatment plan is put in place.
What are the benefits of shockwave?
It’s non-invasive and can be extremely effective.
Why is Shockwave therapy not working?
We often see people at our clinic who before coming to us may have had a few sessions of shockwave elsewhere and written it off as not having worked. In the vast majority of cases these people have had 3 or less sessions and not had the correct surrounding treatment carried out to enable shockwave to work.
Is shockwave the same as a tens machine or a massage gun?
No. In principle radial shockwave has similarities to a massage gun but it is significantly more capable and designed for a different purpose. Focused shockwave is completely different to either a tens machine or a massage gun.
Top conditions that we use shockwave for in clinic…
Shockwave for plantar fasciitis – foot pain
Plantar fasciitis is chronic inflammation around the plantar fascia. Shockwave is often used as a treatment for plantar fasciitis because it is a chronic condition that we need to improve the internal environment inside the foot for the plantar fascia to heal.
The problem with it is that it only treats the source of the pain not the reason why the plantar fascia is inflamed in the first place eg the plantar fascia may be inflamed because it is overloaded.
the shockwave can help to get rid of the pain however, if you don’t treat the wider mechanical cause the pain will return. In the clinic we therefore use shockwave in the majority of cases as part of a wider treatment plan. For more information on this please click through to our foot pain page.
Although both types of shockwave may be applicable, focused shockwave is generally a less painful approach for the patient and therefore the one that we choose in the clinic.
Patellar tendinopathy is where the tendon around the patellar is in a chronic state of repair and is likely to have a reduction in its tensile strength (tensile is where a structure is pulled from both ends and its ability to resist tearing when this happens). Shockwave therefore rewinds the healing process to then encourage it to optimise healing.
Shockwave is not a cure in its own right but it works incredibly effectively in most cases as part of a wider treatment plan that may include laser, exercise, manipulations, mobilisations and fascial manipulation. For more information on this please click through to our knee pain page.
Shockwave for achilles tendonitis or ankle sprain – ankle pain
Achilles tendonitis is inflammation of the peri-tendon (a structure that sits around the tendon) that becomes inflamed and puts pressure on the achilles itself. Shockwave therefore is useful to once again help with the inflammation process. In clinic we use it alongside fascial manipulation where indicated. Click here for more information on fascial manipulation. Click here for more information on ankle pain.
Shockwave for nerve damage
Shockwave can be used as a way of helping to sensation where patients are suffering with nerve damage. However, there are often other complexities to also consider in these cases so it is assessed on a case by case basis.
If you are suffering with pain…
Please click on the relevant treatment area to find out how we can help you…