Medical Effects of Shockwave Therapy

  1. New Blood Vessel Formation

Nutrient blood flow is necessary to start and maintain the repair processes of damaged tissue structure. The application of acoustic waves creates capillary micro ruptures in tendon and bone. Due to micro ruptures the expression of growth factors such as eNOS, VEGF, PCNS and BMP is significantly increased. As a result of these processes arterioles are remodeled, stimulated to grow and new ones are formed. The new blood vessels improve blood supply and oxygenation of the treated area and support faster healing of both the tendon and the bone.

  • Reversal of Chronic Inflammation

Chronic inflammation occurs when the inflammatory response is not completely halted. It can damage healthy tissue and results in chronic pain. Mast cells are one of the key components of the inflammatory process. Their activity may be increased by using pervasive acoustic waves. Mast cell activation is followed by the production of chemokines and cytokines. These pro-inflammatory compounds first enhance the inflammatory process and in the next step help restore normal healing and regenerative processes. 

  • Stimulation of Collagen Production

The production of a sufficient amount of collagen is a necessary precondition for the repair processes of the damaged myoskeletal and ligamentous structures. Shockwave therapy accelerates procollagen synthesis. The therapy forces the newly created collagen fibers into a longitudinal structure which makes the newly formed tendon fibers denser and stiffer and creates a firmer structure.  

  • Dissolution of Calcified Fibroblasts

Calcium build-up is most often a result of micro-tears or other trauma to a tendon. Acoustic waves break up the existing calcifications. Shockwave therapy starts the biochemical decalcification of the calcium build-up of a toothpaste-like consistency and treats the tendon. The granular particles of calcium are then removed by the lymphatic system.

  • Release of Trigger Points

Trigger points are the principal cause of pain in the back, neck, shoulder and limbs. They are associated with palpable nodules in taut bands of muscle fibers and have extremely contracted sarcomeres. The dysfunctional sarcomeres contract so tightly that they begin to cut off their own blood supply. This causes the waste products to build up. Waste product build-up irritates the sensory nerve endings which then causes even more contraction. This vicious cycle is referred to as “metabolic crisis”. The assumed mechanism of action is that the delivered acoustic energy unblocks the calcium pump and thus reverses the metabolic crisis in the myofilaments and releases the trigger points.

Is there clinical evidence supporting the use of shockwave therapy?

There is a significant body of evidence supporting the use of shockwave therapy in many common conditions. The use of shockwave therapy for tendon issues is well supported by the National Institute for Health and Care Excellence (NICE). NICE provides national guidance and advice to improve health and social care in both NHS and private practice. It provides evidence-based recommendations to guide best practice within healthcare. NICE have produced guidelines for the use of shockwave in the treatment of Achilles tendinopathy, plantar fasciitis and calcific tendinopathy.

In summary, shockwave therapy significantly reduced the pain that accompanies tendinopathies and improves functionality and quality of life. It has been stated that shockwave therapy has a 70% success rate for tendinopathies (Moya et al, 2018, Dedes et al 2018).