Does Shockwave Work To Heal & Repair Tendons? Here’s What The Evidence Says

Does Shockwave Work To Heal & Repair Tendons? Here’s What The Evidence Says

If you’ve yet to meet our team here at PhysioCentral, there’s something you should know: the way we practice and treat you is founded on evidence-based medicine. It’s very important to us that the services we offer reflect the latest research and knowledge in our respective fields, and are in line with best practice principles.

Shockwave therapy is no exception. Shockwave is a gold-standard therapy that uses soundwaves to stimulate the body’s natural healing and repair process. When the shockwave handpiece is applied over a specific region where tendon or tissue damage is present, it penetrates down to increase the blood flow to the area and stimulate the production of growth factors and stem cells that support the growth of new blood vessels and tissues, helping repair the damage. Shockwave also works to reduce the inflammation markers in the targeted area, which means that our clients experience less pain and more comfortable movement.

So what can you expect with shockwave? While we’ve already shared an overview of what you need to know about shockwave, its benefits, and how it works (read it here), so here’s a look into the evidence behind shockwave for a range of areas of the body, including the feet, knees, back, shoulder and elbow.

Shockwave For Achilles Pain (Pain At The Back Of The Heel)

Using shockwave for Achilles injuries, we’re able to see results for both new (acute) injuries, as well as existing chronic injuries that have been problematic for our clients on and off for months or years. According to research:

  • There is a high level of evidence for efficacy when it comes to using shockwave for chronic Achilles tendinopathy. A review of the evidence found several randomised placebo-controlled trials which confirm shockwave’s excellent results with regards to function and pain.[1]
  • Shockwave has contributed to both “excellent” and “good” result categories after both 3 and 12 months for chronic non-insertional Achilles tendinopathy.[2]
  • When shockwave is paired with an eccentric loading exercise program (that we offer here), 82% of participants fell into the “completely recovered” or “much improved” categories for their chronic mid-portion Achilles tendinopathy, a higher result than compared to the loading program alone.[3]
  • A systematic review on the effectiveness of shockwave on chronic achilles tendinopathy showed that it could produce short-term pain-relieving effects and long-term increased blood flow, both of which improve outcome measures.[4]
  • Despite some gaps in the knowledge as published in literature, shockwave therapy is a safe, well-tolerated treatment modality for Achilles tendinopathy.[5]
  • The National Institute of Health Care Excellence (NICE) in the UK has declared shockwave to be safe and that it has demonstrated positive results.[6]

Shockwave For Heel Pain (Plantar Fasciitis)

At the end of 2021, a large systematic review came out that evaluated the best management approach to plantar heel pain. It included 51 eligible trials and examined 10 different treatments (interventions). There was good expert agreement with systematic review findings recommending radial shockwave for first-step pain in the short term and the long term. Interestingly, the other therapies that were found to be very helpful in managing heel pain were stretches, taping, patient education and custom foot orthotics - all of which we offer here at PhysioCentral, too.

  • Shockwave is effective for plantar fasciitis across different time points from the first date of treatment, taking into consideration a person’s pain, function and quality of life.[7]
  • This study found no side effects with shockwave, and superior results compared to a placebo for the treatment of chronic plantar fasciitis, even at 12 months after treatment.[8]

Shockwave for Knee Pain

When it comes to knee pain, the research is promising in supporting the use of shockwave therapy as an effective treatment and recovery modality.

  • A systematic review and meta-analysis demonstrated that shockwave significantly reduces pain and improves function in patients with knee osteoarthritis for up to 12 months, and with only minor complications occurring after the treatment.[9]
  • Alongside pain reduction and movement enhancement, research has shown that shockwave has beneficial effects on cartilage and subchondral bone alterations associated with osteoarthritis progression.[10]
  • Incorporating shockwave as part of a rehabilitation program following ACL reconstruction surgery has been found to improve joint function, pain relief and ability of daily living in the short term.[11]

Shockwave for Shoulder Pain

When it comes to managing and rehabilitating shoulder pain, studies concluded that:

Shockwave therapy proved to be efficient and safe in the treatment of shoulder pathologies, improving pain, range of motion and functional scores in all groups of patients that were evaluated.[12]

Adding radial shockwave therapy to a designed physical therapy program in patients recovering from a stroke is more efficient in reducing shoulder structural abnormalities, pain, and disability, compared to using a sham (fake) shockwave option.[13]

Even a decade ago, shockwave was already confirmed in the studies to be an efficient tool for the treatment of rotator cuff calcifications, with promising results reported when used on other shoulder pathologies including adhesive capsulitis (frozen shoulder), bicipital tendinopathy and distal clavicle osteolysis.[14]

Research from earlier this year showed that compared with the control group, shockwave can provide better pain relief, functional recovery, and maintenance of function in patients diagnosed with rotator cuff tendinopathy, though the evidence for this specific condition is still limited.[15]

On the other hand, for those with calcific rotator cuff tendinopathy, other recent small-scale studies conclude that shockwave is proven to be effective and thus strongly recommended for the management of this condition, improving the pain, functionality, and quality of life of these participants and decreasing the size of calcified deposits.[16]

A small-scale study that looked at both shoulder and neck pain after using shockwave found that consecutive treatments (twice per week) were effective in treating neck and shoulder pain syndrome with functional improvement and pain reduction.[17]

Shockwave for Back Pain

Managing pain in the upper and lower back is a multifaceted issue, with back pain being one of our key areas of focus. Each rehabilitation and management plan is designed uniquely based on your symptoms, diagnosis and causative factors. In circumstances where shockwave is a suitable treatment modality:

  • Shockwave treatment using the exact Swiss DolorClast®️ machine we have available proved itself to be safe, effective and also the most efficient in reducing low back pain, even compared to non-steroidal anti-inflammatory medication.[18]
  • A systematic review and meta-analysis involving 632 patients found that shockwave provided better pain relief and improved lumbar dysfunction compared with the other interventions they included in the study, and no serious adverse effects were found.[19]

Shockwave for Elbow Pain

Finally, another common use for shockwave is to help with elbow pain, for example, with tennis elbow and golfer’s elbow. Studies report:

  • When compared with local and systemic drugs, shockwave therapy recorded a higher improvement rate in all the parameters. The study concluded that shockwave is a non-invasive, effective and safe technique that can be successfully used in the treatment of abarticular pathology of the elbow.[20]
  • For newly diagnosed patients with tennis elbow, shockwave can reduce the severity of pain and improve daily activity.[21]
  • Shockwave therapy revealed better improvement on long-term clinical and ultrasonographic follow-ups compared to corticosteroid injections, despite both proving to be helpful for pain and function.[22]
  • A 2020 systematic review and meta analysis found that shockwave therapy can effectively relieve the pain and functional impairment (loss of grip strength) caused by tennis elbow, with better overall safety than several other methods.[23]

Shockwave Is Proven To Be Effective In Managing A Range Of Musculoskeletal Injuries

The bottom line across many studies is that shockwave has repeatedly proven its efficacy for a range of musculoskeletal pains and injuries, both in its healing and reparative effects, and even in its superior results compared to other treatment modalities. We’ve explained exactly how it works in our shockwave article (read it here), but as a recap, shockwave is thought to produce its beneficial restorative effects by:[24] 

  • Stimulating collagen production - collagen is an essential component of repairing certain tissues, so helping produce more helps to optimise the repair process
  • Reducing pain - by reducing the concentration of a neurotransmitter called substance P involved in feeling pain
  • Promoting new blood vessels to form - blood flow carries oxygen and nutrients, so the more that gets to an injured area, the better for the repair process
  • Helping release trigger points in the muscles
  • Helping break up calcifications in the tendon fibres which may have previous built up from injury

 

If you have any questions, or are unsure if shockwave could be right for your pain or injury, get in touch with our team. Contact us by calling +852 2801 4801 or send us an email on info@physiocentral.com

 

References

[1] - https://www.sciencedirect.com/science/article/pii/S1743919115011164

[2] - https://pubmed.ncbi.nlm.nih.gov/18006678/

[3] - https://journals.sagepub.com/doi/10.1177/0363546508326983

[4] - https://pubmed.ncbi.nlm.nih.gov/23386759/

[5] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6948318/

[6] - https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/TraumaandOrthopaedics/6459-1-Extra-corporeal-Shock-Wave-Therapy-ESWT-for-non-insertional-Achilles-tendinopathy.pdf

[7] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006537/

[8] - http://www.ncbi.nlm.nih.gov/pubmed/18832341

[9] - https://academic.oup.com/painmedicine/article/21/4/822/5593618

[10] - https://portlandpress.com/bioscirep/article/40/11/BSR20200926/226702/Extracorporeal-shockwave-treatment-in-knee

[11] - https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-024-07177-8

[12] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8478428/

[13] - https://www.archivesofmedicalscience.com/The-influence-of-radial-extracorporeal-shock-wave-therapy-on-shoulder-pain-and-structural,151477,0,2.html

[14] - https://www.sciencedirect.com/science/article/pii/S1743919115011917

[15] - https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-024-07445-7

[16] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8916860/

[17] - https://www.kjsm.org/journal/view.html?doi=10.5763/kjsm.2020.38.4.208

[18] - https://www.ems-dolorclast.com/studies-library/reswt-nsaids-or-both-which-approach-works-best-when-treating-low-back-pain

[19] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290808/

[20] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421473/

[21] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869227/

[22] - https://erar.springeropen.com/articles/10.1186/s43166-021-00081-2

[23] - https://onlinelibrary.wiley.com/doi/10.1155/2020/2064781

[24] - https://www.hindawi.com/journals/bmri/2019/3086910/