Shock wave therapy has emerged as a possible treatment option for patients with chronic tendon problems. The procedure uses either pressurized air or electromagnetic pulses to delivers shock waves to the body to help treat a variety of chronic disorders, including:
How It Works
There is both a high-energy and low-energy form of shock wave treatment. Both forms can be used in the treatment of these conditions.
Low-energy shock wave treatments are given as a series of three or more treatments. The low-energy shock waves are not painful, or mildly painful.
By contrast, the high-energy shock wave treatments are given at one session. High-energy shock wave treatments are quite painful, and often some type of anesthesia is needed. Either a regional block or general anesthesia can be administered for the high-energy treatments.
Shock wave therapy is thought to work by inducing microtrauma to the tissue that is affected by these problems. This microtrauma initiates a healing response by the body. The healing response causes blood vessel formation and increased delivery of nutrients to the affected area. The microtrauma is thought to stimulate a repair process and relieve the symptoms of pain.
First reported in 1996, several investigators have published successful results when using shock waves to treat these conditions. The U.S. Food and Drug Administration (FDA) subsequently approved the use of shock waves for the treatment of plantar fasciitis in 2000.1
Since that time, different versions of the technology have been developed to treat this and other musculoskeletal conditions.
Extracorporeal shock wave therapy (ESWT) uses pneumatic (pressurized air) technology to induce microtrauma, while focused shock wave therapy (FSWT) typically uses electromagnetic pulses to induce the same effect.
There are many reports about the effectiveness of the treatment of these different conditions. Some studies demonstrate good results for the treatment, particularly with calcific tendonitis and plantar fasciitis. However, there are also numerous reports that have not been as successful and show no significant difference when compared to more standard treatments of these problems.
The most attractive aspect of shock wave treatment is that it is a noninvasive option for problems that are sometimes challenging to treat. Because of these challenges, doctors are always seeking more effective treatment for patients who do not seem to improve with simpler treatments. There is increasing evidence that shock wave therapy may be a solution.
A 2017 study published in the journal Medicine suggested that ESWT was more likely to provide relief from chronic plantar fasciitis than no treatment at all. By contrast, the benefits of FSWT in treating plantar fasciitis remain unclear.2
Furthermore, one of the most concerning aspects of surgical treatment of conditions such as plantar fasciitis is that there are potentially serious complications. Few complications have been reported with the use of shock wave therapy. Patients who have surgery are at risk for continued pain, wound problems, and infections. The primary problem with ESWT is that not all patients are cured of their symptoms.
Shock wave therapy is quite expensive, and whether or not it is an effective treatment is controversial. Each individual treatment can cost a lot of money and, depending on the form you choose, may end up requiring multiple treatments.
Finally, the effectiveness of treatments is questioned. If the shock wave treatments are helpful, the difference is small. The reports in the literature are quite variable, but even in studies that show a good effect of ESWT, it probably helps only a fraction of patients. Therefore, a significant number of patients will still have pain after shock wave treatments.
Due to the lack of clear evidence supporting its use, most health insurers will not cover shock wave therapy for musculoskeletal disorders, including plantar fasciitis or tendonitis. Check the terms of your policy before starting treatment.
The jury is still out on whether or not shock wave therapy is an effective treatment for these orthopedic conditions. Current recommendations for this treatment are that it is a safe treatment for patients who have failed conservative measures and may require more invasive treatment.
It is important that patients try more traditional treatments for a period of at least six months to a year before considering shock wave therapy. For patients with plantar fasciitis, conservative treatment measures consisting of medications, ice application, exercises, and shoe inserts are often effective treatments. Furthermore, it has also been suggested that shock wave therapy be delivered over a period of six months to one year to be effective.3
Patients who have no success with these traditional treatments may benefit from shock wave therapy. It is a reasonable option to consider ESWT prior to surgical intervention. Potential side-effects of ESWT are minimal.
Therefore, in patients who have chronic plantar fasciitis, and who have failed a minimum six month trial of standard treatments, shock wave therapy is a safe treatment alternative to surgery.