Where do we start with the research, as there are thousands and thousands and thousands of papers? Some excellent RCTs and some not-so-good studies, but the overriding feedback is that shockwave therapy, both radial and focused, is SAFE – that is the number one thing.
To build on that, it is RIDICULOUSLY SAFE!!!
Of course, you can be unsafe with it e.g. if you treat a patient who meets one (or more) of the contraindications (below) or if you are using toooo high of energy for wayyyyyy too long i.e. 0.5mJ/mm2 for 20,000 shocks.
There is always a risk, so if you are unsure about something, DON’T treat the patient and seek help or advice.
Our specialists are always on hand to offer free advice and guidance,
*Disclaimer – the decision is still yours to treat and not our responsibility so if you are not comfortable treating a patient, just don’t do it.
Overall, shockwave therapy has limited risks and side effects, making it a safe treatment option for several MSK conditions, injuries and pain.
Shockwave – Contraindications
Cited from the International Society of Medical Shockwave Therapy (ISMST). For device-specific contraindications, speak to your local, OFFICIAL, supplier/representative.
Absolute contraindications:
Radial pressure waves (RPW) and/or focused shockwaves with low energy:
- Malignant tumour in the treatment area (not as an underlying disease)
- Fetus in the treatment area
Relative contraindications:
- Epiphyseal plate in the treatment area
- Brain or Spine in the treatment area
Absolute contraindications with high energy focused waves:
- Lung tissue in the treatment area
- Malignant tumour in the treatment area (not as an underlying disease)
- Severe coagulopathy
- Fetus in the treatment area
What do the bigwigs say…
Both NICE and the FDA have published several approvals for shockwave therapy across many indications.
It is noted that shockwave therapy must be delivered by a qualified therapist who can show competency in delivering shockwave therapy. The vast majority of major insurers in the UK will need to have evidence of this.
Shockwave therapy is reimbursed by several private healthcare insurers. We advise you to call them and find out their tariffs and see what shockwave therapy can pay you!
Effectiveness on indications
Where on Earth do we start on this, as we mentioned before, there are thousands of papers! First, let’s look at what the ISMST have as their primary and secondary treatment indications:
1. Approved standard indications
1.1. Chronic Tendinopathies
1.1.1. Calcifying tendinopathy of the shoulder
1.1.2. Lateral epicondylopathy of the elbow (tennis elbow)
1.1.3. Greater trochanter pain syndrome
1.1.4. Patellar tendinopathy
1.1.5. Achilles tendinopathy
1.1.6. Plantar fasciitis, with or without heel spur
1.2. Bone Pathologies
1.2.1. Delayed bone healing
1.2.2. Bone Non-Union (pseudarthroses)
1.2.3. Stress fracture
1.2.4. Avascular bone necrosis without articular derangement
1.2.5. Osteochondritis Dissecans (OCD) without articular derangement
1.3. Skin Pathologies
1.3.1. Delayed or non-healing wounds
1.3.2. Skin ulcers
1.3.3. Non-circumferential burn wounds
1.3.4. Cellulite
Secondary Indications (empirically tested)
2. Common empirically-tested clinical uses
2.1. Tendinopathies
2.1.1. Rotator cuff tendinopathy without calcification
2.1.2. Medial epicondylopathy of the elbow
2.1.3. Adductor tendinopathy syndrome
2.1.4. Pes-Anserinus tendinopathy syndrome
2.1.5. Peroneal tendinopathy
2.1.6. Foot and ankle tendinopathies
2.1.7. Trigger Finger
2.2. Bone Pathologies
2.2.1. Bone marrow edema
2.2.2. Osgood Schlatter disease: Apophysitis of the anterior tibial tubercle
2.2.3. Tibial stress syndrome (shin splint)
2.2.4. Knee Osteoarthritis
2.3. Muscle Pathologies
2.3.1. Myofascial Syndrome
2.3.2. Muscle sprain without discontinuity
2.4. Neurological Pathologies
2.4.1. Spasticity
2.4.2. Carpal tunnel syndrome
Now some of these indications may be WAYYYY outside of your scope of practice, and some, admittedly, maybe a little questionable. The indications highlighted in BLUE are the “biggies” we highly recommend using both radial and focused shockwave therapy for.
Rather than go into it much more, we would recommend having a look at a couple of our other blogs:
- How does shockwave work
- Shockwave for plantar fasciitis
If you want to delve into it more, a visit to the ISMST website would be a good start. If you want to look into the research, try starting with a couple of systematic reviews on MSK disorders. The 3 below is what we recommend starting with and see how you get on from there.
- Extracorporeal shockwave therapy in musculoskeletal disorders (2012) Ching-Jen Wang. Journal of Orthopaedic Surgery and Research
- The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders (2018) Daniel Moya et. al. Journal Bone Joint Surg Am.
- Clinical Application of SWT in MSK Disorders (2014) Ioppolo et. al. European Journal of Physical and Rehabilitation Medicine
Otherwise, is shockwave therapy effective? It is used and highly trusted treatment by hundreds of private clinics, NHS hospitals and elite sports teams across the UK and hundreds of thousands more worldwide.
If you want to speak to one of our demo centres to find out their experiences, contact us.