By Gordon, R. and Johnson, K. (2018)
What is Focused Shockwave?
As the general public, we will often strive through any aches or pains that we experience and manage them on a daily basis. We will often perceive that a chronic/long-standing injury will be better resolved through surgery. Whilst this is true for some conditions, many can be managed conservatively with the use of therapeutic techniques including exercises, rehabilitation, and manual therapy.
Extracorporeal Shockwave Therapy has been used to help break up kidney stones and choleliths (gallstones) for more than 30 years. Focused Shockwave is the latest generation of this technology to be developed through scientific advances in medical research for the safe and often pain-free treatment of many musculoskeletal, fascial, and vascular conditions.
Advantages of Focused Shockwave?
- It’s non-invasive (does not cut the skin or enter any body spaces)
- There’s no risk of infection
- It has National Institute for Health & Clinical Excellence (NICE) approval
- No risk of tendon rupture compared with long term steroid injections
- Requires no anesthesia or pain medication for treatment
- It is approved by most medical insurers
How can it help me?
Focused Shockwave will specifically target the injured area and treat the injury at the piezoelectric transducer (treatment head). The depth of penetration of this focused acoustic pressure wave is achieved by using specially shaped gel pads. The depth of penetration ranges from 5mm to 60mm below the surface of the skin. If the pain is affecting mobility and activities of daily living due to muscle or fascial tightness, tendinopathy, or joint stiffness, Focused Shockwave, combined with a comprehensive treatment plan of exercise, physiotherapy, and/or ergotherapy may help people who have not had success with traditional treatments.
How does it work?
Without getting too technical, the waves from the piezoelectric transducer are focused on a specific point. Think of it as a gentle sonic jackhammer that focuses its energy on targeted tissue. It goes deep into the tissue and joints where a therapist’s fingers or hands cannot penetrate. The focused energy will cause micro trauma to the targeted tissue. This trauma to the muscle, joint, or tendon jumpstarts the body’s natural inflammatory and repair responses. It triggers the cells to respond to the physical stress by releasing the body’s own healing agents to repair and ultimately heal.
The results from the mechanical stimuli can lead to improved circulation (neovascularisation), and pain relief which are key components in the healing process. Tissue needs blood flow to carry oxygen and other nutrients to the tissue, whilst at the same time carrying away the metabolic waste caused by inflammation.
What should I expect?
The pressure wave is created is outside of the body (extracorporeal) by a precision-engineered mesh of man-made crystals that react to electricity. When an alternating current is passed through the crystals they expand and contract in synchrony and generate a pressure wave. Think of when you drop a stone into a puddle, it creates a ripple or wave on the surface. In the case of the pebble in water, the waves diverge or spread out. However, with Focused Shockwave, the waves all focus to come together and meet at a specific point (ie. at the target tissue).
As the energy is focused, it is much more efficient. As opposed to other shockwave machines this device is a lot less painful and allows us to adjust the intensity and frequency depending on your symptoms. Other devices are often referred to as “shockwave”. It is just that, a very intense violent mechanical impact that is like a mini hammer pounding on your sensitive tissue. It is much more like the “divergent” or “diffusive” impact where there is a point of impact and subsequent diffusion of the energy. The deeper the tissue the higher the point of impact is needed to reach it.
As with either device, results are not always instant, but if properly applied within sessions the results can be quite dramatic. The treatment, as with most things in life, is often operator-dependent. Your therapist will talk you through your condition and what you are likely to experience as normal to put your mind at ease.
While some treatments may be extremely effective, rarely is it a quick fix. It will often take a combination of different therapies, proper management of a stretching and strengthening program. Your therapist will also take you through a rehabilitative exercise program for your long-term benefit and prevent the injury from reoccurring.
What conditions can it treat?
- Carpal Tunnel Syndrome
- Tennis Elbow
- Calcific Tendonitis of the Shoulder
- Frozen Shoulder
- Golfers Elbow
- Trigger Point treatment
- Pseudarthrosis (a fracture that doesn’t heal after 6-8 weeks it is considered to be a non-union)
- Greater Trochanteric Pain Syndrome
- Patella Tip Syndrome (Jumpers/Runners knee)
- Medial Tibial Stress Syndrome (Shin Splints)
- Plantar Fasciitis
- Achilles Tendinopathy
- SacroIlliac Joint Pain
 Contraindications to Treatment
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- Infections/Skin abrasions over the treatment area
- Tumor/Lung/Brain tissue in the piezo-wave entry window
- Fitted Pacemaker
- Pregnancy (within the surrounding area)
- Taking anti-coagulants
- Blood clotting disorders (including thrombosis)
- Hemo-diluting medication
- If you have received a steroid injection or FluoroQuinolones within 6 weeks
- Neuropathic conditions affecting sensation in the treatment field