Shockwaves run through running injury treatments
How many of us runners have endured painful injections, even surgery to reduce pain in the Achilles, plantar fascia or knee? There is a new treatment choice that is literally sending shockwaves through the running therapy community, getting faster and greater results that more invasive methods have ever achieved before.
Extracorporeal shockwave therapy (ESWT) was first discovered to have benefits to common soft tissue injuries back in the mid 1980's, but some poor early research meant that many healthcare practitioners denounced its claims and turned their back on ESWT.
However as long ago as 2000 that the treatment gained approval for plantar fasciitis and by 2002 things were really moving when tennis elbow was also approved. Sciatica Since then the achillies tendon, shoulder injury, patella tendons and high hamstring tendinopathy have all been added to the list.
With success rates ranging from 65 – 91% its clear to understand why shockwave therapy is fast becoming the leading treatment for musculoskeletal disorders with more and more injuries being added to the approved list as new research is presented.
I have been in private practice for nearly 15 years and worked with athletes for over 20 years as an exercise physiologist and physiotherapist and I haven't ever achieved the results I can now since buying my shiny new shockwave therapy machine in early 2015.
The treatments are expensive, with average prices of £500 for a course of treatment, t first it appears to be something reserved for the elite or wealthy, but as more and more machines become available the prices will start to come down. www.physioandtherapyUK.co.uk offer shockwave therapy for as little as £59.25 per session for example and others will follow suit.
So how does it work?
Shockwave therapy encourages the natural healing process through increased blood supply and by breaking up the calcium deposits within the tendon.
The shockwaves produce a mechanical pressure and tension force on the afflicted tissues, increasing the cell permeability. This increases circulation, increasing metabolism, thus promoting healing and dissolution of the pathological calcium deposits.
Behind this initial shockwave, comes hundreds of thousands of cavitational bubbles, created behind the energy front, which expand and then col expand and then collapse, causing microjets, a secondary force directed at the tissues.
Soft tissue cells required for tissue growth and healing are called fibroblasts and bones cells have their version of this cell called osteoblasts. Both fibroblasts and osteoblasts are stimulated by shockwave therapy, thus increasing the tissue repair and remodeling phase, following the breakdown of calcium and increased circulation.
Finally, evidence has shown that ESWT reduces pain in two ways. First of all through hypostimulation of the tissues causing anesthesia. Whilst this is short lived, there is an effect on the pain gate mechanism, whereby messages to the brain are reduced as shockwave therapy serves to ‘close the gate' for pain signals to the brain, thought to trigger a sort of ‘reset' button that can recalibrate pain perception.
Shockwave is available in a handful of private clinics across the UK, with prices per session ranging from £60 - £100's per session, there is a vast difference in how much you will expect to pay and some of this is frankly down to a postcode lottery. The number of sessions required is 3-4 per injury site. The diagnosis of the injury, the decision clinically to offer shockwave therapy resides with the clinician based upon your examination. There may well be a cost for this consultation on top of the treatment itself and as yet it is not possible to simply turn up to a clinic and ask for the treatment, it has to be right for you.
The treatment is not pain free, but is very mild when you compare injections or even surgery and the complications are very minimal. No treatment can be applied directly over lung tissue and it is contraindicated for those taking anticoagulant medication, but other than a few other common reasons for avoiding treatments of any kind, shockwave therapy has very few limitations to its application. You will not be allowed ESWT for 12 weeks following a steroid injection.
The sessions are over quickly, 10 shocks per second for 2000 shocks is normal, following a lower setting for 500 warm up shocks. The total time in clinic can be as little as 15 minutes for the treatment itself. You only need to attend 3-4 times and you can largely go about your normal business immediately afterwards. There is a recommendation that you take a break from strenuous training for 2 days after each treatment and these are 7-14 days apart.
Studies are looking at the long-term effects of the treatment, with studies showing an improvement in symptoms at 3months, 6 months and even 24 months after the treatment. I have noticed that my patients almost always feel an immediate improvement following the first treatment with one long term achillies sufferer being 90% pain free after just the first application, others took 4 weeks to be convinced of the treatments benefit. Most clients have experienced a slight return of their symptoms 3 weeks after the last treatment but by 6 weeks post treatment the beneficial effects have returned and they are back running and enjoying pain free training.
Shockwave therapy is not used alone, patients must be complaint with their rehabilitation programme and in the example of the achillies clients, eccentric heel drops have been maintained throughout, however these alongside other treatments had previously had no effect.
As a practitioner, working as a specialist running physiotherapist, treating the elite level runners such as Steve Cram, Paula Radcliffe, Scott Overall, Rossco Murray and alike, I am always looking to keep up to date with the latest treatments. In the UK health care practitioners have been looking unfavorably at shockwave therapy for the last decade, whereas our counterparts in Europe have been enjoying the benefits. Whilst at a conference at the royal college of surgeons in London this year I was privileged to hear from one of Germany's pioneering research forces behind ESWT, who was almost laughing at the British attitude to this treatment choice. We held onto poorly performed research that seemed to disprove its use and have continually and routinely injected tendons and ligaments with less scientific basis than there is for shockwave therapy.
Shockwave therapy has less implications and risks and a significantly higher percentage success rate than surgery, injection or standard physiotherapy, in fact it is what many would consider the ‘leader' of many musculoskeletal injury treatments, especially those chronic ones typically sustained by runners.
I would not consider myself a leading clinic if I did not offer this therapy, yet hardly anyone in the UK has heard of it, until now. So if you have a long standing achillies, plantar fascia, patella tendon or high hamstring injury that hasn't responded to all the usual treatments, then please take my advice and seek out shockwave therapy at the most convenient clinic. Even if it does cost you several hundreds of pounds, consider the amount of money already spent and the value of getting back to running will hold for you.
For more information or for an email consultation go to shockwave@physioandtherapyuk.co.uk