What is Shockwave Therapy?
Shockwave therapy is used to treat chronic (long-term) soft tissue conditions such as plantar fasciitis that has failed to respond to normal treatment. The technology is based on lithotripsy, which has been used since the 1980's for the treatment of kidney stones. shockwave therapy technology was adopated for use in soft tissue conditions in the 1990's and has gradually grown in popularity since. A shockwave is a high-energy sound wave that is targeted to the injury using a hand-held applicator. Shockwaves are repeatedly applied to the injury area, which breaks down scar tissue and calcifications.
Radial Shockwave Therapy vs Focused ShockwaveTherapy
There are two main types of shockwave therapy, which are radial shockwaves and focused shockwaves. The differences are around how the shockwaves are generated and interact with biological tissue. In terms of effectiveness, there currently isn't enough research to prove that one is more effective than the other. Radial shockwave therapy is more readily available so most providers offer this option and typically it involves 3 weekly treatment sessions, whereas focused shockwave therapy is less frequently used and typically involves 1 treatment session. Focused shockwave therapy can penetrate deeper structures than radial shockwave therapy, however this is not a benefit when treating heel pain as the depth of radial shockwave therapy perfectly adequate.
Does it Work?
In short, yes, shockwave therapy does work for the majority of patients with plantar fasciitis, however it doesn't work for everyone. I have been using shockwave therapy for over 7 years and find that the success rate is approximately 70%. This success rate appears to be similar to clinical studies investigating shockwave therapy for treating plantar fasciitis. If you would like to learn more about the research check out my blog article here
How Does it Work?
Researchers don't yet fully understand how exactly shockwave therapy works, however it is proposed that the mechanical effects of the shockwaves stimulate a cascade of biological changes which promote healing and tissue repair. It is believed that as the shockwave breaks down the injured tissue, it re-ignites the acute phase of healing, which is the body's natural process for injury repair.
Generally, shockwave therapy for plantar fasciitis is very safe. It is non-invasive and does not require a local anaesthetic. Rarely, there may be increased swelling, pain or bruising after treatment. Patients taking blood thinners medications are advised to stop their medication before receiving shockwave therapy due to the increased risk of bleeding. Contraindications include a surgical implant near the treatment area, patients with cancer and pregnancy.
Shockwave therapy is a good treatment option for chronic cases (longer than 3 months) of plantar fasciitis. In my experience, the majory of patients wait until their heel pain has become chronic before seeking treatment. This often means that the degenerative changes within the plantar fascia are more advanced and are less likely to heal despite normal treatment. This is when shockwave therapy is a good treatment option, however, it should not be used as an isolated treatment as it does not address the underlying cause of the condition. shockwave therapy increases your body's own ability to heal itself and should, therefore, be used as an adjunctive treatment with other mechanical treatments such as stretching, orthotics, a night splint, and appropriate footwear.