Extracorporeal Shockwave Therapy (ESWT)
What is shockwave therapy?
At Sports and Spine Physiotherapy, we offer cutting-edge treatments to help you recover from musculoskeletal injuries and conditions. Located in the heart of Bondi Junction, one of the techniques we specialise in is Focused Extracorporeal Shock Wave Therapy (ESWT), a non-invasive and proven way to alleviate pain and promote healing.​
How does shockwave therapy work?
Shockwave Therapy uses high-energy sound waves (1000 times greater than ultrasound), which has mechanical and cellular effects that improve tissue healing and alter pain signalling.
Radial Versus Focused Shockwave Therapy
There are two types of shockwave therapy, radial and focused. Radial delivers low energy shockwaves to the affected area in a radial pattern, spreading out from the point of contact with the skin. It’s used to treat superficial tissues.
Focused shockwave therapy, on the other hand, uses a device that delivers high-energy shockwaves to a specific, targeted deeper area of the body. Focused shockwave therapy can be used to target deeper tissues and is typically used for more severe conditions such as fracture, or deep tendon injuries.
At Sports and Spine Physiotherapy, we use Focused Shockwave Therapy. We are one of the few clinics in Sydney that offer this cutting-edge approach, with up to 90% of patients experiencing a substantial improvement in their symptoms across the course of their treatment, with the majority of patients feeling some immediate relief of their symptoms after the first two treatments.
Mechanisms of Shockwave Therapy
Boosts Collagen Production
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Shock wave therapy stimulates the release of growth factors that promote collagen production. Collagen is a key protein that helps repair and regenerate tissues like tendons and ligaments, speeding up healing after injury.
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Enhances Tendon Healing
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Tendons are made up of cells called tenocytes that are responsible for maintaining and repairing the tissue. Shock waves can increase the activity of these cells, supporting faster recovery from tendon injuries.
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Stimulates Bone Healing
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Shock wave therapy activates bone-forming cells called osteoblasts, encouraging the growth of new bone tissue. This is especially helpful for treating bone injuries, like fractures that aren’t healing properly (e.g., non-union fractures or stress fractures).
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Accelerates Muscle Tear Recovery
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Shock waves can speed up muscle tear recovery by stimulating tissue repair and improving blood flow to the affected area, reducing recovery time.
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Pain Relief and Nerve Inhibition
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Shock wave therapy can help reduce pain by inhibiting pain signals from nerves. The shock waves interfere with the nerve pathways that transmit pain, providing a natural form of pain relief. It can also help reduce muscle tension and improve overall comfort during the healing process.
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Promotes New Blood Vessels
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Nitric oxide is released during shock wave therapy, which helps relax blood vessels and improve circulation. This increased blood flow delivers more oxygen and nutrients to the injured area, promoting healing. It also helps reduce inflammation, which is beneficial for chronic pain or injuries involving swelling.
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Enhances Surgical Outcomes
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Shockwave has been shown to facilitate orthopaedic surgeries, such as ACL surgery, in the success of the graft and healing of the bone.
Conditions Shockwave Therapy Treats
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Acute Musculoskeletal Injuries in Elite Athletes
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Osteoarthritis [1]
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Cartilage Regeneration
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Reduction of Bone Oedema
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Fractures [2, 3]
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Non-Union Fractures
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Poor Healing Fractures
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Stress Fractures
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Tendinopathies [4-7]
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Rotator Cuff Tendinopathy
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Proximal Hamstring Tendinopathy
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Achilles Tendinopathy
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Patella Tendinopathy
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Tibialis Posterior Tendinopathy
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Peroneal Tendinopathy
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Gluteal Tendinopathy
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Calcific Tendinopathy, Rotator Cuff Calcific Tendinopathy
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Plantar Fasciitis [8]
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Iliotibial Band Syndrome [9]
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Medial Tibial Stress Syndrome / Shin Splints [10]
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Muscle Tear Healing [11, 12]
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Accelerates Return to Play and Reduces Risk of Reinjury
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Post ACL Reconstruction [13]
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Improved Graft Ligamentisaion, Bone Oedema, and Size of Tibial Tunnel
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Faster Return to Play
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Hip Bursitis [14]
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Frozen Shoulder [15]
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Urological indications (ED) Erectile Dysfunction [16]
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Chronic Pelvic Pain / Endometriosis [17]
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Wound Healing and Scar Treatment [18]
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Scar Tissue [18]
ACL Reconstruction Healing Before (A & B) and After 3 Sessions of Focused Shockwave (C) [13]
Different sagittal MRI scans show bone marrow oedema ((A), orange star), tunnel liquid effusion ((B), orange star) and no signs of oedema or liquid effusion after shockwave (C).
Shockwave Therapy is a useful treatment for chronic conditions that have not responded to other treatments.
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Most of the patients who undergo shock wave therapy show significant reduction of pain and improvement in movements of the affected part comparable to other conservative options. At Sports and Spine Physiotherapy, we’ve had many patients go on to run marathons and Ironman distance events following 3 sessions of shockwave therapy for the management of painful tendons, plantar fasciitis.
What Can I Expect in a Shockwave Treatment session?
Each treatment session lasts approximately 20 – 30 minutes where your physiotherapist will apply the Shockwave energy to the target area. This involves positioning the Shockwave therapy handpiece onto the injured area to allow the unit to gently and extensively transmit shock waves deep into that region. The feedback you provide helps the clinician fine-tune the position of the applicator and the intensity of the treatment.
How Many Sessions of Shockwave Therapy Do I Need?
The recommended protocol for shockwave for most conditions is 3-5 sessions, spaced 5-7 days apart. For some more significant conditions, such as fractures, up to 7 may be recommended.
Does Shockwave Therapy Hurt?
Focused Shockwave Therapy may cause mild discomfort, but it is generally not unbearable. Many patients describe the sensation as a "mild discomfort" or feeling that their pain is being reproduced directly over the injured area during the treatment. This discomfort typically resolves immediately after the session. However, in some cases, patients may experience mild soreness for up to 24 hours afterwards. This is because the shockwave treatment creates microtrauma in the area, prompting the body to begin its natural healing process.
Are There Any Contraindications to Shockwave Therapy?
Shockwave should not be used in the following conditions
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Pregnancy
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Malignancy
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Severe circulatory disorders
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If you have a pacemaker fitted
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If you have received a steroid injection in the past 6 weeks in the treated area
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Treating areas over the lung space
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If you have an open wound at the treatment site
How Much Does Shockwave Therapy Cost?
Focused Shockwave Therapy is included in your physiotherapy consultation, if clinically indicated ($160 initial, $115 follow up). We offer a special discount for those who would like to buy a pack of 5 upfront.
Associated Shockwave Research
Liao, P.C., S.H. Chou, and C.L. Shih, A systematic review of the use of shockwave therapy for knee osteoarthritis. J Orthop, 2024. 56: p. 18-25.
2. Willems, A., O.P. van der Jagt, and D.E. Meuffels, Extracorporeal Shock Wave Treatment for Delayed Union and Nonunion Fractures: A Systematic Review. J Orthop Trauma, 2019. 33(2): p. 97-103.
3. Beling, A., et al., Outcomes Using Focused Shockwave for Treatment of Bone Stress Injury in Runners. Bioengineering (Basel), 2023. 10(8).
4. Mani-Babu, S., et al., The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. Am J Sports Med, 2015. 43(3): p. 752-61.
5. Cacchio, A., et al., Shockwave therapy for the treatment of chronic proximal hamstring tendinopathy in professional athletes. Am J Sports Med, 2011. 39(1): p. 146-53.
6. Xue, X., et al., Effect of extracorporeal shockwave therapy for rotator cuff tendinopathy: a systematic review and meta-analysis. BMC Musculoskelet Disord, 2024. 25(1): p. 357.
7. Bannuru, R.R., et al., High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review. Ann Intern Med, 2014. 160(8): p. 542-9.
8. Melese, H., et al., Extracorporeal shock wave therapy on pain and foot functions in subjects with chronic plantar fasciitis: systematic review of randomized controlled trials. Disabil Rehabil, 2022. 44(18): p. 5007-5014.
9. Razie, M., K. Leila, and K. Saied, Shockwave Therapy Versus Dry Needling for the Management of Iliotibial Band Syndrome: A Randomized Clinical Trial: SWT Vs. DN for the Treatment of ITBS. Galen Med J, 2021. 10: p. 1-8.
10. Gomez Garcia, S., et al., Shockwave treatment for medial tibial stress syndrome in military cadets: A single-blind randomized controlled trial. Int J Surg, 2017. 46: p. 102-109.
11. Mazin, Y., et al., The Role of Extracorporeal Shock Wave Therapy in the Treatment of Muscle Injuries: A Systematic Review. Cureus, 2023. 15(8): p. e44196.
12. Morgan, J.P.M., et al., Return to play after treating acute muscle injuries in elite football players with radial extracorporeal shock wave therapy. J Orthop Surg Res, 2021. 16(1): p. 708.
13. Weninger, P., et al., Extracorporeal Shockwave Therapy Improves Outcome after Primary Anterior Cruciate Ligament Reconstruction with Hamstring Tendons. J Clin Med, 2023. 12(10).
14. Ramon, S., et al., Focused Shockwave Treatment for Greater Trochanteric Pain Syndrome: A Multicenter, Randomized, Controlled Clinical Trial. J Bone Joint Surg Am, 2020. 102(15): p. 1305-1311.
15. Zhang, R., et al., Extracorporeal Shockwave Therapy as an Adjunctive Therapy for Frozen Shoulder: A Systematic Review and Meta-analysis. Orthop J Sports Med, 2022. 10(2): p. 23259671211062222.
16. Ghahhari, J., et al., Shockwave Therapy for Erectile Dysfunction: Which Gives the Best Results? A Retrospective National, Multi-Institutional Comparative Study of Different Shockwave Technologies. Surg Technol Int, 2022. 40: p. 213-218.
17. Melki, E., Endometriosis treatment with shock waves: A novel approach. Med Hypotheses, 2019. 124: p. 114-117.
18. Zhang, L., et al., Efficacy and safety of extracorporeal shock wave therapy for acute and chronic soft tissue wounds: A systematic review and meta-analysis. Int Wound J, 2018. 15(4): p. 590-599.
