One year. Happy One Year Anniversary to our Radial Shockwave Machine! After nearly 1 million “shocks” or pulses delivered, it’s time to evaluate how this technology has contributed to our practise. Welcome to the August blog everyone and we hope you are having a restful, active and enjoyable summer!

Shockwave therapy was first introduced and used in clinical practise by nephrologist for non-invasive lithotripsy: the use of powerful sound waves to break down kidney stones. The technology since then has been used for musculoskeletal conditions especially tendon pain and injuries (“tendinopathies”) and to stimulate broken bones to heal faster.

The sound waves produced by these machines are intense pressure waves that travel faster than the speed of sound. Unlike the soundwaves produced by ultrasound machines, shockwaves travel nearly unchanged through fluids without any heat loss. Hence, shockwaves can penetrate much deeper than ultrasound waves.

When bones and soft tissues in our body receive shockwaves, its effects are both physical and chemical. Each treatment takes about 5 minutes. As the waves travel through muscles and tendons, it will reduce their tightness or resistance and so patients will often report that they feel “looser” after each treatment.

However, it is far from being a massage treatment. Each treatment should actually feel quite uncomfortable and moderately painful. I like to explain chronic, unresolved conditions using the metaphor of home building projects. The human body often times is very good at starting projects but tends to be very poor at finishing them. As many of our patients will attest, conditions such as tennis elbow, achilles, hip, shoulder and knee tendon injuries can be painful for weeks, months and sometimes years without any significant resolution. Intentional rehabilitation is important and for most patients, a program consisting of strengthening, stretching, activity modification and a gradual return to activity is usually successful.

However, even when these injuries are managed well, some tendon and muscle injuries can be very resistant to change and can stay painful and weak. It is for these very resistant cases that shockwave has a role. If the human body has stopped paying attention to the painful tissue, then shockwaves can produce an irritation to the tissue to get the body to respond to it again. In other words, if the building project has been abandoned, then shockwave brings the right “workers” back to complete the project: red blood cells, white blood cells, leukocytes, and plasma cells. The shockwaves are producing a mild to moderate inflammatory response to stimulate a new cycle of healing. Which is why these treatments should hurt. After each treatment, patients should expect 1-2 days of discomfort and specific exercises should be performed as prescribed by their health care practitioner.

After a year of using shockwave, our Team and patients’ feedback has been very positive and overall, its inclusion into our comprehensive rehab program has improved our patient outcomes. Here is a summary of our experience especially with very resistant and hard-to-resolve muscle and tendon conditions:

1. Shockwave is not a magic cure. It is most effective when combined with other tools within a comprehensive rehab program that is tailored to the specific needs of each patient. To build a home, you need many trades to complete the building project. Shockwave is but one “trade” or tool and cannot build a home all by itself.
2. The management of tendon and muscle injuries is still best accomplished within a graduated and progressive loading (strength) program. However, when patients cannot progress their program because of a stubborn tissue that refuses to respond, shockwave has helped patients proceed past these obstacles.
3. Our experience has been similar to the research literature. For some patients, it has been an important key to unlock a very stubborn door and many have experienced a very fast and incredible resolution of their pain. Without the pain, these patients have been able to progress their loading programs to full resolution of their problem. And for these patients, shockwave has been immensely worthwhile.

Finally, our Clinic does not charge extra fees or surcharges for its use. Just like IMS or dry needling, every modality in our Clinic is included in your one treatment fee. If you are curious about whether shockwave can help with your stubborn condition, be sure to ask one of our Team members if it is appropriate for you.

Submitted by Albert Chan