Shockwave Therapy

Shockwave therapy is a non-invasive treatment that stimulates the body’s natural healing process. It can relieve pain and promote healing of injured tendons, ligaments, and other soft tissues. It accomplishes this by releasing growth factors in the injured tissue. Shockwave therapy is sometimes referred to as EPAT, or extracorporeal pulse activation technology.

Shockwave therapy is a type of regenerative medicine (also known as an orthobiologic therapy). It is used to treat tendinopathy as well as difficult-to-heal ligament injuries. Some degenerative tendinopathies have an associated buildup of calcium in the tendon. Focused shock waves can break those deposits up.

The treatment can also promote healing after orthopedic surgery — for instance, if a hip impingement has damaged tendons and ligaments around the hip. Surgery may correct the hip impingement, but after years of overworking and degeneration because of the impingement, the surrounding tendons often remain painful. Shockwave therapy can be used to address this secondary issue.

Shockwave therapy is used to reduce pain and promote healing from tendinopathy and many other sports injuries. Some examples include:

• Foot pain: plantar fasciitis and Achilles’ tendinopathy
• Achilles' tendonopathies
• Knee pain: patella tendinopathy (jumper’s knee)
• Leg pain: hamstring injuries
• Hip pain: rectus femoris and lateral hip pain with gluteal tendinopathies
• Elbow pain: Little League elbow and tennis elbow
• Shoulder pain: rotator cuff injuries

Shockwave therapy is typically administered by a sports medicine physician or athletic trainer with a physician’s supervision. An athlete’s doctor typically has a detailed understanding of their health history. Athletic trainers have deep knowledge in the anatomy of joints, tendons, and ligaments and common patterns of sports injury.

During treatment, the clinician holds a shockwave device next to the skin. The device sends shockwaves into the injured tissues, stimulating increased blood flow and growth hormones to the area, promoting new tissue growth.

There are two types of shockwave therapy. Usually, patients receive both types:

• Focused shockwave therapy sends waves into a small area.
• Radial shockwave therapy delivers shockwaves over a broader area, for instance, along the length of an injured tendon.

Most patients report some discomfort during shockwave therapy, but most do not find it painful. The amount of discomfort depends in part on the person, their injury, and whether the damaged tissues are close to a bone. (Treatments delivered closer to a bone are generally more uncomfortable.) The clinician will rub a topical gel on the skin to reduce the discomfort. As soon as the treatment is over, the discomfort typically stops.

A single treatment usually takes between 15 to 20 minutes. Depending on the injury, a patient will usually receive three to five treatments over a period of several weeks.

Sports medicine specialists at Boston Children’s and other centers have observed significant healing in many of their patients who receive the treatment. Studies are currently underway to better understand the effectiveness of shockwave therapy.

It is important for patients to know that the results of shockwave therapy may not be apparent immediately but should increase over time as their injured tissues heal.

Shockwave therapy is often used in combination with other therapies such as physical therapy and platelet rich plasma injections. In the case of sports-related injuries, an injury-prevention specialist may work with the athlete to analyze their movement patterns and help them build strength and adjust their technique, so they are less prone to re-injury.

Athletes can typically return to activity within 24 hours of a treatment.

Complications of shockwave therapy are quite rare; however, it is important that a physician assess the patient’s injury and health before treatment begins. If a tendon or ligament is almost fully torn, shockwave therapy could cause the remaining tissue to tear. If a patient has significantly low bone density (osteoporosis), shockwave therapy could cause a stress fracture.

Shockwave therapy is part of the extensive sports medicine and injury prevention services available through Boston Children’s Sports Medicine Division and Sports Ultrasound Clinic.

Our sports medicine specialists take time to understand the underlying source of each patient’s injury so they can recommend the best treatment, starting with the least invasive approach possible. Depending on the athlete and their injury, we may suggest shockwave therapy alone or in combination with other therapies, including physical therapy and platelet-rich plasma (PRP) injections.

We also work closely with the injury prevention specialists at The Micheli Center for Sports Injury Prevention to help our patients return to sport stronger and less prone to injury than they were before. Our athletic trainers work with athletes analyze and correct athlete’s movement patterns and help them build strength in key areas to reduce their risk of future injuries.

If an injury is serious or does not improve after conservative treatment, our team of orthopedic and sports medicine surgeons have deep experience operating on sports injuries in children, adolescents, and young adults.

We currently offer shockwave therapy in our Boston, Peabody, North Dartmouth, and Weymouth locations.