Shockwave Therapy

Shockwave therapy is an emerging, non-invasive treatment. Early studies suggest it may have the potential to reduce pain and promote healing in some sports injuries. Shockwave therapy is sometimes referred to as EPAT, or extracorporeal pulse activation technology.

While many clinicians and patients have reported positive outcomes, formal clinical studies are still underway to better understand how shockwave therapy works and its effectiveness.

Shockwave therapy may reduce pain and increase function after sports injuries, such as:

• Foot pain: Plantar fasciitis and Achilles’ tendinopathy
• Knee pain: Patellar tendinopathy (jumper’s knee)
• Leg pain: Hamstring tendinopathy
• Hip pain: Greater trochanter pain syndrome
• Elbow pain: Little League elbow and tennis elbow
• Shoulder pain: Rotator cuff injuries
• Bone injuries: Delayed union fractures and bone stress injuries

Some degenerative tendinopathies have an associated buildup of calcium in the tendon. Focused shock waves may break those deposits up.

By mitigating pain, shockwave therapy may also hasten recovery after orthopedic surgery. For instance, if a hip impingement has damaged nearby tendons and ligaments, surgery may correct the impingement without reducing the pain already caused by the impingement. Shockwave therapy may be used to address this secondary issue.

Clinical studies are underway to better understand how shockwave therapy affects injured tendons and ligaments. One theory is that the high-energy waves stimulate growth of new cells and blood vessels while also decreasing pain. Further research is needed to better understand how this works.

Shockwave therapy is typically administered by a sports medicine physician or athletic trainer with a physician’s supervision. During treatment, the clinician holds a shockwave device next to the patient’s skin. The device sends shockwaves into the injured tissues, stimulating increased blood flow and growth hormones to the area.

There are two types of shockwave therapy. Often, 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.

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.

The results of shockwave therapy may not be apparent immediately but may increase over time.

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 an emerging therapy offered through Boston Children’s Sports Ultrasound Clinic.

Our sports medicine specialists may suggest shockwave therapy if a sports injury continues to cause pain or limit function after other non-invasive treatments. 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.

If an injury is serious or does not improve after conservative treatment, our orthopedic surgeons specialize in correcting sports injuries in children, adolescents, and young adults.