Shockwave Therapy

Shock Wave Therapy (ESWT) in Paris 6

Extracorporeal Shock Wave Therapy (ESWT) is a non-invasive treatment modality that uses acoustic pressure waves to stimulate healing in damaged musculoskeletal tissues. Originally developed for the treatment of kidney stones (lithotripsy), shock wave therapy has been adapted for orthopaedic and rehabilitation use over the past two decades. It is now widely used for the treatment of chronic tendinopathies and other musculoskeletal conditions that have not responded to conventional therapy.

Indications

Shock wave therapy is most commonly indicated for the following conditions:

• Plantar fasciitis — Chronic heel pain caused by inflammation and degeneration of the plantar fascia. ESWT is supported by strong evidence for this condition and is recommended in cases resistant to conservative treatment.
• Achilles tendinopathy — Chronic pain and thickening of the Achilles tendon, common in runners and athletes. Shock waves promote tendon remodelling and pain reduction.
• Calcific shoulder tendinopathy — Calcium deposits within the rotator cuff tendons that cause pain and restricted shoulder movement. ESWT can help to break down calcifications and reduce symptoms.
• Lateral epicondylitis (tennis elbow) — Chronic pain at the outer elbow caused by overuse of the forearm extensor muscles. Shock wave therapy targets the degenerative tendon tissue and promotes healing.
• Patellar tendinopathy (jumper's knee) — Chronic pain at the base of the kneecap, common in sports involving jumping and rapid changes of direction.
• Greater trochanteric pain syndrome — Lateral hip pain associated with gluteal tendinopathy or trochanteric bursitis.
• Myofascial trigger points — Localised areas of muscular tension and pain that can be treated with focused shock wave application.

Mechanism of Action

Shock waves are acoustic pulses characterised by a rapid rise in pressure followed by a gradual return to baseline. When directed at affected tissue, they produce several therapeutic effects:

• Neovascularisation — Stimulation of new blood vessel formation in the treated area, improving blood supply and promoting tissue repair.
• Collagen synthesis — Promotion of collagen production, supporting the structural integrity of tendons and other connective tissues.
• Pain modulation — Reduction of pain signalling through the gate control mechanism and through the release of substance P, a key mediator in pain transmission.
• Calcification dissolution — In calcific tendinopathies, shock waves can help to fragment and disperse calcium deposits.
• Tissue regeneration — Stimulation of stem cell activity and growth factor release, accelerating the healing process in chronic degenerative conditions.

Treatment Protocol

A typical course of shock wave therapy consists of 3 to 6 sessions, spaced one week apart. Each session lasts approximately 10 to 15 minutes. The practitioner applies a coupling gel to the treatment area and positions the shock wave applicator over the target tissue. The intensity is gradually increased based on the patient's tolerance.

Some discomfort is normal during the procedure, but it should remain within tolerable limits. Mild soreness in the treated area may persist for 24 to 48 hours after each session. The full therapeutic effect typically develops over 6 to 12 weeks following the completion of the treatment course.

Shock wave therapy is often combined with osteopathic manual treatment to address any associated biomechanical factors contributing to the tendinopathy, such as joint restrictions, muscular imbalances or postural deficiencies.

Contraindications

Shock wave therapy is not suitable in the following cases:

• Pregnancy (treatment near the uterus)
• Blood clotting disorders or anticoagulant therapy
• Treatment over malignant tumours
• Treatment over growth plates in children
• Acute infection or inflammation in the target area
• Treatment directly over nerves, major blood vessels or the spine
• Patients with pacemakers (treatment near the device)

Frequently Asked Questions

Is shock wave therapy painful?

Most patients experience some discomfort during the treatment, described as a tapping or pulsing sensation. The intensity is adjusted to the patient's tolerance level. After the session, mild soreness is normal and usually resolves within 48 hours.

How quickly can I expect results?

Some patients notice improvement after 2 to 3 sessions, but the full effect of treatment develops gradually over 6 to 12 weeks as the tissue healing process progresses.

Can I continue exercising during treatment?

Light activity is generally permitted, but high-impact or aggravating activities should be avoided for 48 hours after each session. The practitioner will provide specific guidance based on the condition being treated.

Is shock wave therapy covered by insurance?

Coverage varies depending on the insurance provider and policy. Some complementary health insurance plans (mutuelles) may partially reimburse shock wave therapy. Patients are advised to check with their insurer.

References

• Mani-Babu S, Morrissey D, Waugh C, Screen H, Barton C. (2015). The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. The American Journal of Sports Medicine, 43(3):752-761. PMID 24817008
• Defined A, Pavone V, Testa G et al. (2020). Efficacy of extracorporeal shock wave therapy for lateral epicondylitis: a systematic review and meta-analysis. Orthopedic Reviews, 12(2):8601. PMID 32309425