What is Radial Shockwave Therapy (RSWT)?
Evidence demonstrating the benefit of Radial Shockwave Therapy (RSWT) for musculoskeletal injuries, especially tendon injuries and plantar fasciitis, has been accumulating since the early 1990s mainly in Europe. RSWThas been shown to be effective in plantar fasciopathy (fasciitis) Achilles tendon injuries including tendinitis. It is currently in use in private clinics, elite sporting teams and also during various Olympic games (polyclinics) recently. Radial shockwaves are produced pneumatically in the handle and produce a rapid rise of pressure in the affected tissue. Shockwaves destroy the nerves which are responsible for pain. After a delay of approximately 4-6 weeks, there is an increase in the concentration of various growth factors in the injured tissue (repair phase).
What is the process involved in RSWT treatment?
RSWT requires an initial visit to diagnosis and plan the treatment. This is followed by three or four treatment sessions. The painful site is identified clinically or occasionally by ultrasound. Shockwaves are administered by applying a handle to the affected area. Each treatment consists of approximately 2-3000 shockwaves with different pressures depending on the nature of the affected tissue and the diagnosis. During the course of treatment, pain levels generally of the order of 4-5/10 may be experienced. Generally the pain ceases when the treatment is finished and people can walk out quite comfortably. Each treatment including the consultation lasts approximately 10-15 min. Ultrasound may be used to localise the painful area especially where there are localised calcium deposits such as calcific tendinitis of the shoulder. Approximately 10% of people will require additional treatments. This will be discussed as required.
What conditions can Shockwave be used to treat?
|tendinopathy elbow (tennis elbow)||chilles tendinopathy (tendinitis)|
|patellar tendinopathy||plantar fasciitis (fasciopathy)|
|calcific tendinitis rotator cuff||Fracture non-unions|
|iliotibial band syndrome||stress fractures|
|medial tibial stress syndrome||chronic ulcers lower limb|
How long does RSWT take to be effective?
Our experience is that approximately 65% of people get significant pain relief within 12 weeks. Temporary pain reduction is noticed after the first treatment generally lasting from two hours to 2 days in our experience. Most people require a full course of treatment to get a satisfactory clinical effect. Final response to treatment is determined 12 weeks after treatment is commenced. RSWT destroys nerves responsible for pain and then increases growth factors prior to subsequent repair. For this reason maximum relief is usually felt at the twelfth week (final review) after the last treatment. Return to running programs may start about week 4-6 depending on the response and diagnosis.
What adverse effects if any occur from RSWT?
Minor/moderate pain (4-5/10) and discomfort during the treatment are the most commonly reported adverse effects. Sometimes a temporary reddening or erythematous response in the skin can be observed in the area treated. Apart from these minor adverse effects there are very few problems related to RSWT. In 1200 cases, only two patients stated their pain increased for 24 hours after treatment.
What contraindications or precautions need to be considered with RSWT?
Rarely, RSWT despite being appropriate treatment is contraindicated in certain individuals who have the following problems. Please consult with your treating specialist if you have any concerns regarding this.
- coagulation disorders and the use of anticoagulants such as warfarin, heparin, and Coumadin
- polyneuropathy in case of diabetes mellitus
- Please do not take anti-inflammatories (NSAIDS). one week prior to treatment
Has RSWT been shown to be effective in clinical studies?
Since the early 1990s, RSWT has had many randomised controlled trials (RCT S) published. In these trials (RCTs), RSWT has shown to be more effective compared with standard treatment (plantar fasciitis and stretching, 2008), as effective as current treatment (RSWT versus eccentric exercise in mid Achilles tendinopathy, 2007) as effective as surgery (calcific tendinopathy of the shoulder). Generally speaking, at our clinic, at least 65% of people get significant clinical benefits from a course of RSWT T.
In follow-up studies undertaken at our clinic, 65-80% of patients get significant persistent benefit. The average duration of follow-up is eight months for cases of Achilles tendinopathy, planet fasciopathy.
How much does RSWT cost?
When patients are referred by the treating medical practitioner to our clinic there is an initial consultation fee of $225. There may be an associated ultrasound cost depending on the area involved and the nature of the problem. Three treatments of RSWT cost $585. Medicare (Australian residents) will refund $105 approximately for the consultation component of the treatment. Unfortunately rebates are lacking in Australasia and Europe.
RSWT, in our clinic, is administered by a specialist medical practitioner trained in the diagnosis and management of chronic overuse injuries. RSWT is an affordable treatment option. To date, Work Cover is the only insuring agency that supports this treatment. Approval needs to obtained from the relevant case manager prior to initiating treatment.