Managing Musculoskeletal and Neurological Diagnosis: Exploring the Advancing Application of Extracorporeal Shock Wave Therapy

Extracorporeal shock wave therapy (ESWT) is a non-invasive medical treatment that involves the use of high-energy shock waves to stimulate healing and alleviate pain in various musculoskeletal and neurological conditions. These shock waves are generated outside the body and then directed towards the targeted area, penetrating the tissues and promoting tissue regeneration, reducing inflammation, and improving blood circulation.

ESWT is commonly used to treat conditions such as plantar fasciitis, tendinitis, calcific tendinitis, stress fractures, non-healing wounds, and certain neurological disorders. It was first used in the early 1980s, this type of ESWT emerged as a noninvasive treatment known as lithotripsy to eliminate kidney stones. In the decades that followed the advent of lithotripsy, researchers began to examine other potential clinical applications for focused ESWT and another form of shock wave therapy known as radial ESWT. In contrast to focused ESWT, radial ESWT acoustic waves are transmitted in a more diffuse, radial pattern.

As interest in these modalities grew, researchers began exploring their therapeutic potential. During the 1990s and early 2000s, numerous research teams shared findings suggesting that ESWT could be used as a therapeutic tool. Researchers demonstrated the use of ESWT to reduce pain and promote healing in bone, tendon, ligament, and fascia in patients with musculoskeletal disorders, and to reduce spasticity in patients with neurological disorders. In one of the research articles by Michael C. Wainberg, M.D., he discussed the potential uses of ESWT for patients in the physical medicine and rehabilitation setting. Dr. Wainberg is a physiatrist in Physical Medicine and Rehabilitation. His research interests include musculoskeletal disorders and spasticity.

 Dr. Wainberg acknowledges the rapid expansion of interest in Extracorporeal Shock Wave Therapy (ESWT) among physiatrists. Notably, physicians in Minneapolis are already utilizing radial shock wave therapy to address musculoskeletal disorders, while their counterparts in Rochester, Minnesota, are applying this treatment to both musculoskeletal and neurological disorders. Dr. Wainberg further highlights the current use of radial ESWT as a therapeutic approach to facilitate healing and alleviate pain in patients with various musculoskeletal and neurological conditions. The treatment has shown promising results in managing tendinopathies, as well as promoting healing in cases of delayed and non-union bone defects and fractures. This indicates the expanding role of radial ESWT in improving patient outcomes across a range of diagnoses.

How Radial ESWT works

Compressed air accelerates a projectile up to 80 to 90 kph within a guiding tube that strikes a metal applicator placed on the patient's skin. The kinetic energy is converted into a radial shock wave. The projectile generates stress waves in the applicator that transmit pressure waves into the tissue to a depth of 4 to 5 cm (about 1.97 in).

The evolving list of diagnoses for which ESWT shows potential includes:

• Shoulder tendinopathy
• Lateral epicondylitis
• Greater trochanteric pain syndrome
• Hamstring tendinopathy
• Patellar tendinopathy
• Medial tibial stress syndrome
• Achilles tendinopathy
• Plantar fasciitis*
• Knee osteoarthritis
• Fracture nonunion
• Spasticity of spinal and supraspinal origin (stroke, brain injury, multiple sclerosis, cerebral palsy) 

Adverse Effects and Contraindications

Adverse effects include:

• Transient discomfort
• Skin erythema
• Localized swelling

More severe but exceptionally rare AEs include:

• Achilles tendon rupture
• Humeral head osteonecrosis (after focused ESWT)
• Calcaneal stress-type fracture (presumed after focused ESWT)

Contraindications or situations in which ESWT may be inappropriate include:

• Pregnancy
• Age less than 18 (except for patients diagnosed with Osgood-Schlatter disease)
• Treatment over air-filled tissue (lung, gut)
• Treatment of pre-ruptured tendons
• Presence of local tumor or infection
• Less than six weeks since local corticosteroid injection
• Blood-clotting disorders, including local thrombosis

Numerous published research studies have extensively explored the application of Extracorporeal Shock Wave Therapy (ESWT) in patients with musculoskeletal disorders and spasticity associated with neurological conditions. One such study, published in Europa Medicophysica in March 2005, concluded that patients suffering from lateral epicondylitis, a condition resistant to conservative treatment, experienced a reduction in pain and functional impairment while undergoing radial ESWT. Additionally, their pain-free grip strength test showed improvement.

Another study, featured in the November 2017 edition of the Journal of Stroke and Cerebrovascular Diseases, demonstrated promising outcomes when ESWT was tested on patients with spasticity resulting from strokes. Furthermore, the use of ESWT was found to effectively reduce spasticity associated with multiple sclerosis, as documented in studies published in the Multiple Sclerosis Journal in April 2015 and the Archives of Physical Medicine and Rehabilitation in November 2018.

These findings collectively highlight the positive effects of ESWT in improving pain levels, functionality, and spasticity in patients with various musculoskeletal and neurological conditions. One known Physiotherapy Clinic is set to start its own theory to support the study and encourage clinics to embrace the advancements of new practices.

So far, the available data for ESWT is promising. Further studies are needed to identify the mechanisms of action, optimal shock wave characteristics, and appropriate dosing for this form of treatment. Further research studies will help define treatment protocols and guidelines for target populations.