Extracorporeal Shock Wave Therapy For Pain And Function

What Is Extracorporeal Shock Wave Therapy (ESWT)?

ESWT is a non-surgical approach that may help reduce pain and support healing in certain musculoskeletal conditions. Initially developed in sports medicine, ESWT utilizes a specialized external device to deliver controlled mechanical energy to targeted tissues, including tendons, bones, or ligaments.

This energy may stimulate biological responses in the affected area, including increased blood flow and cellular activity. The main goal of ESWT is to support the body’s natural repair processes. This may promote tissue remodeling and reduce inflammation, potentially leading to improved function and decreased discomfort over time.

How ESWT May Support Pain Management

ESWT works through several biological responses that may help support the body’s natural ability to manage certain musculoskeletal conditions.

Findings from published studies suggest that shockwaves can influence soft tissue and bone by stimulating cellular responses. This potentially includes increased blood flow, changes in inflammation, and activation of tissue remodeling.[2]

As a non-surgical approach to care, ESWT may offer several potential benefits:

• May help reduce pain by affecting nerve signals and inflammation.
  
• Supports tissue healing through biological activity linked to regeneration.
  
• Can improve mobility and range of motion as discomfort lessens.
  
• May enhance daily function by promoting comfort during movement.
  
• Potentially speeds recovery by supporting natural tissue repair over time.
  

While individual results vary, ESWT is being explored as a tool that may help patients manage symptoms and improve quality of life without surgery.

Common Conditions Treated With Shock Wave Therapy

ESWT is a non-surgical option that may help support recovery in various musculoskeletal conditions. For appropriate patients, ESWT may be used on its own or with other treatment approaches, depending on the specific condition, severity, and goals.

Conditions that may respond to ESWT include:

• Tendon Conditions: These involve irritation or degeneration of tendons, the fibrous tissues connecting muscle to bone. ESWT may be used to help support healing in cases of chronic overuse or injury. Common tendon conditions include:
  • Achilles Tendonitis: Pain, stiffness, or swelling may develop due to repeated strain, especially during running, jumping, or uphill activity.
    
  • Patellar Tendonitis: Often seen in athletes, this condition involves irritation or degeneration in the tendon connecting the kneecap to the shinbone.
    
  • Shoulder Tendonitis: Rotator cuff tendons can become irritated or damaged over time, leading to shoulder pain, weakness, and limited range of motion.
    
  • Tennis Elbow: Repetitive gripping or wrist extension may cause pain on the outer elbow.
    
  • Golfer’s Elbow: This condition affects the inner elbow, and is often caused by repeated lifting or throwing motions.
    
  • Plantar Fasciitis: This condition involves irritation in the thick band of tissue along the foot’s arch, often causing sharp heel pain with walking or standing.
• Bone Marrow Lesions: These are inflamed areas within the bone, typically identified on MRI and associated with joint pain or stress-related injury.
  

• Acute Muscle Strains And Tears: Sudden overstretching or tearing of muscle fibers may result in localized pain, swelling, and temporary loss of strength or mobility.
  

Treatment suitability varies by patient. When appropriate, ESWT may be considered on its own or as part of a broader treatment plan involving injectates processed using the Regenexx approach, such as Platelet-Rich Plasma (PRP) or Bone Marrow Concentrate (BMC) injectates.

Your ESWT Procedure: A Step-by-Step Look

ESWT is a quick, non-invasive procedure that typically lasts about 10 minutes. A handheld probe is applied to the skin over the targeted area to deliver focused acoustic energy to the underlying tissue. Local anesthetic is often not necessary for patients, and the treatment is generally well-tolerated.

Below is a step-by-step look at what patients can expect before, during, and after an ESWT session:

Preparation

Before the procedure, the physician will review the patient’s condition and medical history to confirm that ESWT is the appropriate treatment. The treatment area will be cleaned and positioned for easy access. Local anesthetic is often not necessary, as discomfort is typically mild and temporary.

Pinpointing Your Pain Source

Using physical examination or imaging guidance (when necessary), the physician will locate the specific area of pain or tissue damage. This step helps ensure that the shock waves are delivered with precision to the intended tissue.

Application Of Shock Waves

A hand-held probe is placed on the skin over the targeted area. This probe delivers focused mechanical energy—acoustic shock waves—into the underlying tissue. The sensation may feel like small pulses or a tapping sensation. Each session typically lasts around 10 minutes, depending on the area being treated.

Treatment Schedule

ESWT is often delivered over a series of sessions spaced several days to a week apart. The number of treatments varies depending on the condition, the patient’s response to care, and treatment goals. The physician in the licensed Regenexx network will customize a plan that may involve combining ESWT with other procedures using Regenexx injectates, if appropriate.

Post-Treatment Care

Most patients can resume normal activity shortly after the procedure. Mild soreness or redness at the treatment site is possible, but usually resolves within a day or two. Physicians in the licensed Regenexx network may give additional guidance based on the patient’s condition and overall treatment plan.

What Recovery May Look Like After The Treatment

Most patients experience little to no downtime following an ESWT procedure and can typically return to normal daily activities the same day. Mild soreness, swelling, or occasional bruising at the treatment site may occur, but these effects are usually temporary and resolve within a few days.

Recovery occurs gradually, as the body responds to the mechanical stimulation over time. The acoustic energy delivered during treatment is intended to support tissue repair by promoting localized blood flow and cellular activity. This process may lead to the development of new blood vessels and tissue remodeling over several weeks.

A series of treatments is typically recommended to help achieve the best possible outcome. Your Regenexx provider will determine the appropriate treatment schedule based on your condition, health history, and response to therapy. While some patients report early relief, continued improvement may develop progressively after the final session.

To help maximize treatment benefit, you may be advised to avoid high-impact or strenuous activities for a short time after each session and to follow personalized rehab or activity guidelines provided by your Regenexx network physician.

Who May Not Be A Candidate For This Therapy

While ESWT is generally well-tolerated, it may not be appropriate for everyone. Physicians in the licensed Regenexx network will perform a thorough evaluation of the patient’s health history and condition to determine whether this treatment is a safe and suitable option.

Individuals who may not be candidates for ESWT include:

• Pregnant Individuals: ESWT is not recommended during pregnancy, as the effects of acoustic energy on fetal development have not been fully studied.
  
• Patients With Cancer Near The Treatment Site: Applying shock waves close to an active tumor may stimulate unwanted tissue activity and is generally avoided for safety.
  
• Those With Bleeding Disorders Or On Blood Thinners: These conditions may increase the risk of bruising, bleeding, or delayed healing at the treatment site.
  
• Individuals With An Active Infection Or Open Wound: ESWT should be postponed until the infection clears or the wound fully heals to reduce the risk of complications.
  
• Treatment Areas Over Air-Filled Organs: Shock waves are not applied near the lungs, intestines, or other gas-filled tissues due to the risk of internal injury.
  
• Children With Open Growth Plates: Because growth plates are still developing, ESWT is typically avoided to prevent unintended effects on bone growth.

Complementary Therapies That May Support Recovery

For some patients, combining ESWT with other regenerative therapies may offer additional support for healing and recovery, especially in more advanced or chronic cases. Depending on the patient’s condition, the physician may recommend pairing ESWT with orthobiologic treatments such as PRP or BMC.

• PRP involves using a concentration of platelets from the individual’s blood to support tissue repair and may help promote healing at the treatment site.
  
• BMC involves using the body’s own healing agents processed using Regenexx techniques and may be used for more complex injuries involving joint, tendon, or ligament damage.

Procedures using Regenexx injectates follow proprietary processing and treatment protocols developed by Regenexx, designed to support the body’s natural healing processes with a non-surgical approach. Physicians in the licensed Regenexx network utilize image guidance to target treatment areas precisely and accurately, which may help optimize the recovery plan.

By combining ESWT with regenerative therapies when appropriate, patients may be better positioned to regain mobility, reduce discomfort, and get back to the activities they enjoy. The physician will customize the patient’s treatment approach based on the individual condition, response to therapy, and overall goals.