Focused Extracorporeal Shockwave Therapy (F-ESWT)
Focused extracorporeal shock wave therapy (F-ESWT) is a non-invasive medical treatment that uses focused, high-energy acoustic waves to stimulate deep tissue healing and promote the formation of new blood vessels and tissue in conditions like chronic tendinopathies, plantar fasciitis, osteoarthritis, and specific bone injuries. The waves are precisely targeted to specific, deep areas, delivering their full energy to the affected tissue, which allows for the treatment of deeper structures such as tendons, ligaments, and bones.
Role of F-ESWT in Treating Tendinopathy:
Tendinopathy, often involving tendons like the Achilles, patellar, or rotator cuff tendons, is characterised by chronic pain and dysfunction due to degeneration and failed healing of the tendon fibres.
Mechanism of Action:
Pain Reduction: Shockwaves can help reduce pain by desensitising the nerve endings and altering pain signals at the site of injury.
Enhanced Blood Flow: The mechanical energy from shockwaves promotes microvascular circulation, improving nutrient and oxygen delivery to the damaged tissues, which can speed up healing.
Collagen Synthesis: Shockwave therapy stimulates the fibroblasts, which are the cells responsible for collagen production. This leads to the strengthening and repair of the tendon tissue over time.
Reduction of Calcification: In conditions like calcific tendinopathy, ESWT can help break down calcific deposits, leading to reduced pain and improved mobility.
Trigger Point Deactivation: In some cases, tendinopathy is accompanied by myofascial trigger points. Shockwaves can deactivate these points, thereby reducing muscle tension and pain.
Promotion of Tissue Repair: Shockwaves induce a mild inflammatory response, which is beneficial in initiating the body's natural healing processes.
Effectiveness:
Numerous studies have demonstrated the effectiveness of ESWT in treating chronic tendinopathies, especially in conditions like plantar fasciitis, rotator cuff tendinopathy, Achilles tendinopathy, and tennis elbow. Typically, the effects are seen after 3-5 sessions, spaced about 1-2 weeks apart.
Pain relief, improved function, and enhanced mobility are commonly reported outcomes.
Role of ESWT in Treating Stress Fractures:
Stress fractures are small, microfractures that occur due to repetitive stress or overuse, often seen in athletes or individuals involved in high-impact activities. These fractures are usually not severe enough to cause a complete break but can be painful and require time to heal.
Mechanism of Action:
Stimulation of Bone Healing: Shockwave therapy can stimulate osteoblasts (bone-forming cells), thereby accelerating the bone repair and regeneration process.
Enhanced Blood Flow to the Bone: Like tendons, bones also benefit from improved circulation, which shockwaves can help promote, facilitating the delivery of nutrients to the bone.
Increase in Bone Density: Some studies suggest that ESWT can increase bone mineral density, which is crucial for the healing of stress fractures.
Pain Modulation: Shockwave therapy also helps manage the pain associated with stress fractures by desensitising the area and reducing inflammation.
Effectiveness:
ESWT for stress fractures is particularly useful in healing chronic or non-union fractures, where the bone healing process has been delayed, especially in lower extremity stress fractures, including tibial and metatarsal fractures.
Contraindications:
While generally safe, focused shockwave therapy is not recommended for everyone and may be inadvisable for individuals with:
Pregnancy
Severe infection or blood-clotting disorders
Certain blood cancers or the presence of tumours in the treatment area
Focussed ESWT is a promising tool in the management of both tendinopathies and stress fractures. For tendinopathies, it aids in pain relief, tissue repair, and functional recovery. For stress fractures, it accelerates bone healing and can reduce pain. However, ESWT is often used as part of a comprehensive treatment plan that includes rest, physical therapy, and in some cases, pharmacological interventions.