One of the limiting factors for many practitioners is the number of clinical tools they have available. Many physiotherapists rely heavily on exercise prescription whilst chiropractors historically have lend heavily on spinal manipulations. By integrating more evidence-based tools into our practice, in addition to the large array of osteopathic tools available, we are able to provide an even more robust patient-centred approach to healthcare.
In addition to integrating Western medical acupuncture into our Osteopathic practice at Movement Mechanics, we have also integrated Shockwave therapy, a fast, effective and non-invasive treatment option for our patients. Below are some examples of some types of injuries and conditions shockwave therapy can help with, especially when used in combination with osteopathy.
Ligament Repair
Knee ligament injuries are some of the most common injuries we see in our Osteopathic clinic. Of these ligamentous injuries, anterior cruciate ligament (ACL) injuries are some of the most common amongst both professional and recreational athletes. Rupture of the ACL leads to to knee instability and
may cause secondary damage to knee structures such as menisci and/or cartilage. Reconstruction of the torn ACL is a frequently performed surgical procedure to avoid instability of the injured knee joint. Reconstruction of the ACL with hamstring tendon (HT) grafts is the most frequently used surgical method worldwide in ACL reconstruction. The “return-to-sports” decision after ACL reconstruction is a complex process and depends on many factors, such as objectively tested physical and psychological readiness as well as biological healing (Weninger et al., 2023). Extracorporeal shockwave therapy (ESWT) has shown its influence on bone and soft tissue regeneration both in experimental as well as clinical studies. Research has shown that how long it takes to “return-to-pivoting-sports”, as well as “return-to-running activity” was significantly shortened in those receiving shockwave therapy. Furthermore, shockwave therapy has demonstrated a significantly higher likelihood of patients achieving their “pre-injury activity level”(Weninger et al., 2023).
Plantar Fasciitis (Fasciopathies)
Plantar fasciitis (PF), is one of the most common causes of heel pain seen in our clinic. It accounts for approximately 11% to 15% of foot symptoms presenting to physicians (Schmitz et al., 2013). Despite its name, like lateral epicondylitis (Tennis Elbow), PF is associated with degenerative changes in the fascia and atrophy of the abductor minimi muscle therefore the disorder is better classified as ‘fasciosis’ or ‘fasciopathy’. Traditionally initial treatment is non-operative and consists of relative rest, physical therapy, stretching, exercises, shoe inserts/orthotics, night splints, non-steroidal anti-inflammatory drugs, and local corticosteroid injections. We find that for many these approaches are time intensive and have mixed results.
If we get patients through our doors, especially those who have not responded well to conservative treatment for 4 to 6 months (between 10% and 20% of all patients), we strongly recommend they consider extracorporeal shockwave therapy (ESWT). The alternative often is a more invasive approach such as cortisone injections or even surgery. ESWT and radial extracorporeal shockwave therapy (rESWT) have several advantages over surgery in the treatment for chronic PF, including being non-invasive, does not require patients to avoid weight bearing or a prolonged time for return to work and allow patients to return to activities of daily life within 1 or 2 days, with an immediate return to most jobs and normal daily shoe wear.
Tendon damage and pain (Tendinopaties)
Extracorporeal Shock Wave therapy (ESWT) is being increasingly used for musculoskeletal complaints including subacromial shoulder pain, with and without calcification. Our Osteopathic treatment of subacromial shoulder pain often is a combination of Radial extracorporeal shockwave therapy (rESWT) and exercise therapy. rESWT creates a diverging pressure field, which reaches a maximal pressure already at the source, and therefore has a more superficial, but broader, effect (Kvalvaag et al., 2015).
Tendon issues such as chronic calcifying tendinitis of the shoulder can be difficult to treat. At Movement Mechanics Osteopathy we have found through clinical experience that conventional management of tendinopathies, especially chronic issues are tricky often resulting in a large number of treatments and extensive exercise prescription. These two things can lead to poor compliance as well as cause a financial strain on patients not to mention often leading to poor healing. That is why we incorporated radial shockwave therapy using the industry leading, evidence-based, EMS DolorClast shockwave machine. A study by Padua et al., (2002) showed a good clinical response to pain and to joint movement with shockwave therapy using the EMS shockwave unit. The study also showed that from both the patient's perspective and according to imaging outcomes improvements were statistically significant making it an effective therapy for chronic calcifying tendinitis of the shoulder.
Bone healing (Bone stress injuries and fractures)
We often come across patients who are entering the rehabilitation period following an acute fracture or having issues from poor bone healing and fracture nonunions. Radial extracorporeal shockwave therapy (rESWT) provides a safe and effective alternative for the management of fracture nonunions of superficial bones (Kertzman et al., 2017). Nonunion refers to the failure of bone fractures to
achieve cortical continuity seen on X-ray. Key to its success is early radiographic diagnosis and rESWT can provide a non-invasive option that is void of the risk factors associated with surgical fracture stabilisation. It can be a great treatment option to try for those hoping to avoid surgical interventions if deemed appropriate by your medical physician.
Combining Shockwave Therapy with Osteopathy for long-term improvements and optimised healing.
Treatment of musculoskeletal conditions in both athletes & non-athletes with extracorporeal shockwave therapy (ESWT) is gaining popularity as greater evidence supports its use, enhanced further when implemented alongside physical therapy. ESWT is a safe, non-invasive and effective treatment option that can treat various musculoskeletal conditions from rotator cuff tendinopathy, lateral epicondylitis, greater trochanteric pain syndrome, hamstring tendinopathy, patellar tendinopathy, Achilles tendinopathy and bone stress injuries. ESWT requires minimal to no time away from from sport and ADL's which may result in rapid benefits (Schroeder et al., 2021). By combining Shockwave therapy with osteopathic treatment and management helps facilitate longer-term gains in function and optimises healing (Schroeder et al., 2021).
Jonathan Hall M.Ost, GradDipHeal, BAppSci (HB)
Jonathan Hall is the founder and principle Osteopath at Movement Mechanics Osteopathy, and specialises in Shockwave Therapy. A fully qualified Osteopath and currently studying Western Medical Acupuncture out of AUT New Zealand, Jonathan founded Auckland Shockwave Therapy to help bring evidence-based Shockwave treatment to New Zealand using the industry leading EMS Radial Shock Wave device.
Kertzman, P., Császár, N. B. M., Furia, J. P., & Schmitz, C. (2017). Radial extracorporeal shock wave therapy is efficient and safe in the treatment of fracture nonunions of superficial bones: a retrospective case series. Journal of orthopaedic surgery and research, 12(1), 164. https://doi.org/10.1186/s13018-017-0667-z
Kvalvaag, E., Brox, J. I., Engebretsen, K. B., Søberg, H. L., Bautz-Holter, E., & Røe, C. (2015). Is radial Extracorporeal Shock Wave Therapy (rEWST) combined with supervised exercises (SE) more effective than sham rESWT and SE in patients with subacromial shoulder pain? Study protocol for a double-blind randomised, sham-controlled trial. BMC musculoskeletal disorders, 16, 248. https://doi.org/10.1186/s12891-015-0712-1
Padua, R., Bondì, R., Ceccarelli, E., Ripanti, S., Bondì, L., & Campi, A. (2002). Extracorporeal shock wave therapy for chronic calcifying tendinitis of the shoulder. Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2(3), 147–150. https://doi.org/10.1007/s101950200016
Schmitz, C., Császár, N. B., Rompe, J. D., Chaves, H., & Furia, J. P. (2013). Treatment of chronic plantar fasciopathy with extracorporeal shock waves (review). Journal of orthopaedic surgery and research, 8, 31. https://doi.org/10.1186/1749-799X-8-31
Schroeder, A. N., Tenforde, A. S., & Jelsing, E. J. (2021). Extracorporeal Shockwave Therapy in the Management of Sports Medicine Injuries. Current sports medicine reports, 20(6), 298–305. https://doi.org/10.1249/JSR.0000000000000851
Weninger, P., Thallinger, C., Chytilek, M., Hanel, Y., Steffel, C., Karimi, R., & Feichtinger, X. (2023). Extracorporeal Shockwave Therapy Improves Outcome after Primary Anterior Cruciate Ligament Reconstruction with Hamstring Tendons. Journal of clinical medicine, 12(10), 3350. https://doi.org/10.3390/jcm12103350
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