A radial pressure shockwave is a treatment option that our physiotherapists can use – often for chronic tendon injuries. The machine generates a pressure wave into the affected tissue. It does this by way of a small projectile inside the applicator tube that moves quickly back and forth when it is accelerated by compressed air. When this projectile hits the inside portion of the applicator tip, the pressure wave is produced. Ultrasound gel is used between the applicator and skin to minimize the loss of energy. This mechanical energy is “aimed” at a specific tissue and can have various bio-chemical effects at the cellular level in this area.

The shockwave unit has different transmitter heads that can produce different radial pulse waves. The strongest can penetrate up to approximately 6cm into the tissue. These waves can affect a change at the tissues through mechano-transduction and cavitation.

Mechano-transduction occurs when a mechanical force, such as the radial pressure wave, is sensed by cells in the region and causes a bio-chemical response. One of these responses is the release of nitric oxide which increases vasculature and blood flow. Other effects include kick-starting tendon and scar tissue remodelling. There can even be an analgesic effect as this process can release the body’s natural pain mediators.

Cavitation involves the formation and reduction of tiny gas bubbles that impose a force on nearby cells which, in turn, stimulates a tissue regeneration process.

Given the effects shockwave can have on the tissue, it is used for such conditions as tennis elbow, golfer’s elbow, achilles tendonitis or tendinopathy, patellar tendonitis or tendinopathy, hamstring tendonitis or tendinopathy, shoulder calcific tendinitis and plantar fasciitis. These are conditions that are typically difficult to heal and have exhibited a stalled healing response.

After a thorough assessment, if it is determined that radial pressure shockwave is indicated, the physiotherapist will administer the treatment with the patient in a comfortable position. The exact point of treatment is determined based on this assessment, where the patient feels pain and where they are most tender. Treatments typically don’t take much longer than 5 minutes. It can be sore initially but often the tissues accommodate and there is actually an analgesic, pain relieving effect after. This treatment modality is best combined with optimal loading exercises to strengthen the tissue. Depending on if there are other imbalances that are found during the assessment, the physio may choose to also use other manual therapy techniques that can compliment the radial pressure shockwave treatment.