Shockwave Therapy
Extracorporeal Shock Wave Therapy (ESWT) involves the application of high-energy acoustic waves directly to the injured area of the body using specific devices (focal or radial). These waves penetrate the tissues and promote mechanical and biological stimuli that favor tissue regeneration, increase local vascularization, and reduce inflammation and pain.
Because it is a non-invasive method, requiring no surgery or anesthesia in most cases, shock wave therapy is an excellent option for patients with chronic pain or musculoskeletal injuries who have not responded to conventional treatments.
Historical context
The history of shockwave therapy dates back to observations made during wars, especially World War II, in which it was noted that bomb explosions caused internal damage to organs, such as the lungs, of soldiers and divers, even without apparent external injuries.
This evidence that shockwaves had an effect on biological tissues caught the attention of researchers.
In the following years, the idea of using shockwaves in medicine evolved. The first major clinical application was in the specialty of urology for the fragmentation of kidney or urinary stones. Later, from the late 1980s and early 1990s, researchers and specialists in orthopedics and rehabilitation began to realize that the same shockwaves, when properly modulated (intensity, focus, number of pulses, etc.), could exert beneficial effects beyond the fragmentation of stones. It was observed that they stimulated tissue regeneration, promoted local vascularization, and could aid in bone consolidation, healing, and the treatment of soft tissue injuries.
Thus, the technique migrated from urology to orthopedics, traumatology, sports medicine, and rehabilitation, giving rise to what we now know as ESWT for the treatment of tendinopathies, fasciopathies, musculoskeletal injuries, and other conditions.
Indications for Shockwave Therapy
According to the guidelines of the Brazilian Medical Society for Shockwave Therapy (SMBTOC), the therapy may be indicated for various orthopedic and musculoskeletal problems, especially chronic problems or those that are difficult to heal, after conventional conservative treatments have failed. The main indications are:
Tendons/tendinopathies and bursae
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Periarticular calcifications of the shoulder (calcific tendinitis)
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Patellar tendinitis/tendinopathy (jumper's knee)
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Achilles tendon tendinopathy (calcaneal tendon)
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Lateral or medial epicondylitis of the elbow (tennis/golfer's elbow)
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Greater trochanteric pain syndrome/trochanteric bursitis (hip)
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Plantar fasciopathy
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Other tendinopathies resistant to conventional treatment
Bone pathologies/bone consolidation
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Fractures with delayed union or pseudoarthrosis (non-union fractures)
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Stress fractures or delayed consolidation
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Avascular bone necrosis, without joint derangement
Muscle/myofascial pathologies
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Myofascial pain syndrome (Trigger points)
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Chronic or delayed-healing muscle injuries without frank discontinuity
Skin / soft tissue / wound healing
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Non-healing chronic wounds
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Skin ulcers / difficult-to-heal lesions
Advantages of Shockwave Therapy
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Pain relief and functional improvement, in many cases, after the first few sessions.
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Stimulates tissue regeneration and accelerates healing, facilitating the recovery of tendons, muscles, and bones.
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Modulates the inflammatory process in the injured area.
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Minimally invasive alternative.
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Avoids surgery, anesthesia, and long periods of absence.
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May allow for a faster return to daily and sporting activities, which is especially relevant for athletes.
How is the Treatment Performed?
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Treatment generally involves 3 to 5 sessions, with weekly intervals, which may vary depending on the pathology and clinical response.
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The device's tip (focal or radial), intensity, and number of shots are adjusted according to the characteristics of the lesion and the patient's tolerance.
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The procedure should be preceded by a medical evaluation with clinical examination and imaging of the area to be treated.
Important Considerations
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Shockwave therapy should only be prescribed and performed by a qualified physician.
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In some cases, there may be discomfort during application, and mild reactions such as temporary swelling and/or redness; more serious complications are rare.
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Results are usually evaluated approximately 3 months after the end of treatment.
