Have you ever re-injured an old injury? When you injure a body part, like sprain an ankle or tear a shoulder, you increase the chances of re-injuring the same area. You also likely have chronic pain or ongoing dysfunction in that body part. Old injuries leave behind scar tissue, degenerated tendons, or even dying collagen fibers. You feel this as stiffness, weakness, or pain. It interferes with the way you run, lift, and even your posture. Massage and traditional soft tissue techniques can skim the surface to take care of some fascial adhesions that develop from soft tissue injuries. However, to get deep to the heart of the injury, you need something more powerful. This is where shockwave therapy comes in. 

Extracorporeal shockwave treatment also goes by the terms ESWT, pulsewave, acoustic compression therapy, or just plain shockwave. Shockwave is an acoustic wave that is concentrated enough to agitate damaged or scarred soft tissue to promote the healing process. The effects of this acoustic wave is that it helps accelerate the healing factors in muscle, bone, and ligament/tendon. It also has a pain relieving effect on tender areas, and it helps promote mobility. 

Biological effects of Shockwave Therapy

  1. New Blood Vessel Formation
    1. Shockwaves stimulates release of growth factors in soft tissue. These growth factors include BMP, eNOS, VEGF, and PCNA. These growth factors promote neovascularization and improved blood flow. BMP helps bone repair. Neovascularization helps with tendon repair. All of this comes together to promote better and faster soft tissue swelling.
  2. Stop The Cycle of Chronic Inflammation
    1. Chronic inflammation is when an acute injury remains much longer than necessary for the healing process. It damages healthy tissue, and it leads to chronic pain. Chronic inflammation is stagnant healing, and shockwave therapy helps break this cycle by increasing mast cell formation. Mast cells promote the healing process in healthy injury cycles, but are missing from chronic inflammation. Bringing mast cells back brings back the healing process.
  3. Stimulate Collagen Production
    1. Tendons, ligaments, and other soft tissue structures are made of collagen fibers. Degenerated fibers have lost their normal linear alignment. Shockwave therapy helps procollagen synthesis. Subsequently, new collagen helps with stronger and more compact, dense tendon healing.
  4. Dissolve Calcified Degeneration
    1. Degenerative joint disease deposits calcium in the damaged and degenerated tissue, creating bone spurs on x-ray. Over time, shockwave therapy has been demonstrated to break up calcium mineral deposits to be absorbed and carried away through lymphatic drainage. While this is not a claim that you will experience reversal of degenerative joint disease with care, this effect has been observed in experimental studies.
  5. Analgesic Effects By Dispersing Painful Chemicals
    1. Shockwave disperses a neuropeptide called “substance P.” Smoothing this painful chemical away helps reduce pain by decreasing the painful signal at the source. This also has an effect to reduce edema in the painful area. Like a deep, deep tissue massage, shockwave therapy will massage away substance P, other inflammatory metabolites, and histamines at the painful tissue. 

Treatment Protocols

For best results, we combine shockwave therapy with chiropractic care. Chiropractic care mobilizes restricted movement with stretches or adjustments. In addition, our care uses therapeutic exercises when appropriate to stabilize old injuries and strengthen weak tissue. We may recommend chiropractic visits more frequently than the shockwave therapy. Shockwave therapy is usually done once per week. The protocols go for 4-6 weeks typically. 

We base these treatment plans on published case reports, case series, and randomized trials both within the realm of shockwave research and other evidence-based condition specific protocols.

Ryan Todd Lloyd, DC

About Ryan Todd Lloyd, DC

Dr. Lloyd has been working on Bay Area patients since 2002, and he has been with Rincon Chiropractic since 2014.