The treatment of tendinitis by shock waves consists of applying percussion to the affected tendon. It can be done by a physiotherapist or a doctor.
A overuse of the tendons (which attach muscles to bones) can cause irritation and inflammation. It’s here tendonitis. It is common in people who perform repetitive movements (at work) and at the sporty. Tendinitis of the elbow,shoulder, wrist, Achilles tendon or hip are the most common. From treatments proposed for treat tendonitis : the use ofshock waves (not the same as ultrasound). What is this ? How it works ? What Side effects ? For who ? At the physiotherapist ? Explanations with Dr Eric Noël, rheumatologist at the Paul Santy Orthopedic Center in Lyon.
“The treatment of tendinitis by shock waves consists of use mechanical waves from a point of percussion directed at the area to be treated. Their action is facilitated by theinterposition of a gel between the therapeutic probe and the skin. The purpose of shock waves is to soften calcifications to facilitate their absorption. In addition, and in particular on degenerative tendons, the shock waves cause bleeding from the small vessels which help to heal the damaged tendonexplains Dr. Eric Noël.This is the same principle that is used to destroy kidney stonessays Dr. Eric Noel.Since 1997, the devices used by urologists have also been used to treat calcifications of the shoulder by analogy to kidney stones. Then, in Germany and then in France, specific machines for treating tendon pathologies have been developed. Today, it is a treatment that is done more frequently” reports the rheumatologist.
Radial shock waves in physiotherapists, focal shock waves in doctors
“Today, there are two types of machines to treat tendon pathologies by shock waves: radial shock waves, used by physiotherapists and focal shock waves rather used by doctors “informs Dr. Eric Noël. “The radial shock waves disperse around the area to be treated and go less in depth. Focal shock waves penetrate deeper over a narrower perimeter. These two types of shockwave have different protocol, different results, different cost. Focal waves work best on deeper calcifications and tendonitis” he describes. In practice, shock wave sessions are done on an outpatient basis. It is possible to leave with your car.
“Athletes should avoid sporting activity for the duration of shock wave treatment”
What is the duration of a shock wave treatment?
The duration of treatment depends on the type of machines used. “For thes radial waves (physiotherapist), it takes between 8 and 12 sessions, for focal shock waves 2 to 3 sessions, inform the rheumatologist. There is no consensus on the treatment scheme: on average, the protocol is 3000 shocks per session, others do more and others less. IAthletes should avoid sporting activity for the duration of treatment by shock waves ” warns Dr. Eric Noël.
For who ? What tendonitis?
Shockwave therapy is indicated in the tendinopathy treatment : patellar, achilles (from the Achilles tendon), tennis elbow (epicondylitis), plantar aponeurosis, at the level of the elbow or the shoulder. It is also used as mentioned above to treat calcifications of the shoulder. The treatment of tendinitis by shock waves should only be carried out after a clinical diagnosis and an ultrasound assessment.
The tendinopathies which respond best to treatment are tendonitis of the Achilles tendon and the elbow.
How effective are shock waves on tendonitis?
“The results of scientific publications are favorable to shock waves. They are recognized as an effective treatment but they are more or less effective depending on the type of pathologies, age…” says Dr. Eric Noël. “The results are better on tendinitis than on calcifications (these must be more than 1cm in diameter, be homogeneous for the shock waves to be effective). The tendinopathies that respond best to shock wave treatment are tendinitis of the Achilles tendon, tendinitis of the elbow (Tennis elbow), which represent the two most common types of tendonitis, with the plantar aponeuroses” inform the specialist. “Shock waves are a complementary treatment which is added to the small range of treatments we already have” says Dr. Eric Noël.
Who to consult to make shock waves? A physio? Doctor ?
Radial shock waves are made by physiotherapists and focal shock waves rather by sports doctors and rheumatologists. “It’s a rather second-line treatment, when first-line treatments have not worked” says Dr. Eric Noël.
What are the side effects ? Does it hurt ?
“Shockwave therapy does not cause side effects, but it is painful, slightly more for radial shock waves” informs Dr. Eric Noël. However, you should know that the sessions are quite short, lasting 7 to 10 minutesincluding setup and breaks.
Contraindications to shock waves
“There are several basic contraindications to shock waves: the Pacemaker, pregnancy, taking blood thinnerssays the rheumatologist.There the presence of a wound also contraindicates shock wave therapy.“
Price and reimbursement of shockwave therapy
“Shock wave sessions carried out by physiotherapists are integrated into physiotherapy, these are reimbursed acts. When the shock waves are done by a doctor, this treatment which has a cost per session of 60 to 100 euros is done during a consultation, but has no specific nomenclature“Informs Dr. Eric Noël.
Thanks to Dr Eric Noël, rheumatologist at the Paul Santy Orthopedic Center in Lyon.