Shockwave Therapy for runners

Shockwave therapy illustration

Our regular physio Dave Mott explains to us how shockwave therapy can help with recurrent runners’ injuries.

How can Shockwave Therapy help runners?

We have some ‘shocking’ news for runners!

  • 82% of runners will get injured at some point in their running career
  • 65% of runners are injured in any given year
  • 50% of running injuries are recurring
  • On average, an injury occurs every 100 hours of running

But…  that’s not true ‘shocking’ news. The shocking news is: by shocking your injury, you can get relief and possibly resolution of your injury! That is, by applying powerful bursts of soundwaves to the area through a treatment called ‘Shockwave Therapy’ (SWT). Certain injuries have been proven to heal well, even if other methods of treatment for the same condition have failed.

Three common injuries sustained by runners respond well to SWT. Especially if combined with regular physio such as soft tissue release, taping and appropriate exercise:

  • Achilles Tendonopathy
  • Patella Tendonopathy
  • Plantar Fasciitis

The evidence

Let’s look at the evidence. The first major study we will examine was published in 2006 by D. Scot Malay and colleagues. This study was a double-blinded placebo-controlled trial, meaning that neither the participants nor the doctors examining the patients knew who received the real SWT treatment and who received a ‘sham’ placebo session of SWT. All of the participants had chronic plantar fasciitis that did not respond to conservative treatment.

While the control group did indeed reduce their heel pain during the three-month follow-up period of the study, the experimental group, who received real shockwave therapy, improved significantly more, as measured both by the patients’ own assessments and by a doctor.

Further, the authors write that there were no adverse outcomes related to the shockwave therapy, even after following the subjects for a year after treatment.  This is important because surgery—one alternative treatment for patients with chronic plantar fasciitis—carries a substantial risk
of complications.

SWT is similarly supported for treating patellar tendonosis (knee cap tendon). A study published in 2008 by three researchers at the University of Groningen in the Netherlands reviewed seven trials of SWT for patellar tendonosis. While the particulars of each study were too diverse to develop any agreement on ideal treatment parameters – such as the intensity of the shockwaves or the number of shockwaves delivered – the authors estimated that about 75% of patients with patellar tendonosis would see improvement after treatment with SWT.

Additionally, no adverse effects or complications were identified, leading the authors to recommend additional research into shockwave therapy not only as an alternative to surgery in chronic cases, but as a first- or second-line treatment for less severe cases of patellar tendonosis.

When it comes to Achilles tendonosis, there are some randomised trials demonstrating success, but others have found SWT to be no more helpful than a sham treatment.

No major review study has yet endorsed SWT as a clearly beneficial treatment for Achilles tendonosis, though a 2009 review by Magnussen, Dunn and Thomson of Vanderbilt University left open the possibility that SWT could become a useful non-invasive treatment for Achilles tendonosis, calling for more studies to be done.  There is no consensus on treatment specifics when using SWT for Achilles tendonitis, like energy level and number of treatments, making comparing studies challenging. However, our experience here at Physio Fitness is that SWT combined with traditional physiotherapy such as massage, taping and eccentric exercises has proven very beneficial in treating Achilles tendonosis’ that have been present for three months plus.

Should you look at SWT as a treatment option for chronic injury?

Taped-up injured runner

In all, SWT at least appears to do no significant harm, at least in the 1-3 year
follow-ups of studies to date. It is quite new and treatment protocols have not been standardised.  For this reason, it is hard for researchers to quantify how useful of a treatment it is.

Regardless, studies have shown that there is good evidence to believe that SWT is a helpful treatment option for patellar tendonosis and plantar fasciitis; evidence for its use in Achilles tendonosis is awaiting further justification in the research, but when combined with other treatment measures the anecdotal evidence is strong.

Realistically, it may take five or 10 more years for doctors and researchers to develop coherent guidelines for who should get SWT, which injuries it is appropriate for, and the energy intensities and frequencies of the individual treatment sessions.

Until then, you should still think of SWT as an experimental treatment for chronic tendon and fascia injuries that don’t respond to traditional conservative treatment. 
If you’ve had one of these injuries for several months and have not improved with the best mainstream treatments like eccentric exercises, specific stretches, or
custom orthotics, you could consider talking to your medical specialist or practitioner about SWT.

It is worth checking if your insurance company will cover it, and you should see a practitioner you trust—given the lack of universally agreed-upon treatment protocols, your probability of having success may also depend on the experience and knowledge of the practitioner administering the treatment.  SWT is an expensive treatment option for a relatively experimental treatment.

It is certainly an option to explore prior to any invasive procedures such as injections or surgery. However, it is not a staple of mainstream injury treatment yet nor a miracle cure-all.

How it works

Shockwave therapy is a non-invasive treatment that is generated through soundwaves, using a handheld applicator and gel which is applied onto the affected injured area.  The applicator then creates an almost ‘pulse like’ affect which stimulates the cells in the surrounding area and increases the bloods circulation rapidly. This is what triggers the body’s natural self-healing and will allow the damaged tissue to regenerate and grow normally and healthily. This treatment can also be used to break down scar tissue which is detrimental to normal full range of flexibility and can prevent normal function and movement by weakening surrounding tissue and causing pain.

One theory is that the therapy helps remind the body of the presence of an injury that it has become accustomed to, triggering natural healing processes like the formation of new blood vessels.

Can I still run?

Unfortunately, not! Not for a period of time anyway. Mind you, if you have any of the three conditions you’re probably not running anyway. Typically, we do three treatment sessions over three weeks then gradually return you to running with the use of taping, specific exercises and advice over the following three weeks. However, this can vary depending on the extent and chronicity of the problem.

Is SWT available on the NHS?

What do you think? If it was there would be a waiting time of [please insert your guess] and probably a restricted number of treatments. The machines are expensive, and the protocols have not been researched enough so it is unlikely it will be available on the NHS for some time.

SWT is not everyone’s cup of tea, as it is painful and expensive. However, many patients have come to our clinic exasperated because their running is limited or just not happening. Other treatments have failed, and frustration has set in. SWT has often been successful, especially when combined with traditional physiotherapy.

If you are considering this as a treatment option, do not hesitate to contact us on 01202 611244, or email