Extracorporeal Shockwave Therapy for Knee Osteoarthritis

Extracorporeal Shockwave Therapy for Knee Osteoarthritis Blog

Aging brings with it a multitude of physical changes. For active people, one of the most common problems is osteoarthritis — degeneration of the cartilage in joints—particularly in the hips and knees.

Pain in these weight-bearing joints can prove disabling, and a prevalent option has been to eventually replace the joint. However, a simpler, far less invasive solution is able to treat knee osteoarthritis and even halt its progress in much earlier stages through extracorporeal shockwave therapy — also known as ESWT.

What is Extracorporeal Shockwave Therapy?

ESWT is frequently associated with its first medical use—its ability to break kidney stones into small pieces. However, researchers have been experimenting with using pulses of electromagnetic waves transmitted to a body area through a pad or wand to treat musculoskeletal — often joint — problems since the 1980s:

Therapists had noted the therapy’s marked ability to improve mobility as well as reduce pain in their patients.
studies examining ESWT’s effects on the intertwined subchondral bone and common to joints have demonstrated improvements in bone remodeling as well as slowed degeneration of the cartilage.
ESWT has proved effective in treating a wide variety of musculoskeletal problems, to include osteoarthritis in the knee.

Evaluating ESWT for Osteoarthritis of the Knee

Clinical trials have demonstrated marked differences between patients taking ESWT versus those receiving only a placebo treatment for significant levels of osteoarthritis of the knee:

Patient-reported pain ratings improved drastically after just 1 week of treatment for the ESWT group and continued to improve over the 12-week period.
Patients undergoing ESWT demonstrated greater physical mobility, reduced stiffness and improved pain levels on standardized functionality indexes.

Proven Uses of ESWT

While the goal is to remain active, aging individuals nevertheless face many orthopedic challenges due either to disease or simple wear and tear. As a noninvasive option, ESWT has become the preferred therapy for treating a number of complex musculoskeletal problems, to include:

Tendinosis, tendonitis and other chronic tendon overuse injuries.
Nonhealing bone fractures, particularly those of long bones like the tibia, for example.
Femoral head avascular necrosis—deterioration due to a lack of blood supply to the bone—typically due to trauma, overuse or disease.

Benefits of ESWT

One of the most promising benefits of ESWT is how the therapy can actually slow and possibly even halt the progression of osteoarthritis. In addition, the therapy:

Improves joint function. Functionality for study therapy recipients was more than double that of the placebo group.
Relieves pain. ESWT selectively impacts minor, smaller nerves that lack a myelin sheath without affecting major, myelin-sheathed ones.
Is noninvasive. Extracorporeal means the shockwave pulses are generated outside the body and are delivered via a device applied to the skin. No surgery is involved.
Requires no prescription drugs or pharmacology.
No side effects or complications; some patients experience minor skin reddening or swelling at the site.
Is cost-effective, far less expensive than joint replacement.

As an effective, noninvasive means of treating osteoarthritis of the knee, ESWT is not only promising but a pain-free way of staving off aging, remaining active and retaining quality of life.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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