Extracorporeal Shockwave Therapy for Musculoskelatal Disorders


How does extracorporeal shockwave therapy work?

This treatment is a highly refined way of delivering targeted electric shockwaves to specific locations in the patient’s body to stimulate healing or disintegrate stones within organs like the liver, kidneys and gallbladder. It’s completely non-invasive, and it has the name “extracorporeal” because the electricity comes from a source outside the patient’s body and penetrates through their body tissues to hit their target.

Doctors can generate the electrical shockwave in one of three ways:

  • Electrohydraulic shockwaves are acoustic. This concentrated energy of sound comes from high-voltage electrodes operating under water inside the machine.
  • Electromagnetic shockwaves harness the energy of an electric current that goes through a coil, creating a powerful magnetic field. An internal lens focuses the waves.
  • Piezoelectric shockwaves are an advanced form of ultrasound. The type of machine running on piezoelectricity transforms electrical energy into high-speed mechanical vibrations using the device’s internal crystals to focus the shockwave and build a powerful circuit of energy.

What conditions can you treat with extracorporeal shockwave therapy?

Research has proven that these shockwaves can successfully treat a wide range of medical conditions. Initially, doctors used extracorporeal shockwave treatments to treat internal diseases like kidney stones. In lithotripsy, doctors aim shockwaves exactly at stones inside the organs of your urinary system to break them up into small pieces so that your body can naturally eliminate them with very little or no pain.

However, the use of shockwaves in Orthotripsy to treat musculoskeletal disorders has a different purpose. Here, it stimulates the tissues to heal faster and regenerate themselves when they are struggling to heal on their own. Another benefit of this procedure is that you can often remain conscious, so there are less risks of side effects. Specialists apply local anesthesia to the area of the injury first. They will target the shockwaves at the areas where the patient is experiencing the most pain. In numerous tests, scientists have found that using shockwaves in this way promotes new growth of bone and tendon tissues, which are the fibers connecting your muscles to your bones.

What happens when shockwaves hit the chronically inflamed tissues or broken bones is that they boost blood circulation to that area, which leads to a decrease in inflammation and pain after the patient recovers from the procedure. This technique has been around for more than 10 years, and its most-common use is in treating cases where patients have injuries from over-use of their tendons or in fractures that are slow to heal.

These tendon diseases often come from many micro-tears in the tissue, often seen in instances of proximal plantar fasciitis of the heel, for example. The same problem appears in cases of lateral epicondylitis of the elbow, known as tennis elbow. Here the tissues joining the forearm muscles that lie on the outside of the elbow suffer from overuse and become damaged.

Shockwave therapy also works well for healing calcific or non-calcific tendonitis of the shoulder, in which you feel pain in the rotator cuff that connects shoulder muscles to the larger bone in your upper arm. Often, the body creates calcium deposits here to heal the damaged tissue, and the body is supposed to reabsorb these deposits. Sometimes other factors interfere with the body’s ability to absorb the deposits properly, so the shockwaves help speed up this process.

In patellar tendinopathy — caused by the overuse of the knee in activities like repetitive, heavy jumping — the patella tendon that helps your muscles extend your knee becomes overstressed. To help alleviate the knee pain, stiffness and swelling, shockwave treatments aimed at the knee tissues speed up the body’s internal healing process.

Doctors have been highly pleased by the great success rates they have seen from using electric shockwaves to help patients recover from these musculoskeletal disorders. An average of between 65 to 91 percent of those treated healed very well with extremely low instances of complications.

Additional applications of extracorporeal shockwave therapy that also work well are in cases of ischemic heart disease and in treating those with ulcers. Shockwave therapy’s ability to help non-joining bone unions has a success rate of 50 to 85 percent, making it a valuable treatment for many as well.


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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