Shockwave Treatment for Shoulder Tendonitis
Do you have achy/sore pain in your shoulder that isn’t going away? Especially pain and weakness/difficulty with reaching overhead or merely trying to sleep on that side?
QUICK SHOULDER TEST TIME!
1st) Give yourself a “thumbs up” (with your arm outstretched in front of you) for taking the initiative to learn more about your shoulder!
2nd) Then, because shoulder pain is unpleasant, give pain a “thumbs down”.
3rd) Keeping that “thumbs down” position, try to reach that hand overhead…
If that 3rd position hurts the top of your shoulder and/or you have more difficulty/limited range reaching overhead on that side (compared to the opposite side), there’s a ~58% chance that you may have shoulder tendinopathy (1). Getting your shoulder checked out thoroughly by a physiotherapist and/or doctor can help give you a more definite and confident diagnosis.
WHAT’S GOING ON?
In general, there are 2 types of shoulder tendinopathy – calcified and non-calcified. When a tendon in the shoulder is subject to too much compression for too long, without enough time to recover, and/or in the presence of other pro-inflammatory health factors such as diabetes, smoking, stress, or having a higher BMI, a tendon tends to thicken (2,3,4).
However, there isn’t a lot of room inside the shoulder (specifically under the acromion process) to begin with…which leads to more compression, which leads to more thickening…creating the painful cycle of thickening begets thickening.
In some cases, when there is lower blood flow to tendons, these thickened tendons can develop “calcifications” (5). (Note that these “calcifications” typically have a more “chalk-like…toothpaste” consistency rather than little “crystals” that people tend to envisage (5)).
With usual conservative physiotherapy care – including activity modification, NSAIDs (Non-Steroidal Anti-Inflammatories – such as ibuprofen), exercises, and cortisone injections, most people’s shoulder pain and function improves (6). However, if you’ve tried everything above and are still struggling with your shoulder pain, and even considering going ‘under the knife’ for surgery – there is an effective NON-INVASIVE option to try first.
IT’S CALLED SHOCKWAVE THERAPY!
As few as 3 or 4 shockwave treatments can help reduce your pain, improve your ability to reach overhead, and avoid surgery (thereby dodging any risk of post-op complications) (6,7,8). Shockwave has also been shown to help reduce the size of the calcium deposits and, in 54-86% of cases, completely dissolve these calcifications (9, 10). Scientists are still researching the exact mechanism of how these shockwave devices affect tissues. The best current hypothesis is that the rapid sound waves help stimulate the healing process by re-establishing normal tendon tissue conditions (11, 12).
Good news is that BOTH Thrive Now Physiotherapy Clinics in Duncan AND Cobble Hill have Shockwave Therapy machines.
WHAT DOES IT FEEL LIKE?
Most patients report the sensation of light to moderate tapping with a numbing effect afterwards. Feel free to let your physiotherapist know if the tapping is too strong – as the intensity can be adjusted to make it more comfortable.
Contact us here at Thrive Now Physiotherapy (Duncan – 250-856-0531 Or Cobble Hill – 250-743-3833) if you would like to find out more about shockwave therapy!
1) Alqunaee M, Galvin R, and Fahey T (2012). Diagnostic accuracy of clinical tests for subacromial impingement syndrome: a systematic review and meta-analysis. Arch Phys Med Rehabil; 93: pp. 229-236 Accessed May 21/2021 https://www.archives-pmr.org/article/S0003-9993%2811%2900795-7/pdf
2) Cook JL & Purdam CR (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med;43:409–416. doi:10.1136/bjsm.2008.051193
3) Cook, J (2019 Mar 24). Current concepts in tendon rehabilitation. Online TrustMe Ed lecture. Accessed Dec 8/2020: https://www.trustme-ed.com/lectures/current-concepts-in-tendon-rehabilitation/current-concepts-in-tendon-rehabilitation
4) Ellulu, M. S., Patimah, I., Khaza’ai, H., Rahmat, A., & Abed, Y. (2017). Obesity and inflammation: the linking mechanism and the complications. Archives of medical science: AMS, 13(4), 851–863. https://doi.org/10.5114/aoms.2016.58928 Accessed May 21/2021: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507106/
5) Wainner RS & Hasz M (1998). Management of Acute Calcific Tendinitis of the Shoulder JOSPT Volume 27 Number 3 March 1998
6) Moya D, Ramón S, Guiloff L, Gerdesmeyer L (2015). Current knowledge on evidence-based shockwave treatments for shoulder pathology. Int J Surg. 2015 Dec;24(Pt B):171-8. doi: 10.1016/j.ijsu.2015.08.079. Epub 2015 Sep 9. PMID: 26361863. Accessed May 23/2021: https://www.sciencedirect.com/science/article/pii/S1743919115011917
7) Schofer MD, Hinrichs F, Peterlein CD, Arendt M, Schmitt J. High- versus low-energy extracorporeal shock wave therapy of rotator cuff tendinopathy: a prospective, randomised, controlled study. Acta Orthop Belg. 2009 Aug;75(4):452-8. Accessed May 21/2021: https://pubmed.ncbi.nlm.nih.gov/19774810/
8) Ioppolo, F. et al. (2013). “Clinical Improvement and Resorption of Calcifications in Calcific Tendinitis of the Shoulder After Shock Wave Therapy at 6 Months’ Follow-Up: A Systematic Review and Meta-Analysis.” Archives of Physical Medicine and Rehabilitation 94(9): 1699-1706. Accessed May 21/2021: https://pubmed.ncbi.nlm.nih.gov/23499780/
9) Cacchio, A. et al. (2006). “Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study.” Phys-Ther. 86(5): 672-82. Accessed May 21/2021: https://pubmed.ncbi.nlm.nih.gov/16649891/
10) Moretti, B. et al. (2005). “Medium-energy shock wave therapy in the treatment of rotator cuff calcifying tendinitis.” Knee Surg Sports Traumatol Arthrosc 13(5): 405-10. Accessed May 21/2021: https://pubmed.ncbi.nlm.nih.gov/15800753/
11) Notarnicola A, Moretti L, Tafuri S, Forcignanò M, Pesce V, Moretti B (2011 Mar). Reduced local perfusion after shock wave treatment of rotator cuff tendinopathy. Ultrasound Med Biol; 37(3):417-25. doi: 10.1016/j.ultrasmedbio.2010.11.019.. Accessed May 23/2021: https://www.umbjournal.org/article/S0301-5629(10)00664-2/fulltext
12) Ho, C. (2007). “Extracorporeal shock wave treatment for chronic rotator cuff tendonitis (shoulder pain).” Issues Emerg Health Technol(96 (part 3)): 1-4. Accessed May 23/2021: https://pubmed.ncbi.nlm.nih.gov/17302022/