For quite some time I have been keeping an eye on Extracorporeal Shockwave Therapy (ESWT) as a treatment modality for a number of different conditions, but most notably plantar heel pain. There has been a slow but steady flow of fairly reliable research that now indicate a strong likelihood ESWT is effective in the management…
Simon Bartold
Director of Bartold Clinical
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2 responses to “Is ESWT effective for shin pain?”
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In my experience of using ESWT to treat MTSS, there are very few patients who can tolerate high pressures over the posteromedial tibial border and it’s often the case that it’s administered at lower pressure and via a headpiece with larger surface area (36mm compared with 16mm) for this reason. So in effect most treatment in the real world is likely to be at a lower dosage than indicated and maybe that’s why I see good outcomes in my patients?
It does also not surprise me that at lower dosages pain on palpation improves compared with higher doses. I would suggest the analogy of rubbing a bruise on your arm, which may have the effect of over riding the pain signals being sent to the brain, versus being punched repeatedly at the site and exacerbating the injury.
I agree that the fact that activity was not modified in the participants included in the study is a real problem when trying to relate the findings to real life practice, as it seems at odds with what we know about the stages of bone injury and the narrow zone of load tolerance the participants would be functioning within. So if ESWT does indeed have the effect of stimulating bone remodelling, then this would surely be “undone” through continued loading of unhealthy bone tissue?
A thought provoking paper nonetheless and definitely hi lights the need for further research. Thank you Simon
Thanks very much for sharing your experience Emily.. very interesting and for me highlights the fact that ESWT is not cookie cutter and requires substantial knowledge of the variations within the therapy is success is to be consistent.