Extracorporeal Shock Wave Therapy as Regenerative Medicine Tool

By Sara Pepitone

Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment that uses high-energy sound waves to stimulate blood flow, initiating the body’s natural healing response. The result: long-term relief from musculoskeletal pain.

“There are no needles or surgery involved, and shock wave therapy allows the body to create the cellular process needed to heal injured tissue,” says Kristian Johnson von Rickenbach, MD, an assistant clinical professor of rehabilitation and regenerative medicine. “Patients can maintain normal physical activity levels throughout treatment, which is a plus.”

First used in medicine in 1980 to eliminate kidney stones, ESWT has been evolving with new clinical applications ever since. ESWT is used to treat various musculoskeletal injuries, including small tears in muscles or tendons, plantar fasciitis, Achilles tendinitis, gluteal tendinitis, rotator cuff injuries, and stress fractures—often in combination with physical therapy.

There are two primary types of ESWT: Focused shock wave therapy uses piezoelectric mechanics to produce high-energy waves that penetrate deeper tissues. Radial shock wave therapy uses a pneumatic system to create lower-energy waves dispersed over a wider area for surface tissues. Both approaches can be used in combination, customized to the injury.

In addition to being non-invasive and achieving long-term pain relief, Dr. von Rickenbach says the fact that ESWT can be used “in season” is an important point for many patients. “It enables athletes to avoid the downtime associated with some other therapies and keep training, which is a very unique feature.”

To generate shock waves, a handheld probe is placed over the patient’s skin with an applied gel to help with energy transmission. Each session lasts 15-30 minutes depending on the area of the body being treated. A full series is three to four sessions, with one-week intervals in between.

ESWT usually causes discomfort over injured areas, and some patients find the pressure applied by the probe uncomfortable. But Dr. von Rickenbach recommends against local anesthetic or numbing because the procedure requires feedback from the patient to guide treatment location and strength.

“Although the procedure itself can be painful, the beauty of this modality is that the force at which the shock waves are being generated can be increased or decreased in real time depending on a patient’s response,” Dr. von Rickenbach says.

Columbia’s Department of Rehabilitation and Regenerative Medicine has used ESWT since 2020. Today, many physical medicine and rehabilitation providers have been trained in this modality, and other departments have started research on patient outcomes as well. Word is also getting out among patients. “More and more patients seek our expertise,” says Dr. von Rickenbach. But only a few receive the procedure because it is typically an out-of-pocket expense.

ESWT’s effectiveness compared to existing therapies varies based on the condition being treated. “Although more studies are needed, research suggests shock wave therapy is as effective and, in some cases, more effective than more invasive procedures, like steroid or platelet-rich plasma injections,” says Dr. von Rickenbach. “We hope we can continue to prove the utility of shock wave so that one day all insurances cover it.”