From orthopedics to aesthetics to neurology, Dr. How’s review highlights the expanding clinical applications of Shockwave and EMTT across diverse medical disciplines.
Keep reading to learn more about what this incredible body of evidence means for medical practitioners.
We started by asking Helen about the single most important piece of evidence for medical professionals who are aware of Shockwave but not closely acquainted with the research.
Her answer? Extracorporeal Shockwave Therapy in Musculoskeletal Disorders, Wang et al. (2012), the “landmark paper that every clinician using Shockwave should read before treating tendinopathy.” This research demonstrates that Shockwave initiates an early biological signalling response (within 1 week), but true tendon regeneration doesn’t begin until around 4 weeks and continues for 12+ weeks.
In other words, Shockwave starts working right away, but patients may not feel an immediate difference. “The problem is that most clinicians still judge success by early pain change,” noted Helen, “when in reality pain is a poor and delayed marker—so they completely misunderstand the biological timeline and often mismanage loading or abandon treatment too early.”
Researchers realized the acoustic wave was, in fact, activating a biological signal. Helen How notes that “Cells respond to mechanical force. They always have. Shockwave was essentially speaking a language cells already understood.”
‘Substance P’ provides an instructive example of how researchers began to clarify the deeper story behind Shockwave. “The early Shockwave literature,” notes How, “described it as a pain molecule that Shockwave releases, causing a temporary flare before things settle. That framing wasn’t wrong, but it was a fraction of the picture.”
We now know Substance P isn’t simply a pain molecule, but a biological first responder involved in bone repair, wound healing, stem cell fate, and immunity. Shockwave goes far deeper than local release by depleting SP-immunoreactive neurons in the dorsal root ganglia, selectively remodeling the unmyelinated C-fibres that carry it.
For Helen, the most surprising aspect of her literature review was finding such a clear answer already there in the research to a question she had based on her own clinical work:
“I worked through three decades of studies because I had a patient who woke up from cervical spine surgery with complete C5, C6, and C7 motor paralysis. I needed to understand how Shockwave had helped reverse it. What I found was remarkable. Focused Shockwave drives angiogenesis into ischaemic tissue. It remodels Substance P signaling at the dorsal root ganglion — at the spinal level, not just locally. It pulls stem cells to the treatment zone. It creates the biological conditions in which nerve regeneration becomes possible.”
2013 was a key moment for Shockwave research. Helen How explains that “Up until then, the research was largely asking clinical questions. Does Shockwave help plantar fasciitis? Calcific tendinopathy? Fracture non-union? The outcomes were consistently positive, but the biology underneath them was poorly explained. Sun et al changed that in 2013.”
In short, this research mapped the entire osteogenic pathway, from the mechanical impulse, through ATP release, through P2X7 receptor activation, all the way to stem cell differentiation into bone.
Coupled with advancing research on Substance P, researchers were beginning to build a body of evidence showing how Shockwave was operating on multiple biological systems simultaneously.
How notes that “when most clinicians think of Shockwave, they think tendon, bone, pain. And that evidence base is solid, decades deep, and well replicated. But the current research is exploring territory that would have seemed implausible twenty years ago.”
Our thanks to Helen for this informative discussion!
If you’re interested in learning more, we take a deeper look at the evolution of Shockwave research here.
Connect with the CuraMedix team to learn more about integrating Shockwave into your practice.
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Helen How, Registered Osteopath of Edinburgh, Scotland, has over 30 years of experience, specializing in sports medicine, rehabilitation, and Shockwave therapy. Connect with Helen How on LinkedIn. |