Treatment of shock wave tendinitis

Treatment for shock wave tendonitis involves applying percussion or ultrasound to the affected tendon. Two types of machine exist, one used by physiotherapists, the other by doctors. Explanations with Dr Eric Noël, rheumatologist at the Paul Santy Orthopedic Center in Lyon;

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  • Definition
  • Technique and apparatus
  • Duration of treatment
  • Indications
  • Efficiency
  • Which specialist?
  • Side effects and pain
  • Contraindications
  • Price and reimbursement

Definition: what is shock wave therapy?

“The treatment of tendonitis by shock waves consists of using mechanical waves from a point of percussion directed on the area to be treated. Their action is facilitated by the interposition of a gel between the therapeutic probe and the The purpose of the shock waves is to soften the calcifications to facilitate their resorption. In addition, and in particular on degenerative tendons, the shock waves cause bleeding from the small vessels which help to heal the damaged tendon “explains Dr Eric Noël , rheumatologist at the Paul Santy Orthopedic Center in Lyon. ” It’s the same principle that is used to destroy kidney stones, ” says Dr Eric Noël. “Since 1997, the devices used by urologists have also been used to treat calcifications of the shoulder by analogy with kidney stones, then, in Germany and then in France, specific machines for treating tendon pathologies have been developed. Today, it is a treatment that is done more frequently “ reports the rheumatologist.

Technique and apparatus: how does the shock wave treatment work?

” Today, there are two types of machines for treating tendon pathologies by shock waves: radial shock waves, used by physiotherapists and focal shock waves rather used by doctors” informs Dr Eric Noël. ” Radial shock waves scatter around the area to be treated and go shallower. Focal shock waves penetrate deeper over a narrower perimeter. These two types of shock waves have a different protocol, results different, a different cost. the focal waves work best on calcifications and tendonitis deeper“He describes. In practice, the shock wave sessions are done on an outpatient basis. It is possible to leave with your car.

Duration of treatment

The duration of treatment depends on the type of machines used. ” For radial waves, it takes between 8 and 12 sessions, for focal shock waves 2 to 3 sessions,  informs the rheumatologist. There is no consensus on the treatment regimen: on average, the protocol is of 3000 shocks per session, others do more and others less. Athletes must avoid having a sporting activity during the whole duration of the shock wave treatment “warns Dr. Eric Noël.


Shock wave therapy is indicated for the treatment of tendinopathies  : patellar, achilles (Achilles tendon), tennis elbow (epicondylitis), plantar fasciitis, in the elbow or shoulder. It is also used as mentioned above to treat calcifications of the shoulder. Treatment of shock wave tendonitis should only be performed after clinical diagnosis and ultrasound workup.

Effectiveness of this treatment

” The results of scientific publications are favorable to shock waves. They are recognized as an effective treatment, but they are more or less effective depending on the type of pathology, age, etc.” indicates Dr Eric Noël. “The results are better on tendonitis than on calcifications (these must be more than 1cm in diameter, be homogeneous for the shock waves to be effective). The tendinopathies which respond best to shock wave treatment are the Achilles tendonitis, elbow tendonitis (Tennis elbow), which represent the two most frequent types of tendonitis, with plantar aponeurosis “ informs the specialist. Shock waves are a complementary treatment that is added to the small range of treatments that we already have “, explains Dr Eric Noël.

Which specialist does this treatment?

Radial shock waves are done by physical therapists and focal shock waves are done by sports physicians and rheumatologists instead. ” It is more of a second-line treatment, when the first-line treatments have not worked”  specifies Dr Eric Noël.

Side effects and pain

“The shock wave treatment does not cause side effects but it is painful , a little more for radial shock waves ” informs Dr. Eric Noël. However, you should know that the sessions are quite short, lasting 7 to 10 minutes, including installation and breaks.


“There are several contraindications in principle to shock waves: the Pacemaker, pregnancy, taking anti-coagulants ” indicates the rheumatologist. ” The presence of a wound also contraindicates shock wave therapy, ” he adds.

by Abdullah Sam
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