17 Shockwave Therapy Treatment Cases And Clinical Applications

Preface

As rehabilitation medicine and physical therapy continue to evolve, shockwave technology has steadily gained recognition for its non-invasive, safe, and fast-acting results. Today, it plays an important role in helping patients manage pain and restore function without surgery.

To make this technology easier to apply in daily practice, we have prepared the "Shockwave Therapy Application and Operation Guide." It brings together the core principles of shockwave therapy, its main indications and precautions, as well as clear step-by-step operation procedures. Our aim is to provide medical and rehabilitation teams with practical support that can be directly applied in clinical settings.

 

 

What is a shock wave?

Functions:

1. Tissue damage repair and reconstruction, promoting fiber growth and tissue healing
2. Vasodilation and angiogenesis effects
3. Analgesic and nerve ending blocking effects
4. High-density tissue lysis effect
5. Inflammation and infection control effects

 

Indications for shock wave therapy:

• Shoulder: Frozen shoulder, biceps long head tendonitis, subacromial bursitis, calcific supraspinatus tendonitis
• Elbow: Lateral epicondylitis, medial epicondylitis
• Wrist: Tendonitis, finger arthritis
• Knee: Patellar tendonitis, knee arthritis
• Foot: Plantar fasciitis, Achilles tendonitis
• Neck and lower back: Shoulder and neck muscle pain, T3 transverse process syndrome
• Bone tissue: Non-union not exceeding 1cm, delayed fracture healing, avascular necrosis of the femoral head
• Hemiplegia and cerebral palsy: Muscle spasms, nerve damage
• Male diseases: Impotence, prostatitis

 

 

Principles of shock wave therapy:

Shockwaves are divided into focused and radial types:

• Focused shockwaves penetrate deeper, mainly generating energy through piezoelectric, electrohydraulic, and electromagnetic focusing. They are suitable for deep, clearly painful skeletal muscle diseases, such as calcific tendonitis, non-union, early-stage femoral head necrosis, deep fascial pain points, male dysfunction, etc.
• Radial shockwaves penetrate more shallowly, mainly generating energy through pneumatic ballistics. The focal point is on the skin surface, entering the tissue in a radial form. They are suitable for superficial, larger-area muscle group pain, such as tennis elbow, Achilles tendonitis, tendonitis, "wealth packet" (fatty hump on the back of the neck), and relaxation of the neck, shoulder, and back muscle groups.

 

 

Contraindications:

Bleeding disorders, coagulation dysfunction, thrombosis at the operation site, growing pain in children (affects epiphyseal development)

Sensory dysfunction, cognitive impairment and mental illness, severe arrhythmia, severe hypertension, heart disease, malignant tumors, and other major diseases

Tendon and fascia rupture and severe trauma, acute phase of infectious diseases, bone defects, non-union greater than 1cm, joint fluid leakage are prohibited

Pregnant women and those with pacemakers are prohibited from operation

 

Operating Principles:

The key to shockwave therapy is applying appropriate energy to precise locations. The energy used and the sites selected determine the final treatment outcome. Each treatment should select at least 2-4 treatment points, with intervals of 3-4 days between sessions. A course consists of 6-8 sessions. During treatment, the injured area will continuously recover and rebuild. Further operations can be performed based on the patient's recovery progress.

 

Shockwave Therapy Cases

I. Fat Accumulation:

Shockwaves can break down the fat components in fat cells, making fat lumps smoother, accelerating blood circulation, and thus promoting fat metabolism.

1. The patient lies in a supine position. Identify and mark areas with thick fat accumulation, such as the abdomen and buttocks.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 4000-6000 (set based on the size of the area).
3. Frequency: 10-21 Hz (the faster the frequency, the shallower the penetration; the slower the frequency, the deeper the penetration)
4. Energy: Start at 2.5 Bar (adjust based on the patient's tolerance)
5. Apply coupling gel to the treatment area. During treatment, move the handpiece slowly and continuously to oscillate the fatty areas, loosening the fat tissue and enhancing systemic circulation and metabolism.

 

 

II. Elbow Joint Medial/Lateral Epicondylitis, Tennis Elbow:

1. The patient lies supine or sits. Palpate the common flexor tendon and flexor muscle belly around the medial/lateral epicondyle, identify tender points, and mark them.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 2000-4000. Start energy at 3 Bar (adjust based on the patient's tolerance).
3. Apply coupling gel to the marked points. Deliver 500-800 shocks per tender point. During treatment, slowly move the handpiece to loosen the tissues around the pain points.
4. After loosening the pain points, perform sliding operations on the medial side of the humerus and the lateral side of the arm for auxiliary therapy.

 

 

III. Wrist Joint Pain:

1. The patient lies supine or sits. Palpate around the wrist joint and the thenar and hypothenar muscle groups, identify tender points, and mark them.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 2000-4000, frequency 7-15 Hz, starting energy at 2 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. Deliver 500-800 shocks per tender point. During treatment, slowly move the handpiece to loosen the tissues around the pain points.
4. After loosening the pain points, perform sliding operations on the anterior muscle fascia of the forearm for auxiliary therapy.

 

 

IV. Tendonitis:

1. Palpate the affected tendon sheath (e.g., extensor pollicis tendon, wrist extensor tendon), identify tender points, and mark them. Also mark the proximal muscle belly and fascial adhesion areas for auxiliary therapy.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 2000-4000, frequency 5-15 Hz, starting energy at 2 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. Deliver 500-800 shocks per tender point. During treatment, slowly move the handpiece to loosen the tissues around the pain points.
4. After loosening the pain points, perform sliding operations on the proximal muscle fascia for auxiliary therapy.

 

 

V. Frozen Shoulder, Rotator Cuff Injury:

1. The patient lies prone. Palpate the soft tissues around the shoulder (e.g., supraspinatus, infraspinatus, teres major and minor), and mark pain points around the scapular soft tissues.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 2000-4000, frequency 5-15 Hz, starting energy at 5 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. Deliver 500-800 shocks per tender point. During treatment, slowly move the handpiece to loosen the tissues around the pain points. Also, palpate the levator scapulae, trapezius, erector spinae, and other back muscle fascias for sliding auxiliary therapy.

 

 

VI. Supraspinatus Tendonitis, Biceps Tendonitis:

1. The patient lies supine. Palpate the supraspinatus, biceps, and deltoid areas, identify pain points, and mark them.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 3000-6000, frequency 5-12 Hz, starting energy at 4 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. Deliver 500-800 shocks per tender point. During treatment, slowly move the handpiece to loosen the tissues around the pain points. Also, palpate the surrounding muscle fascias (e.g., pectoralis minor, trapezius, infraspinatus) for sliding auxiliary therapy.

 

 

VII. Back Soft Tissue Fascial Adhesion:

1. The patient lies prone. Palpate the erector spinae, trapezius, and rhomboid muscles, identify tender points, and mark them.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 3000-6000, frequency 7-15 Hz, starting energy at 5 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. Deliver 800-1000 shocks per tender point. During treatment, slowly move the handpiece to loosen the tissues around the pain points.
4. After loosening the pain points, perform sliding operations on the muscle fascia around the painful area for auxiliary therapy..

 

 

VIII. L3 Transverse Process Syndrome:

1. The patient lies prone. Palpate the L3 transverse process and the surrounding muscle fascias of the lower back (e.g., erector spinae, quadratus lumborum, thoracolumbar fascia), identify tender points, and mark them.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 3000-6000, frequency 6-15 Hz, starting energy at 6 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. Deliver 800-1000 shocks per tender point. During treatment, slowly move the handpiece to loosen the tissues around the pain points.
4. After loosening the pain points, palpate the hip and buttock muscle fascias for sliding operations for auxiliary therapy.

 

 

IX. Patellar Tendonitis:

1. The patient lies supine. Palpate the soft tissues of the leg (e.g., quadriceps muscle tendon and patellar tendon area), identify tender points, and mark them.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 2000-4000, frequency 7-15 Hz, starting energy at 2 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. Deliver 500-800 shocks per tender point. During treatment, slowly move the handpiece to loosen the tissues around the pain points.
4. After loosening the pain points, palpate the distal thigh and proximal calf muscle fascias for sliding operations for auxiliary therapy.

 

 

X. Achilles Tendonitis:

1. The patient lies prone. Palpate the Achilles tendon and surrounding soft tissues, identify tender points, and mark them.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 3000-6000, frequency 7-15 Hz, starting energy at 3 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. Deliver 500-800 shocks per tender point. During treatment, slowly move the handpiece to loosen the tissues around the pain points.
4. After loosening the pain points, perform sliding operations on the calf and sole areas for auxiliary therapy.

 

 

XI. Ankle Joint Arthritis:

1. The patient lies supine with knees bent. Palpate the ankle joint and surrounding soft tissues of the talus, identify tender points, and mark them.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 2000-3000, frequency 7-15 Hz, starting energy at 3 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. During treatment, slowly move the handpiece to loosen the tissues around the pain points.
4. After loosening the pain points, perform sliding operations on the proximal muscle fascia of the calf for auxiliary therapy.

 

 

XII. Iliotibial Band Syndrome:

1. The patient lies on their side. Palpate the lateral thigh and the end of the iliotibial band, identify tender points, and mark them.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 4000-8000, frequency 8-15 Hz, starting energy at 4 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. Deliver 500-800 shocks per marked point. During treatment, slowly move the handpiece to loosen the tissues around the pain points.
4. After loosening the pain points, perform sliding operations on the surrounding muscle fascias of the hips and legs for auxiliary therapy.

 

 

 

XIII. Medial Knee Pain:

1. The patient lies supine. Palpate the posterior and medial thigh and the pes anserinus tendon, identify tender points, and mark them.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 2000-4000, frequency 8-15 Hz, starting energy at 2 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. Deliver 500-800 shocks per marked point. During treatment, slowly move the handpiece to loosen the tissues around the pain points.
4. After loosening the pain points, perform sliding operations on the muscle fascia around the knee joint for auxiliary therapy.

 

 

XIV. Plantar Fasciitis:

1. The patient lies prone. Palpate the calcaneus and plantar fascia, identify tender points, and mark them.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 2000-4000, frequency 6-15 Hz, starting energy at 3 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. During treatment, slowly move the handpiece to loosen the tissues around the pain points.
4. After loosening the pain points, perform sliding operations on the calf muscle fascia for auxiliary therapy.

 

 

XV. Greater Trochanteric Bursitis:

1. The patient lies on their side. Palpate the soft tissue pain points around the greater trochanter, identify tender points, and mark them.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 3000-5000, frequency 7-15 Hz, starting energy at 5 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. Deliver 500-800 shocks per marked point. During treatment, slowly move the handpiece to loosen the tissues around the pain points.(Early avascular necrosis of the femoral head and surrounding damage can be treated in the same way.)
4. After loosening the pain points, perform sliding operations on the lateral and posterior thigh and buttocks for auxiliary therapy.

 

 

XVI. "Wealth Packet" (Fatty Hump on the Back of the Neck):

1. The patient lies prone. Palpate the soft tissue pain points around the cervical "wealth packet," and mark the area with a circle.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 2000-3000, frequency 7-15 Hz, starting energy at 3 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. Slowly move the handpiece within the "wealth packet" to loosen the muscles. Note: When operating near cervical bones, move quickly and avoid staying too long. Hitting bony areas may cause pain. Continuously ask about pain during operation. If there is pain, pause and strike; if no pain, continue circular operation.

 

 

XVII. ED Treatment Method (Focused Shockwave is More Effective):

1. The patient lies supine. Manually stretch the penis, and mark five points: the distal, middle, and proximal penis, and the left and right crus of the penis at the posterior end of the corpus cavernosum.
2. Select the corresponding area on the device interface, choose the appropriate treatment head, and adjust the number of strikes to 1500-2000, starting energy at 2 Bar. Fine-tune based on the patient's tolerance.
3. Apply coupling gel to the marked points. Deliver 300-400 shocks per marked point.
4. During treatment, no psychological intervention or support is provided, and patients are required to maintain normal sexual habits.
5. The shockwave ED treatment course is twice a week for 3 weeks, followed by a 3-week break before repeating. The effectiveness rate can reach 70%, and results can last for about 2 years.

 

 

Conclusion

The "Shockwave Therapy Application and Operation Guide" serves as a bridge between clinical knowledge and real-world practice. By combining theory with step-by-step operational cases, it offers a structured framework to ensure safe, effective, and reproducible treatments.

We believe this guide will not only assist healthcare providers in optimizing patient outcomes but also contribute to the broader development of rehabilitation medicine. Through standardized application, shockwave therapy can reach its full potential in relieving pain, restoring function, and improving quality of life.