Indications and contraindications for physiotherapy

Indications and contraindications for physiotherapy

Shock-wave therapy: benefits and harms

Shock-wave therapy (SWT) is a method of physiotherapeutic effect on bone and connective tissue with the help of acoustic impulses of different energy.

Waves are generated by a special device (e.g., SoskMaster 500, Masterpuls, Storz Medical, SWISS DOLORCLAST). The depth of effective impact of shock waves is up to 6 cm, and the area is more than 17 cm. The pulse rate is between 1 and 23 impulses per second.

The principle of UHT

The method has defibrosizing, hypoalgesic, reparative-regenerative, myorelaxing and locomotor-corrective therapeutic effects. Simply put, the essence of UHT therapy is to accelerate the recovery and healing of affected tissues, relax skeletal muscles, relieve stress in the joints and muscles, improve mobility.

This is achieved by penetrating the acoustic wave into the joint/bone, where it loosens salt deposits and other dense formations.


Shock-wave therapy is widely used in orthopaedics for tendopathy, a pathology that occurs when a tendon is damaged at its junction with the bone. The process is accompanied by pain, inflammation and swelling.

Tendopathies are caused by increased strain (usually on athletes), age-related changes, flat feet, wearing bad shoes, and infection.

Thus, the evidence for the UHT is:

  • Chronic degenerative-dystrophic and inflammatory diseases of the musculoskeletal system – styloiditis, epicondylitis, arthrosis, tendonosis, calcinosis, tendinitis, Dupuytren’s syndrome, heel spur, fasciitis, flat feet, stress fractures, bursites.
  • Chronic degenerative-dystrophic diseases of the spine – osteochondrosis, hernias, protrusion disks, myofascites, pelvic ligaments.
  • Damage to muscles, ligaments and tendons.
  • Consolidated bone fractures.


Shock wave therapy is contraindicated in all general cases where physical therapy is not recommended (e.g., systemic blood diseases, cardiovascular diseases, fever, mental illness).

In addition, it is contraindicated to HBV:

  • Unfixed unstable bone fractures.
  • Presence of a pacemaker.
  • Reception of direct anticoagulants.
  • Acute purulent-inflammatory processes of various localizations
  • Collagenosis.
  • Increased vascular fragility.
  • Increased pressure.
  • Cancer diseases.
  • Childhood.
  • Pregnancy.

The benefits of shock-wave therapy

Positive effects of SST are manifested in primary and secondary effects.

The primary effect of UHT therapy comes almost immediately. After a couple of sessions, the patient feels a decrease in pain syndrome. This is most noticeable in the treatment of heel spurs, arthrosis. Also, blood circulation in the area of exposure improves almost immediately, which is comparable to a deep massage.

After completing the full course of treatment, there is a secondary effect. Mobility of the joint is restored and improved. Calcium deposits loosen, decrease or disappear completely areas of fibrous tissue and bone growths.

Ligaments and tendons are strengthened and less prone to injury. Thanks to improved blood supply in the affected areas, new capillaries germinate, which leads to tissue renewal and more sustainable pain reduction.

After shock-wave therapy, a lasting positive effect is observed for 3-6 months.

Side effects

Despite the undeniable benefits of SWT, this procedure should be carried out with caution and taking into account all contraindications. Otherwise, complications of shock-wave therapy in the form of pain and exacerbations may occur. This depends on the intensity of exposure and individual susceptibility of the patient.

HCV damage may also manifest itself as a small subcutaneous hematoma at the site of exposure.

Examples of complaints from patients may include: “A week after UHT the foot started to hurt”, “the pain increased after UHT”, “it got worse after UHT”.

This may indeed be the case. Let’s look into the possible causes. First of all, a competent specialist will not take up SST during the acute period, as well as without preliminary preparation of the site of exposure.

For “warming up” can be used massage, more gentle methods of physiotherapy. It is important that there is no excessive synovial fluid that causes swelling by the start of the procedure. A comprehensive approach provides the lion’s share of success in remission.

Second, outdated or low-quality equipment. The painfulness of the procedure is influenced by the wave generated by the device. Radial – almost painless, used in advanced models.

The focused shock wave causes tangible painful feelings. Do not hesitate to find out in advance which device the doctor will use, with which wave. Good modern equipment is mainly produced in Europe (Germany and Switzerland).

Thirdly, the qualification of a doctor plays an important role. Unfortunately, most of the time you have to rely on the feedback, which is not very much, and on the certificates and licenses you have received. An experienced doctor should be able to use different nozzles, pulse frequencies on different tissues, tendons and bones, depending on the diagnosis. Feedback from the patient is very important.