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Understanding Shockwave Therapy vs Ultrasound

April 15, 2024
Read Time: 11 Minutes

At ChiroCare of Florida, our trained staff works hard to ensure that our patients are knowledgeable about our treatments. Some of the techniques we use are fairly technical or easily confused with similar techniques or methods. This is often the case with ultrasound and shockwave therapy treatment.

While each name represents an entirely different treatment, the fact that they both use waves to achieve the desired results makes the confusion understandable. By the time you finish this article, you’ll have an in-depth understanding of both shockwave therapy and ultrasound therapy, including how each treatment works, when we apply them, and why we choose to use one instead of the other.

How Shockwave Therapy Works

Sound waves can physically affect objects. Consider a glass of water sitting on a table. When there’s a loud sound or crash, the water in the glass starts to move. This is also the case with the fluids in your body.

Shockwave therapy involves the use of a handheld device that produces sound waves that pass through the skin. These waves increase blood flow to the affected area, accelerating the healing process.

Shockwave therapy uses a broad range of lower-frequency sounds — from 1 to 22 kilohertz (kHz).

How Ultrasound Therapy Works

Many people are familiar with ultrasound's exploratory uses, including creating fetal images. Ultrasound therapy uses high-frequency sound waves to excite the tissues, blood, and other fluids in the area of injury. This rapid movement in the injured area creates heat, which stimulates cellular growth and repair.

Ultrasound machine outputs are in the 3 megahertz (MHz) range, which is about 130 to 3,000 times higher than the shockwaves used for therapy.

The Benefits of Non-Invasive Therapies

There are many benefits to using non-invasive instruments to help patients in their recovery. Here are a few reasons why our doctors often prefer these treatments:

  • Lower Risk – Non-surgical treatments allow medical professionals to treat injuries without local anesthetic, anesthesia, incisions, or injections.
  • Virtually No Side Effects – While some patients feel soreness and discomfort immediately after their treatment due to their injuries, side effects from ultrasound and shockwave therapies are extremely rare.
  • Recovery Time – Invasive surgical procedures require patients to avoid certain activities in the days or weeks after to avoid infection or reinjury. Most patients can resume normal activities (within the limits of their injuries) immediately after the treatment.
  • Relatively Painless – In many cases, these non-invasive therapies are painless for the patient.
  • Reduced Costs – Many patients prefer to try these therapies because they are much less expensive than surgery.

Shockwave and ultrasound therapies are not a one-two punch for all injuries. There are many types of injuries for which neither is prescribed. However, many individual and joint studies have proven the efficacy of both types of therapy.

Medical Applications for Ultrasound and Shockwave Therapies

It would be easy for a patient to think that medical professionals might base their decision to use ultrasound or shockwave therapy on professional preference or that they might just try both to see which one works better.

However, like most medical treatments, each type of therapy is indicated for different conditions. In other words, there are injuries where ultrasound is the better option, some where shockwave is the better option, and many where neither is believed to be helpful.

In fact, for some types of injuries, these treatments may even be harmful, which is why our doctors never recommend these non-invasive treatments without a thorough examination of the patient and careful consideration.

Shockwave Therapy Applications

As was previously mentioned, shockwave therapy benefits specific classifications of injuries. The following are some of the types of injuries and conditions that our doctors often recommend shockwave therapy for.

Tendinopathies (Tendon Conditions)

Tendons are bands of tissue that attach muscle to bones. As one might imagine, tendons experience a significant amount of wear and tear over time. Tendinopathies include micro-tears of the tendon, inflammation (also known as tendinitis), and tendon degradation. These injuries may be the result of a single incident or repetitive stress. Some of the tendinopathies that our doctors can treat with shockwave therapy include:

  • Plantar Fasciitis and Achilles Tendinopathy– Inflammation of tendons in the heel.
  • Tennis Elbow – A specific tendon injury to the outside of the elbow.
  • Golfer’s Elbow – Another specific tendon injury, but affecting the tendon on the inside of the elbow.
  • Jumper’s Knee – An injury to the base of the patella or kneecap.
  • Rotator Cuff Tendinitis – A tendon condition that causes shoulder pain and immobility.

Tendinopathies are among the most common types of injuries treated with Shockwave therapy. Other injuries that our doctors might use shockwave therapy to treat include:

  • Calcification of the Tendons – The shockwaves break down the calcification to restore the tendons.
  • Bursitis – Bursae are small sacs near the tendons and muscles filled with fluid. Shockwave therapy can alleviate bursitis, which is the inflammation of the bursae.
  • Shin Splints – Common among runners and athletes, shockwave therapy can sometimes alleviate shin pain caused by connective tissue damage.
  • Healing Fractures – Shockwave therapy does not heal the bones, but rather stimulates the tissue, which can accelerate healing.
  • Erectile Dysfunction – Some forms of erectile dysfunction can be the result of decreased blood flow and blockages. While using shockwave therapy to treat vasculogenic ED is still in the early stages, the theory is sound. The shockwaves help to form new blood vessels, increasing blood flow to the penis. This is a non-invasive, low-risk procedure that seems to be working in practice.

Shockwave therapy is by no means a one-size-fits-all treatment option, even for the above-listed conditions. It’s a tool that is effective for some patients with certain conditions and is usually used as a part of a comprehensive treatment plan.

Ultrasound Applications

As previously mentioned, ultrasound therapy operates at a much higher frequency than the shockwaves used for medical treatment. Many people are familiar with ultrasound's diagnostic imaging capabilities but don’t know as much about how it’s used in physical therapy and injury treatment. We will explore both applications.

Diagnostic Imaging

This is achieved by the technician placing ultrasound probes (transducers) on the skin. These probes both produce and detect sound waves. The waves bounce off the internal organs and are reflected back. The machine then interprets the distance-time data of the waves and returns an image.

Medical professionals commonly use ultrasound to produce the following image types:

  • Pregnancy – Ultrasound produces effective images of the fetus and amniotic fluids.
  • Cardiology – An echocardiogram can produce images of the heart, chambers, valves, and blood vessels.
  • Abdominal Organs – These include the liver, gallbladder, spleen, pancreas, kidneys, and more.
  • Pelvic Region – This can be used to view the sex organs of both men and women.
  • Musculoskeletal Ultrasound – This is commonly used in physical therapy and chiropractic medicine to diagnose pain and injuries.
  • Emergency Medicine – Focused Assessment with Sonography in Trauma (FAST) is used to rapidly assess traumatic injuries.

Because ultrasound uses high-frequency soundwaves instead of radiation, as is the case with X-rays, it is much safer — particularly when examining a fetus or organs that are particularly sensitive to radiation.

Like shockwave therapy, there are effective treatments that employ ultrasound. However, it works a bit differently. Instead of sending slow pulses through the system, its high-frequency vibrations accelerate blood flow and increase heat, promoting cellular activity and healing.

Your doctor may recommend ultrasound in lieu of shockwave therapy or in conjunction with it. Ultrasound is administered over the course of multiple sessions and may be used in conjunction with other forms of physical therapy.

Technology and Equipment

There are many different types and brands of shockwave and ultrasound machines on the market. These must be FDA-approved for medical use. Consequently, their effectiveness has more to do with the operator's training and experience than with the brand of machine they use.

Shockwave Therapy Devices

A clinician may use different shockwave machines depending on the patient, the condition, and the treatment area. As the name indicates, focused-wave machines can concentrate the waves to a specific area. They are also able to penetrate deeper into tissue.

Radial shockwave therapy devices, on the other hand, spread through the tissue from the point of contact or application. Radial shockwaves don’t penetrate as deeply as focused waves, so they’re used for injuries that lie closer to the surface, like plantar fasciitis or muscle tension.

Shockwave machines can also be divided into low-energy and high-energy categories. Naturally, most machines offer a range of options in this area. Most clinicians will begin by treating the injury with low-energy shockwaves before moving onto higher settings or a high-energy machine.

Numerous shockwave machines are marketed for home use. While some people use these devices like personal massagers, we recommend against using them for injury treatment. You should always consult a doctor about pain, injuries, weakness, or decreased mobility.

Ultrasound Machines

Ultrasound machines are usually designed for diagnostic imaging or physical therapy, but not both. For imaging, there are large, stationary machines that offer high-resolution images for most applications. Portable and handheld ultrasound machines are much more common in medical practices for imaging and physical therapy.

There are several types of specialty ultrasound machines that are designed to examine specific areas of the body or to treat specific conditions.

3D ultrasound devices generate three-dimensional images, and the more advanced 4D machines show movement as well.

Safety Considerations

While no treatment is safe in all circumstances, the risk to a patient when a trained professional uses shockwaves or ultrasound is minimal.

Shockwave Therapy Safety

Because shockwave therapy causes the affected area to vibrate or move, it’s not ideal for all conditions and can exacerbate an injury. This is why it’s essential to seek the advice of trained professionals who are aware of the nature of your injuries and are famillar with the proper application of shockwaves.

The operator will be familiar with the affected area, prescribed intensity and settings, and the duration of application. In addition, they are able to monitor your in-session response to the treatment.

Ultrasound Safety

Ultrasound is considered a safe, effective, and non-invasive way to obtain internal images. When it comes to physical therapy, the safety concerns are also minimal. However, patients may experience discomfort during treatment. It may also adversely affect the injury, which is why it’s also important that a trained sonographer administers the treatment.

Costs and Accessibility of Treatment

Many insurance plans cover shockwave and ultrasound therapy, either as a line item treatment or as part of a comprehensive treatment plan. Even if your insurance does not cover ultrasound or shockwave therapy, however, it is usually affordable and much more cost-effective than other treatments.

Shockwave Therapy can be about $50 to $100 per session but may be cheaper when purchased as part of a package or a comprehensive recovery plan. When compared with more invasive treatments, shockwave therapy is very cost-effective.

Ultrasound therapy is often covered by insurance and Medicare for specific conditions. Even when paying out of pocket, the average cost for an ultrasound therapy session is similar to the cost of shockwave therapy. It’s similarly a cost-effective treatment.

Summary of Key Differences

Shockwaves and ultrasound waves are similar in that they are both forms of sound. However, the frequency, the intensity of the pulses, and the intensity of the treatment are different. Consequently, they are used to treat different conditions. They are not interchangeable. Cases that would benefit from ultrasound may be harmed by shockwave therapy, and vice versa.

We do not recommend that patients use home ultrasound or shock therapy devices for physical therapy. Patients should also use caution when using these devices for muscle soreness and other minor conditions.

Addressing Common Misconceptions

At ChiroCare of Florida, we administer thousands of ultrasound and shockwave therapy treatments every year. We want to dispel some of the most common misconceptions about these two efficacious therapies.

Shockwave Therapy

  • It’s painful – Many patients have heard that shockwave therapy is painful. This is also a misconception about ultrasound, but far less common. Shockwave therapy should not be painful. If it is, the intensity can be lowered. It also doesn’t have to be painful to work.
  • It administers electric shocks – Shockwave therapy does use electricity, but to produce sound waves, which are the shockwaves. The patient does not experience electric shock of any kind.
  • Higher intensity is better – The intensity needs to be correct for the condition. If the intensity is too high, it can exacerbate the condition instead of helping it.

Ultrasound Therapy

  • It’s Too Weak – Ultrasound treatments are usually milder than shockwaves. That doesn’t mean it’s not working. The effect of ultrasound on the treatment area is different than with shockwave therapy.
  • It’s Only for Imaging – While diagnostic imaging is a better-known use of ultrasound, it’s widely used in physical therapy.
  • It’s Unsafe – When properly administered, ultrasound is a safe, non-invasive treatment. It is not safe to administer ultrasound therapy on your own, however,

Frequently Asked Questions About Ultrasound and Shockwave Therapy

These are some of the most common questions our staff hear from patients. If you have a question about either of these treatments, contact your local Chirocare of Florida office today.

Is Shockwave Therapy Better than Ultrasound?

One thing we’ve stressed in this article is that both treatments are applicable to different conditions. As a result, either treatment, both, or neither may be recommended.

Are There Age or Health Restrictions for Individuals Considering Shockwave Therapy?

Shockwave therapy is not recommended for pregnant women if the treatment area is close to the abdomen or lower back. Because shockwave therapy is indicated for specific conditions, its application is based on the patient's health rather than age.

Several other conditions will deter medical professionals from using shockwave therapy, including blood clotting disorders, cancer, infections in the treatment area, and cardiac conditions.

Are There Specific Patient Demographics that Benefit More From One Therapy Over the Other?

Because these therapies are designed to treat specific medical conditions, patient demographics such as age, weight, gender, etc., are less significant factors.

How Long Does a Typical Session of Shockwave Therapy or Ultrasound Last?

Both types of treatment sessions last about 15 minutes.

If you have a condition that shockwave therapy and/or ultrasound therapy can help, our doctors will assess your candidacy. These effective, noninvasive, low-cost treatments do not work for everyone, and we do not recommend self-administration of ultrasound or shockwave therapy.

If you have a musculoskeletal injury, the best thing you can do is seek the advice of a professional. Schedule your appointment with ChiroCare of Florida today!

About the Author:
Dr. Steven Schwartz
Raised in Coral Springs, Florida, Dr. Steven Schwartz is a major advocate for the South Florida community. CEO of ChiroCare of Florida, Dr. Schwartz has grown the group from one facility to 11. Whether he’s treating patients or volunteering for community service, Dr. Schwartz’s long-term goal is to ensure that each and every patient can experience the ChiroCare of Florida difference.
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