As society shifts towards an ageing population, and cases of weight mismanagement continues to rise, knee osteoarthritis (KOA) is becoming increasingly prevalent. Over the age of 60 years, about 13% of people assigned female at birth and 10% of people assigned male at birth suffer from symptoms related to KOA.¹ Put into numbers, that equates to about 365 million cases worldwide.²

After finishing everyday tasks such as going up the stairs or engaging in hobbies you enjoy like going for afternoon walks, you might experience intense pain. At times, one may feel powerless as the wear-and-tear issue worsens, facing the decision between temporary relief from medication and the daunting possibility of surgery.

Medical specialists are constantly looking for solutions against this debilitating prevalent condition. Extracorporeal shock wave therapy (ESWT) has shown promise as a novel treatment option, boasting a non-surgical approach that has been shown to lower pain, encourage healing, and promote mobility. Already an effective instrument used in many medical specialties, ESWT offers osteoarthritis (OA) patients renewed hope as it becomes common in joint health medical practice.

What is knee osteoarthritis?

Osteoarthritis results from progressive use and stress, causing deterioration of the smooth protective cartilage that covers bones in the joint.³ The function of this cartilage is to facilitate smooth movement between bones at the joint interface. Without it, the underlying bones tend to rub against each other, resulting in pain, stiffness, and swelling that typically is slow and progressively worsens.³

Symptomatic OA can have a serious impact on a person’s quality of life if left untreated. That is why finding effective treatment options remains a top priority among medical professionals. Conventional solutions are the cornerstone of OA management; however, they don’t necessarily provide long-term relief. Knee replacement surgery remains our only definitive treatment option, but its invasive nature and long recovery time can make it a daunting decision.

What are conventional knee osteoarthritis treatments?

Firstly, it is important to understand the most widely used treatments and what they have to offer:

• Over-the-counter pain medications – ibuprofen, paracetamol, and prescription drugs assist in managing discomfort. Unfortunately, they only offer temporary symptom control and can have adverse effects if misused
• Physical therapy – orientates around guarding the joint and strengthening muscle groups surrounding the knee, which can have a positive impact by reducing strain on the joint. The underlying cartilage deterioration is not addressed, however
• Steroid injections – cortisone injected into the joint provides temporary relief of pain and swelling but can negatively affect the joint with repeated use
• Surgery – knee replacement surgery remains the solution for extreme cases, despite its invasive nature, high cost, and long recovery period

Although they focus primarily on managing symptoms rather than targeting the foundations of the condition, each treatment option remains an effective management strategy. ESWT stands out in this regard, as it aims to facilitate the body’s healing process.

Extracorporeal shock wave therapy

ESWT utilises sound wave energy to non-invasively promote tissue healing.⁴ Commonly used in medicine for the treatment of kidney stones, ESWT in recent years is now being used to treat musculoskeletal conditions such as tendonitis and fasciitis.⁵ ‘Extracorporeal’ means ‘outside the body’, representing how sound waves are applied externally to the knee with a hand-held device to treat KOA. After penetrating the knee joint, the waves promote tissue regeneration, enhanced blood flow, and reduced swelling, all of which supports tissue healing and rehabilitation.⁶

During the therapy session, gel is applied to the knee area to enhance the delivery of sound waves, similar to ultrasound diagnostics. Precise sound wave delivery to the affected area is conducted by a skilled professional using the ESWT device. Sessions can last approximately 15 to 20 minutes, with several sessions typically required over a few weeks to experience optimal effects.⁷

For people looking for a more all-encompassing approach to controlling KOA, ESWT is becoming a fantastic choice, particularly if they are not interested in invasive surgeries or long-term medication use.

What makes ESWT so appealing?

ESWT is becoming more and more popular since it provides a drug-free, non-invasive substitute for injections or surgery. Here are some of the primary benefits:

• Non-invasive – invasiveness is essentially a measure of how many cuts of the skin the procedures require. Unlike surgery, no incisions or anaesthesia is required, making it an attractive option for people looking to avoid the risks and recovery associated with surgery
• Medication-free – avoiding the use of medications also alleviates the risk of negative effects brought on by anti-inflammatory or painkiller drugs
• Stimulates healing – instead of focusing on symptom management, ESWT incorporates stimulation of the body’s healing mechanisms. This addresses the root cause of OA, cartilage deterioration
• Improved mobility and function – reduced pain and inflammation leads to better joint mobility, making it more comfortable to walk, move, and engage in activities you enjoy

Taking a look at the research on ESWT

The volume of research on the use of ESWT continues to expand, bringing forth great opportunities for its use in the treatment of KOA. Through medical reviews, it has been indicated that ESWT could possibly aid in targeting some of the structural alterations brought about by OA, such as the deterioration of the cartilage and underlying bone.⁸ The ‘chondroprotective’ effect of ESWT has been demonstrated, supporting the idea of it preserving the integrity of the cartilage that is important to our joints.⁹ 

Studies have shown the positive effect on cartilage cell activity, which in turn can decrease cartilage surface damage and prolong the life of these cells.¹⁰ Additionally, human-oriented trials have resulted in increased mobility and reduced discomfort after treatment.¹¹ ESWT is proving to be a positive treatment option for KOA patients according to recent findings, and most definitely deserves continued attention within the field.

Is ESWT right for you?

It's possible that you're unsure of if ESWT is the best course of action for you. People with mild to moderate KOA of early or late stage, tend to have the best response to this therapy. Especially attractive is the possibility of avoiding surgery and long-term medication use. Of most importance is to discuss your options with your physician before deciding to make decisions about your health. 

Work alongside healthcare professionals to assess whether ESWT is appropriate for your condition and what the possible outcomes may look like. Setting reasonable expectations is also an important aspect of your treatment, although, some patients see noticeable improvements after a few sessions, others may need to be more patient.

Supporting your knee health with lifestyle adjustments

When used in conjunction with lifestyle modifications, ESWT is a potential approach that shows incredible promise. Applying the following strategies are key to promoting and maintaining knee health:

• Exercise for strength and flexibility – engaging in low-impact exercises like swimming, cycling, or yoga can help strengthen the muscles around the knee and improve flexibility. This reduces the load on the joint and supports better movement¹²
• Weight management - carrying extra weight can put added pressure on your knees, worsening the progression of OA.¹³ Maintaining a healthy weight can reduce the stress on your joints, potentially enhancing the benefits of ESWT
• Anti-inflammatory diet - incorporating anti-inflammatory foods like fish, leafy greens, and berries into your diet can help reduce overall inflammation in the body, including the knee joint¹⁴
• Mind-body practice - mindfulness, meditation, and gentle practices like Tai Chi can help manage pain and stress, improving your overall sense of well-being¹⁵

What to expect following treatment

Among its numerous benefits is the fact that ESWT requires virtually no recuperation time. There may be slight tenderness in the treated area, but this normally passes after a day or two. Unlike surgery, there is no need for weeks of recovery or extended immobility.

For optimal results, it is essential to adhere to your healthcare provider's aftercare recommendations. If required, this can mean resting your knee for a short while with cold compresses, then gradually increasing your degree of physical activity. By taking appropriate care of your knee following treatment, you can maximise the benefits of ESWT and maintain joint health.

Summary

If you find yourself or someone you know suffering from symptomatic KOA, you can be reassured that their options are not limited. Thanks to treatments like extracorporeal shock wave therapy, there are now more alternatives than ever before for treating the illness without surgery. Although, it might not be the ideal answer for everyone, many people have already found relief and reclaimed control over their everyday lives, thanks to it.

If you're tired of enduring knee pain and osteoarthritis limits, think about discussing ESWT with your doctor. By being proactive and informed about your health, you can open new treatment possibilities and receive the relief and hope you deserve. With numerous advancements leading to better, less invasive treatments, including ESWT, joint health has a promising future.