Interview with Paul Hobrough – exploring the power of shock waves in physiotherapy
In recent years, Extracorporeal Shock Wave Therapy (ESWT) has established itself as a non-invasive and innovative method for treating a variety of musculoskeletal disorders. We sat down with Paul Hobrough, a seasoned physiotherapist with over 15 years of experience in shock wave therapy and education, to discuss the use in physiotherapy and its benefits for therapists.
To start, what specific musculoskeletal conditions are most effectively treated with shock wave therapy?
When we look to answer a question like this, we either look to the literature or our own anecdotal evidence as a clinician. The evidence would indicate Achilles tendinopathy, plantar fasciitis, bone healing etc. Anecdotally, the clinician who treats a lot of one type of injury will likely find more positive results due to volume. The truth is, the injury which is around 2 – 3 months old, in a medium to large size tendon, with a physically active individual will get the best result. Shock wave patient selection has always been the key to success, not the specific indication or injury. I think most musculoskeletal conditions in the body will benefit from shock wave therapy, but this is due to the positive effect it has upon the pathology. The pathology may well return if the patient is not educated in rehabilitation exercises, strength development and sometime biomechanics. If pushed to answer with just one condition, I would have to say Achilles mid portion tendinopathy.
Could you provide an overview of a typical shock wave therapy procedure within a physiotherapy setting, and how should therapists prepare their patients for these sessions?
I start with EMTT (Extracorporeal Magnetotransduction Therapy) on the site of the injury. This prepares the cells, gives a reset to the ionic channels holding them open and allowing transference of sodium and potassium. Then radial shock waves (R-SW) to the surrounding muscles, finishing off with focused shock waves at the site of the pathology. I liken this to a dart board. If the pathology is at the bullseye, then EMTT opens up the cells, making the target bigger and the bullseye easier to hit. Afterwards I use R-SW to all the segments around the outside of the bullseye and then finish with focused shock waves (F-SW) on the bullseye itself. It’s a nice way of visualising the treatment of the body’s tissues, I think.
Can you share any success stories or patient experiences with shock wave therapy that stand out in your practice?
I have so many to share, such as an 800 m runner with a groin strain in 2021, 4 weeks before Olympic selection. I used the above treatment method, treating primarily the proximal adductor longus with focused shock waves. But primed with EMTT and R-SW to all the adductor muscles, medial quadriceps, medial hamstrings and even some to the glutes. At the trials he not only qualified for the Olympic team, but ran the world’s fastest time of 2021. Another great story is the patient who was just 11 years old who was bullied because of the way he walked. He had bowlegs more akin to a child with cerebral palsy. He would fall over regularly and couldn’t run. He was timid and clearly very upset. We started using R-SW on his medial hamstrings to take away the contracture. In fact, he was not suffering from cerebral palsy, but his parents let him spent most of the early years in a baby car seat. We retrained his nervous system, strengthened his abductors with exercises and used radial shock waves extensively on the muscle with contracture. We used focused shock waves on his low back to develop nerve signal. He recently turned 13, is happy, outgoing and with lots of friends. The bullying has ceased. But most of all he is now on the school running team and competing well with his peers. Shock wave changes lives.
What do you see as the future of shock wave therapy in physiotherapy, and how do you envision it evolving in the coming years?
My PHD is on the use of shock wave therapy in health athletes. There is very persuasive evidence that shock waves can develop healing in muscle tissue. Hard training causes micro tears in muscle tissue, therefore if we can recover athletes faster with shock waves – they can train more often and therefore reap the rewards with improved performances. I also believe that shock waves produce the same mechanotransduction as training – thus, in a few months’ time I believe I will have the first evidence that shock waves improve strength in healthy athletes. This is the future. This is my niche in respect of the use of shock waves.
Thank you Paul, for sharing your insights on the use of shock waves in physiotherapy.
Good to know:
Paul Hobrough is the founder of ESWT Hub on LinkedIn, a platform dedicated to educating and connecting healthcare professionals interested in ESWT, EMTT, US and further regenerative therapies for musculoskeletal conditions.
