Can Shockwave Therapy Actually Help a Damaged Shoulder Heal? What a Landmark 2003 JAMA Study Found
Patients with shoulder pain that has been worsening for months or years usually come to our office feeling frustrated.
When your shoulder has been hurting for months or years, there’s an underlying problem that needs to be addressed and healed.
Quite often this involves addressing tendon injuries in the shoulder rotator cuff, arthritic changes in the bone- such as bone spurs or calcium deposits, or both.
A 2003 landmark study published in JAMA on focused shockwave therapy for chronic shoulder pain demonstrates how this treatment not only reduces pain, but can also have a healing, regenerative effect on the damaged tendons and the shoulder joint itself.
Researchers didn’t just ask whether patients felt better. They measured shoulder function and took X-rays to see whether the abnormal calcium deposits within the damaged tendon actually changed.
And the results were impressive.
What Is Calcific Rotator Cuff Tendinopathy?
Your rotator cuff is a group of muscles and tendons that helps stabilize and move your shoulder.
In a condition called calcific rotator cuff tendinopathy, calcium deposits develop within one of these tendons, most commonly the supraspinatus tendon.
These deposits can be associated with significant shoulder pain, restricted movement, difficulty reaching overhead, and pain while sleeping on the affected shoulder.
Unlike a simple sore muscle, the abnormality can actually be visible on an X-ray.
Researchers Tested Focused Shockwave Therapy
In this randomized, double-blind, placebo-controlled study, researchers studied 144 patients with chronic calcific rotator cuff tendinopathy.
Patients were assigned to one of three groups:
- High-energy focused shockwave therapy
- Low-energy focused shockwave therapy
- Placebo treatment
One of the remarkable aspects of the study was the amount of treatment involved.
Patients received just two focused shockwave treatment sessions, approximately two weeks apart.
Researchers then followed their progress for up to a year.
What Happened?
At six months, shoulder improvement was substantially greater in the group receiving high-energy focused shockwave therapy.
Researchers used a standardized measurement called the Constant-Murley Score, which evaluates shoulder pain, daily activities, movement, and strength.
The average improvement at six months was approximately:
31 points with high-energy focused shockwave
15 points with low-energy focused shockwave
7 points with placebo treatment
The difference between high-energy focused shockwave and placebo was statistically significant.
Patients receiving focused shockwave had over 4 times greater improvement than placebo, and double the improvement of low-energy focused shockwave.
The results of this study mirror what we see frequently in the clinic: focused shockwave therapy such as Stemwave seems to have particularly beneficial effects for shoulder pain and tendinopathy.
Even more interesting, the benefits weren’t limited to what patients reported feeling.
Researchers Could See Changes on X-Ray
This may be the most compelling part of the study.
Researchers also evaluated the calcium deposits within the shoulder using X-rays.
Patients treated with focused shockwave demonstrated significantly greater disintegration and resorption of the calcium deposits compared with placebo.
In other words, researchers weren’t simply seeing a change in pain perception.
They were observing three different types of improvement:
Less pain → Better shoulder function → Objective changes on imaging
That distinction is important.
Pain relief is valuable, but our focus for long term healing is tissue regeneration, and that’s where Stemwave, which is focused shockwave therapy, really shines.
Could focused shockwave be influencing the healing environment of the tendon itself?
How Does Shockwave Affect Shoulder Tendons?
Focused shockwave therapy delivers precisely targeted acoustic mechanical energy into these tendons and the surrounding tissues.
Cells can respond to mechanical forces through a biological process known as mechanotransduction.
In simple terms, mechanical signals can become biological signals.
Laboratory and clinical research into shockwave therapy suggests that these mechanical signals can influence biological processes associated with tissue repair, including cellular signaling, blood-vessel formation, inflammatory regulation, and tissue remodeling.
What this JAMA study demonstrates is something clinically important: patients receiving focused shockwave experienced significantly greater functional improvement, accompanied by measurable changes in the calcific deposits seen on imaging.
Not All “Shockwave” Is the Same
There is another important detail about this research.
The study used focused extracorporeal shockwave therapy. The Stemwave therapy we use in our clinic is a powerful electrohydraulic form of this focused shockwave, and has very precise effects on the shoulder joint and the tendons that surround it.
Focused shockwave technology concentrates acoustic energy at a targeted location and depth within the tissue.
This differs from radial pressure-wave devices, which produce their greatest pressure near the surface and disperse energy as it travels into the body.
This key difference is in focused versus radial shockwave also contributes to why patients also report that focused shockwave therapy is more comfortable for patients.
Focused shockwave bypasses pain receptors in the skin, and directly influences joint tissues, creating a very comfortable treatment experience for the patient.
Our Goal: Less pain. Better function. Improved Quality of Life.
For our patients with calcific rotator cuff tendinopathy, focused shockwave therapy may therefore represent a real healing, regenerative solution to long standing shoulder pain.
This landmark JAMA study was one of the first and strongest examples of how applying focused acoustic waves to damaged tendons and joint tissues often improves both pain levels and long term shoulder healing.
Reference
Gerdesmeyer L, Wagenpfeil S, Haake M, et al. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA. 2003;290(19):2573–2580.