Shockwave therapy for knee osteoarthritis

Everyone wants to grow old, but no one wants to deal with the aches and pains of aging. A healthy body makes shouldering the wrinkles and greying hair so much easier. The global population is aging rapidly, leading to a sharp rise in chronic conditions such as knee osteoarthritis. Currently, one-third of people over 60 suffer from symptomatic knee osteoarthritis worldwide. But due to unhealthy diets and lifestyles, osteoarthritis is also increasingly affecting young people. Without any medications to cure or prevent this condition, an invasive joint replacement surgery might be your patient’s only option.

However, postponing surgery as long as possible is preferable since a knee replacement only has a lifespan of 15 to 20 years. Delaying that procedure can eventually prevent the need for revision surgery. And that is precisely where you as a physiotherapist come into play. With education, exercise therapy, and shockwave therapy -a promising new treatment for knee osteoarthritis- in your treatment arsenal, , you can help reduce your patients’ pain and improve their functioning, thereby indirectly delaying a potential surgery

What is knee osteoarthritis and what are the consequences?

Knee osteoarthritis is a degenerative joint disease that leads to a progressive loss of cartilage. There are two types of knee osteoarthritis:

• Primary osteoarthritis: the joint degenerates without a clear underlying cause.
• Secondary osteoarthritis: caused by abnormal force distribution across the joint (e.g., trauma) or abnormal cartilage, as seen in rheumatoid arthritis (RA).

What is the Kellgren and Lawrence classification of knee osteoarthritis?

The Kellgren and Lawrence classification is a widely used method to assess the severity of osteoarthritis. It categorizes the condition into four grades:

• Grade 1: Doubtful narrowing of the joint space, possible early osteophytes.
• Grade 2: Definite osteophytes, possible joint space narrowing.
• Grade 3: Multiple osteophytes, clear joint space narrowing, sclerosis, possible bone deformities.
• Grade 4: Large osteophytes, severe joint space narrowing, significant sclerosis and bone deformities.

Common symptoms of knee osteoarthritis

Patients with knee osteoarthritis generally complain about the following symptoms:

• Knee pain that worsens with activity
• Stiffness and swelling
• Pain after resting or sitting down for a long time
• Joint instability
• Reduced quality of life

These symptoms can majorly impact your patients’ daily routine, limiting them in their day to day activities, their ability to work and restrict them in their social engagements and exercise routine. [1] While osteoarthritis rarely results in total disability, your patients might be forced to consider adjusting their workplace or reducing their working hours. [2]

Treating knee osteoarthritis without surgery

The initial approach to knee osteoarthritis is usually conservative and often includes braces, painkillers, corticosteroid injections, and—most importantly—education and exercise therapy under the guidance of a physiotherapist. [3] If these treatments are insufficient, a knee replacement becomes the course of action. However, with the increasing number of osteoarthritis cases comes a rising demand for knee replacements, leading to higher healthcare costs. A knee replacement can cost up to €20,000, and rehabilitation can take up to a year. Since revisions are typically required after 15 to 20 years, delaying such a surgery as long as possible is crucial.

Fortunately, scientific research points physiotherapists towards a promising additional treatment option: shockwave therapy.

Shockwave therapy for knee osteoarthritis: How does it work?

Extracorporeal Shockwave Therapy (ESWT) has recently emerged as a non-invasive physiotherapy intervention for osteoarthritis. ESWT uses short, intense sound waves to stimulate the body’s natural healing processes, leading to pain relief and an enhanced recovery process. Shockwave therapy is generally considered safe, easy to apply, and is well-tolerated by most patients.

Clinical studies: results of shockwave therapy for knee osteoarthritis

The first study on shockwave therapy for knee osteoarthritis was conducted in 2013, and reported positive outcomes with no adverse effects.[4] Since then, numerous clinical studies have put the effectiveness of ESWT in managing osteoarthritis and cartilage degeneration under a microscope:

• Ediz et al. (2018) studied the effects of ESWT on primary medial knee osteoarthritis in older adults. They found that shockwave therapy reduced pain and led to functional and radiological improvements without significant complications. These benefits even persisted one year after treatment.[5]
• Lizis et al. (2017) compared shockwave therapy to exercise therapy for knee osteoarthritis and found that shockwave therapy produced greater and statistically significant improvements when it comes to pain (WOMAC scale) and range of motion (ROM). [6]
• Romeo et al. (2014) reported that ESWT improved the hyaline cartilage structure and simultaneously reduced joint stiffness. Additionally, the study found positive effects on surrounding tendons, muscles, and ligaments, further enhancing patients’ mobility. [7]

Systematic reviews and meta-analyses on shockwave therapy for knee osteoarthritis

Several systematic reviews and meta-analyses have examined the use of ESWT—including radial shockwave therapy—for treating knee osteoarthritis. While these studies vary in methodology, the majority support the potential benefits of ESWT with regard to pain relief and functional improvement:

• A systematic review by Cao et al. (2024) comparing  seven non-pharmaceutical treatments (shockwave, laser therapy, acupuncture, ultrasound, nerve stimulation, minimally invasive puncture, and exercise therapy) across 24 randomized controlled trials (RCTs) found shockwave therapy to be the most effective treatment option for pain relief and improved functioning. Only laser therapy outperformed shockwave with regard to the aspect of mobility. [8]
• Liao et al. (2024) determined ESWT to be more effective than other treatment options, such as intravenous prostacyclin, bisphosphonates, corticosteroid injections, hyaluronic acid injections, platelet-rich plasma injections, and traditional physiotherapy. [9]

Innovative shockwave therapy for knee osteoarthritis: make a difference for your patients and your practice

Shockwave therapy provides physiotherapists with an innovative solution for treating knee osteoarthritis. This therapy can lead to pain relief, improved functioning, and a general better quality of life for patients. Despite its promising results, many physiotherapists are still unaware of its potential. And it’s precisely that lack of awareness deterring physiotherapists worldwide to use shockwave for this distinct condition.

Truly a missed opportunity—both for patients and physiotherapists. By integrating shockwave therapy into your practice, you can set yourself miles apart from competitors without shockwave devices. Not to mention the fact that you will be able to attract more patients by offering a clinically proven, non-invasive treatment modality that helps delay surgery. So consider shockwave therapy as the gateway towards higher patient satisfaction scores and even greater financial success for your clinic.

More patients with shockwave therapy

Shockwave therapy isn’t just beneficial for knee osteoarthritis—it has so much other valuable applications you might not yet be aware of. Request a demo or attend a (free) workshop to stay up-to-date of the latest insights on shockwave therapy. You may find yourself using your shockwave device much more frequently—or, if you don’t have one yet, might even consider a purchase. We’re happy to help!

Do you have questions about our shockwave equipment or are you interested in purchasing a device? Feel free to contact us!

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1. https://reumanederland.nl/nieuws/europese-onderzoekers-slaan-handen-ineen-voor-tsunami-van-artrose

2. Bijlsma, J. W., Berenbaum, F., & Lafeber, F. P. (2011). Osteoarthritis: an update with relevance for clinical practice. Lancet (London, England), 377(9783), 2115–2126. https://doi.org/10.1016/S0140-6736(11)60243-2

3. Everaert C. (2014). Gevolgen van heup- en knieartrose voor arbeidsparticipatie TBV. Tijdschrift voor Bedrijfs- en Verzekeringsgeneeskunde, 22 (4), 160-161.

4. https://richtlijnendatabase.nl/richtlijn/artrose_in_heup_of_knie/startpagina_-_heup-_of_knieartrose.html

5.  Zhao, Z., Jing, R., Shi, Z., Zhao, B., Ai, Q., & Xing, G. (2013). Efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a randomized controlled trial. The Journal of surgical research, 185(2), 661–666. https://doi.org/10.1016/j.jss.2013.07.004

6. Ediz, L. & Özgökçe, M. (2018). Effectiveness of extracorporeal shock wave therapy to treat primary medial knee osteoarthritis with and without bone marrow edema in elderly patients. Turk Geriatri Dergisi, 21, 394-401. https://geriatri.dergisi.org/uploads/pdf/pdf_TJG_1062.pdf

7. Lizis, P., Kobza, W., & Manko, G. (2017). Extracorporeal shockwave therapy vs. kinesiotherapy for osteoarthritis of the knee: A pilot randomized controlled trial. Journal of back and musculoskeletal rehabilitation, 30(5), 1121–1128. https://doi.org/10.3233/BMR-169781

8. Romeo, P., Lavanga, V., Pagani, D., & Sansone, V. (2014). Extracorporeal shock wave therapy in musculoskeletal disorders: a review. Medical principles and practice: international journal of the Kuwait University, Health Science Centre, 23(1), 7–13. https://doi.org/10.1159/000355472

9. Cao, S., Zan, Q., Wang, B., Fan, X., Chen, Z., & Yan, F. (2024). Efficacy of non-pharmacological treatments for knee osteoarthritis: A systematic review and network meta-analysis. Heliyon, 10(17), e36682. https://doi.org/10.1016/j.heliyon.2024.e36682

10. Liao, P. C., Chou, S. H., & Shih, C. L. (2024). A systematic review of the use of shockwave therapy for knee osteoarthritis. Journal of orthopaedics, 56, 18–25. https://doi.org/10.1016/j.jor.2024.04.020

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