Summary
Dr. Gina Fick discusses how focused extracorporeal shockwave therapy is used to treat bone stress injuries in runners, covering the Fredrickson grading scale, return-to-sport timelines, and real clinical case studies. She explains how ESWT promotes bone growth (osteogenesis) and can significantly reduce healing times for grade 3 and grade 4 bone stress injuries. The episode reviews a 2023 study on shockwave outcomes in 40 runners with bone stress injuries, showing that low-grade injuries returned to sport in about 10.9 weeks and high-grade injuries in 15.5 weeks. Dr. Fick also presents clinical cases from her practice, including a high school runner with a grade 3 tibial stress injury who returned to competitive running in just three weeks using a combination of focused shockwave, radial shockwave, deep tissue laser, dry needling, and blood flow restriction training.
Key Points
- Bone stress injuries in runners range from grade 1 (periosteal edema) to grade 4 (visible fracture line/stress fracture)
- Focused ESWT promotes osteogenic effects that enhance bone healing at the injury site
- Radial shockwave is used alongside focused ESWT to treat trigger points and muscle tightness around the injury
- A 2023 study showed 40 runners treated with ESWT had average return-to-run times of 10.9 weeks (low-grade) and 15.5 weeks (high-grade)
- Booster shockwave treatments during return-to-run progression protect newly healed bone
- Patients must avoid NSAIDs during and after shockwave therapy to preserve the healing cascade
- RED-S (relative energy deficiency in sport) and nutritional factors significantly affect bone healing timelines
Key Moments
Focused ESWT promotes bone growth for stress fracture healing
Dr. Fick explains how focused shockwave therapy causes bone hypertrophy visible on x-ray and MRI, making it a promising non-surgical treatment for bone stress injuries in runners.
"that the use of shockwave can be really effective in treating bone stress injuries because it causes bone growth or bone hypertrophy. And we've seen that on plain x-ray and we've seen the effects on the bone through MRI as well."
Case study of a grade 3 bone stress injury returning to competition in 3 weeks
A high school senior with a grade 3 posterior medial tibial bone stress injury returned to competitive running within three weeks using combined focused shockwave, radial shockwave, deep tissue laser, dry needling, and blood flow restriction training.
"After two weeks, he started running on the Alter-G treadmill. He started land running this past week and is going to be able to compete in the state cross-country meet when many people probably thought that would be impossible or a bad idea."
Booster shockwave treatments protect newly healed bone during return to running
Booster focused shockwave sessions during the return-to-run progression protect vulnerable newly healed bone through continued osteogenic stimulation, reducing the risk of re-injury.
"during this return to run progression, we know that this newly healed bone is vulnerable and we use the shockwave therapy for its bone building effects or osteogenic effects to ensure continued bone healing rather than the return of injury."
