Cortisone Injections: For patients who suffer from plantar fasciitis, shoulder tendinopathy, tennis elbow, or other inflammatory related pain cortisone injections are commonly used. They provide short-term relief by reducing the inflammation but they do not address the underlying cause of the pain and their use comes with risks. Cortisone has been shown to weaken the tendons with repeated use.

Shockwave Therapy: Shockwave therapy is non-invasive treatment that utilizes sound waves to create biological responses in the tissue. This in turn stimulates regeneration in the damaged area, increases blood flow, and enhances collagen production. This trifecta results in the healing of damaged tissue by the body which results in a better long-term solution for chronic conditions. It does not just mask the pain like cortisone; it addresses the underlying cause of chronic pain and soft tissue injuries.

Study Insight: Rompe et al. (2001) found that shockwave therapy showed superior results at 12 months in comparison to cortisone for lateral epicondylitis.

PRP Therapy: PRP is an invasive treatment which involves drawing a small amount of the patient’s blood about 10–30 ml. That blood is then centrifuged to separate out the platelet-rich plasma (PRP). PRP is a concentrate of platelets and growth factors that promote healing. It can be effective for long-term healing; however, it is a costly procedure due to the fact that it requires multiple sessions and it carries its own possible risks and complications. They are:

• Infection at the injection site (very rare, <1%)
• Bleeding or hematoma
• Nerve irritation
• Vasovagal response (lightheadedness)

Rare Complications
Extremely uncommon, but documented:

• Chronic pain flare in sensitive patients
• Scar tissue formation if the area is repeatedly inflamed
• Injury to nearby structures (tendon, vessel, nerve) if not guided properly
• Allergic reaction to local anesthetic (not the PRP itself)

Patients who may not be good candidates include those with:

• Active infection
• Low platelet count or platelet dysfunction
• Uncontrolled diabetes
• Cancer (depending on type and stage)
• Severe anemia
• Use of anticoagulants that cannot be paused

Shockwave Therapy: Unlike PRP, shockwave therapy is non-invasive and doesn’t require any blood draw or injection. It offers similar benefits by stimulating tissue repair and neovascularisation (the formation of new blood vessels). Shockwave is non-invasive, requires fewer sessions, and is more affordable than PRP. It also has a quick recovery time.

Study Insight: A systematic review by Li et al. (2019) showed that shockwave therapy and PRP were equally effective for chronic tendinopathies, though shockwave required less downtime.

Dry Needling: Dry needling is used to treat myofascial pain syndrome (trigger points) by inserting thin needles directly into the affected muscle. While effective, it’s invasive, and patient comfort can vary depending on their tolerance of needles. It comes with the following risks:

Less Common Risks

1. Local Infection
   Extremely rare when proper sterile technique is used. Risk is minimized by single-use needles and skin antisepsis.
2. Nerve Irritation
   May cause temporary tingling, numbness, or referral sensations. Permanent nerve injury is very rare.
3. Persistent Pain or Trigger Point Irritation
4. Fainting (Vasovagal Syncope)
   More likely in anxious patients or those who have not eaten recently. Usually resolves quickly when the patient lies down.

Serious but Rare Complications:

1. Pneumothorax (Collapsed Lung)
2. Significant Bleeding / Hematoma
3. Infection of Deeper Structures
4. Injury to Internal Organs

Absolute Contraindications

• Active infection or open wounds at the site
• Uncontrolled bleeding disorders
• Patients who refuse or cannot consent
• Areas over tumors or metastatic disease
• Patients with a strong needle phobia leading to unsafe reactions

Relative Contraindications

• Patients on blood thinners
• Pregnancy (certain areas avoided)
• Compromised immune system
• Diabetes
• Seizure disorders
• Metal allergies
• Severe anxiety or vasovagal tendencies

Shockwave Therapy: In contrast, shockwave therapy is noninvasive and uses high-energy acoustic waves to treat soft tissue injuries and pain. It works not just on muscles but also on tendons, ligaments, and fascia, making it a more versatile option for a wider range of conditions.

In review, dry needling targets specific muscle groups with needles, effective for trigger points and is invasive. Whereas, shockwave treats broader areas and promotes healing across tissues, from muscles to tendons.

Study Insight: Han et al. (2017) compared shockwave therapy and dry needling for myofascial pain syndrome and found that both were equally effective in providing long-term pain relief and patient satisfaction.

Physiotherapy: Physiotherapy is utilized for rehabilitation and chronic pain management. It involves a combination of manual therapy, exercise therapy, and education, all of which are critical for long-term recovery.

Shockwave Therapy: Shockwave therapy can complement physiotherapy by accelerating tissue healing, reducing pain, and improving blood flow. Shockwave is particularly helpful when physiotherapy alone doesn’t provide sufficient relief.

Study Insight: A study by Malliaras et al. (2013) demonstrated that combining shockwave therapy with eccentric strengthening produced better outcomes for chronic Achilles tendinopathy than exercise alone.

Chiropractic and physical therapy both play important roles in restoring musculoskeletal health, but chiropractic care offers several unique advantages for many patients. Chiropractors are specifically trained to identify and correct spinal and joint dysfunction through precise adjustments, which often provide faster relief and more immediate improvements in mobility and nervous system function than exercise-based therapy alone.

Physical therapy excels at strengthening and rehabilitation, yet it generally cannot address joint fixations or alignment problems with the same level of direct, hands-on correction. For this reason, many patients find that chiropractic care not only eases pain more quickly but also helps restore proper biomechanics so the body can function as it should.

When chiropractic adjustments are combined with focused rehabilitation exercises and advanced therapies like radial shockwave treatment, results can be even stronger. Shockwave therapy enhances tissue healing, reduces chronic inflammation, and breaks up adhesions that interfere with normal motion, making chiropractic adjustments easier, more comfortable, and longer lasting. Together, chiropractic care, targeted exercise, and shockwave therapy create a comprehensive, drug-free approach that addresses the root cause of pain while promoting long-term recovery and stability.

Surgical Intervention: Surgery is often considered a last resort for chronic conditions that haven’t responded to other treatments. Surgical procedures, especially for conditions like calcific tendinopathy or rotator cuff tears, can require extended recovery times and involve inherent risks.

Shockwave Therapy: Shockwave therapy is a non-invasive alternative that can reduce the need for surgery in many cases. By stimulating tissue regeneration and improving blood flow, shockwave can provide a non-surgical solution for many musculoskeletal issues.

Comparison:

Surgery: Often necessary for severe cases, but involves high costs, longer recovery times, and potential complications.

Risks, Complications, Contraindications & Residual Effects of Joint and Spine Surgery

Orthopedic surgeries—including procedures for calcific tendinopathy, rotator cuff repair, knee meniscus or ligament repair, and spinal decompression or fusion—can be effective in certain cases. However, like all invasive procedures, they carry meaningful risks and potential long-term consequences that patients should understand before choosing surgery.

1. General Risks of Any Orthopedic Surgery

These risks apply to nearly all joint and spine surgeries:

• Infection
• Blood clots (DVT / Pulmonary Embolism)
• Bleeding or hematoma
• Anesthesia complications
• Nerve damage
• Vascular injury
• Scar tissue formation
• Failure to improve or worsening symptoms

2. Surgery-Specific Risks & Residual Effects

A. Calcific Tendinopathy Surgery (Shoulder)

• Persistent shoulder stiffness
• Adhesive capsulitis (“frozen shoulder”)
• Recurrence of calcium deposits
• Rotator cuff tendon weakening

B. Rotator Cuff Repair Surgery

• Re-tear of the tendon
• Stiffness and long-term range of motion limitations
• Hardware failure

C. Knee Surgery

• Persistent knee pain
• Earlier osteoarthritis
• Joint instability
• Blood clots

D. Spine Surgery

• Dural tears and spinal fluid leaks
• Nerve root injury
• Failed Back Surgery Syndrome
• Adjacent segment degeneration
• Hardware loosening or breakage

3. Contraindications to Joint or Spine Surgery

Absolute Contraindications

• Active infection
• Uncontrolled bleeding disorders
• Severe anesthesia risk
• Patient refusal or inability to comply with rehab
• Advanced osteoporosis (in some spinal procedures)

Relative Contraindications

• Poorly controlled diabetes
• Autoimmune disease flares
• Severe obesity
• Smoking
• Advanced age
• Low activity level

4. Long-Term Residual Effects After Joint or Back Surgery

• Altered biomechanics
• Chronic pain
• Scar tissue & adhesions
• Reduced strength or endurance
• Possible need for additional surgeries

5. Why Many Patients Seek Chiropractic, Shockwave Therapy, or Other Conservative Options First

• Reduce pain without major risks
• Break down calcific deposits gradually
• Improve joint mechanics and reduce inflammation
• Stimulate tissue healing (especially with shockwave)
• Delay or eliminate the need for surgery
• Faster functional improvements with far fewer complications

Most evidence-based guidelines recommend exhausting conservative care before considering orthopedic surgery, except in cases of severe trauma or neurological deficit.

In review: Shockwave vs Surgery
Shockwave: Non-invasive, with shorter recovery time, and can be just as effective in avoiding surgery in many cases.

Study Insight: Gerdesmeyer et al. (2003) showed that shockwave therapy helped reduce calcification in the rotator cuff, often preventing the need for surgical intervention.

Conclusion

Shockwave therapy is a versatile, non-invasive treatment that can provide long-lasting relief for a range of musculoskeletal conditions. Whether you’re considering cortisone injections, PRP, or even surgery, shockwave therapy may be a highly effective, lower-risk alternative.

At our office, we integrate shockwave therapy with a comprehensive treatment plan to optimize recovery and performance for our patients. If you’re struggling with chronic pain or soft tissue injury, we’re here to help you explore all of your treatment options. Call our office today; we would be glad to assist you in your health needs.