By Jeanne Davant, for UCHealth

Annalise Carr was in her third year on the lacrosse team at the University of Colorado Colorado Springs when injuries to her back forced her medical retirement.

She had two back surgeries, but throughout 2023, she also had lingering foot pain that did not yield to treatment. Toward the end of the year, her trainer referred her to Dr. Nicholas Piantanida, UCHealth’s medical director for sports medicine and head team physician at UCCS.

Carr consulted with Piantanida, who suggested shockwave therapy. After half a dozen sessions at the UCHealth Primary Care and Sports Medicine Clinic, her pain had resolved significantly.

“She had not benefited from a very generous period of rest in a boot, as well as appropriate treatment with medications,” Piantanida said. After completing the series of shockwave treatments in late 2023, “she was able to re-engage her running schedule in the new year.”

Treated with extracorporeal shockwave therapy

Carr was among the first patients treated at the clinic with extracorporeal shockwave therapy, which delivers acoustic energy waves to stimulate healing in soft tissue, ligaments and tendons. Although the technique has been around for several decades, its use now is widening as the technology has been upgraded.

Piantanida began using it at the clinic in south Colorado Springs in November 2023, after he experienced its benefits himself.

“I was at an international conference in Phoenix, Arizona, in early April 2023, where the machine was being demonstrated,” he said. “I had hurt my calf running, and I hopped onto the treatment table as one of their demo patients.”

After the treatment, “I had significant reduction in pain, and three days later, I was able to do a modified workout.”

UCHealth uses two of the devices, which produce energy in nanosecond bursts at penetration depths of 3-6 or 13-14 centimeters.

Finding solution for minimizing discomfort

When Carr first consulted a doctor, the source of her foot pain wasn’t apparent.

“We thought it was potentially a stress fracture, but the x-rays showed nothing. There was no soft tissue calcification, so it was kind of a mystery,” she said.

She was given a boot to wear, which she would take off to play or practice and put on afterward. Walking remained uncomfortable, and in late summer 2023, the pain worsened and persisted even when she was off her feet.

Piantanida explained that shockwave therapy can be useful for patients with soft-tissue injuries who have not recovered after treatment with other modalities including medication, massage, physical therapy and acupuncture. Through a musculoskeletal ultrasound, he found Annalise had a small, partial tear to one of the ligaments in her foot.

“I thought it was worth a shot, because I didn’t know what else to do,” she said.

Carr’s treatments lasted about five minutes each.

“It was kind of like an ultrasound machine because there were gels,” she said. “After my first treatment, I noticed a difference. I took the boot off, and I was able to walk a little better without a limp.”

Carr experienced little discomfort during the treatments, she said. As they continued, she began to feel some discomfort after treatment. But that would lessen after a couple of days, and she felt significant relief between treatments.

“I still have pain every once in a while,” she says, “but on a scale of one to 10, it probably reaches a three, compared to before, when it hit a nine or 10.”

Stimulating the healing process through shockwave therapy

With a muscle, tendon or ligament injury such as Carr’s, “there should be initial signs of recovery in four to six weeks,” Piantanida said.

“The body was originally intended to heal itself,” he said. “It provides all of the growth factors, neurohormonal changes and the blood supplies important to heal the injured part.”

Shockwave therapy becomes an option in scenarios where the body has not produced an appropriate healing response. The acoustic energy delivered by the shockwave machine improves blood flow to the injured tissue.

“It essentially kickstarts the inflammatory and, ultimately, healing cascade,” Piantanida said. “With more blood flow, we’re stimulating fibroblasts and other tissue-growth factors. I think of it as an orchestra — you start off with the horns, and the conductor then brings in other brass and maybe the string instruments. Before long, a beautiful melody of healing happens.”

Besides athletes of all ages, shockwave therapy is being used to benefit older individuals with degenerative joint changes and can be combined with other regenerative products such as platelet-rich plasma.

Piantanida points out that, as a regenerative treatment, shockwave therapy is not currently covered by health insurance. UCHealth has striven to keep the treatments affordable for self-pay patients.

Carr received six treatments, but Piantanida has found that the orchestration of healing is optimized by the fourth treatment. After that, patients can experience an incremental recovery and return to their sport.

Now serving as a lacrosse coach at UCCS, Carr said she recommends injured athletes give shockwave therapy a try if it is appropriate.

“It does help lower the level of pain you’re experiencing,” she said. “I would highly recommend using it.”

To learn more about shockwave therapy, click here.