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  • Chronic Trigger Points
  • Avascular Necrosis
  • Hip Arthritis
  • Trochanteric Bursitis

Hip pain helped with extracorporeal shockwave therapy- ESWT


Myofascial trigger points can play an important role in chronic pain and an alteration in hip joint mechanics. This can lead to damage of the hip joint in the form of degeneration and arthritis.  We have even had people come to us in our San Jose and Los Gatos offices who were recommended for surgery based on a medical evaluation but, after a course of ESWT care for their hips, were functional again.

Too many middle aged people are getting hip replacement surgery.  The Piezowave 2 is delaying and even eliminating the need for surgery.


Trigger points can be detected by:

  • Palpation [1]
  • MRI scan [2]
  • Infrared thermography [3]
  • Ultrasonography [4]
  • Diagnosed and treated with the Piezowave 2 ESWT [5].  

Trigger points are irritable points within the muscle that radiate and affect other areas of your body. Whatever the hip problem, trigger points usually play a vital role in bringing back the function of the hip and the Piezowave 2 has been shown to eliminate trigger points.

The three muscle groups that refer pain to the hip joint are the Quadratus Lumborum (QL), the Tensor Fascia Latae (TFL) and the Piriformis.  All are easily accessible with our Piezowave 2 machine.  The German study showed objective before and after MRI trigger point changes in trigger points and decreased pain. They believe that the Piezowave 2 increased proteolytic enzyme activity that  and when you are being treated you feel it working.

Piezoelectric extracorporeal shockwave therapy for hip pain


Your bones need a regular supply of blood to stay alive.  When blood is decreased, a dying-off, or necrosis, occurs.  In the hip this is called Avascular Necrosis of the Femoral Head and, if it continues, the femoral head will crumble and collapse.  The joint cartilage then tends to degenerate and the joint becomes severely arthritic.

Trauma, Cortisone use, alcohol abuse, autoimmune diseases and other conditions contribute to causing AVNFH.

One of the most researched results from ESWT is the result of angiogenesis or blood vessel proliferation.  This is exactly what someone with avascular necrosis needs and now there is research to back up the claims:

“…application of shockwave results in regeneration effects in hips with osteonecrosis of the femoral head.” [6]

“… therapeutic effect in the repairing and reconstructing osseous tissue.” [7]

“The overall clinical outcomes were improved in 83%…” [8]

“…this method may offer an alternative to invasive treatment modalities for femoral head necrosis.” [9]

In the Ma study microvessel density, vascular endothelial growth factor and mRNA expression were increased for as much as 12 weeks after ESWT. [10]

All of this combined with the clinical results we have seen in our office with the Piezowave 2 are giving people hope.

NOTE:  Hip trigger points can radiate down the leg and into the outer part of the knee creating something called IT Band Syndrome.


Working outside of The Villages retirement community in San Jose, CA, we have seen hip arthritis from a small joint restriction to hip replacement.  When the ball-and-socket joint of you hip takes a lot of wear-and-tear, the long-term result is osteoarthritis.  Osteoarthritis is a common cause of hip pain and extracorporeal shockwave therapy (ESWT) is showing promising results for arthritic joints.Arthritis of the hip socket and the role of ESWT

The pain with hip arthritis is often a stiffness in the groin and pain can spread from there.  Extracorporeal shockwave therapy can help arthritic hips by:

  • Increasing tendon elacticity
  • Taking pressure off of the arthritic hip joint
  • Increasing blood flow to arthritic hips [6]
  • Helping heal osteoporotic arthritic hips [11]

People have come to our offices in San Jose and Los Gatos thinking they needed surgery for their hip arthritis and knees that are leading active lives again without the need to get cut open.


Trochanteric Bursitis is helped with ESWT

Cross section of the trochanteric bursa

If you have pain on the side of your hip, you may have trochanteric tendinitis or bursitis. Overstraining of the surrounding muscles and ligaments on the side of the hip can lead to inflammation and intermittent pain. The good news is that extracorporeal shockwave therapy (ESWT) can help.

In one study, people who suffered from greater trochanteric bursitis for approx. 14 months and had tried many other modalities still had significant decreases in pain with ESWT [12].

With Trochanteric Bursitis it is important to have a proper evaluation of your hip mechanics, inflammation in the area, possible scar tissue and any trigger points.  With this condition, in particular, a doctor with excellent palpation skills is imperative.  For this reason, you will be evaluated by one of our doctors of chiropractic to determine location and penetration depths of your treatment.

Some techniques to aid in your hip’s recovery:

  1. Corrie Myburgh, PhD, Anders Holsgaard Larsen, PhD, Jan Hartvigsen, PhD. A Systematic, Critical Review of Manual Palpation for Identifying Myofascial Trigger Points: Evidence and Clinical Significance. Arch Phys Med Rehabil 2008;89:1169-76.
  2. Chen Q, et al “Identification and quantification of myofascial taut bands with magnetic resonance elastography” Arch Phys Med Rehab 2007; 88: 1658-1661.
  3. Fischer AA: Advances in documentation of pain and soft tissue pathology. J Fam Med, 24-31, Dec. 1983.
  4. Rha DW1, Shin JC, Kim YK, Jung JH, Kim YU, Lee SC.Detecting local twitch responses of myofascial trigger points in the lower-back muscles using ultrasonography.Arch Phys Med Rehabil. 2011 Oct;92(10):1576-1580.e1. doi: 10.1016/j.apmr.2011.05.005. Epub 2011 Aug 12.
  5. Müller Ehrenberg. A presentation of High Definition 3 tesla MRI Imaging Pictures of a Myofascial Triggerpoint before and after piezoelectric focused sound MyACT – Poster MyoPain 2013 Seattle
  6. C.-J. Wang,F.-S. Wang,J.-Y. Ko,H.-Y. Huang, C.-J. Chen,Y.-C. Sun, Y.-J. Yang. Extracorporeal Shockwave Therapy Shows Regeneration in Hip Necrosis.. Rheumatology (2008) 47 (4): 542-546.
  7. Kong FR, Liang YJ, Oin SG, Li JJ, Li XL: Clinical application of extracorporeal shock wave to repair and reconstruct osseous tissue framework in the treatment of avascular necrosis of the femoral head (ANFH). Zhongguo Gushang. 2010, 23 (1): 12-5.PubMedGoogle Scholar
  8. Wang CJ, Wang FS, Yang KD, Huang CC, Lee MS, Chan YS, Wang JW, Ko JY: Treatment of osteonecrosis of the hip: comparison of extracorporeal shockwave with shockwave and alendronate. Arch Orthop Trauma Surg. 2008, 128 (9): 901-8. 10.1007/s00402-007-0530-5.PubMedView ArticleGoogle Scholar
  9. Ludwig J, Lauber S, Lauber HJ, Dreisilker U, Raedel R, Hotzinger H: High-energy shock wave treatment of femoral head necrosis in adults. Clin Orthop. 2001, 387: 119-26.PubMedView ArticleGoogle Scholar
  10. Ma HZ, Zeng BF, Li XL: Upregulation of VEGF in subchondral bone of necrotic femoral heads in rabbits with use of extracorporeal shock waves. Calcif Tissue Int. 2007, 81 (2): 124-31. 10.1007/s00223-007-9046-9.PubMedView ArticleGoogle Scholar
  11. Ching-Jen Wang, Chien-Yiu Huang, Shan-Ling Hsu, Jen-Hung Chen and Jai-Hong Cheng, Extracorporeal shockwave therapy in osteoporotic osteoarthritis of the knee in rats: an experiment in animals. Arthritis Research & Therapy201416:R139 DOI: 10.1186/ar4601
  12. Peled, D. Norman, D. Levin, C. Zinman. Greater Trochanteric Bursitis and ESWT. Orthopaedic Proceedings,19 August 2008