Focused Shockwave Therapy 

Lumbar Facet Joint Pain / Mechanical Low Back & Facet Arthropathy

 

What it does: Clinical Goal
Focused high energy shockwave applied to the posterior elements (Paraspinal Facet complexes / Facet Joint region) aims to reduce nociceptive and neuropathic pain from facet arthropathy, improve function and reduce reliance on injectable interventional procedures. It may also modulate local bone marrow oedema and periarticular inflammatory processes.

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How it works
Proposed effects include mechanical stimulation of periarticular tissues that reduces local inflammation, alters pain signaling, and promotes local bone/tissue remodeling; MRI changes (reduced bone-marrow oedema) have been reported in translational and clinical work. Mechanistic data are evolving but clinical trials suggest symptomatic and functional benefit in selected patients.

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Who is suitable
Patients with chronic lumbar facet pain confirmed by clinical exam, and imaging and who have failed conservative measures, may be considered. Those who are not candidates for, or who wish to avoid, radiofrequency denervation or steroid facet injections can be offered a course of focused ESWT as a non-invasive alternative.

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What to expect & Recovery
Treatment is delivered with patient lying (prone); focal shockwaves target the facet region under ultrasound guidance. Sessions are usually short and require weekly visits. Some patients report immediate pain reduction and functional improvement over weeks; activity modification and standard back rehab continue to be essential.

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Outcomes & Evidence
Recent focused ESWT studies report sustained pain and function improvements in chronic lumbar facet pain patients at medium-term follow-up 6–12 months and promising MRI correlates; larger RCTs are emerging and show focused ESWT as a promising non-invasive option, but longer-term >12 months data are still being collected.