The Hidden Cause of Chronic Back Pain Most Doctors Overlook

Focused shockwave therapy is used for myofascial pain by directing acoustic pulses at active trigger points, serving two purposes at once: reproducing the patient's familiar pain to confirm the trigger point as its source, and reaching muscle and fascia at a depth more superficial methods cannot.

This interview examines how focused shockwave therapy is used for myofascial pain and trigger points in diagnosis as much as treatment, and particularly in the lumbar region, where myofascial contributors are easily overlooked.

Dr. Hannes Müller-Ehrenberg is a specialist in conservative musculoskeletal medicine whose work centres on the diagnosis and treatment of  myofascial pain and trigger points with focused shock waves.

How did Dr. Müller-Ehrenberg come to use shockwave therapy for myofascial pain? 

Dr. Müller-Ehrenberg encountered extracorporeal shockwave therapy in the conservative medical treatment setting, finding his way into it through the treatment of muscle and fascia alongside manual and invasive techniques.

His clinical work focuses on the interaction between muscles, fascia, and the musculoskeletal system, often in combination with manual and interventional techniques.

In this context, focused shockwave therapy has been used on myofascial trigger points. According to his observations, this approach may contribute not only to treatment considerations but also to a more differentiated assessment of pain origins.

Because the painful point can be reproduced during treatment, patients better understand symptoms that cannot be attributed to joints or discs alone.

What are the clinical characteristics of trigger point syndrome?

Trigger point syndrome is associated with localised pain, often reported in the back or near joints. In some cases, imaging findings such as degenerative changes do not fully correspond to the symptoms described.

Such findings may also be present in individuals without symptoms. When muscular and fascial structures are taken into account, myofascial factors may be considered as a possible contributor.

In everyday clinical practice, there may be indications that myofascial trigger points play a role in the development or persistence of pain.

What role can trigger point syndrome play in lower back pain? 

Lower back pain is among the most frequently reported musculoskeletal complaints. Diagnostic attention is often directed towards conditions such as disc degeneration or irritation of the sciatic nerve.

Myofascial aspects are not always considered to the same extent. Based on clinical observations, muscles and fascia in the lumbar region may represent an additional factor in some cases. 

Focused extracorporeal shockwave therapy (ESWT) is used to reach deeper tissue structures which helps pinpoint painful areas more precisely during both examination and treatment.

How is shockwave therapy used in clinical practice? 

In orthopaedics and pain medicine, ESWT is discussed as a non-invasive treatment option that may be considered as part of an overall therapeutic concept. The procedure does not require injections or surgical intervention.

In user reports and clinical observations, the treatment is sometimes described as well-tolerated. As with other medical procedures, individual experiences may vary depending on the indication and patient-specific factors.

Are there examples from clinical practice? 

In addition to established indications, Dr. Müller-Ehrenberg describes individual cases from everyday practice, including long-standing symptoms following tissue injuries where different treatment approaches had previously been applied.

In such cases, extracorporeal shockwave therapy may form part of an individual treatment plan. These are single experiences and cannot be generalised to other patients.

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When myofascial trigger points are the pain generator, focused shock waves can both confirm that source and act on muscle and fascia at depth — a role imaging-led diagnosis alone can miss. MTS Medical's Spark Wave systems generate focused electrohydraulic shock waves engineered to deliver within that therapeutic depth — the property clinicians like Dr. Müller-Ehrenberg rely on when treating deep myofascial structures.

Watch the full interview with Dr. Müller-Ehrenberg on YouTube.

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Disclaimer 

This content is intended for qualified healthcare professionals only, and it reflects clinical experience and current medical discussion. It does not replace individual medical advice.

The use of extracorporeal shockwave therapy depends on the specific indication and should be assessed by a qualified healthcare professional.