SHOCK WAVE THERAPY
Shock Wave Therapy is a non-surgical technique developed for the treatment of localized musculoskeletal pain.
Shockwaves are sound waves that can heal deep and superficial tissue in the body. The sensation of shockwaves feels more like a strong and deep vibration, as there is no electrical current or shock produced. These super sonic sound waves promote rapid tissue healing and cellular regeneration. It has been scientifically evaluated and numerous studies on shockwave can be found in various medical journals including.
Radial Shock Wave Therapy is the form of shock waves that are used in my office. They involve the application of a series of high-energy impulses to an affected area. The shock wave is a physical shock, not an electric one, that is used to shock the body into healing by create a localized inflammatory response. The body responds by increasing the metabolic activity around the site of treatment, therefore stimulating and accelerating the healing process. Shock wave therapy can also help break down scar tissue and calcified areas as well.
WHAT CAN IT DO FOR YOUR BODY?
It is well known that shockwaves are mechanical sound waves that are shown to remove pain, positively regulate inflammation, increase angiogenesis (blood vessel formation), and stem cell activity. Shockwave therapy is widely used in orthopedics based on the principles used in clinical urology for the implosion of kidney stones. It is a safe, non-invasive, versatile and effective treatment for many conditions of the musculoskeletal system.
SHOCKWAVES HAVE BEEN SHOWN TO
- Decrease pain
- Decrease and regulate inflammation
- Promote tissue repair and regeneration through cellular excitation
- Induce angiogenesis to promote neovascularization (formation of blood vessels)
- Remove calcium deposits
- Increase mechanical stimulation (decrease pain and muscle tightness)
WHAT CONDITIONS CAN YOU TREAT WITH SHOCKWAVE THERAPY?
Extracorporeal Shock Wave Therapy (ESWT) is currently being applied to a wide range of pathologies of different origins. It is utilized in orthopedics and rehabilitative medicine (tendon pathologies, muscle pain and tightness, inflammation), bone healing problems (stress fractures or shin splints, non union fracture), and vascular diseases (femoral head avascular necrosis, intermittent claudication, erectile dysfunction).
It can also be seen in fields such as Dermatology (wound healing for ulcers and open wounds, and painful scars) and neurology (spasticity or severe muscle tightness, ‘pinched nerves’ and radicular pain).
Shockwave Therapy, in virtue of its noninvasive application, limited side effects, tolerability during application and high success rate, make it a popular choice. Shockwave is highly effective for people dealing with conditions that have been resistant to conservative care.
Below is a table of common conditions that we see in the clinic and have a high success rate with shockwave therapy.
COMMON CONDITIONS TREATED
( calcification, rotator cuff, tendonitis, adhesive capsulitis ie. frozen shoulder, pain, bursitis, impingement, arthritis, AC joint, trigger points )
( cervical, thoracic, lumbar, and sacral pain )
( muscle tightness, IT band syndrome, bursitis, tendonitis, radiating pain, piriformis, trigger points, sciatic pain, tendonopathy, tendonitis, post surgical, joint pain and arthritis )
( PFPS, tendonitis, runners knee, patellar tendonitis, arthritis, bursitis, bakers cyst, swelling, sprain/strain, post surgical )
- Foot and Ankle
( heel spur, plantar fasciitis, achilles tendonopathy, metatarsal neuralgia, hallux rigidis, bunions, sprain/strain )
( carpal tunnel syndrome, arthritis, trigger finger )
( golfers, tennis, sprain/strains )
( chronic neck pain, headaches, trigger points )
( chronic headaches, TMJ dysfunction )
( fractures, shin splints, non union fractures )
- Wound therapy
( diabetic foot ulcers, scars, burns, skin grafts )
- Men’s Pelvic Health
( dysfunction/disorder, chronic pelvic pain, erectile dysfunction, Peyronie’s disease, pelvic trigger points )
- Chronic Pain
- Sports Rehabilitation
( repetitive injury, trauma, post event )
Shockwave therapy is also beneficial for trigger point therapy for the treatment of myofascial pain and highly effective for all ligament, tendon and muscular tissue.
HOW EFFECTIVE IS SHOCKWAVE THERAPY?
Regenerate Shockwave Therapy Edmonton provides all patients with education prior to treatment. There is an emphasis on expectations of outcomes regarding the treatment.
Because all patients are unique, shockwave therapy protocols are designed to meet the needs of each individual patient. This is why some patients will receive therapeutic exercise right away, while others may be advised to rest.
Generally speaking, shockwave therapy is highly effective when applied to the conditions that have been reported by the literature as such.
Importantly, the effectiveness of the treatment can be influenced by a number of factors identified in the scientific literature. This can include; the energy level delivered into the tissues, the type of shockwave therapy generator (focused or radial), the size or type of the shockwave applicator, the type of shockwave machine or generating source, the type of person or patient selected for the treatment, the defined measure of what is ‘success’ and the condition that is being treated.
Stating this, the success rates range from 70% to 95%. Recovery time and expectations of treatment is our priority so that all patients understand how the healing process will occur.
Shock wave therapy is used for both pain relief and to accelerate healing by a complex interaction of the following:
- Removal of neurogenic inflammation
- Release of growth factors
- Changes in gene expression
- New bone formation
- Activation of mesenchymal stem cells
WHAT DOES THE RESEARCH SAY ABOUT SHOCKWAVE THERAPY?
There is a tremendous amount of research that is currently being produced and shared in the scientific community. Currently, the International Society of Medical Shockwave Treatment (ISMST) published a list of approved treatment indications. They have been constructing their experience over the past 15 years in this field. In fact, the scientific board of the ISMST has compiled recommendations for the use of shockwave therapy.
APPROVED STANDARD INDICATIONS
- Chronic tendinopathies
- Plantar fasciitis with or without heel spur
- Achilles tendon
- Radial epicondylopathy (tennis elbow)
- Rotator cuff with or without calcification
- Patella tendon
- Greater trochanteric pain syndrome
- Impaired bone healing function
- Delayed bone healing
- Stress fractures
- Early stage of avascular bone necrosis
- Early stage osteochondritis dissecans (OD)
COMMON EMPIRICALLY-TESTED CLINICAL USES
- Ulnar epicondylopathy
- Adductor syndrome
- Pes anserinus syndrome
- Peroneal tendon syndrome
Impaired wound healing
- Myofascial syndrome
- Injury without discontinuity
EXCEPTIONAL INDICATIONS/EXPERT INDICATIONS
- Early stage osteochondritis dissecans (OD) pre-skeletal maturity
- Apophysitis (Osgood Schlatter disease)
- Peyronie’s disease (IPP)
Furthermore, please visit our blog to find out more information regarding the current research. You can visit our blog by clicking here.
Or visit, www.ISMST.com
1. Approved standard indications
1.1. Chronic Tendinopathies
1.1.1. Calcifying tendinopathy of the shoulder
1.1.2. Lateral epicondylopathy of the elbow (tennis elbow)
1.1.3. Greater trochanter pain syndrome
1.1.4. Patellar tendinopathy
1.1.5. Achilles tendinopathy
1.1.6. Plantar fasciitis, with or without heel spur
1.2. Bone Pathologies
1.2.1. Delayed bone healing
1.2.2. Bone Non-Union (pseudarthroses)
1.2.3. Stress fracture
1.2.4. Avascular bone necrosis without articular derangement
1.2.5. Osteochondritis Dissecans (OCD) without articular derangement
1.3. Skin Pathologies
1.3.1. Delayed or non-healing wounds
1.3.2. Skin ulcers
1.3.3. Non-circumferential burn wounds
2. Common empirically-tested clinical uses
2.1.1. Rotator cuff tendinopathy without calcification
2.1.2. Medial epicondylopathy of the elbow
2.1.3. Adductor tendinopathy syndrome
2.1.4. Pes-Anserinus tendinopathy syndrome
2.1.5. Peroneal tendinopathy
2.1.6. Foot and ankle tendinopathies
2.2. Bone Pathologies
2.2.1. Bone marrow edema
2.2.2. Osgood Schlatter disease: Apophysitis of the anterior tibial tubercle
2.2.3. Tibial stress syndrome (shin splint)
2.3. Muscle Pathologies
2.3.1. Myofascial Syndrome
2.3.2. Muscle sprain without discontinuity
2.4. Skin Pathologies
3. Exceptional indications – expert indications
3.1. Musculoskeletal pathologies
3.1.2. Dupuytren disease
3.1.3. Plantar fibromatosis (Ledderhose disease)
3.1.4. De Quervain disease
3.1.5. Trigger finger
3.2. Neurological pathologies
3.2.3. Carpal Tunnel Syndrome
3.3. Urologic pathologies
3.3.1. Pelvic chronic pain syndrome (abacterial prostatitis)
3.3.2. Erectile dysfunction
3.3.3. Peyronie disease
4. Experimental Indications
4.1. Heart Muscle Ischemia
4.2. Peripheral nerve lesions
4.3. Pathologies of the spinal cord and brain
4.4. Skin calcinosis
4.5. Periodontal disease
4.6. Jawbone pathologies
4.7. Complex Regional Pain Syndrome (CRPS)
1. Radial and focused waves with low energy
1.1. Malignant tumor in the treatment area (not as underlying disease)
1.2. Fetus in the treatment area
2. High energy focused waves
2.1. Lung tissue in the treatment area
2.2. Malignant tumor in the treatment area (not as underlying disease)
2.3. Epiphyseal plate in the treatment area
2.4. Brain or Spine in the treatment area
2.5. Severe coagulopathy
2.6. Fetus in the treatment area
RESEARCH AND SHOCKWAVE
According to a systematic review (106 studies), there are a number of important and relevant findings. These include:
- Shockwave therapy is effective and supported by the data. This means that the studies showed positive outcomes significantly better then placebo or alternative treatments and modalities used in rehabilitation.
- Shockwave therapy is safe. There were NO reports of serious adverse events. Please note that focused shockwave should never be aimed towards the lung or abdominal cavity. Furthermore, some patients are not appropriate for this treatment. Regenerate Shockwave Therapy Edmonton is one of very few clinics in North America that utilize both focused shockwave and radial shockwave technology using both high and low level energies.
- Application of shockwaves without sufficient energy may effect the outcome. Therefore, your shockwave treatment will always be completed by a registered physiotherapist certified by the International Society of Medical Shockwave Treatment (ISMST). Our physiotherapists are equipped with extensive training in the musculoskeletal system. This allows them to acutely identify the tissue depth and correct energy levels to treat the affected tissue.
- There is no significant evidence in favor of radial or focused shockwave therapy with respect to treatment outcomes. This means that both radial and focused shockwave therapy are effective at treating a variety of conditions. Depending on the type of tissue to be treated, we will utilize either one or both of the technologies.
- Optimal treatment protocol is 1-week intervals, 2000 impulses and the highest energy that can be applied. Please note, this is a standard indication and our clinical experience along with scientific findings will determine the parameters to be used.
Please keep in mind that shockwave therapy is only one form of medicine that you will receive. When appropriate, your shockwave therapy program in Edmonton may be combined with exercise and other modalities to optimize treatment outcomes. You will be given education on how to manage your condition and optimize regeneration of the tissue.
DID YOU KNOW?
Astonishingly, the benefits of shockwaves can be realized in as soon as one treatment, and are shown to systematically eliminate pain and improve joint and muscle mobility. Since research and clinical expertise have identified that a combined physiotherapy program significantly benefits patients receiving shockwave therapy, all patients are provided with a unique and effective shockwave therapy protocol. When indicated, shockwave therapy may be combined with physiotherapy, manual therapy, manipulation, individual exercise prescription, joint/muscle taping, or muscle energy techniques.
Focused and Radial shockwaves differ in their physical characteristics and in the technique for generating them, and in the parameter used in the therapeutic penetration depths into the tissue.
What Is The Difference Between Focused Verses Radial Shockwave Therapy?
Focused (ESWT) and radial (RSWT) shockwaves differ in a number of ways, the physical principles are different from the way they are generated, the energy and energy density of each wave as well as the therapeutic penetration depths into the tissue.
However in saying that the stimulation effects and therapeutic mechanism of ESWT verses radial shockwave therapy are fairly similar with radial shockwaves well suited for indications more near the surface of the body and for deeper target areas focused shockwave therapy seems to be favorable.
Radial Shockwave Therapy Has A Slower Wave Form
RSWT differs from the other forms of shockwave technology in a couple major regards. RSWT waves travel at speeds of approximately 10 meters per second much slower than ESWT wave speeds. The speed of RSWT waves does not break the sound barrier, and hence, no actual shockwave is produced with radial shockwave therapy which is different to that of ESWT.
Not only does the wave speed differ but so to does the wave form, focused shockwaves of ESWT are very short and very intense the radial shockwave waves are slower, less intense, elongated, and more sinusoidal in appearance. The focused shockwave used in ESWT is a special acoustic pressure wave characterised by a high positive pressure amplitude and an abrupt rise and short pulse duration. When the pressure wave amplitudes reach high values (typically 20-100 MPa), the steepening pressure wave becomes a shock wave.
- With radial shockwave therapy the waveform and traveling speed of the wave is very different and some consider it more accurately described as a pressure wave technology.
Focused Shockwave Therapy Bypasses The Skin
With ESWT the shockwaves and force produced in the machines is translated past the skin and superficial tissues without effect, and are instead focused at the desired tissue depth. ESWT can be aimed and delivered past the skin to different tissue depths, allowing for delivery of the therapeutic waves at a specific depth.
In contrast RSWT is applied to the skin and the pressure waves are generated ballistically at the surface of the skin by radial pressure wave devices, the generated pressure wave then propagates divergently through the body.
With radial shockwave therapy this wave must dissipate through the superficial tissues prior to reaching the target tissues below, meaning deeper tissue injuries are therefore potentially more difficult to treat with radial shockwave therapy but the benefit of RSWT is that unlike most ESWT anesthetic is not required for radial shockwave therapy sessions.
The Major Differences Between Focused And Radial Shockwave Therapy
- Radial shockwave therapy is effective at treating more superficial complaints.
- Focused shockwave therapy can specifically target deeper tissues.
- Focused shockwave therapy may require anesthetic prior to treatment where as radial shockwave therapy is only mildly painful and doesn’t require any anesthetic to be administered before application.
Overview of the PHYSICS fundamental differences between
Focused & Radial shockwaves: Current clinical studies, show, that the stimulation effects and therapeutic mechanism are fairly similar, regardless of the physical differences and the resulting different application areas (on the surface and in depth). Radial shockwaves are well suited for indications near the surface and inn the case of myofascial pain syndromes, radial is indispensable for smoothing the muscles before or after focused shock wave treatment. For the therapy of deep local pain points, chronic insertion tendinitis and deeper trigger points, the application of focused shockwaves seems to be favorable. Planar or defocused shockwaves are primarily used for the treatment dermatological or aesthetic indications.
To underline the differences between the two, various other terms are also comment used, such as “Extracorporeal Pulse Activation Therapy“ (EPAT) or “Acoustic Wave Therapy” (AWT) or similar used for Radial.
In medicine, extracorporeal shock waves generated were first used for kidney stone fragmentation in the 1970’s and have since become the method of choice for most kidney and ureteral stones. In the 1990’s, these shock waves were successfully utilized for the treatment of several musculoskeletal disorders. Shock waves are mechanical waves passing through the surface of a body without causing injury and may act therapeutically in determined areas within the body.
FOCUSED SHOCK WAVES RELEASE THEIR ENERGY INSIDE THE BODY
GENERATION OF FOCUSED SHOCK WAVES
Focused shock waves can be generated with electrohydraulic, piezoelectric, and electromagnetic(todays state-of-the-art) techniques.
The first principle of shock wave generation, was the electrohydraulic principle. Shock waves are generated by high voltage discharging to a spark plug in the underwater source, thus creating a very loud spark with shock waves very painful and large low intensity focus area that blast the entire region. In Europe this principle of shockwave generation has largely disappeared.
Newer principles of shock waves generation which generate steepening and overlapping are todays state-of-the-art, generated by Piezoelectric and electromagnetic principles.
Piezoelectric shock waves principles generate small needlelike focus areas, which may carry very high intensity, similar to a burning glass effect, thus caution needs to be observes at some treatment regions.
Piezo elements are arranged on a spherical surface and are synchronously excited by an electrical pulse to emit a pressure wave in the direction of the center of the spherical surface. The process is self-focusing.
Electromagnetic principles of shock waves generation are characterized by optimized intensities and focus zones, with long lasting constant dosage outputs, resulting in a gentle, less painful thus well tolerable and low noise treatment.
The method of electromagnetic shock wave generation is based on the physical principle of electromagnetic induction, as used for example in loudspeakers. The arrangement of coils and membranes is optimized to generate powerful and short acoustical pulses.
Two different configurations can be distinguished:
1. A flat coil with focusing through an acoustical lens
2. A cylindrical coil with a parabolic reflector.
NOTE: Focusing is important to limit the effect to the target area while
simultaneously reducing side effects outside this area.
… in addition to focused, radial shock waves with somewhat different physical features are used in modern medicine today with the similar effective results.
Radial shock waves are generated by means of a pneumatic system. With compressed air a projectile is accelerated to a high-speed then suddenly decelerated by a transmitter. The transmitter is held to area to be treated. The generated kinetic energy is than transmitted to the tissue from where it propagates outwards (radially) as a »radial« wave into the tissue.
The maximum energy is reached in the superficial areas of the body.
Radial sound wave propagation in the tissue provides excellent therapy results when treatment is performed on musculoskeletal conditions near the surface.
Radial extracorporeal shock waves therapy
Today focused extracorporeal shockwaves are only used I few indications like bone pathologies or calcific tendinitis. The radial extracorporeal shock waves technology is now indicated in most soft tissue disorders.
In the future further indications will expand the treatment spectrum. Most recently rESWT is now used in some generalized musculoskeletal diseases like myofascial pain syndromes, trigger point associated disorders and in dermatology chronic wound care.
Application of shockwaves and their intensities
Depending on the intensity of the shockwaves applied – the latest State-of-the-Art ESWT technology allows precise adjustment – the mechanical stimulation of cells, membranes, and bone trabecular, as well as the stimulation of cells through reversible deformation of the cell membrane are possible. In this way, it is possible to destroy brittle structures such as kidney stones, or to irritate and/or stimulate tissue structures, which promote and lead to the healing processes.
In high-enegy levels, focusing is an important part to limit the likely effect to the target area while reducing any possible side effects outside this area.
What areas of the body or conditions can be treated?
Shock wave or Radial Shock Wave Therapy (RSWT) is a non-surgical technique developed for the treatment of localized musculoskeletal pain. Common conditions that can be successfully treated with RSWT are:
- Heel Pain (Plantar Fasciitis and/or Heel spurs)
- Patellar Tendonitis/tendonosis (Jumper’s knee)
- Achilles tendon pain (Achilles Tendonitis/tendonosis)
- Tennis and Golfer’s elbow
- Rotator Cuff tendonitis including calcifying tendonitis
- Shin pain / tibial stress syndrome
- Chronic neck, shoulder and back pain
- Muscular trigger points
- Very tight fascia and muscles
- Connective Tissue Pain and Degeneration
There is quite a bit of evidence supporting the use of shock wave therapy. Although some other conditions have not shown as much research on the efficacy of shock wave therapy, In recent years there have been some promise in the use of shock wave therapy for spinal cord injuries, adhesive capsulitis (frozen shoulder), stroke rehabilitation, and some urogenital conditions. Shock wave therapy is a non-surgical option with results that match surgical outcomes, and should be considered when other treatment options have failed or when surgery is not an option. In many situations, shock wave therapy is combined with other therapies to get the most effective results for patient care.
How is Shock Wave Therapy performed?
After a thorough patient history, detailed assessment, and the use of a musculoskeletal ultrasound I, Dr. Nick, will determine if shock wave therapy is for you. If you are a candidate for shock wave therapy, the primary area of pain is localized and a skin gel is applied to the treatment area to allow the shock waves to be properly transmitted into the body. In addition to the localized area of treatment, a global approach to your care is considered, making sure that the dysfunctional movement patterns are rectified so that you do not have a recurrence of symptoms.
You are scheduled for an initial course of therapy which includes four (4) to six (6) treatments. Three of the treatments are only for shock wave therapy, which is often used in conjunction with laser therapy. You will also be scheduled for an active rehabilitation session to implement exercises that will be used to enhance the strength and endurance of your affected areas as well as increase the mobility of the entire area. A few other manual therapy sessions may be added to work on some of the other dysfunctional tissues either being the initial cause of the problem or that may have developed as a compensation of your symptoms.
How does Shock Wave Therapy feel?
Shock wave treatment sessions can be uncomfortable, but they are usually well tolerated.
What will I experience after a Shock Wave Therapy session?
After a shock wave therapy session you will most likely be feeling no pain but you may experience throbbing pain 2-4 hours following the treatment. This throbbing pain may occur for up to 24 to 48 hours. In rare cases, patients may experience temporary skin reddening, pain or worsening of symptoms during the first few days after treatment.
It is important that following shock wave treatment activity levels are decreased for 48 hrs following the treatment.
Contra-Indications for Shock Wave Therapy
- Pre-ruptured tendons (greater than 50% tear of myotendinous junction)
- If under the age of 18 (except of the treatment of Osgood-Schlatter or Sever's Disease)
- During pregnancy
- Cancer or diabetes
- Heart or circulatory problems
- If you have hemophilia or any blood-clotting disorder (including local thrombosis)
- If patient is being treated with oral anticoagulants (blood thinning medications), such as Heparin or Coumadin
- Treatment of tissue with local tumors or local bacterial and/or viral infections
- If a patient has been treated with cortisone injections within the last six (6) weeks
DISCLAIMER: The following blog represents views and thoughts that are my own. I have no interest groups to declare. This article is involves some simple and honest experiences treating patients with extracorpeal shockwave therapy, RPW, FSW, ESWT, high energy, low energy….
I have been hearing a lot of confusing terms lately regarding shockwave therapy…And its not just me who is questioning this.
Why is it that we habitually label and re-label our therapies and techniques? CAN WE JUST COME TO TERMS and call it what it is? I know I have continued to change how, why, and what I choose to call shock wave therapy. In fact, I am as guilty as all the rest. But what really are we guilty of?….
It has been suggested that the myriad of different names and labels for a treatment technique essentially confuses patients, clinicians, doctors or scientists, and members of the public. This is often observed in rehab medicine, where we essentially invent names for similar treatment techniques!
I am not even going to confuse this subject more with how scientists and clinicians are determining therapeutic dosage and demonstrating treatment parameters. To make matters worse, we are confronted with many different shockwave companies; each claiming to have the new and the latest breakthrough in the complicated and often debated topic of PAIN!
As stated, there remain a multitude of names and phrases that essentially say the same thing. However, let’s give credit as these identifiers can be important, because it may accurately detail the treatment technique. For me, I believe ‘extracorpeal shockwave therapy’ to be a good umbrella term for shockwave therapy. Under this umbrella, perhaps we could include subgroups; focused shockwave therapy and radial shockwave therapy (as i described more clearly in a previous blog post). To keep things simple, could we only reference the above names when talking about shockwave therapy for musculoskeletal conditions? And attempt to eliminate all other confusing terms that predominately are the same thing?
For me, an important part of working with shockwave is to define the technology that we are using and develop protocols that include a strengthening or rehabilitation plan. I am a firm believer that exercise should always be part of a rehabilitation program that utilizes shockwave therapy (unless it is a condition that requires off loading or rest).
I have summed up what I think makes a successful shockwave treatments and help optimize patient outcomes. They include:
- Research the evidence, remain up to date, and use recommendations on patients. Follow ISMST recommendations and combine with exercise when appropriate. Keep it safe!
- Accurately reflect and educate each patients to optimize patient expectations
- Talk open and honest on what treatment you are administering (focused or radial shockwave therapy).
- Create outcome measures (objective and subjective) to track patient progress and long term follow ups.
- Create a therapeutic relationships that emphasizes, trust, empathy, and avocation for self management of a condition.
Overall, Its certainly not easy to simplify shockwave therapy. But the art of simplification may suffice in providing our patients with more accurate information. In Canada, there is currently no National Level Shockwave Therapy association that can offer expert opinion, demonstrate the newest level of evidence or bring together clinicians to offer better treatment education for practitioners using the technology.
However, for now, we are still able to attend great conferences with our neighbors in Europe and surrounding areas. Not to mention, the attendance location of the ISMST conference changes yearly to include different countries.
It is an exciting time in the field of shockwave therapy. For all those that use the technology, I hope we can continue to collaborate and focus on good patient outcomes combined with a safe and effective application of the technology.
Extracorporeal Shock Wave Therapy is used to treat a variety of musculoskeletal and orthopaedic conditions through the use of shock waves. This is a non-invasive, non-surgical treatment and is incredibly effective in treating chronic pain, inflammation and large range of other joint, bone and muscle injuries and illnesses.
ESWT uses shockwaves to stimulate healing. It offers advantages over surgery as it is non-invasive with fewer potential complications and a faster return to normal activity.
Three treatments are performed at weekly intervals. Each treatment is simple with no injections. Your affected area is positioned against the head of the ESWT machine and a shockwave is delivered to the area. This is felt as a pulse.
Conditions commonly treated by ESWT include:
- Heel Pain / Plantar Fasciitis
- Shoulder Pain
- Tennis and Golfer's Elbow
- Achilles Pain
- Hip Pain
- Jumper's Knee Patella Tendonitis
- Shin Splints
- Neck and Lower Back Pain (Trigger Points)
More information about the conditions ESWT can treat
Plantar fasciitis is a painful condition that affects the heel of your foot. It can cause your heel to hurt, feel hot and even to swell. The pain is usually caused by inflammation of the plantar fascia - a thin layer of tissue that supports the arch of your foot.
Standing for a long time can cause pain in plantar fasciitis, but often the pain is worst first thing in the morning - when you get out of bed. Sometimes it is noticeable at the beginning of an activity and then gets better as the body warms up.
Treating plantar fasciitis surgically can be hugely risky and can even lead to permanent disability. But, left untreated, severe plantar fasciitis pain can cause serious disruption to your life and limit your mobility permanently.
Achilles tendonitis is a debilitating inflammation or injury of the Achilles tendon - which runs down the back of the lower leg and attaches to your heel bone. The Achilles tendon connects the leg muscles to the foot - which is what gives you the ability to rise up on your toes - a key component in the mechanism of walking.
When you suffer with Achilles tendonitis you often feel pain and swelling in the posterior part of your heel as you walk or run. You may also feel tightness in your calf and find it difficult to flex your foot.
Achilles tendonitis can make walking almost impossible and can have an enormous impact on your ability to go about your daily routine.
Tennis elbow doesn’t only affect tennis players. Usually it is caused by movements that repeatedly engage the muscles in your forearm - so it is a common workplace or athletic injury.
Tennis elbow usually starts as a mild pain before gradually worsening. In some cases the pain can be severe and unrelenting. Normally, sufferers will feel pain when they grip or carry even a light object.
Shoulder tendinitis can either cause pain in the affected area, or it can cause a debilitating restriction of movement in the shoulder.
The condition is caused by the degeneration of tissue in one of the tendons at the top of the upper arm bone. It is normally repeated mini-traumers to the rotator cuff tendons that cause the problem, rather than a one-off trauma.
Jumper's knee - also known as patellar tendonitis - is the inflammation or injury of the patellar tendon, the tissue that connects your kneecap to your shin bone. Jumper's knee occurs when repeated movements cause tissue damage or irritation to the tendon - which makes it particularly common in athletes who play high-impact sports.
Sports and activities that involve repetitive jumping and frequent changing direction can cause tears and damage to the patellar tendon. So sports like athletics, basketball, volleyball etc. can put a lot of strain on your knees.
It is important to treat jumper's knee as early as possible. Ignoring the symptoms and continuing to play sport can lead to serious damage to the knee and may mean that surgery is required.
Trochanteric bursitis is a syndrome that causes pain in the bony, outside part of the hip and may radiate down the thigh. It happens when the fluid between the hip and the muscles and tendons of the thighs, becomes inflamed.
Thid condition can be caused by inflammation, overuse of the tendons and muscles or an acute physical trauma. There are also a number of underlying conditions that can cause Trochanteric bursitis - including osteoarthritis, fibromyalgia and gout.
Extracorporeal Shock Wave Therapy (ESWT)
Extracorporeal Shockwave Therapy is a treatment modality in which shockwave energy interacts with the tissues of the body. This leads to a cascade of beneficial effects such as formation of new blood vessels, modulation of chronic inflammation, stimulation of connective tissue cells called fibroblasts, and the break down of calcium eposits in the targeted area.
A shockwave differs from ultrasound by its extremely large pressure amplitude. Additionally, ultrasound typically consists of a periodic oscillation, whereas a shockwave is a single pulse.
Evolution of shockwave therapy
In 1980, the shockwave method was used for the first time to disintegrate kidney stones. This method has become the standard treatment of choice for kidney stones.
Shockwaves therapeutic effect
Shockwave therapy is not used to disintegrate tissues, but rather cause microscopic interstitial and intracellular, and cell membrane changes which tend to up-regulate the healing mechanisms in connective tissue. Mechanical wave energy is conducted from the point of origin, a pneumatic generator, to the affected body part.
Biology of ESWT
Nutrient blood flow is necessary to start and maintain the repair processes of damaged tissue structure. The application of acoustic waves creates capillary micro ruptures in tendon and bone and significantly increasing the expression of growth indicators such as the Endothelial Nitric Oxide Synthetase, Vascular Endothelial Growth Factor, and Bone Morphogenic Protein.
These compounds stimulate the growth and remodeling of new blood vessels. The new blood vessels improve the blood supply and the oxygenation resulting in the faster healing of both tendon and bone.
Applications for ESWT.
The treatment of recalcitrant chronic musculoskeletal conditions including:
· Rotator cuff tendinopathy – with and without calcification.
· Lateral and medial epicondylopathy.
· Plantar fasciitis.
· Shin splints.
· Patellar tendinopathy.
· Achilles tendinopathy.
· Iliotibial band friction syndrome.
· Delayed long bone healing.
· Myogeloses (trigger points).
Stimulation of Collagen
The production of sufficient amounts of collagen is a necessary precondition of the tissue repair process. Shockwave therapy accelerates collagen synthesis. The newly created collagen fibers are forced into a longitudinal structure. These newly formed tendon fibers are more dense and stiff.
Analgesia and restoration of mobility
Dispersion of Pain Mediators Substance P and Prostaglandin E.
Substance P and Prostaglandin E (2) are naturally occurring compounds that mediate pain information. These compounds are generally associated with intense, persistent and chronic pain. Maier et al. demonstrated in rabbits that although shockwave therapy caused a transient rise in the concentration of these compounds, there was a prolonged substantial decrease in their concentration in the weeks following treatment.
Dissolving of Calcified Fibroblasts
Micro-tears or other trauma to a tendon often result in calcinosis. Acoustic waves can break up these calcifications. Acoustic wave therapy can reduce the calculi to a paste consistency. The granular particles of calcium are removed by the lymphatic system.
Release of Trigger Points
Trigger points are the principal cause of pain in the back, neck, shoulder and limbs. They are associated with palpable nodules in taut bands of muscle fibers and have extremely contracted mscles. These muscles contract so tightly that they begin to cut off their own blood supply. This causes the build-up of waste products, which in turn irritate the sensory nerve endings resulting in further contraction. This vicious cycle is referred to as a “metabolic crisis”. Although the precise medical effects of acoustic wave therapy are still unclear, it is assumed that the delivered acoustic energy activates the calcium pumps in the sarcomeres thus releasing these trigger points.
ESWT should not be used
· In the presence of bone tumors.
· Neurological disease in the foot.
· Vascular disease in the foot.
· History of rupture of the plantar fascial ligament.
· Over any implanted metal devices.
· In the presence of pacemakers.
· In patients on anti-coagulants
· Metabolic bone disorders.
· Nerve or circulatory disorders.
· Open growth plate.
· Over any air filled cavities
If you would like to find out if Shock Wave Therapy is right for your condition, Call the Clinic Now
CAUTION: The above is only a guide and should not be used as a substitute for being evaluated by a regulated health care professional that has experience in managing whiplash associated disorders. If you have any questions about your condition, please feel free to contact me at your convenience. If you feel that this is a medical emergency, please visit your closest hospital emergency department.