Extracorporeal shock wave therapy (ESWT) is a non-invasive (does not breach the skin) treatment in which a hand held device is used to pass inaudible, high-energy sound waves (shockwaves) through the skin, to the origin of the damaged area. Over the past 15 years the use of extracorporeal lithotripsy, also known as Shockwave therapy, for the treatment of musculoskeletal disorders, such as chronic therapy-recalcitrant tendinopathies, has become a significant subject of research worldwide. ESWT utilises a ballistic technique. A projectile, accelerated by compressed air and propelled at high kinetic energy, hits an applicator placed on the skin. By using a coupling medium such as ultrasound gel, this impulse is delivered to the tissue in the form of a shock wave.
From this point the shock wave continues to spread inside the body in the form of aspherical “radial” wave. In this generating principle, the applicator surface constitutes the geometric point with the highest pressure and the highest energy density.
How does ESWT work?
The treatment initiates an inflammation-like condition in the tissue that is being treated. The body responds by increasing the blood circulation and metabolism in the impact area which in turn accelerates the body’s own healing processes. The shockwaves break down injured tissue and calcifications.
What are the advantages of ESWT?
ESWT is applied without medication, for example Cortisone injections. The treatment stimulates and effectively supports the body’s self-healing mechanisms. It is usual to experience immediate pain relief following the treatment and hence improved movement. Reported side effects are minimal.
How long does each treatment last?
It takes 5 – 10 minutes to administer 2000 – 2500 shockwaves per treatment.
Is the shockwave treatment itself painful?
Sometimes the treatment is a bit painful, but most people can tolerate this without medication.
Will I be in pain after the treatment?
You will normally experience a reduced level of pain or no pain at all immediately after the treatment, but a dull and diffuse pain may occur a few hours later. This dull pain can last for a day or so and in rare cases a little bit longer.
What shall I do if I am in pain after the treatment?
ESWT initiates an inflammation-like condition in the tissue that is being treated. The body responds by increasing the metabolic activity around the impact area which in turn stimulates and accelerates the body’s own healing processes. If necessary, you may use ordinary prescription-free pain killers. Do not use anti-inflammatory medication and do not cool down the treated area both will interfere with the body’s self-healing abilities.
What if I am painless after the shockwave treatment?
Even if you have no pain, we strongly recommend that you refrain from intensive activities that stress the treated area for the next 48 hours after each treatment.
What if the shockwave treatment doesn't work for me?
Even though the response to shockwave treatment normally is exceptionally good within a few weeks it may take several months before maximum effect is achieved. If you after 3-4 months still do not experience a pronounced improvement, surgery for example may be an alternative depending on your particular clinical picture.
Are there any contraindications or precautions that I should be aware of?
Yes.
- Cortisone injections are not to be administered within the last month before treatment is initiated
- Haemorrhage tendencies and coagulation system disturbances with supporting medication
- Heart conditions and blood circulation disturbances
- Acute inflammation in the treatment area
- Cancer and pregnancy
Mr Sugathan uses Storz machine, a state-of-the-art device. ESWT is not normally available on the NHS.
Plantar Fasciitis
Four scientific randomised controlled trials have shown shock wave therapy is effective for plantar fasciitis. Three separate treatments spaced approximately a week apart are normally required, each lasting about 5-10 minutes. Significant resolution of pain takes up to 2 months after completing treatment. For private medical insurance purposes, the treatment (CCSD) code is 3 sessions of T5780.
Achilles Tendinopathy
There is good evidence that ESWT works and in combination with an Eccentric Stretching Protocol, it is better than eccentric stretches alone. Three separate treatments spaced approximately a week apart are normally required, each lasting about 5-10 minutes. Significant resolution of pain takes up to 2 months after completing treatment. For private medical insurance purposes, the treatment (CCSD) code is 3 sessions of T7250.