The options offered to patients suffering due to chronic tendinopathies are often limited to surgery or long-term pain management.
Surgery is disruptive and requires time off from normal life for the procedure and recovery. Surgery is also expensive, can cause complications, and doesn’t guarantee results. Medicated pain management comes with side effects and can also be an expensive solution.
Yet, there is an alternative. Extracorporeal shock wave therapy (ESWT) is a non-invasive outpatient procedure. It reduces pain, promotes healing, and helps patients avoid surgery. In an FDA study, chronic plantar fasciitis patients experienced an average pain reduction of 92% from a single treatment.
ESWT is a valuable addition to a medical professional’s options for holistic patient treatment.
What Is ESWT?
Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment for soft tissue injuries, such as chronic tendinopathy. The mechanical force sends high-energy waves through the body’s tissues. These high-energy waves are also known as shockwaves.
Each shockwave has a positive and a negative phase. Direct mechanical force is applied to the injured area during the positive phase. The negative phase creates cavitations, causing gas bubbles that implode, sending a second round of shockwaves which increase bone density and encourage tissue growth.
The potential use of shockwaves for healing was first noticed by urologists who use similar shockwave therapy to get rid of kidney stones. They noticed that the kidney stone patients who had undergone lithotripsy showed new tissue growth and an increase in bone density. The benefits of shockwave therapy were clear, triggering the development of ESWT.
What Does A Typical ESWT Treatment Session Look Like?
Session lengths vary from 18 to 30 minutes. Once the patient is comfortable, apply a layer of gel to the skin over the affected area. Gel conducts shock waves well. In bony areas, such as heels, you may use oil instead.
Choose a therapeutic head that will best fit the treatment area. If you’ll be using high-frequency waves, you’ll need to use local or regional anesthetic. No anesthesia is necessary for low-frequency waves.
Encourage the patient to actively communicate with you. ESWT works best when applied to the exact area of pain. The patient might need more than one session. If the patient isn’t feeling any pain relief after two sessions, it is possible that they aren’t a good candidate for ESWT.
ESWT Recovery
The process of ESWT shocks the body into creating new tissue cells in the affected area. Healing is a gradual process that will happen over days, weeks, and months. Your patients may experience mild bruising or pain after the treatment.
Some patients will be pain-free after one session, others will take longer. Most patients will experience a significant improvement by week 13. If necessary, the patient can have a second treatment at sixteen weeks. Healing in the damaged area can continue up to a year after treatment.
When Should a Patient Consider ESWT?
A patient who hasn’t had results from three consecutive therapies, or whose condition has persisted for longer than six months should consider ESWT.
Tendonosis conditions won’t heal by themselves and continuing to use the affected tendon tissue will intensify the degeneration process. If the condition isn’t treated and the tendon fibers rupture, surgery will be the only option.
Patients can pick up compensation issues if they don’t get their chronic pain treated. To avoid putting strain on the injured area, they change their usual way of moving. Accommodating their chronic injury in this way causes strain in other areas of the body.
Athletes whose injuries don’t respond to the usual treatments: RICE, therapeutic exercise, orthotics, and bracing, but who aren’t ready to undergo surgery, are excellent candidates for ESWT. Sports medicine practitioners are embracing ESWT as an excellent option for injury rehabilitation.
Tendonitis vs Tendonosis and When to Use ESWT
Tendonitis is inflammation that can sometimes resolve by itself. If it doesn’t, treat with physical therapy, strapping, cortisone injections, or anti-inflammatory medications. These treatments are either to deal with the inflammation or rest the injured area. Tendonitis that has been around for less than six months is considered acute.
If the injury persists beyond six months, it becomes chronic tendinosis. This is more serious than inflammation as the tissue is damaged or degenerating.
At this point, steroid injections won’t help and surgery would have been the only answer. Tendonosis can be healed by using ESWT. Shockwave therapy triggers healing in the damaged tendon.
Conditions That Can Benefit From ESWT
ESWT is used to bring pain relief and healing to a broad spectrum of common musculoskeletal conditions. Here are some of the common conditions that ESWT is used for:
- Degenerated tendon conditions, such as shoulder or Achilles tendinitis.
- Plantar Fasciitis (heel pain)
- Lateral, Radial and Ulnar Epicondylitis (Tennis elbow)
- Acute Calcific Shoulder Tendinitis
- Patellar tendinopathy
- Achillodynia
- Heel Spurs
- Trochanteric Bursitis
- Periostitis / Shin splints
- Dupuytren’s Disease
- Arthritis
- Long bone fractures that won’t heal
- Osteoarthritis of the knee joint
- Medial tibial stress syndrome
- Avascular necrosis – femoral head
- Adhesive capsulitis
- Greater trochanteric pain syndrome (gluteus medius and minimus)
Areas of the Body That Can Benefit From ESWT
Issues in the attachment points for ligaments and tendons in major joints tend to respond well to treatment as well. Some of the areas of the body that respond well to ESWT treatment are:
- Rotator cuff
- Proximal hamstring origin
- Rectus femoris
- Distal quadricep
- Neck and back myofascial trigger point
The Benefits of Using ESWT
ESWT is a non-invasive procedure that treats conditions from outside the body, potentially eliminating the necessity for surgery, along with the expense and risks that go with it.
The recovery time after ESWT is short. Most patients are able to bear weight directly after treatment, though they should limit their physical activity level for a week or two. This means that they don’t have to take time off work.
There is no risk of further complications following the procedure. Unlike major surgery or strong medication, things don’t get have to get worse before they get better.
Are There Any Side Effects?
Following ESWT patients may experience tenderness, pain, mild bruising, hypersensitivity, numbness, or tingling at the treatment location. The discomfort will fade with time. Compared to post-surgery recovery, any side effects a patient experiences following ESWT treatment recovery is mild.
The original pain and disability will be present if the shock wave therapy isn’t successful.
Who Should Avoid ESWT?
ESWT is contra-indicated for patients who will be unable to cooperate, such as an elderly dementia patient, or a patient in a compromised mental state. ESWT treatment is also not recommended for patients with hypersensitivity or neuropathy (poor sensation) in the treatment area. Patients with pain over major nerves or blood vessels should not receive ESWT treatment.
The following conditions are contraindications for ESWT treatment:
- Pregnancy
- Seizures
- Heart conditions, including pacemakers
- Cancerous tissues
- Infections
- Open sores
- Thrombosis, or other blood clotting disorders
- Epiphysis
- Any joint replacements
What Equipment Do You Need?
To offer your patients Extracorporeal shock wave therapy, we recommend the PhysioPRO or PhysioPRO II. Both ESWT machines are simple to use and come with more than 25 preset treatment recommendations.
Both PhysioPRO and PhysioPRO II weigh in at just over 2kgs. They each come in an aluminum carry case. You’ll need a small amount of counter space as they measure 12 x 9.5 inches, and 5 inches high. If you’re looking for a portable solution, we’d recommend the PhysioPRO II.
The PhysioPRO and the PhysioPRO II ESWT machines come with three different size therapeutic heads. They are interchangeable and fit onto a handle that comes with a handy pedestal. A footswitch comes with the PhysioPRO model.
All software operations on the PhysioPRO are controlled via a full-color touchscreen on the device. PhysioPRO II software operations are performed via a smartphone or tablet app.
ESWT for Safe, Effective Pain Reduction
A study conducted by the FDA using a group of 150 patients showed how effective ESWT is for pain reduction. Their average pain level before treatment was 7.7 out of 10. They each received a single treatment. A year after ESWT treatment patients reported average pain levels of 0.6, a reduction of 92%.
As a medical professional, you want to give your patients every opportunity to heal, live pain-free, and improve the quality of their lives. ESWT is an invaluable addition to the treatment options that you are able to offer your patients.
With an Extracorporeal shock wave therapy machine, you can fill in the gap for patients who aren’t healing but can’t face surgery. Contact our Outpatient Supply office today at +1(727)475-7608 to order yours.