Extracorporal Shockwave Therapy (ESWT)

By Nigel Chua

Rehab Body parts: Whole Body,

HOW EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT) WORKS

Shockwave therapy treatment is non-invasive and produces an inflammatory response, which will increase metabolic activity around the site of pain.

The #1 function and goal is to stimulate and accelerate the healing process for the treatment of chronic muscular and tendon disorders, back, lower limb and foot pain.

The equipment used in the procedure will generate a series of rapid impulses whereby a projectile in the handle is programmed to move up and down at a specific frequency and power.

The projectile in the handle will hit the metal applicator head repeatedly, causing a series of rapid “shockwaves” which will penetrate up to several centimeters into the tissues.

The energy will cause a hyper-stimulation analgesic effect which results in many patients feeling some relief over targeted areas almost immediately.

These controlled impulses also initiate a cascade of cellular reactions which improve blood flow and tissue repair, even in areas which have been damaged for long periods of time.

GENERALLY THERE ARE THREE DIFFERENT KINDS OF SHOCKWAVE THERAPY AVAILABLE:

Radial shockwave therapy which is typically used for for large area treatment
Focal shockwave therapy focused for specific pin-point targeted treatment
De-focused shockwave therapy which is used in treatment of complex diabetic wounds and ulcers.

Each different types of shockwave therapy machine is used by a variety of health professionals to treat specific conditions.

SHOCKWAVE THERAPY CAN BE USED TO TREAT THE FOLLOWING CONDITIONS:

Painful Shoulder
Tennis Elbow
Jumper’s Knee
Shin Pain
Heel Pain
Plantar Nerve Neuritis
Golfer's Elbow
Gout related flare ups on the foot
Tight Calf Muscles
Achilles Tendinitis/Achilles Tendinosis
Achilles Tendinopathy
Hip Pain
Plantar Fasciitis
Chronic neck, shoulder or back pain and tension (trigger points)
Proximal iliotibial band friction syndrome
Calcific tendonitis of the shoulder
Heel Spurs
Sesamoiditis
Metatarsalgia
Bunions
PTTD
Shin Splint
Runner's Knee
Knee Pain
Back Pain
Frozen Shoulder
Chronic Tendinopathy
Chronic Tendonitis of the Shoulder/Elbow/Wrist/Hip/Knee/Ankle
Plantar Fasciosis (strained arch)
Morton’s Neuroma
Calcific Rotator Cuff Tendinitis
Trochanteric Tendonitis

15 REASONS FOR SHOCKWAVE THERAPY TREATMENTS

No injections required
Non-surgical / Non-invasive
No medications or medicines involved
Convenient - can be done in our Phoenix Rehab clinics at your convenience
No need for anaesthesia or painkillers
Minimal risks or side effects
Quick pain relief with numbing analgesic effect (decrease of muscle tension by inhibiting spasms)
Stimulates blood flow, circulation and faster healing
May stimulate collagen production for faster healing
Highly effective in treating chronic conditions
Breaks up inflammation tissue
Release of trigger points
Promotes restoration of tissue and joint mobility
Improved micro-circulation and metabolism shockwave therapy technology accelerates removal of nociceptive metabolites, increases oxygenation and supplies the damaged tissue with a source of energy. It supports removal of histamine, lactic acid and other irritating agents.
Clinically proven and used successfully throughout the world in major hospitals and treatment centers.

EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT) SEQUENCE

Shockwave therapy is a non-invasive treatment that can be done in 3 simple steps:

The location of the area to be treated is located and determined by the doctor through palpation. This is done to ensure the therapy is delivered accurately.
A friction-reducing gel is applied to the area targeted. The gel is necessary so the transfer of the percussion waves is done smoothly and efficiently.
The shockwave applicator is pushed into the area that needs treatment and the start button is pressed for an indicated number of impulses to each section.

ARE ALL SHOCKWAVE THERAPY MACHINES THE SAME?

There are three major factors that come into play with regards to shockwave effectiveness:

Quality of the shockwave therapy machine: This impacts the shockwave quality and will affect the healing outcomes. To ensure that you receive the best shockwave therapy care possible, pay attention to the make and model of the shockwave device that is used to treat you and check it online - if it can be purchased from online platforms, please be cautious.
Quality, skill and experience of the therapist administering: This is why at Phoenix Rehab we cherry-pick the most experienced principal physiotherapists, hand therapists, and TCM physicians to work with - because only the most experienced and the best will do.
Timely and consistent follow up for patients: This is important for both shockwave therapy as well as hands-on manual therapy with our skilled principal therapists. Accelerating healing and recovery takes effort and dedication. We will do our utmost to serve you and get you back to 100%, but we will need you to turn up and come back for follow up.

WHAT IS RADIAL SHOCKWAVE THERAPY?

BROAD HEALING PULSATION FOR LARGE TREATMENT AREAS

Radial Shockwave Therapy (RSWT) is the most common form of shockwave therapy available in the market today. Radial shockwave is an efficient treatment method for achieving pain relief in a short period of time for many orthopedic and musculoskeletal conditions such as

back pain
heel spur
shoulder pain
knee pain
and more (see all the conditions we treat at Phoenix Rehab).

Radial shockwave is ballistically generated.

This means that the radial shockwaves are formed from a projectile that is mechanically hitting a transmitter. This transmitter produces pressure waves that impact on the surface of our skin and continue to travel inwards into deeper tissues and structures. This translates to deeper tissue management and treatments that cannot be achieved with manual therapy, massage or tools.

Hence, it is a good combination to be used with manual therapy with our principal physiotherapists and hand therapists, as well as our INDIBA radio-frequency machine.

WHAT IS FOCUSED SHOCKWAVE THERAPY?

SNIPER: PIN-POINT PULSATION TARGETS SMALL TREATMENT AREA

Focused Shockwave Therapy (FSWT) directs a concentrated shockwave therapy beam into our body and tissues. This provides deeper, more precise treatment than previous types of shockwave technology.

Focused shockwave is generated via an electromagnetic coil, which produces a shockwave which has the most intense part of its beam inside the body, with a small surface area. This translates to a consistent high energy which can be targeted at the specific part of the body that needs the treatment.

As it is a very specialized technology, focused shockwave therapy tends to be more costly than radial shockwave therapy. However, depending on certain conditions, focused shockwave can be more efficient and effective.

HISTORY OF SHOCKWAVE THERAPY IN HEALING

The original reason and application of shockwave therapy was mainly to treat kidney stones.

This type of high-energy shockwave therapy is known as ESWL or extracorporeal shockwave lithotripsy, and is done in an operating theatre inpatient setting.

Shockwave researchers later found that a lower intensity and power shockwave therapy was able to treat various musculoskeletal conditions and to manage pain. Of course, the power used for orthopedic, sports and musculoskeletal pain is much lower than the shockwave used to treat kidney stones.

The low intensity shockwaves used in therapy and pain management, also known as ESWT, are clinically safe and are designed to induce healing.

They have been extensively studied, and are an accepted modality in many orthopaedic practices, podiatry centres, and hospitals in Singapore and around the world.

EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT) FREQUENTLY ASKED QUESTIONS (F.A.Q.)

IS SHOCKWAVE THERAPY PAINFUL?

During the ESWT session, patients may feel a mild to strong ‘tapping’ sensation with each shock wave, and the treatment usually lasts 10-15 minutes.

These shockwaves may cause slight discomfort or pain but most patients tolerate it well. Minor bruising may develop, but this is usually temporary and rare.

WHAT ARE THE BENEFITS OF SHOCKWAVE THERAPY?

Shockwave therapy has a proven track record that can be as effective or even more effective than other methods such as surgery or pharmaceuticals without the risks, complications or long recovery times.

It is non-invasive and promotes recovery by accelerating the healing process.

Shockwave therapy stimulates our natural healing, metabolism and improves blood circulation for one cohesive goal: so that the damaged tissues can regenerate and fully heal.

WHAT HAPPENS AFTER A SHOCKWAVE THERAPY TREATMENT PROCEDURE?

This usually ranges from patient to patient. Often the patient may feel or experience a mild to significant difference.

Walking, moving around or driving after shockwave therapy usually causes no issues, but we like to be more conservative and protective of our patients so we will advise patients to reduce their physical activity levels for at least a couple of weeks.

To prevent certain conditions from getting worse, we can also prescribe you customized insoles for arch support, and prescribe sports tape to secure and support the treated area.

IS THERE ANYTHING THAT SHOULD BE DONE AFTER EACH SHOCKWAVE THERAPY TREATMENT?

Patients can resume their routine activities after each treatment, but we usually advise patients to decrease their activity levels for a couple of weeks during the weeks of shockwave therapy.

This will also help to allow the painful injuries and conditions to heal up faster by preventing aggravations, though some gentle activities are recommended.

Patients can perform cold therapy and ice the area if there is discomfort.

Any aggravating activities should be avoided if pain is still present. Concurrent therapy such as physiotherapy or hand therapy or use of customized insoles is important to address the underlying biomechanical causes of the injury.

Our principal physiotherapists, hand therapists, TCM physicians and team will advise you accordingly after each session.

HOW MANY SHOCKWAVE THERAPY TREATMENTS DO I NEED TO RECOVER FROM MY PAIN?

Generally, an average of 4 to 8 shockwave therapy sessions are recommended, usually at weekly intervals (hence 4 - 8 weeks).

That being said, the number of treatments can be more or less than that, depending on other factors such as

severity of the condition
how long the condition has been
patient medical profile
patient compliance
patient body / natural response to shockwave
tolerance.

We usually advise patients to consider combining shockwave therapy together with

Physiotherapy, hand therapy, TCM (acupuncture/cupping) or massage sessions
INDIBA radio-frequency therapy.

WHAT SHOULD I DO IF I AM IN PAIN AFTER THE TREATMENT?

Shockwave therapy is specifically designed to trigger an inflammatory response, which is the body’s natural process of healing.

For this reason, please do not take anti-inflammatory medications or apply ice packs if you can help it. The pain should subside within 24-48 hours max.

Use Tylenol if necessary, provided you have no allergic reactions with this medication.

SHOCKWAVE THERAPY POTENTIAL COMPLICATIONS/SIDE EFFECTS

The main complications of shockwave therapy are pain and hypersensitivity at the site of treatment. Most of the time, either of these should steadily resolve within a couple of days.

Some patients may experience soreness in the treated area within 2 to 4 hours after the treatment. This soreness has been reported as tolerable and not limiting.

In some situations, pain and disability may persist if the patient aggravates the pre-existing condition with too much physical activity right after treatment.

Shockwave therapy is a highly effective procedure to treat pain with minimal risks or side effects when performed by qualified therapists. Many patients report complete pain relief or significant pain reduction after only 3 to 5 treatments.

IS SHOCKWAVE THERAPY SUITABLE FOR ME/MY CONDITION? WHO SHOULDN'T GET SHOCKWAVE?

Complications are infrequent with proper application of shockwave therapy by experienced healthcare providers.

Most of the time, the general public are good candidates for shockwave therapy, however we will advise and not provide shockwave to patients who:

are pregnant (can see our women's health physiotherapist instead)
have a pacemaker
have cancer/a tumor
are taking anticoagulants
have blood clotting disorders

IF YOU HAVE HAD A RECENT CORTICOSTEROID (CORTISONE) INJECTION IN THE PAST 6 WEEKS, TELL OUR PRINCIPAL PHYSIOTHERAPISTS AND HAND THERAPISTS - you should wait at least 6-8 weeks after any injections before starting shockwave therapy.

This list is not exhaustive. If you have any questions or concerns, please check with your physician before undergoing shockwave therapy.

IS SHOCKWAVE A SUBSTITUTE FOR SURGERY?

Shockwave therapy is a non-invasive treatment which can help the patient recover from painful orthopedic, sports and musculoskeletal conditions such as heel spurs, plantar fasciitis, knee pain, shoulder pain, hip pain, and tennis elbow without surgery.

The response to shockwave treatment will vary from patient to patient. Unfortunately, in some cases, especially when all conservative treatment options have been exhausted, surgery may be what is needed.

WHAT IF IT FEELS GOOD AFTER THE SHOCKWAVE TREATMENT?

That's great!

That being said...please note that patients are still recommended to decrease strenuous activities for up to 48 hours after the shockwave therapy treatment.

WHAT IS THE SUCCESS RATE OF SHOCKWAVE?

A shockwave treatment is considered to be successful when a patient has at least a 75% reduction in pain within 3 months. Worldwide, success rates are close to 80-90% in pain reduction.

IS SHOCKWAVE THERAPY COVERED BY INSURANCE? CAN I CLAIM MY SHOCKWAVE TREATMENTS UNDER INSURANCE?

This depends entirely on the insurance policy coverage and terms.

Please discuss it first with your insurance agent/provider, or you can also connect with Nigel at nigel@phoenixrehabgroup.com or WhatsApp him at 98734073.

If you still have any doubts about whether this treatment is for you, feel free to contact our experts, or book a consultation to see if you really do need shockwave therapy.

Is shock wave therapy expensive?

It depends on where you go - some places charges $120 - $1000+ per session of shockwave and usually with shockwave packages.

We do not charge such a high rate nor lock you in with unnecessary packages, unless you request for a package for convenience. As of 2020, we charge $95 per shockwave therapy session, which is on top of a physiotherapy session unless the patient wants a shockwave therapy session only.

How does shock therapy work?

Shockwave therapy causes high energy stimulations to be applied.

How does shockwave therapy work on tendons?

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.

How long does it take for shockwave therapy to work?

The typical treatment course is 6 treatments over 6 weeks, and 50-80% of patients will report an improvement in 30 days after they have completed the full treatment cycle.

Is shockwave therapy effective?

From the results of the present study, extracorporeal shockwave therapy is an effective modality in relieving pain intensity and increasing the functionality and quality of life in various tendinopathies such as plantar fasciitis, elbow tendinopathy, Achilles tendinitis and rotator cuff tendinopathy.

What are the side effects of shockwave therapy?

Side effects from ESWT are limited to mild bruising, swelling, pain, numbness or tingling in the treated area, and the recovery is minimal compared with that of surgical intervention. "Most patients take a day or two off after treatment but don't require a prolonged recovery period," says Dr. Finnoff - Feb 5, 2019.

How often can you have shockwave therapy?

Shockwave treatment is usually done once a week for 3-6 weeks, depending on results. The treatment itself can cause mild discomfort, but it only last 4-5 minutes, and the intensity can be adjusted to keep it comfortable.

What is the difference between shockwave therapy and ultrasound therapy?

Ultrasound therapy applies an alternating high frequency load to the tissue, with a frequency range of several megahertz, thus leading to heating, tissue tears and cavitation at high amplitudes. The shock wave's effect in comparison, is forward directed energy (in the direction of the shock wave propagation).

Does shock wave therapy break up scar tissue?

The shock waves produce a rapid increase in blood circulation to the target area and will break down fibrous scar tissue which builds up over time, especially with chronic conditions. The breakdown of scar tissue is the key to why shock wave therapy is so effective.

What does Shockwave feel like?

Shockwave therapy is a non-invasive, non-surgical treatment, but you might feel a little pain or discomfort in the treatment area during the procedure. Most patients say it feels like small pulses against the skin. Your specialist may be able to adjust the way they use the shockwave device if your pain is significant.

What do you do after shockwave therapy?

ESWT forces your body to create new tissue cells in the damaged area. Expect gradual healing to take place over days, weeks or months. Though not typical, some patients have mild soreness or bruising after treatment.

Can you walk after shock wave therapy?

Most patients do experience some pain or discomfort during the procedure. You will be asked how much pain you are experiencing during the treatment, and we will attempt to adjust the treatment to help manage this. After the treatment you will be able to get up and walk straight away.

Does shock therapy work for back pain?

Extracorporeal shock wave therapy is an effective intervention for the treatment of pain, disability, and depression in chronic low back pain patients (www.ncbi.nlm.nih.gov).

Is shockwave therapy the same as ultrasound therapy?

Compared to the continuous lower-energy waves of therapeutic ultrasound, ESWT machines send higher-energy pulses 2 or 3 times per second.

What happens if shockwave therapy doesn't work?

Usually the initial response to shockwave therapy treatment is good, however it may take a few months before maximum effect is achieved. If pain is still persistent then surgery may be an option.

Is shockwave therapy good for plantar fasciitis?

Shockwave therapy is a gentle, quick non-surgical treatment that helps eliminate heel pain from plantar fasciitis. This treatment is currently one of the most advanced and highly-effective therapy available for plantar fasciitis. ESWT is both effective and safe.