Extracorporeal ShockWave Therapy (ESWT)
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ShockWave Therapy (EWST) is becoming more widely known and used as a treatment for a number of orthopaedic conditions. The benefits of shockwave are increasingly being experienced by people who have chronic painful soft tissue complaints, predominantly with tendinopathies, as a non-surgical solution to help reduce pain and return to function. |
What is ShockWave Therapy?
First of all forget the image in your head of someone, suffering from mental illness, having electrodes stuck to their head - thankfully medicine has moved on somewhat! The concept of shockwave therapy first originated in the field of aerospace research and development, where staff at Dornier, in the early to mid 20th century, began to notice ‘pitting’ on the metal exteriors of planes as advancements allowed them to reach the speed of sound.
This pitting turned out to be the effect of cavitation, the formation of small bubbles (liquid free zones in fluid) that occur when rapidly changing forces are applied, when the internal pressure is relatively low. These bubbles/voids then implode, when subjected to a higher pressure again (flying at high speed causes rapid fluctuations in pressure) and this creates a shock wave. In the air, this occurs in the small droplets of water that are naturally present.
It was during collaborative research between Dornier’s research development laboratories and hospitals that the concept of using this destructive phenomena in medicine, was born. There are in fact a number of different types of Shockwave therapies that have been developed from that original, focused Shockwave, other wise known as Lithotripsy (used for breaking down kideney stones etc). At Team Rehab uk we used a slightly less destruction version called Extracorporeal Shockwave Therapy (ESWT).
First of all forget the image in your head of someone, suffering from mental illness, having electrodes stuck to their head - thankfully medicine has moved on somewhat! The concept of shockwave therapy first originated in the field of aerospace research and development, where staff at Dornier, in the early to mid 20th century, began to notice ‘pitting’ on the metal exteriors of planes as advancements allowed them to reach the speed of sound.
This pitting turned out to be the effect of cavitation, the formation of small bubbles (liquid free zones in fluid) that occur when rapidly changing forces are applied, when the internal pressure is relatively low. These bubbles/voids then implode, when subjected to a higher pressure again (flying at high speed causes rapid fluctuations in pressure) and this creates a shock wave. In the air, this occurs in the small droplets of water that are naturally present.
It was during collaborative research between Dornier’s research development laboratories and hospitals that the concept of using this destructive phenomena in medicine, was born. There are in fact a number of different types of Shockwave therapies that have been developed from that original, focused Shockwave, other wise known as Lithotripsy (used for breaking down kideney stones etc). At Team Rehab uk we used a slightly less destruction version called Extracorporeal Shockwave Therapy (ESWT).
A Chattanooga ESWT Mobile machine. We have the new 2018 Mobile 2 version at Team Rehab uk
It's effectiveness in the treatment of specific injuries/conditions is becoming increasingly recognised but the availability is still limited due to the financial outlay needed to purchase the technology.
How does it work?
Extracorporeal literally means 'situated or occurring outside of the body'. This type of Shockwave is produced by a ball bearing like bullet, that is fired rapidly, by compressed air, up and down creating an low energy acoustic/sound wave as it hits the applicator. It is this acoustic wave, that you can clearly hear, that travels through the body tissue and creates the shock wave effect.
Extracorporeal literally means 'situated or occurring outside of the body'. This type of Shockwave is produced by a ball bearing like bullet, that is fired rapidly, by compressed air, up and down creating an low energy acoustic/sound wave as it hits the applicator. It is this acoustic wave, that you can clearly hear, that travels through the body tissue and creates the shock wave effect.
Shock Wave Therapy Applicator showing the bullet in the chamber and the wave being produced at the treatment head.
The energy transference at the applicator head causes an increase in blood flow and localised, low level inflammation, to the area which is a natural response to injury. The biophysical reaction behind this treatment can get relatively complicated but the best way to think of it is this. Whenever we get undergo a physical injury we have a normal bodily response to that injury that would normally include a chemical soup that aids recovery, otherwise known as inflammation. As a rule of thumb, most soft tissue injuries heal between 2-12 weeks and need little to no input but it is when, for some reason, whether repeated injury exposure during this time or just a failure of the body to heal properly, that ESWT may be able to help.
The low level inflammatory response from the ESWT application, along with a carefully individualised plan from your treating practitioner effectively allows you body a second chance at getting it right. We call this type of treatment effect pro-inflammatory and for this reason you should avoid taking anti inflammatory for 2 weeks prior to your first session and throughout the treatment.
The low level inflammatory response from the ESWT application, along with a carefully individualised plan from your treating practitioner effectively allows you body a second chance at getting it right. We call this type of treatment effect pro-inflammatory and for this reason you should avoid taking anti inflammatory for 2 weeks prior to your first session and throughout the treatment.
What can it be used on?
Most of the current research looks at treating tendinopathies, ligament injury or deep seated soft tissue presentations. Due to the high treatment effects that are being seen however, across a range of presentations, there is a high volume of ongoing research in to new areas for potential application. As with all rehabilitation approaches that can be taken, ESWT is not a magic 'one fits all' option. It's appropriateness is vital and is why all potential clients must undergo a full assessment by one of our specialists prior to starting treatment.
Most of the current research looks at treating tendinopathies, ligament injury or deep seated soft tissue presentations. Due to the high treatment effects that are being seen however, across a range of presentations, there is a high volume of ongoing research in to new areas for potential application. As with all rehabilitation approaches that can be taken, ESWT is not a magic 'one fits all' option. It's appropriateness is vital and is why all potential clients must undergo a full assessment by one of our specialists prior to starting treatment.
ShockWave Therapy to a patella Tendon
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ShockWave Therapy to a presentation of Lateral Epicondylitis (Tennis Elbow)
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What does it Feel Like?
The way you process and interpret diffetn stimuli is very subjective (diffent to us all) but I thik it would be fair to say that in this case, it really as you would imagine it. There is a flat applicator, which can be several different sizes/shapes and this is pressed against the skin, though some water based gel. As the internal bullet in the applicator is rapidly fired up and down you will feel 'pulses', as if someone with a firm finger was prodding you, travelling through your skin, at the applicator site. The frequency (rate at which the bullet hits the applicator) of the ShockWaves is altered depending on your presentation, as is the power at which the bullet hits the treatment head.
The way you process and interpret diffetn stimuli is very subjective (diffent to us all) but I thik it would be fair to say that in this case, it really as you would imagine it. There is a flat applicator, which can be several different sizes/shapes and this is pressed against the skin, though some water based gel. As the internal bullet in the applicator is rapidly fired up and down you will feel 'pulses', as if someone with a firm finger was prodding you, travelling through your skin, at the applicator site. The frequency (rate at which the bullet hits the applicator) of the ShockWaves is altered depending on your presentation, as is the power at which the bullet hits the treatment head.
It is recommended that your treatment should be given at the highest intensity that you feel comfortable with. To low and you may find that it is simply not able to create the desired inflammatory effect, which will result in a failed response. At Team Rehab uk we have the latest 2018 portable device which has the same pressure capabilities of the larger static devices, ensuring that our clients get the best treatment available whether it is in clinic, or at a satellite location.
The treatment tends to cause an analgesic effect in the tissue so it does tend to get easier once the initial bit of the treatment is over. Many clients also report significant decreases in symptoms following the first session however it is recommended that you stick to the individualised plan that has been made for you so you do not limit the effectiveness of the treatment.
The treatment tends to cause an analgesic effect in the tissue so it does tend to get easier once the initial bit of the treatment is over. Many clients also report significant decreases in symptoms following the first session however it is recommended that you stick to the individualised plan that has been made for you so you do not limit the effectiveness of the treatment.
Does it take long?
All clinets needs to have an assessment before undergoing Shockwave Therapy. This is for both your safety and also to ensure that your are suitable and stand a good chance of a positive treatment response. This will be a standard 40 minute time slot but with a focus on shockwave.
Treatments are very quick and as such follow up treatment appointments for Shockwave application are only 20 mins long. The recommended treatment dose is 3 sessions, each 1 week apart, with the possibility of needed 1-2 more after (this is only if you are showing a very positive treatment effect but are just not quite there yet). We then ask you to follow the plan and return for a normal, 40-minute follow-up 4-6 weeks after your final ESWT treatment.
You will need to be able to see the treatment process through as per the required time frames otherwise it is unlikely to work. There is no clinical argument in having just a single session and as such, as a responsible clinic, we will not undertake this.
All clinets needs to have an assessment before undergoing Shockwave Therapy. This is for both your safety and also to ensure that your are suitable and stand a good chance of a positive treatment response. This will be a standard 40 minute time slot but with a focus on shockwave.
Treatments are very quick and as such follow up treatment appointments for Shockwave application are only 20 mins long. The recommended treatment dose is 3 sessions, each 1 week apart, with the possibility of needed 1-2 more after (this is only if you are showing a very positive treatment effect but are just not quite there yet). We then ask you to follow the plan and return for a normal, 40-minute follow-up 4-6 weeks after your final ESWT treatment.
You will need to be able to see the treatment process through as per the required time frames otherwise it is unlikely to work. There is no clinical argument in having just a single session and as such, as a responsible clinic, we will not undertake this.
Should I have Shock Wave Therapy?
We would only recommend Shock Wave Therapy for chronic conditions (over 12 weeks old) that have failed to settle spontaneously, or have not responded to other modalities such as physiotherapy, orthotics (insoles or leg braces), rest, steroid injection, ice therapy and pain relief.
There is some research and claims that ESWT works in more acute injuries as well (less than 6 weeks) but they did not use control subjects so it is impossible to to tell if they were going to get better anyway, regardless of the treatment. We would prefer to be honest to our clients!
There is a small risk of tendon or ligament rupture, or soft tissue injury, but our experienced physiotherapists will undertake a full assessment to determine your suitability prior to any treatment being undertaken.
You should avoid ShockWave Therapy if you:
1) are pregnant
2) are taking antiplatelets excluding aspirin 75mgs (for example, clopidogrel) or anticoagulants (such as warfarin or rivaroxaban)
3) have a blood clotting disorder
4) are under the age of 18
5) have been diagnosed with bone cancer
6) have an infection in the area to be treated
7) have a history of tendon or ligament rupture
8) have had a steroid injection into the affected area in the previous 6-8 weeks.
We would only recommend Shock Wave Therapy for chronic conditions (over 12 weeks old) that have failed to settle spontaneously, or have not responded to other modalities such as physiotherapy, orthotics (insoles or leg braces), rest, steroid injection, ice therapy and pain relief.
There is some research and claims that ESWT works in more acute injuries as well (less than 6 weeks) but they did not use control subjects so it is impossible to to tell if they were going to get better anyway, regardless of the treatment. We would prefer to be honest to our clients!
There is a small risk of tendon or ligament rupture, or soft tissue injury, but our experienced physiotherapists will undertake a full assessment to determine your suitability prior to any treatment being undertaken.
You should avoid ShockWave Therapy if you:
1) are pregnant
2) are taking antiplatelets excluding aspirin 75mgs (for example, clopidogrel) or anticoagulants (such as warfarin or rivaroxaban)
3) have a blood clotting disorder
4) are under the age of 18
5) have been diagnosed with bone cancer
6) have an infection in the area to be treated
7) have a history of tendon or ligament rupture
8) have had a steroid injection into the affected area in the previous 6-8 weeks.
How much will it cost?
You will need to attend for an initial assessment just as any new patients or conditions are required to do and this is charged at our standard rate of £49.50 (40 mins). If Shockwave is deemed appropriate there are various ways in which you can fund your treatment. If you have private insurance, many will recognise Shockwave therapy and the various rates that we have contracted with them. Our specialists will give you the appropriate information to pass to your company so that you can speak to them to gain authorisation.
If you are self funding you will be required to book a course of treatment (3 x 20 mins treatments and 1 x 40 min follow-up) that costs £195. If our specialists feel that you need 1-3 additional sessions of shockwave as part of your treatment, these will be charged in addition to this rate, but at £25 , fifty percent off the normal rate. We do not anticipate that many people will require this which is why we are happy to give such a large reduction.
You will need to attend for an initial assessment just as any new patients or conditions are required to do and this is charged at our standard rate of £49.50 (40 mins). If Shockwave is deemed appropriate there are various ways in which you can fund your treatment. If you have private insurance, many will recognise Shockwave therapy and the various rates that we have contracted with them. Our specialists will give you the appropriate information to pass to your company so that you can speak to them to gain authorisation.
If you are self funding you will be required to book a course of treatment (3 x 20 mins treatments and 1 x 40 min follow-up) that costs £195. If our specialists feel that you need 1-3 additional sessions of shockwave as part of your treatment, these will be charged in addition to this rate, but at £25 , fifty percent off the normal rate. We do not anticipate that many people will require this which is why we are happy to give such a large reduction.
