Last Sunday, toward the end of September 2017, I attended a workshop to learn more about a machine newly available for me to use on my patients. For the past few months I picked up a bit of knowledge from a colleague and some online reading, and found it to be quite revolutionary on tendon injuries and plantar fasciitis in particular that just don’t seem to clear off. In that workshop I of course took notes and listened with great interest so that I could come away and relay some of that to you, the reader. I hope the information explains what ESWT does and how it works clearly, and if any further questions please let me know.
What’s it for?
ESWT is primarily used for tendon issues that have had other methods of rehab and treatment but to no avail. Tennis elbow, Achilles tendinopathy, patellofemoral pain to name a few common occurrences are all the bread and butter for treatments through shockwave. Much research over the last 20 years has been done on ESWT as to how effective it is, and the vast majority show astonishing results. Limited research has been undergone on other areas but through individual clinician experience to whom I’d spoken to at the workshop, there’s some good results with other problems within joints such as frozen shoulder and even arthritis.
How does it work?
ESWT works through sound waves passing through the skin to the point of origin. Kinetic energy is passed through a flat metal piece of equipment which is applied with mild pressure onto the exact location of pain which then converts into an acoustic wave as it passes through tissues. There will be a gel applied to your skin beforehand to bridge the gap between the equipment and your skin; shockwaves travel much further through liquid than they do through air. It also prevents a sharp bee-sting feeling due to the dryness when paired up with the moderate pressure.
ESWT effectively takes a long term injury to a tissue and turns it into an acute injury, which sounds counter productive but when the body sustains a chronic problem it learns to almost accept that the pain will remain there and it will never be fixed. When the transfer into an acute injury is made, the body then responds and prepares to repair as if the injury has only just happened. The process can take a maximum of 12 weeks, but on a session point of view there are only 3 procedures over 3 weeks. This through research has shown the best result. The remainder 9 weeks involve the rehabilitation often given by practitioners but with the extra kick-start from the ESWT will make it 10x more effective. It’s worth noting that 12 weeks may sound excessive, but for those suffering with a problem for nearly a year or more, it wont sound bad at all! It’s also worth noting that 12 weeks is a maximum. The pain can subside within the 3 week programme and in my experience it already has shown that, but the rehabilitation must be stuck with otherwise subsequently the problem can re-emerge.
Now explaining the procedure you may be thinking ‘that sounds like it would hurt…’ and you would be right, unfortunately when applying the shockwaves, the patients’ tolerance is the baseline. 2500 shocks are administered over a number of minutes and the intensity is adjusted to the maximum tolerance of the patient. Essentially the more the patient can tolerate, the better for the injury in the long term.
Limitations and side-effects
Due to the nature of the procedure, there is a fair list of contra-indications to be aware of and if you were contact a practitioner with an ESWT machine, these will be outlined beforehand. The most common barriers for using it are:
• Recent steroid injections (3 month gap before ESWT can be administered)
• Prescribed anti-inflammatories (2 week gap before ESWT can be administered)
• Under 18 years of age (Can be administered if patient and guardian are aware of the risks and accept them)
• Applying the shockwaves over the lungs and bowel
The side effects are few and far between, and are rare to occur however its always good to be aware. It’s worth noting all side effects are short-term and wont affect the procedures effectiveness.
• Tingling due to nerve routes under the head of the device
• Aching at the site due to the nature of what has been performed
• Redness and bruising at the site also for the same reason that essentially damage is being done, and can lead to some physical evidence of that
With a procedure like ESWT you need to be aware that it will cost more than a normal session with a practitioner, but with a 60-80% rate of success across the board and no other alternative has a long term solution, it’s well worth it. As a patient once said to me “If I walked into a bookies and put down X amount on a 50/50 bet to get rid of my pain, I’d do it twice over.”