Extra Corporeal Shockwave Therapy

Shockwave therapy's full name is Extra Corporeal Shockwave Therapy (ESWT). This type of therapy has may applications in medicine today. Originally the technology was used to break up kidney stones and today it is heavily used in orthopedics, to treat patients with Alzheimer's, and to help regenerate blood vessels in the heart.

At Ottawa Chiropractic & Osteopathy we utilize the technology as a non-surgical and drug free orthopedic alternative. While it is slowly becoming more popular in Canada it has been and continues to be a primary treatment modality in Europe and the UK.

There are 2 different types of shockwave therapy that you will find in the healthcare marketplace: Radial and Focused.

However, Radial "Shockwave" Therapy is actually Radial Pressure Wave Therapy (R-PWT) or Radial Acoustic Wave THerapy (R-AWT) as it does not produce any shockwaves. Some will make claims that this is simplay a marketing ploy. However, according to the ISMST this is not the case. THe ISMST refers to radial "shockwaves" (note the use of quotation marks) or radial pressure waves or acoustic waves.

R-ESWT is performed by using a device with an applicator that looks like a gun. It even has a barrel.

It works by using an air compressor to generate pressure that is transmitted to the applicator. The pressure then accelerates a projectile through the barrel. The projectile hits the tip of the applicator at the end of the barrel causing a pulse of energy.

The point of maximum energy and effect is the point of impact on the surface of the skin the applicator is held against. This is where maximum treatment effect occurs. Sadly, as the wave dissipates away from the point of impact it loses it's healing energy.

This loss of energy is the critical difference between Radial Pressure Wave Therapy and True Shockwave Therapy.

F-ESWT or Focused Shockwave Therapy provides more depth of therapeutic benefit than radial waves. It's output is more focused, localized, and profound.

Focused shockwaves are generated by electromagnetic induction. The wave is then able to travel through the skin and body tissue to a "focal point" deep in the body tissue. It is at this deep focal point where the maximum therapeutic benefit and healing energy occurs.

The surface of the skin where the applicator contacts experiences minimal impact from the generation of the shockwave leading to a more comfortable and safer treatment than with Radial Pressure Waves.

While RPWT is applied to and spread over the surface of the surface of the skin FSWT treats with more precision and is further adapted to the depth of the tissue requiring treatment.

An important consideration is the depth penetration of Radial Pressure Wave Therapy and Focused Shockwave Therapy. This depth will impact the precision and accuracy of treatment.

The superficial nature of the Radial Pressure Waves make it ideal for treating more superficial conditions that involve outer layers of muscles and connective tissue.

As you can imagine the greater depth the depth of penetration the more efficient and effective that treatment will be for deep issues in tendons, muslces, or bones.

When it comes to treating a problem with the hip or hamstring there really is no contest as Focused Shockwave Therapy is the better choice.

Some other differences of note are:

• Focused Shockwave Therapy can be used on more acute injuries.
• Focused Shockwave Therapy is generally more comfortable.
• Focused Shockwave Therapy is more effective for deeper issues.
• Radial Pressure Wave Therapy is more effective for more superficial soft tissue issues.

With different strengths we believe the most effective treatment to be a combination of the two.

Shockwave Therapy is most often used to treat orthopedic pain, especially joint, muscle, fascia, nerve, and scar tissue pain from the following conditions:

Chronic Tendinopathies:

• Calcifying tendinopathy of the shoulder
• Lateral epicondylopathy of the elbow (tennis elbow)
• Greater trochanter pain syndrome
• Patellar tendinopathy (Jumper’s Knee)
• Achilles tendinopathy
• Plantar fasciitis, with or without heel spur
• Rotator cuff tendinopathy without calcification
• Medial epicondylopathy of the elbow
• Adductor tendinopathy syndrome
• Pes-Anserinus tendinopathy syndrome
• Peroneal tendinopathy
• Foot and ankle tendinopathies
• Trigger Finger

Musculoskeletal pathologies

• Acute (sudden) and chronic (long-term) musculoskeletal injuries
• Chronic non-specific low back pain
• Neck pain.
• Osteoarthritis
• Dupuytren disease
• Plantar fibromatosis (Ledderhose disease)
• De Quervain disease
• Trigger finger
• Frozen Shoulder
• Ligament injuries and sprains
• Greater trochanteric pain syndrome (lateral hip pain)
• Morton’s Neuroma

Muscle Pathologies

• Myofascial Syndrome
• Muscle sprain without discontinuity
• Hamstring injury
• Muscle tears and strain
• Myofascial pain and adhesions related to old injury or surgery

Bone Pathologies

• Acute Fracture (F-ESWT only)
• Chronic pain due to incomplete healing of fracture
• Delayed bone healing
• Bone Non-Union (pseudarthroses)
• Stress fracture
• Avascular bone necrosis without articular derangement
• Osteochondritis Dissecans (OCD) without articular derangement
• Bone marrow edema
• Osgood Schlatter disease: Apophysitis of the anterior tibial tubercle
• Tibial stress syndrome (shin splint)
• Knee Osteoarthritis
• Neurological Pathologies
• Spasticity
• Carpal tunnel syndrome
• Polyneuropathy

Skin Pathologies

• Delayed or non-healing wounds
• Skin ulcers
• Non-circumferential burn wounds
• Cellulite

Urologic pathologies

• Pelvic chronic pain syndrome (abacterial prostatitis)
• Erectile dysfunction
• Peyronie disease

Others

• Lymphedema

There is usually some discomfort associated with both F-ESWT and R-AWT. As stated earlier, F-ESWT is generally more comfortable simply due to the nature of the treatment.

We take all the steps necessary to make sure your treatment is as comfortable as possible and any discomfort you experience will always be guided by your tolerance.

The best way to know is to book an assessment.

The most common side effects are temporary symptom aggravation or discomfort that can last hours to days and temporary redness or pinkness of the skin in treatment areas. Other side effects are possible but tend to be very rare. We will let you know if we anticipate other side effects and we will also screen out patients who may not be appropriate candidates for shockwave.

There are certain groups of people who shouldn’t receive shockwave therapy, including:

• If you are pregnant (this is not an absolute contraindication if the treatment area is something like a foot or shoulder, however, so much changes during pregnancy that it is often easier to wait until after delivery to treat).
• If you have a clotting disorder (including thrombosis or DVT).
• If you have received a steroid (cortisone) injection within the last 6 weeks at the treatment site.
• If tumours are present at the treatment site (having cancer itself is not an absolute contraindication, it depends on the treatment area)
• If you have an infection at the treatment site

This will depend on the problem, how long it's been there, and how healthy you are. Shockwave triggers and accelerates your bodies natural healing mechanism. The healthier you are the less treatment you need!

Typically 3-6 treatments spaced 1 week apart is required to resolve an issue. More advanced degenerative conditions require more treatments. In some cases another 1-2 treatments may be required 4-6 weeks after completion of the initial 3-6 treatments.

In rare cases ongoing treatment may be required every 3-12 months.

We were not going to put this here but then someone asked. He is a physicist. We use Storz Medical shockwave devices. He was very happy to hear that. ;-)