Shock Wave Therapy

Extracorporeal ShockWave Therapy (ESWT) or Acoustic Wave Therapy helps promote regeneration and repair of injured soft tissue.

Shock Wave Therapy is a non-invasive treatment, meaning it does not pierce the skin and involves the delivery of high-energy acoustic waves introduced into the patient‘s body in the form of high-frequency oscillations. These oscillations are delivered pneumatically via compressed air by a machine head and coupling gel at the site of the injury. The high energy sound waves or acoustical energy trigger the body’s own natural repair mechanisms and accelerate healing and the breakdown of fibrotic adhesions (scar tissue).

Shock Wave therapy is a safe and effective. Shock Wave Therapy, aka Extracorporeal Shock Wave Therapy (ESWT), which means outside the body, has been used in Europe since 1992. It was first approved in the United States by the FDA in October 2000 for the treatment of Plantar Fasciitis (arch pain). In March of 2003, the FDA approved ESWT for Lateral Epicondylitis (Tennis Elbow). Now Shock Wave therapy is used for a multitude of soft tissue injuries including:

Conditions Treated with Shock Wave Therapy

■ Plantar Fasciitis (Arch Pain)

■ Rotator Cuff Tendonitis (Supraspinatus, Infraspinatus…)

■ Bursitis (Shoulder, Hip, Knee)

■ Trigger Finger (Thumb)

■ Bone Spurs

■ Heel Pain

■ Joint Pain

■ Calcium Deposits

■ Knee Pain

■ Osteoarthritis

■ Quadriceps Tendonitis

■ Patellar tendonitis (Jumper’s Knee)

■ Achilles Tendonitis

■ Elbow Pain

■ Tennis Elbow (Lateral Epicondylitis)

■ Golfers Elbow (Medial Epicondylitis)

■ Carpal Tunnel Syndrome (CTS)

■ Tendonitis (Shoulder/Rotator Cuff, Hip, Wrist, Ankle)

■ Calcifying Tendonitis of the Shoulder

■ Back pain

■ Neck pain

■ Forearm pain

■ Hand Pain

■ Shin Splints (Medial Tibial Stress Syndrome)

■ Foot pain

■ Heel Pain

■ Ankle pain

■ Hamstring Strain

■ Muscle Strains

■ Muscles Tears

■ Hip pain

■ Impingement Syndrome

■ Frozen Shoulder

■ Tendinopathy

■ Tenosynovitis

■ Trigger Finger

■ Neck Pain

■ Back Pain

The above physiologic effects are achieved through:

This depends on how chronic (length of time) your condition is and how severe it is as well as other things that we can talk about. Many patients will feel relief after the first treatment. Most patients will need 5-8 treatments and others up to 12, but again this depends on your specific condition.
Treatments are done 5-7 days apart depending on the patient’s tolerance and their tissue response.
Class IV Laser Therapy also helps accelerates tissue repair and when used in conjunction with Shock Wave Therapy, patients often see much faster recovery times.
You may experience some mild discomfort but that usually goes away fairly quickly. Also, the intensity can be adjusted throughout the treatment for patient comfort.
Most patients will experience some pain relief following the treatment. However, within 2–4 hours after the treatment, they may experience some soreness in the treated area. This soreness has been reported as tolerable and not limiting and goes away.
It is recommended that patients reduce or refrain from the activity that caused the problem.
Shockwave therapy accelerates healing, tissue repair, cell growth, decreases pain and increases range of motion through the following…

1. New Blood Vessel Formation – The application of acoustic waves create capillary micro ruptures in soft tissue. Due to these micro ruptures the expression of growth factors such as eNOS, VEGF, PCNS and BMP is significantly increased, which helps to improve a nutrient rich blood supply and more oxygen (oxygenation) to the injured area, thus allowing for faster healing of soft tissues.

2. Reversal of Chronic Inflammation – Chronic inflammation occurs when the inflammatory response is not completely halted. It can damage healthy tissue and results in chronic pain. Mast cells are one of the key components of the inflammatory process. Their activity may be increased by using pervasive acoustic waves. Mast cell activation is followed by the production of chemokines and cytokines. These pro-inflammatory compounds first enhance the inflammatory process and in the next step help restore normal healing and regenerative processes.

3. Stimulation of Collagen Production – The production of a sufficient amount of collagen is a necessary precondition for the repair processes of the damaged myoskeletal and ligamentous structures. Shockwave therapy accelerates procollagen synthesis. The therapy forces the newly created collagen fibers into a longitudinal structure which makes the newly formed tendon fibers more dense and stiff and creates a firmer structure.

4. Mediator “Substance P” Substance P is a neurotransmitter that mediates pain information through C-fibers. This neuropeptide is generally associated with intense, persistent and chronic pain. It relays pain messages to the central nervous system. Lowering the concentration of Substance P reduces the stimulation of afferent nociceptive fibers and thus reduces the pain. Decreasing Substance P, histamines and other nociceptive metabolites also helps inhibit development of inflammatory edema. Acoustic waves generated by Shockwave therapy lower the Substance P concentration and trigger pain relief.

5. Release of Trigger Points Trigger points are the principal cause of pain in the back, neck, shoulder and limbs. They are associated with palpable nodules in taut bands of muscle fibers and have extremely contracted sarcomeres. The dysfunctional sarcomeres contract so tightly that they begin to cut off their own blood supply. This causes the waste products to build up. Waste product build-up irritates the sensory nerve endings which then causes even more contraction. This vicious cycle is referred to as “metabolic crisis”. The assumed mechanism of action is that the delivered acoustic energy unblocks the calcium pump and thus reverses the metabolic crisis in the myofilaments and releases the trigger points.
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