Radial Extracorporeal Shockwave Therapy (rESWT)is a fast and effective non-surgical method of eliminating or reducing many painful conditions of the musculoskeletal system. rESWT has been shown, in the short term, to have a 56 to 90% success rate in the treatment of soft tissue disorders, including calcific tendinitis of the shoulder, plantar fasciitis, and tennis elbow.(1) Research has also shown excellent success with treatment of heel spurs, achilles tendinitis, rotator cuff tendinitis, patellar tendinitis. (See the included list of research papers for details of treatments.)
How Does It Work?
rESWT uses a pneumatic generator to physically deliver a shockwave through the skin, into the body. Think of it like a tiny pneumatic jackhammer striking the skin to create a shockwave. The high-energy acoustic waves are transmitted through the surface of the skin and spread radially (spherically) into the body. Next, the body responds with increased metabolic activity surrounding the area of the pain which stimulates and accelerates the healing process.(2)
“Until recently, treatment options for chronic tendinitis have been limited to NSAIDS, stretching exercises and avoidance of activities that cause pain. Occasionally, injections of corticosteroids are performed and, rarely, surgical therapy is attempted all with the goal of reducing the patient’s pain to enable them to return to the activities and sports they love.”
Benefits of rESWT
- Fast, safe and effective
- Decreases pain and increases function
- No incision; no risk for infection at the treatment site; no scarring
- Future treatment options are not limited
- Does not require anesthesia
- Patients can be treated on both sides at the same time, if the condition requires
- Patients can continue their current level of activities
Common Conditions Treated
- Plantar Fasciitis & Heel Spurs
- Elbow Pain (Tennis or Golfer’s Elbow)
- Shoulder Tendinitis
- Calcific Tendinitis
- Achilles Tendinitis
- Patellar Tendinitis (Jumper’s Knee)
- Carpal Tunnel Syndrome
- Trigger Points/Muscle Tension
- Chronic Neck & Back Pain
- Delayed Non-unions (delayed bone healing)
In a recent study with 54 knee patients, rESWT was found to be more effective and safer than traditional conservative treatments in the management of clients with patellar tendinopathy. At the three year follow up from treatment, 100% of subjects treated in this study reported fair to excellent results.(3)More and more research indicates that low energy rESWT is as effective as high energy ESWT and at a better value to the podiatric physician, insurance company, and most importantly the patient.(4)
rESWT can be strongly recommended for clients with therapy resistant plantar fasciitis. Especially in the cases of failed nonsurgical treatment, rESWT represents an excellent alternative to surgery because anesthesia is not required and long recovery times are avoided. Clients are not required to refrain from sport activities during the course of treatment and treatment can be administered outside the hospital.(5)
Radial shockwaves are generated ballistically by accelerating a bullet to hit an applicator, which transforms the kinetic energy into radially expanding shockwaves.(6,7)
A recent study published found rESWT to be safe and effective in the treatment of clients with lateral epicondilytis of the elbow. One to two years following treatment results showed 61.1% free from complaints, 29.5 % were significantly better, 6.8% were slightly better and 2.3% were unchanged.(8)
What Can You Expect?
To begin, a Collegiate Sports Medicine Therapist will determine if you are an eligible candidate for rESWT treatment. The Therapist guides the patient through an extensive evaluation to ensure ESWT is the best option. This includes a complete investigation and documentation of medical history, symptoms, previous injuries and also takes your lifestyle into consideration. The therapist will then perform a hands-on evaluation of the area including observing structure, alignment, strength, range of motion, soft-tissue damage as well as identifying any abnormalities. With this thorough assessment, the therapist will determine your specific needs. If it appears you are a candidate and will respond favorably to rESWT, fees for the treatment will be discussed as well as any other questions you may have.
Assuming you are a candidate, you will be scheduled for treatment where clients typically require 3 separate treatment sessions approximately 7-14 days apart. Chronic tendinitis may require 3-5 visits, other conditions may be treated with 1-8 treatments. Each treatment session lasts approximately 5-15 minutes where the Therapist or assistant will apply ultrasonic transmission gel to the target area. The rESWT hand piece is then positioned to gently and extensively transmit shockwaves into the injured area. Clients may book an initial assessment and shockwave treatment for the same time if time permits in the schedule.
Current clients will have already had an orthopaedic assessment completed and should discuss with their therapist if Shockwave Therapy is an option.
When Should I Consider rESWT?
- When there are no significant or serious side effects or contraindications.
- When you have been diagnosed with a condition that rESWT has been demonstrated effective in treating.
- When surgery is the only other viable alternative.
- When other conservative treatments have failed or did not work.
- When you understand the procedure, costs and other factors involved in your treatment program.
As is the case with most medical treatments, we cannot guarantee how you will respond to treatment or if you will see a significant improvement. Therefore, it is important to talk to your therapist as they can suggest other treatment options for you.
Please carefully consider all factors prior to making your decision for rESWT, as there is a no refund policy in effect.
rESWT Should Not Be Used If You Have
- Diabetes Mellitus, Occlusive Vascular Disease, Collagen Disease
- Cardiac Arrhythmia or Cardiac Pacemaker
- On Immunosuppressant agents within 6 months
- Degenerative Joint Changes
- Circulation or Nerve Disorders
- Bone Tumors
- Active Infection
- Metabolic Bone Conditions
- Open Wounds
- On Anticoagulants
- Are pregnant as the effects on pregnancy have not been evaluated
- Unable to localize pain have a relative contraindication to treatment. These include patients with Alzheimer’s Disease, or other brain conditions, or patients with diffuse pain or many sites of pain making localization of the origin impossible.
- Are on blood-thinning medications or have severe circulatory disorders may also not be eligible for treatment.
Although previous generations of rESWT machines could cause considerable pain requiring freezing or local anesthetic, the radial shockwave technology Collegiate Sports Medicine utilizes does not generally cause this level of discomfort. Although it can be intense, many patients describe their treatment as “strange” or mildly uncomfortable” but few report any significant or lasting pain.
After the rESWT treatment patients may experience temporary soreness, tenderness or swelling for a few days following the procedure. Upon completion of your treatment you often can return to most regular activities almost immediately. Occasionally pain or discomfort may persist for a few days following treatment but no serious complications or side-effects have been reported.
- Gerdesmeyer, L. et al. Radial Extracorporeal Shock Wave Therapy is Safe and Effective in the Treatment of Chronic Recalcitrant Plantar Fasciitis. The American Journal of Sports Medicine. Vol X, No. X: 1-10, 2008
- Gerdesmeyer, L.; Maier, M.; Schmitz, C. Physical-technical principles of extracorporeal shockwave therapy (ESWT). Orthopade.31: 610-617, 2002
- Magosch, P.; Lichtenberg, S.; Habermeyer, P. Radial shock wave therpay in calcifying tendinitis of the rotator cuff – a prospective study. Z Orthop Ihre Grenzgeb.141:629-636, 2003.
- Shockwave Alberta. Frequently Asked Questions. Retrieved June 8,2010 from http://www.shockwavealberta.com
- Wang, CJ, Chen, HS. Shock Wave Therapy for Patients with Lateral Epicondylitis of the Elbow.The American Journal of Sports Medicine, Vol. 30, No.8: 422-425,2002
- Wang, CJ.;Ko, Jy; CHan, YS; Yeng, LH; Hsu, Sl. Extracorporeal Shockwave for Chronic Patellar Tendinopathy. American Journal of sports Medicine, Vol. 35: p972, 2007
- Weil Jr. L. Emerging Concepts in Shockwave Therapy. Podiatry Today. Vol. 21(6); 59-64, 2008
- Weil Jr. LS, et al. Extracorporeal Shockwave Therapy: Hope Or Hype?. Podiatry Today.Issue 11, 2003
- Younger, A. Shock Wave Therapy for Treatment of Foot and Ankle conditions.Techniques in foot and Ankle Surgery. 5(1): 60-65, 2006.