INTRODUCING ESWT

Extracorporeal Shock Wave Therapy - ESWT

Extracorporeal Shock Wave Therapy was originally developed by Dornier MedTech to break up kidney stones nearly a quarter of a century ago. Since then, physicians discovered that Extracorporeal Shock Wave Therapy (ESWT) could benefit people with soft tissue and bone injuries.
The Dornier EPOS Ultra was FDA Class 3 approved for ESWT and the treatment of chronic plantar fasciitis. Other similar tendinopathy treatments now safely and effectively treated by ESWT are Achilles tendonitis and plantar fascia arch pain (among others).

How Does ESWT Work?

ESWT is one of the few medical technologies that performs best on people with chronic conditions that did not respond to conservative traditional therapy. ESWT accelerates the body's own healing process in a number of ways:

  • Through a process called cavitation, ESWT stimulates fibroblast and tenocyte production. Fibroblast or tenocyte cells make up your body's connective tissues, such as tendons and the fascia. In other words, ESWT repairs the damaged tissue that is causing you pain.
  • ESWT diminishes pain by over-stimulating the nerves that send pain sensations to the brain.
  • The procedure can break down pathological calcification deposits (also known as a spur). Depending upon your condition this may or may not be the goal, but an interesting by-product. In all cases, ESWT is targeted at the condition that caused the spur, not the spur itself.

How effective is ESWT?

Our own experience and the FDA ESWT study using our treatment protocol shows an overwhelming success rate. In the study, a group of 150 patients was asked to rate their pain level on a scale of 1 to 10. The average pain level before treatment was 7.7.

After receiving one ESWT treatment, the patients were asked one year later to rate their pain level again on a scale of 1 to 10. The patients who reported had an average pain score post-ESWT of 0.6. This is a 92% reduction in pain. 98% of the patients rated their treatment as successful. ESWT studies repeatedly demonstrate a higher rate of success than any non-surgical or surgical procedure. More importantly, ESWT is very safe.

One-Year FDA Follow-Up Results - Chronic Plantar Fasciitis

I've tried other things but they didn't help. How do I know ESWT will?
Tendonitis sometimes resolves with rest or with the help of treatments such as strapping, physical therapy, anti-inflammatory medications, or cortisone injections. When the condition is new (usually less than six months) it is called acute tendonitis.

Acute tendonitis is an inflammation. All of the treatments used at this stage are meant to rest the area or deal with the inflammation. Those who do not get better in the "acute" phase have what is called chronic tendonosis. The difference between tendonosis and tendonitis is simple: Tendonitis is an inflammation. Tendonosis is degenerative or damaged tissue. You can use steroid injections repeatedly with no result if the problem has gone beyond inflammation. Surgery used to be the only option for tendonosis. ESWT treats tendonosis because ESWT forces the damaged tendon to heal.

WHAT TO EXPECT AFTER ESWT
All of us involved in ESWT would love to be able to tell you exactly what to expect after your treatment. Truth is there is no "norm" for how people progress after treatment, only averages. People respond very differently. Some have soreness after treatment, some people have no more pain from day one, others will have significant improvement, some will have moderate improvement, some minor improvement, and a small minority of people will have no improvement for several months. While waiting several months for pain relief is not normal, those people experience frustration or fear their treatment was a failure. We hope this will help explain ESWT and help understand why patience and letting time do its job is so important with ESWT.

TIME IS THE KEY WITH ESWT...IT ONLY MAKES SENSE
If you think about what happens to the fascia or tendon during treatment, it can help make the waiting time easier to handle. The ESWT Shockwaves are creating micro-trauma to the fascia or tendon. Your body must then take time to heal the area. On that basis alone, ESWT should take time for everyone. However, a second phenomenon can cause rapid pain relief in many patients. This is an interaction between the local pain receptors and the energy of the shock wave. Those who experience pain relief right away or soon after treatment are feeling what is called an analgesic affect. The pain receptors have been affected, therefore less pain. Some people who have chronic pain do not feel immediate pain relief because the pain receptors are not affected during the treatment. These patients will begin to feel pain relief when the fascia or tendon is adequately healed. Pain relief from new cell development may not start before 6-16 weeks and could go on for one year. This is why the success rate changes so dramatically from month to month, up to one year after treatment.

While we understand this waiting time can be frustrating and sometimes disappointing, it is the reality of ESWT. While it is not the norm, please do not worry and become disappointed if you haven't experienced any pain relief for up to 6 months after ESWT. This does happen to a minority of patients, then suddenly they hit a wall and pain relief happens rapidly. Hang in there!

WHAT ABOUT RE-TREATING THE AREA?
Yes, sometimes we may retreat, although it is rare. The studies show a 92% reduction in pain AT ONE YEAR after only one treatment. Re-treating prematurely will only re-injure the area and can set your progress backwards. For patients who are dealing with this, the answer of "wait it out" sometimes feels discouraging. We understand that feeling; we wish everyone had immediate pain relief. If you are having pain, we can help you control the pain while your foot is healing. We will evaluate the necessity of re-treating at approximately 6 months if you have little relief. Again, needing a re-treat is very rare.

UPS & DOWNS IN PAIN POST TREATMENT
It is quite normal for a patient to experience great days and sometimes days "like it was before." There are many reasons for this. It is not a sign that you are going backwards or that it has stopped working. Ups and downs are normal in ESWT and other foot procedures. Contact us for help with controlling the pain while your foot is healing or you can use your post ESWT instructions.

ACTIVITY AFTER TREATMENT
Most sore days often follow days when a person may have overdone it. Marathons, European vacations, exercise,
carrying suitcases, shopping excursions, tennis, 18 holes of golf etc. are all things that can cause some temporary
irritation. This is typical with patients who are having great days and they forget their foot is still healing. Talk to us if you aren't sure. If you do over do it, rest awhile after. While normal activities are not lismited, think about the fact that your body is healing and try to give it some fair rest and relaxation while healing.