Extra Corporal Shock Wave Therapy (ECSWT)
Extracorporeal Shockwave Therapy or ESWT is a treatment used in physical therapy, orthopaedics urology and cardiology. The shockwaves are abrupt, high amplitude pulses of mechanical energy, similar to sound waves generated by an electromagnetic coil or a spark in water.
Similar technology using focused higher energies is used to break up kidney and gallstones, and is termed lithotripsy, “Extracorporeal” means that the shockwaves are generated externally to the body and transmitted from a pad through the skin.
Medical uses of Extracorporeal Shockwave Therapy are used to treat a growing number of tendon, joint and muscle conditions. These include tennis elbow, Chronic tendinitis of the knee and shoulder rotator cuff pain, achilles tendinitis, hamstring tendinitis and plantar fasciitis.
The above conditions are often difficult to treat using other methods and can become chronic. With ESWT, patients report reduced pain and faster healing without significant adverse side effects. Extra corporal Shock Wave Treatment (ECSWT) is used to treat tendon and other soft-tissue problems, particularly those that have not responded to other treatments.
ECSWT offers a high chance of cure, without the need for surgery, needles or a stay in hospital. ECSWT is performed in clinic. You walk in, get treated and then walk out and go about your day as usual. No downtime. No pills. No needles. No surgery.
There will always be an initial consultation prior to administering ECSWT. If apropriate, then a course of ECSWT treatment will be prescribed Typically 3-4 treatments are required at one week intervals.
(The initial three appointments must be booked at the same time, to ensure continuity. There are restrictions to availability of times and locations of treatment as the equipment is normally located at The Alma road Medical Center. For other locations specific requests must be made to ensure the ECSW machine is in the right location).
Treatment is virtually painless and no painkillers are required before or after treatment.It is important that patients should not take any anti-inflammatory medication for 10-14 days before the first treatment and throughout the course of treatment, as these can interfere with the healing process.
Each treatment takes approximately 20-30 minutes. The tender spot is marked, contact gel is applied and then the hand piece is applied. A total of 2500 pulses are delivered per treatment.
ECSWT offers two main advantages over traditional surgical methods: fewer potential complications and a faster return to normal activity.
Sometimes Heel and Tendo Achilles problems do not respond to normal measures and becomes longstanding (chronic). If change of footwear, stretching, physiotheraphy , night splints, orthotics etc, have not helped then I prefer to use shock wave therapy as the next line in management for plantar fasciitis.
As a last resort, in patients with severe symptoms that have not responded to all other treatments, surgery is considered. This involves detaching the plantar fascia from the heel bone. Unfortunately even this can sometimes fail to cure the condition.
Most patients initially have three treatments. These are given at 1-2 week intervals. Allow a half hour for each treatment. The area of treatment will be marked. It takes 15-20 minutes to administer 2500 shockwaves per treatment. The treatment can cause discomfort, but a vast majority of people tolerate this very well, particularly because the first 500 or so impulses have an immediate pain-relieving effect.
Some patients feel a little bit of discomfort for a day after treatment, but this is not seen in most of those treated. It is extremely rare for patients to need painkillers after the treatment. Usually less pain is felt after treatment than was felt before, but sometimes a dull ache can occur for a few hours. It is more common for the dull ache to start at about day 3-4 after the first treatment and not at all after the second and third treatments.In the event that pain should occur, take simple pain killers such as Paracetamol. Do not use anti-inflammatory medication as this will interfere with the healing effect of the body that is stimulated by ECSWT.
A vast majority of patients do not need any pain killers. Even if you have no pain we recommend that you refrain from intensive activities for 48 hours after each treatment.
You should continue your usual stretching/eccentric physiotherapy exercises. Even though a majority of people (70-80%) respond to shockwave treatment within a few weeks (and sometimes earlier than this), it may take several months before the maximum effect is achieved. Some people (approximately 20%) do not respond to this treatment, although a proportion of these will subsequently respond to a further course of treatment.
If, after 3-4 months, a pronounced improvement is not felt, you should discuss this with us further so that we can formulate a plan of management. Remember that there are other treatment options available.
Many of the major medical insurance companies have approved ECSWT and will cover this treatment for some indications.
To claim for this procedure, under your health insurance, you must contact your provider and then provide my office with your authorisation code.
They may agree to covering all or part of the cost of treatment. Some insurance companies have limitation of cover on some policies.
Please be aware that you will be liable for any non insured costs of your treatment.