It frustrates me that this non-invasive procedure that produces results which are sometimes superior to surgery or steroid injection is chiefly used for treating plantar fasciitis and erectile dysfunction in the US. I have found this treatment to be effective for a variety of bothersome orthopedic conditions similar to the ones listed below. But the real beauty of this treatment comes down to a few things:
1: It is fast- A typical treatment of shockwave therapy takes less than 10 minutes.
2: You don't need a ton of visits- Most conditions respond in 4-8 treatments. Sometimes less!
3: It isn't too painful- Although I wouldn't describe it as painless, it is only moderately uncomfortable. Similar to a strong deep-tissue massage.
4: It is affordable- Most practitioners charge $50-$100 per session. So a treatment program might cost $200-$1,000.
5: The results are durable- Research shows that shockwave therapy produces long-term results, unlike massage or steroid injections
6: The research- Ok, I'm a nerd, but I rarely run across a treatment which consistently shows positive benefit in study after study.
7: It plays well with others- Although it can be a stand-alone treatment, shockwave therapy works best when combined with a customized rehabilitation plan to address the reasons why you have an injury in the first place.
I certainly had not heard of shockwave therapy prior to doing some research on plantar fasciitis. At first, I overlooked the treatment because the name sounds kind of gimmicky and similar to ultrasound (which is not very effective). But shockwave therapy kept popping up again and again when I browsed published research, and the results of these studies are very positive.
Eventually, I purchased a shockwave unit for my office and have absolutely fallen in love with this therapy. It has huge benefits for patients if they are lucky enough to know about it and have a provider in their area who uses it. Please allow me to demystify this unique therapy and provide some information on how and why shockwave therapy works.
Extracorporeal Shockwave Therapy AKA ESWT (and also EPAT or AWT) is related to the procedure performed in hospitals to break up kidney stones, called lithotripsy. Most people think this is done with ultrasound but it is actually shockwave therapy. In the late 90's and early 2000's European manufacturers made miniaturized versions of these machines that could be held in the hand and used in general practice.
Shockwave therapy works by creating a pulse of pressure made of strong sound waves. This pressure wave is very powerful, very brief, and can be transmitted deep into tissues. When tissues are stimulated by rapid pressure changes they respond in a variety of beneficial ways. This effect is called "mechanotransduction". Common examples of this include the growth of muscles in response to stress from weight lifting or the relaxation of muscles from the force applied during massage. Shockwave therapy is essentially a scientific tool for applying physical force to the body in a way that creates a beneficial reaction.
Plantar fasciitis was one of the first conditions which was shown to benefit from shockwave treatment. In the US, this remains the only orthopedic condition for which insurance will reimburse for (which is BS). Due to our poor insurance structure, this lack of reimbursement has relegated this powerful treatment to mainly podiatry, and often only as a last resort. The rest of the world has continually expanded the use of shockwave therapy. It has shown promise in the treatment of:
-Tendinopathies including plantar fasciitis, achilles tendinopathy, patellar tendinopathy, proximal hamstring tears, calcific tendinitis, rotator cuff injuries, and golfer/tennis elbow
-Joint pain of the small joints of the hands and feet, the facet joints of the spine, and osteoathritic joints
-Muscular pathologies like trigger points, muscle spasm, and contracture
-Nerve patholgies like carpal tunnel, diabetic neuropathy, sciatica, and small fiber neuropathy
-Various medical conditions like non-healing diabetic ulcers, non-healing fractures, enhanced skin repair following severe pain
-Even things like cellulite and erectile dysfunction have been shown to benefit from shockwave therapy
And these are only the conditions for which I have found research supporting the use of shockwave. There are shockwave therapy machines being developed for heart pain which persists after a heart attack and even a machine to treat the brain directly in the treatment of Alzheimer's!
As you may have noticed, shockwave therapy seems to be effective for a variety of seemingly unrelated conditions. This appears to be due to the general effect that shockwaves have on tissues. Shockwaves have been shown to promote the growth of new blood vessels into tendons and ligaments which typically do not have much blood supply and therefore heal slowly. They also appear to promote the regrowth of tissue by mimicking the forces experienced during significant trauma. Bones will literally grow thicker when treated with shockwaves. Very slow growing nerves also seem to respond to shockwave treatment by increasing their metabolic rate. This same effect has been shown on large wounds. Shockwaves essentially stimulate healing when they are delivered in the proper intensity.
This all appears to be too good to be true. I certainly thought so when I started researching shockwave therapy. The first shockwave unit I purchased was an $8,000 chinese knock-off machine. I was pretty sure I had just lit a pile of money on fire when it arrived. Since I had never been treated with the therapy before, I was unsure what to expect. The machine made a very loud pinging sound and delivered a rapid, sharp, snapping pulse which could be adjusted anywhere between pretty soft and painfully strong. I used this machine for less than 30 days before I returned it...
When the company asked why I wanted to return my unit, I told them that I loved it so much that I wanted to purchase a top-notch machine. I had noticed that most of the research on shockwave therapy was done with the Storz units, either their radial or focused units. The same research shows that the two essentially produce the same result. I opted to purchase the radial unit because it is more versatile in it's use and is extremely safe. My first few weeks with the Storz unit permanently changed my practice. I was able to effortlessly treat frustrating plantar fasciitis, trigger points which had lingered for 5+ years, shoulder pain which persisted after surgery/PT/injections/massage, tricky golfer's and tennis elbow, and a variety of arthritic complaints.
My patients were just as amazed as I was. We all agreed that it really does seem to work quickly, and the results seem to last.
Time will tell how far I can push the limits of this treatment in my clinic, but I really want to spread the word about this treatment. It is a shame that this treatment has been swept under the rug by insurance companies.
I have had a hard time finding referrals for my patients in other areas. If you are looking for a provider near you, I would recommend searching "orthopedic shockwave near (insert your city)" or "ESWT near me" or "Shockwave therapy for (insert condition) near (insert your city)'.
So far, I have had the best luck finding sport chiropractors or physical therapist who have a unit in their office. Some podiatrists will treat conditions besides plantar fasciitis, but none in my city do (despite asking them).
Naturally, if you are in Northern Illinois and are looking for this therapy, give us a call at 224-656-5778.
Thanks for reading.
Feel free to shoot me any questions- ryan@straightupspineandposture.com
Mon-Thurs: 8-11:30 & 1-6
Fri: 8-12
Sat & Sun: Closed
Straight Up Spine & Posture is a Gurnee chiropractic clinic owned by chiropractor Ryan Winslow, providing chiropractic services and shockwave therapy to Gurnee, Libertyville, Grayslake, and northern Lake County. Find us online.
Straight Up Spine and Posture 6021 Washington St., Unit B Gurnee, IL 60031 Directions P: (224) 656-5778 F: (847)-577-4078