EPAT / ESWT / Shock Wave
What is it?
Focused Shockwave
Frequently Asked Questions. /. FAQ
What is Shock wave?
ESWT / Shock wave is an advanced and highly effective non-invasive treatment method for many orthopedic conditions. It is cleared by the FDA. This proprietary technology is based on a unique set of pressure waves that stimulate the metabolism, enhance blood circulation and accelerate the healing process. Damaged tissue gradually regenerates and eventually heals in most cases.
ESWT was first used to target and break up kidney stones and is still used today. This version is more localized to be effective on the musculoskeletal system and is especially effective dealing with calcific tendon deposits. More detailed information on eswt can be found here: https://www.shockwavetherapy.org/about-eswt/introduction/.
How long have you been using ESWT?
ESWT is relatively new to the USA. Members of our team have over 7 years’ experience using the device. ESWT is very popular in Europe and Asia but has been slow to come to the USA. I have collaborated with international experts throughout Europe and Asia to offer this to our patients. I am a founder of the American Society for Medical Shockwave (https://www.asmst.org/) and president elect. I teach shockwave nationally and internationally and attend the annual International Meeting where I work closely with international experts. We are one of only a few NJ based practice to offer focused shock wave. We have state of the art equipment, and I have extensive training and experience. I perform research on shockwave and am published in key journals and am a thought leader in the shockwave world
Are there different types of ESWT?
ESWT comes in two formats, a lower dose scattered form often called radial shock wave or epat. This may be seen in some allied health offices such as chiropractors or podiatrists. It is a much lower energy dose and the beam is not focused. In general, it is significantly less effective then focused shock wave. Focused shock wave is only approved for physician use. It has varying decreased of energy at much higher doses then radial and is a narrow beam. It is recommended to use this under ultrasound guidance for which I have extensive experience. We are one of few providers in NJ providing focused shockwave. Results in the literature and in our experience are significantly better with focused based treatments. Focused treatments allow us to treat a much wider range of problems then lower energy radial systems.
What is involved in the procedure?
ESWT benefits patients because their condition can be treated extracorporeally, meaning outside of the body. Since ESWT is non-invasive, there is no lengthy recovery period, virtually no time off from work or risk of causing further damage. The same cannot be said with surgery. During the treatment, you lie back comfortably with the area to be treated. We make sure you are comfortable throughout the procedure. We use an ultrasound scan to view and target the damaged location. During the treatment, you will hear repetitive clicking sounds. We activate sound waves with the device till you feel mild discomfort. Some discomfort is needed to stimulate the tissue. We can control the amount of sound energy to get an effective balance of stimulation and discomfort for a short period of time.
Your comfort is a priority to us. If you are nervous or anxious about treatment feel free to talk to us. Our goal is to always make sure you are comfortable and relaxed during treatment!
What conditions can be treated by ESWT?
ESWT can effectively treat a range of musculoskeletal conditions. Complaints involving attachment points for tendons and ligaments in major joints such as the plantar fascia, Achilles tendon, shoulder, elbow and knee are common areas for ESWT treatment.
Generally, acute or chronic musculoskeletal pain and/or pain that significantly impairs mobility or quality of life including Plantar fasciitis, Jumpers knee, Achilles tendonitis, Calcific tendonitis, myofascial pain and lateral epicondylitis / tennis elbow. It can also be used in recovery for muscle injuries and with trigger points. More recent evidence shows benefits with bone edema associated with arthritis and nonunion of fractures. ESWT may be used in conjunction with Ortho biologic treatments such as prp and we are studying this in our clinic.
Why consider non invasive Shock Wave?
Shockwave / ESWT has a proven success rate that is equal to or greater than that of traditional treatment methods (including surgery) and without the risks, complications and lengthy recovery time. It also has the following advantages: Performed in your physician’s office/clinic / Does not require anesthesia / Requires a minimal amount of time. Patients can: Bear weight (i.e. walk) immediately / Return to work/normal activities within 24 hours / Continue rehab and exercise without significant downtime.
What are the possible side effects or complications?
One of the main benefits of ESWT is the low risk. The treatment “extracorporeal,” meaning that patients receive the therapy “outside the body” instead of invasive surgery. Depending on the diagnosis patients may experience mild temporary discomfort during treatment as ESWT seeks out painful regions to desensitize them. The shockwaves are directed at the point of maximum symptoms to optimize healing. Rarely ESWT may cause skin redness, bruising, numbness, tingling or radiating pain. If these symptoms do occur, they are short lived and self-resolving.
Contraindications to shockwave therapy include bleeding disorders, thrombosis and pregnancy. This is an FDA approved technology and is currently done throughout the world. Extensive clinical studies and tests have confirmed its safety and efficacy.
What is the duration of the treatment and how many treatments will I need?
Typically, a total of 3-6 treatment sessions are recommended, typically once per week. In general, if enough progress is made at 3 weeks no further treatments are needed. If a PRP is performed as part of the treatment plan, ESWT is ideally performed the day of the procedure and resumed 2 weeks after PRP. Some patients report immediate pain relief, but natural healing of injured tissue occurs approximately 6-8 weeks following treatment. Between treatments, patients are able to resume regular activities as tolerated. The entire office visit will last about 20-30 minutes total with ten minutes or so being treatment time.
What are the expected results? What does the literature say?
Some patients report immediate pain relief after the treatment, although it can take up to 6 to 8 weeks for pain relief to begin. In general, with the appropriate evaluation and treatment protocols, the procedure eliminates pain and restores full mobility, thus improving your quality of life. Over 80% of patients treated report to be pain free and/or have significant pain reduction.
Are there studies documenting its success rate?
There’s an abundance of published research to support its use, including double blind randomized controlled studies. Enclosed are some links to resources to review if further information is needed.
· Curamedix web site with references for multiple studies: https://www.curamedix.com/epat-eswt-clinical-evidence-orthopedics/
· "Extracorporeal Shock Wave Therapy Accelerates Regeneration After Acute Skeletal Muscle Injury."
· The efficacy and safety of extracorporeal shockwave therapy in knee osteoarthritis: A systematic review and meta-analysis March, 2020
· Extracorporeal shock wave treatment can normalize painful bone marrow edema in knee osteoarthritis: A comparative historical cohort study.February, 2018
· New Research Suggests Shock-Wave Therapy May Provide Short-Term Benefit for Tennis Elbow? May, 2018
Does insurance cover ESWT?
At this present time eswt is not recognized by the majority of insurance carriers in the USA. Shockwave treatments can be covered via your health savings account (HAS). We can provide you with codes / itemized bills to provide to your insurance to try to submit for reimbursement, but we have rarely found this works.
ESWT / Shockwave Patient Declaration of Consent Form
(please download and sign)