Extracorporeal Shock Wave Therapy

Extracorporeal Shock Wave Therapy (ESWT)

Gavin BowyerDescription

Extracorporeal shock wave therapy (ESWT) is a treatment method that delivers impulses of energy to targeted tissues of the body. The impulses can be aimed at areas in which there are problems such as tendonitis or fasciitis (pain in the connective tissue or fascia). This initiates an inflammation-like condition in the tissue that is being treated. The body responds by increasing the blood circulation and metabolism in the impact area which in turn accelerates the body’s own healing processes. The shockwaves break down injured tissue and calcifications.

How ESWT works

Studies continue to determine the precise mechanisms that are at work, but the essence seems to be that a chronic problem such as tendonitis or fasciitis is transformed in to an acute inflammatory situation, which the body is then able to heal.The treatment initiates an inflammation-like condition in the tissue that is being treated. The shock waves break down injured tissue and calcification. The body responds by increasing the blood circulation and metabolism in the impact area which in turn accelerates the body’s own healing processes.

Gavin BowyerThe advantages of Shockwave Therapy

Shockwave Therapy is applied without medication, for example Cortisone injections or local anaesthetic. The treatment is non-invasive (no cuts, no needles) and can be safely performed in the outpatient department, with an actual treatment session lasting only about 10 minutes.

The treatment stimulates and effectively supports the body’s self healing mechanisms.

There are several studies indicating the effectiveness of the treatment, even in difficult conditions such as tendonitis at the shoulder and ankle, and plantar fasciitis. It is usual to experience immediate pain relief following the treatment and hence improved movement. Reported side effects are minimal.

Treatment areas

Most experience with ESWT in the musculo-skeletal system has been with shoulder tendonitis, tennis elbow, and the common foot and ankle conditions, Achilles tendonitis and plantar fasciitis (pain in the heel and under the sole of the foot).

Frequently Asked Questions

What Happens?

ESWT is non-invasive – no cuts are made and no needles are used. A gel is applied to the skin over the painful area, and the impulse device is pressed against the area and small shock waves are generated. A treatment session lasts about 5 – 10 minutes.

How much treatment do I need?

Extracorporeal shock wave therapy (ESWT) may be applied, usually in 3 sessions spaced a week or two apart. The treatment is carried out in the outpatient department which has the special equipment, there is no need for anaesthetic, and each treatment session lasts 5-10 minutes.

Does it Hurt?

Extracorporeal shock wave therapy (ESWT) may be applied, usually in 3 sessions spaced a week or two apart. The treatment is carried out in the outpatient department which has the special equipment, there is no need for anaesthetic, and each treatment session lasts 5-10 minutes.

Does it Work?

There are still trials ongoing to see how effective ESWT is in Achilles Tendinitis and Plantar Fasciitis. The National Institute for Health and Clinical Excellence (“NICE”, sometimes called the health watchdog) has looked at the procedure in detail, and you will be offered the summary of their findings. There have certainly been some encouraging trials, but more work is needed, and a record will be kept of your response to treatment if you are offered, and decide to accept, this treatment.

What are the Complications?

There are no major safety concerns. Skin reddening after the procedure, and throbbing or aching in the treated area are common. Achilles tendon rupture is an uncommon complication, but a possibility, as in any treatment of the Achilles tendon problems. Further details are in the NICE guidance.

What happens in cases that do not settle?

Early response in the first few weeks following shockwave treatment is normally good, however it may take several months before maximum effect is achieved. The treatment is often aimed at areas where the common, initial treatments have failed to have a benefit; some of these difficult cases will not respond to ESWT, and in those cases your treating surgeon will be best placed to discuss with you the further treatment options.

Will my Insurance Cover the Treatment?

Most insurance companies have approved a specific coding for ESWT, particularly in its use around the shoulder, elbow, foot and ankle. Companies, and indeed policies, may vary however, and it is important to check with your insurer. We can happily help with a letter to your insurer explaining what is being proposed.

If the policy or insurer does not provide cover, then Spire Southampton Hospital offers a self-pay, or fixed price, package which covers the course of up to 3 treatment sessions – just ask your consultant or his PA/secretary for details.

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