Extracorporeal Shockwave Therapy (ESWT)/EPAT

Extracorporeal Shock Wave Therapy, (or ESWT), is a new technology using shockwaves to treat chronic, painful conditions of the musculoskeletal system. A shockwave is an intense, but very short energy wave traveling faster than the speed of sound. The word “Extra-corporeal” means “outside the body” and refers to the fact that the shockwaves are generated outside the body.
extracorporeal shockwave therapy eswt

What is Shockwave Biosurgery?

Extracorporeal shockwave therapy (ESWT) is sometimes alternatively known as shockwave biosurgery, though ESWT isn’t surgery as the word is usually defined or understood in North America.

Conditions that can be treated with ESWT?

Extracorporeal Shock Wave Therapy can be used to treat a wide variety of musculoskeletal conditions–particularly those involving where major connective tissues attach to bone.

Complaints involving attachment points for tendons and ligaments in major joints like the shoulder (such as the rotator cuff), elbow (epicondylitis or tennis elbow), hip, and knee (tendinitis or jumper’s knee) are common sites for ESWT.

One of the areas most frequently treated with ESWT, however, is the foot. Conditions we treat using Extracorporeal Shockwave Therapy (ESWT) include:

And as ESWT encourages bone healing, it has been used to help treat:

  • Stress Fractures
  • Avascular Necrosis (A dead portion of bone)
  • Slow-healing bone (Delayed unions)
  • Non-healing bone (Non-unions)
  • There are also urological conditions that respond to ESWT, such as Peyronie’s Disease.

When its advised to use Extracorporeal Shockwave Therapy (ESWT)

  • When patient has a diagnosis that is considered to be responsive to ESWT.
  • When simpler and less expensive treatment alternatives have failed or aren’t appropriate for some reason.
  • When surgery or other more invasive treatments are alternatives.
  • When there are no known contraindications to the procedure.

When Extracorporeal Shockwave Therapy (ESWT) can not be used?

ESWT is not typically used in the presence of bone tumours, certain metabolic bone conditions, and certain nerve or circulation disorders.

ESWT isn’t typically used in pregnant patients and locations of an open growth plate, (where the bone is still growing).  It’s not currently used in areas where an infection is present, (though there is some early research suggesting ESWT may actually help with infection).

It also shouldn’t be used in conditions or locations where gas or air is present in the body, (rare in the locations where ESWT is typically used)–or for other conditions as determined by your doctor.

ESWT effectiveness

The vast majority of recent studies suggest that shockwave is highly effective. most recent independent studies suggest somewhere between a 65% and a 95% “success” range, with values around 80% being the most commonly cited number. It’s important to note that most of these studies have success rates as determined by the patient, himself, in terms of pain and function.

We find that our results with the highly accurate piezoelectric technology, are at least this successful. The most important factor in getting a good result with ESWT appears to be in selecting appropriate patients most likely to benefit from this technology. However, we can’t predict which patients will respond successfully to ESWT and which ones won’t.

How fast does ESWT work?

We find that many patients get an initial degree of improvement almost immediately following treatment. This effect is usually (but not always) temporary, and is associated with an anesthesia effect from the hyperstimulation of the tissue from the ESWT.

It takes several days for injuries to begin to heal, and many patients see an improvement before the end of the second week. Depending upon your diagnosis, the healing process may take several weeks or even months to be completed, but pain relief often precedes the completion of the healing process.

How safe is ESWT?

The basic technology involved with extracorporeal shockwave technology has been used for decades now on quite literally millions of people. The technology has been used most extensively in Europe, particularly the German-speaking countries, where this technology originates. In all its use, ESWT of the musculoskeletal system has been found to have virtually no serious side-effects. In fact, even mild side effects like tingling, aching, redness, or bruising are relatively rare, modest and short-lived.

Further, effects like these appear to be more common with higher energy treatments, particularly those from earlier generations of ESWT technology than that which we use. We’ll discuss more about the different ESWT technologies below.

How does ESWT work?

During EPAT therapy thousands of tiny acoustic sound waves are painlessly applied to the area of injury. The application of acoustic waves creates micro-ruptures in the capillaries of the tendon and bone and significantly increase the body’s response to send healing cells to the area.

The new cells improve the blood supply and the oxygenation resulting in expedited healing of the injury. This is the same technology that has been used in recent years to break up kidney stones without surgery and is now being applied to those with chronic pain and injuries.

This treatment is performed in our pain management clinic in Brooklyn on an outpatient basis and requires no anesthesia.