Shockwave Therapy is available at Karak & Wilson Podiatry Group.
Shockwave Therapy FAQ:
- Why does ESWT work?
Substance P is released in the short term, resulting in less sensitivity to pain. In the long term this affects the regulation or fortune pathways towards a healing response. Also an enhanced metabolism, neo-vascularisation and osteoneogenesis can be seen.
- What happens to soft tissue and bone during the procedure?
a) Occasional Side-effects are petechiae and slight oedema.
b) Enhanced metabolism can be seen due to the low energy density emitted, damage of bone is prevented.
- How painful is the treatment? Is anaesthesia required?
It is painful, but the majority of the patients can bear it, especially if the treater is encouraging and talks them through the issues.
E.g.10% of the heel spur and 25% of the tennis elbow patients required a slow ramp up of pressure for approximately 500 shocks to pre-analgese the site.
- What is the difference between Focused machines and the Swiss DolorClast®?
Focused machines are more expensive, their size and weight is bigger. Compared to the big machines, the handling with our equipment is a lot easier, as the equipment can be moved to the patient. The pain of Focused machines is so strong that analgesia is regularly required.
- Where is the focus for the shockwaves?
The Radial Shock Wave Therapy® technology does not require any focussing system. The diseases treated are all very close to the skin surface therefore we do not need a focussing system. See scientific data.
- What additional indications can be treated?
Doctors are also treating many small pain syndromes in areas which are recalcitrant to treatment. We have no RCT studies on these. But we know that the treatment does not harm tissue and promotes a healing response and extra bloodflow. If pain relief is required it may be a useful tool to use from time to time and your clinical judgement needs to be used
- Is there a treatment pre and post feedback form?
Yes, there is. We have differentiated between important and useful information about the patient. However, the follow up will be made easier and standardized with the help of this protocol.
- How can you prove that the bone is not damaged?
The historic scientific data of animal trials etc. e.g. the work of Rompe (“Extrakorporale Stoßwellenlithotripsie”, Chapman & Hall) or Siebert (“Extra-corporeal Shock Waves in Orthopaedic”, Springer), no indications of bone damage has been seen in the energy area we are using (see question 2 )
- What about long-term follow up?
RCT studies are available as are the lower level data. Follow up beyond 1 year is common.
- What is the recurrence rate and adequate proceedings?
As you can see in studies, this figure is very low. However, looking into the details, you can see that mainly professional sportspeople have a higher recurrence rates, but this is not unusual. In this case, a new treatment is indicated.
- Is the DolorClast FDA-approved?
Yes. With results 50% better than Focused machines in the study area- Plantar Fasciitis
- Why do you need no online localization like x-ray or ultrasound?
As the focus is always situated on the skin surface, no control of focal depth is required.
However, a diagnostic imaging of the area to be treated can be useful, particularly before the treatment of a calcified shoulder.
- Why is a treatment of more than three times not effective?
Because of historical empirical data and in order to ensure the quality, it has been decided in the protocol of studies not to do more than three treatments, which was important for the quality.
In practice, however, if pain is reduced after the first three treatments, it may be effective to make a fourth or fifth treatment.
- How do you determine the number of treatments?
Reasons to stop: If pain is cured or if two treatments show no effect.
- What is the time frame between treatments?
The time frame is one to two weeks between the sessions, until the side-effects of the treatments are gone.
- How much time does one treatment need?
The time depends on the frequency used, e.g. 3,33 min at 10 Hz / 2000 impulses.
- How do you decide on the frequency?
The level of frequency depends very much on the patient’s tolerance, the procedure should start at 2.5 bar and can be increased after 300 - 500 shots up to 3 bar if the pain tolerance is OK. If it is too painful a drop in pressure level to ramp up the power will usually resolve the issue.
- When will the effects of the treatment be visible?
Immediately after the treatment, there will be an analgesic effect due to the treatment, therefore the patient will be pain free or nearly pain free. After a few days you will see the real result. Sometimes the pain increases after e.g. one day, but will decrease afterwards.
- How deep does the radial shockwave penetrate?
We have found a therapeutically effective penetration depth of up to 3.5 cm for in therapy of the heel spur, which is the deepest area of all indications. In all other cases, the distance to the pain region is closer to the surface and therefore also closer to the application tip.