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Extra-corporeal shock wave therapy (ESWT) is a treatment used to treat tendon pathology - as well as other musculoskeletal pain. Conditions where this type of treatment has been shown to be effective include plantar fascia pain (plantar fasciitis), Achilles tendinopathy (tendinitis) and hamstring pain. In some cases it has been shown to be more effective than three months of traditional rehabilitation. The treatment does not require any anaesthesia, injections or surgery and is quick and easy to perform.
What to expect
Your doctor will locate the area of pain through palpation. This area will then be marked and some ultrasound gel applied.
The shock wave impulses are delivered using a hand-piece. It takes about five minutes to deliver a single treatment. This is generally said to be uncomfortable (rather than painful) and is well tolerated by the vast majority of patients.
This process is repeated a total of three times - with a week between treatments. Some patients note an immediate improvement in their pain, however the best results occur 12 weeks after the initial treatment.
How does it work?
ESWT initially reduces pain through what is known as 'hyperstimulation anesthesia'. The nerves sending pain signals to the brain are stimulated to such an extent that their activity diminishes, thereby decreasing or eliminating pain.
ESWT alters the release of the pain mediator and growth factor Substance P. Substance P is responsible for causing slight discomfort during and after shock wave treatment. Over time the shock waves lead to the depletion of substance P from free nerve endings. Less substance P in the tissue results in reduced pain. Less substance P also causes so-called neurogenic inflammation to decline.
Extracorporeal shock waves also produce a regenerative or tissue-repairing effect in musculoskeletal tissues. They appear to stimulate the release of growth factors and an improvement in blood supply leading to repair of tendon and bone. These are the mechanisms by which a long-term improvment in symptoms occurs.
What conditions does it work for?
ESWT has been used in sports medicine clinics worldwide for a number of years. It is not a new treatment. There is scientific evidence to show that:
It is as effective as 3 months of eccentric strengthening for Achilles tendinopathy
It is an effective treatment for proximal hamstring tendinopathy in professional athletes
It is superior to eccentric strengthening and more 'traditional' rehabilitation techniques for insertional achilles tendinopathy
It is an effective treatment for plantar fascia dysfunction (fasciitis) and has been FDA approved for this condition
It is effective for treating trochanteric pain
Can be used to treat tennis and golfers elbow (tendinopathy affecting the common extensor and flexor tendons at the elbow)
If you would like to learn more about this treatment please feel free to arrange an appointment with one of our physicians.
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