Extracorporeal Shockwave Therapy or ESWT

Extracorporeal Shockwave Therapy or ESWT is a treatment used in physical therapy, orthopedics, urology and cardiology. 

The shockwaves are abrupt, high amplitude pulses of mechanical energy, similar to soundwaves, generated by an electromagnetic coil or a spark in water. Similar technology using focused higher energies is used to break up kidney and gallstones, and is termed lithotripsy. “Extracorporeal” means that the shockwaves are generated externally to the body and transmitted from a pad through the skin.

Medical uses[edit]

Extracorporeal Shockwave Therapy is used to treat a growing number of tendon, joint and muscle conditions. These include tennis elbow,^[1] where results in double blind studies are reported as excellent. Chronic tendinitis of the knee^[2] and shoulder rotator cuff pain,^[3] achilles tendinitis,^[4] hamstring tendinitis,^[5] plantar fasciitis are also treated successfully.^[6][7]

The above conditions are often difficult to treat using other methods and can become chronic. With ESWT patients report reduced pain and faster healing, without significant adverse side effects. However, the treatment has proven challenging to verify categorically in large controlled studies, in part because the therapist and patient are aware whether or not they are in the treatment cohort or the sham cohort^{[citation needed]}.

ESWT is also used to promote bone healing and treat bone necrosis.^[8] It is an effective alternative to surgical treatment of non-healing fractures.^[9][10]

ESWT is used for wound healing and has shown positive results in short-term and long-term outcomes in diabetic patients suffering from foot ulcers.^[11]

Chest pains associated with heart disease, known as angina have been treated successfully with ESWT. Studies have shown that the shockwaves promote the growth of new blood vessels or revascularization.^[12]

Since 2010 shockwaves have been used in urology, to treat chronic pelvic pain syndrome^[13] and erectile dysfunction. Unlike drugs ESWT is non-invasive, without side effects and promotes long term healing. There are a growing number of double blind sham controlled double blind studies that show success rates of up to 80%.^[14]

Physiological mechanisms[edit]

Shockwaves stimulate angiogenesis (new blood vessels) and neurogenesis (new nerve cells).^[15] The exact physiological mechanisms at this stage are poorly understood, but it appears that the cells undergo microtrauma which promotes the inflammatory and catabolic processes that are associated with removing damaged matrix constituents and stimulates wound healing mechanisms.^[16]

Procedure[edit]

Shockwave therapy on a patient.

When ESWT was used for plantar fascia treatment, the procedure used to be performed in an out-patient setting, under local anesthesia, taking up to 30 minutes. Now with newer and more portable technology, it can be done without anesthesia in the physician's office in less than 10 minutes. There are a variety of ESWT devices, manufacturers include Storz Medical, Dornier, EMS Swiss and Richard Wolf. Recent developments in applicator technology has led to additional indications such as back pain and fascia treatment^{[citation needed]}.

Patient receiving radial ESWT forlateral epicondylitis

Research indicates that there is significant reduction in intensity of application pain with the use of castor oil rather than ultrasound jelly.^[17] The positive effect of castor oil can be explained by its cavitation-free quality. The patient is afterwards able to walk out, the major complaint being of a thumping feeling on the heel. Because re-inflammation is being introduced, the patient cannot take anti-inflammatory medication afterward, nor should the area be iced. Acetaminophen/Paracetamol with codeine may be utilized^{[citation needed]}.

Contraindications for this procedure include: neurological and vascular disease of the foot; history of rupture of the plantar fascial ligament; open bone growth plates; pregnancy, implanted metal in the area (bone screws and pins); and people on medication that interferes with blood clotting such as coumadin and prophylactic aspirin^{[citation needed]}.

Approval[edit]