Shockwave and EMTT Treatments for Pain Management

Acoustic Wave Therapy is a non-invasive alternative treatment for active patients who are struggling with pain and not responding to conventional treatment after an injury. There is an immediate post-procedure reduction in pain and improved range of motion

Shockwave therapy devices deliver acoustic energy shockwaves in a phase of either nanoseconds or microseconds to stimulate healing in injured soft tissue, ligaments and tendons.

Shockwave treatment has been shown to have physiologic benefits by:

• Increasing cell permeability to create a localized inflammatory response. The energy coming into and out of the tissue increases blood flow, much the same as, but to a greater extent than, a deep tissue massage or percussive hand pressure device known as a TheraGun.

• Causing degradation of the nerve bundle (nociception inhibition), which allows for pain modulation via the peripheral nervous system.

• Upgrading the physiologic process of healing by stimulating hormones and cells that are associated with a reparative process of healing.

• Feet: Plantar fasciitis, Morton’s neuroma, nerve impingement or ligament injury

• Ankle: Chronic ankle pain, whether from osteoarthritis or ligamentous instability; a ligamentous defect in the ankle; gastrocnemius muscle strain or injury

• Lower leg: Achilles tendonitis; gastrocnemius muscle strain or injury; retrocalcaneal bursitis (heel pain)

• Knee: IT band; insertional pain; strain to the medial or lateral collateral (ligaments that form either side of the knee); jumper’s knee; patella tendinopathy

• Upper leg: quad injury or hamstring strain or injury

• Hand: strains and injuries

• Elbow: Little leaguer’s elbow; tennis elbow; tricep or bicep elbow injuries

• Hip: Gluteal muscle strain; bursitis; iliopsoas bursitis; hip flexor tendinosis

• Shoulder: Calcinosis of the rotator cuff; partial tear of the rotator cuff; bicep injuries

Patients will experience a number of fast pulses and some warmth.

“I tell patients that I would like for them to have less than 5 out of 10 discomfort. I call it discomfort; I don’t call it pain,’’ Piantanida said. “More discomfort is sometimes felt when we are doing the acoustic shockwave closer to a bone.’’

A little swelling and redness may also occur.

“As we treat tissue with energy, blood flow increases, so there may be some bruising with tissue. We are able to control the machine, so if we are told that the discomfort is 5 out of 10 when we start the machine, we’ll turn it down so it is more comfortable.’’

“The results of treatment are based on completion of the treatment. A lot of our patients, in my experience, even after the first treatment, are feeling significantly better and resuming some normal activity within 24 to 48 hours of the treatment.

“The nice thing about shockwave is you’re going to get results very quickly. Though we have six weeks set aside, I anticipate that many of these patients are going to be at their treatment goal within three to four weeks,’’ Piantanida said

Patients who have lingering injuries and who have not responded to time-honored methods of treatment and therapy are likely candidates.

“We are not willing to push shockwave ahead of all the other therapies (physical therapy). Having said that, there are a large number of patients who we see that deal with chronic or unrelenting pain from a sports or muscular-skeletal injury that may be 4 to 6 weeks in duration or it may be four months or six years in duration.

“Shockwave can handle all of that in terms of the therapeutic indication, but it is costly, so we want to make sure that we are using our health care dollars in a way that our patients are getting the best impact. There will be a variety of acute conditions where it may be relevant, but for the most part, these are patients who are at least four to six weeks out from the injury, and their response to therapy has yet to be realized in terms of the benefit.