As always, Advanced Rehabilitation Parkmore strives to provide you with the most up to date information so that you can make an informed decision on how you can get the best treatment to manage your injury, or treat your pain.
You will recall that we recently introduced you to Extracorporeal Shockwave Therapy (ESWT) in our blog "Shocking news!". You will also be aware that we are one of only a few practices to currently offer this treatment. We've received a number of questions on the subject and thought it would be useful to answer these questions for everyone's benefit:
1. How does ESWT work?
The exact mechanism of action is not yet fully understood, however the list below is based on scientific research articles, and the best evidence available:
- Analgesic effect - pain relief can be achieved through mechanical stimulation of the sensory nerves, utilising the Gate Control mechanism of pain relief - this means that hyperstimulation of the sensory nerves "shuts the gate" on pain stimulus, which are carried via different nerve fibre types to the brain
- Neovascularisation - ESWT causes increased blood flow to the affected tissue - even in relatively avascular tissues. This improved blood flow carries vital nutrients and oxygen to the tissue, and is part of the inflammatory response which is the trigger for tissue repair
- Inflammatory response - ESWT has been shown to stimulate the release of substance P, various prostaglandins, and likely also other cytokines (all inflammatory cells). In tissues where there is a chronic pain state and degeneration, the stimulation of these cells triggers the body's natural healing response
- ESWT is capable of breaking down calcific deposits (particularly within tendons) through the mechanical pulses created by the shockwave unit
2. Is ESWT harmful?
Some detrimental effects (such as tendon damage and disruption of blood vessels) have been shown in research, however these effects only occur at very high doses/intensities of ESWT. It is highly unlikely that such effects can occur in a clinical setting, as people will not tolerate the pain associated with such high doses without some form of local anaesthesia. As long as the treatment dose is monitored and controlled at a therapeutic level, no significant adverse effects have been shown.
3. Is ESWT painful?
ESWT can be painful at the time that it is administered, however the intensity and frequency of the waves can be manipulated to ensure that the treatment is tolerable. It is vital that the therapist is experienced to ensure that the treatment is tolerable, but still effective. The treatment may cause some discomfort for a couple of days, but this is normally mild and subsides quickly. The overall effect is normally one of pain relief.
4. Who can administer ESWT?
ESWT is becoming more widely available in physiotherapy, chiropractic, sports medicine and orthopaedic practices. The evidence seems to show predominantly positive treatment effects, and it is therefore no wonder that every practice wants to be in on the act! Before you go ahead with the treatment though, MAKE SURE OF THE FOLLOWING:
- The therapist must have the appropriate training in administering the treatment to ensure your safety and to give the treatment the best opportunity to be effective. Anyone can point a probe, but not everyone knows why!!
- The therapist must have the ability and skills to clinically diagnose your problem, must have a thorough understanding of the physiology of your injury, with an indepth knowledge of the relevant anatomy, as well as knowledge of the physiological effects of the treatment. These factors will determine how effective the treatment will be
- ESWT should be used as an adjunct to your treatment and not as a stand-alone treatment. The treatment itself only lasts a few minutes, but don't waste your money on multiple quick, costly sessions without also receiving treatment to address the cause of the problem, whether that be errors in training programmes, overuse, biomechanical errors or compenstory postures and movement patterns
- The equipment must be up to the task - ESWT needs to be administered at a therapeutic dosage which can only be achieved by having the right equipment. We are fortunate to be able to offer our treatment using the Storz Medical MP100 unit, widely considered to be one of the best shockwave units around
At Advanced Rehabilitation Parkmore, we believe that we tick all the boxes!!
REMEMBER - WE'RE HERE TO GET YOU BETTER!!
5. How many sessions are needed?
The largest international study collaboration on shockwave therapy (known as the ASSERT programme - Assessment of the Effectiveness of Extracorporeal Shockwave Therapy for Soft Tissue Injuries) recommends up to 6 sessions depending on the progress of your condition. Your physiotherapist will re-assess your condition at every session and adapt your treatment protocol as appropriate.
Phone or email us today to make an appointment, or speak to our physios if you would like to discuss whether this treatment is suitable for you.