Home Treatment Methods Extracorporeal Shockwave Therapy ESWT / EPAT

Extracorporeal Shock Wave Therapy ESWT

About Shockwave Therapy at NYDNRehab

Shockwave therapy begins with a tissue scan using the highest resolution ultrasound equipment. Once we identify the treatment area, we map the focal region, including target size and depth. Next, we mark the area to be treated and set our transducer at the appropriate depth. We use high-resolution ultrasound imaging to guide the shockwave procedure, to ensure accuracy. To follow up after the shockwave procedure, we use high-resolution ultrasonography to monitor the healing process and visualize any changes in the tissues over time.

Dr.Kalika has over 20 years of experience in ultrasound guided procedures. He has been an active member of the International Society of Medical Shockwave Therapy (ISMST) since 2007, and has treated thousands of patients using ESWT. Our clinic features the only shockwave equipment available that lets us combine focused, defocused and radial shock waves.

Click here to learn more about shockwave therapy…

We’re located on 25th street in Manhattan NYC.
Open Monday-Friday, 10am-8pm.

What are Dr. Lev Kalika's qualifications for shockwave therapy? How does ultrasound improve shockwave outcomes? What are the different types of shockwaves? What conditions can be treated with shockwave therapy? What other regenerative technologies are used with shockwaves? Why should I choose NYDNRehab for shockwave therapy? Shockwave therapy FAQs

Some Important Facts about Shockwave Therapy

While there is no perfect regenerative modality, research shows ESWT to be the leading regenerative treatment, surpassing the effectiveness of stem cell and platelet-rich plasma (PRP) injections.
Shockwave therapy is completely non-invasive, with no known side effects.
ESWT is the best treatment modality for tendon injuries.
ESWT is second only to Stecco fascial manipulation and ultrasound guided dry needling for treating myofascial pain and releasing myofascial trigger points.
To treat any pathology, shockwave should be done using ultrasound imaging, to determine the depth of damaged tissues and deliver focused treatment. It is impossible to deliver the most effective combination of shockwaves without visualizing the tissues.
Some pathologies have multiple components and need to be treated with a combination of energy waves (focused, radial and unfocused). For example, Achilles tendinopathy can require focused waves mid-body, the peritenon may need defocused waves, and the myotendinous junction may need radial. At the same time, the Kager’s fat pad may need focused waves where the Achilles tendon meets the fat pad, while the tendon itself may need less focused energy.
EMTT can be used to treat pathologies that shockwave does not work for, and to improve or speed up the results of shockwave therapy. When combined with shock wave therapy for pain relief, EMTT makes ESWT 20% more effective.

Actions Achieved with Shockwave Therapy

Most injuries involve multiple types of tissues at varying depths, covering varying amounts of area. The majority of clinics that offer shockwave therapy as a service only offer radial EPAT therapy, which is only effective for limited types of conditions. At NYDNRehab, we combine different types of shockwaves to penetrate varying depths, cover specific areas, and apply appropriate energy for individual tissue types.

Different types of shockwaves can be combined to accomplish multiple goals in a single session:

Neovasculogenesis
Autologous stem cell proliferation
Nitric oxide release
Collagen remodeling
Bone regeneration
Pain neuromodulation
Tendon regeneration
Restoration of hyaluronic acid
Scar softening
Nerve regeneration
Breakup of soft tissue calcifications
Release of growth factors

Dr. Lev Kalika

Clinical director & DC RMSK

About Shockwave Therapy Specialist Dr. Lev Kalika

Dr. Kalika is an esteemed member of the International Society for Medical Shockwave Treatment ((SMST). He is the only clinician in New York certified by the ISMST to perform extracorporeal shockwave therapy. Dr. Lev Kalika is a world-renowned expert in musculoskeletal ultrasonography, and has published multiple peer-reviewed articles about ultrasound guided procedures. The clinic at NYDNRehab features the most advanced focused, defocused, linear and radial shockwave equipment available in NYC, enabling us to effectively target different tissue types by adjusting the frequency, intensity and depth of the focal zone, and allowing us to select and combine different types of shockwaves to treat specific types of tissues. Our use of ultrasound imaging to guide shockwave procedures ensures that the shockwaves hit their mark, to produce optimal results. Dr. Kalika’s 20+ years of experience and expertise in ESWT and diagnostic ultrasound imaging make NYDNRehab the clinic of choice for extracorporeal shockwave therapy in NYC.

Ultrasound Guidance for Fast Results

Technology provides us with sophisticated tools for treating musculoskeletal disorders, but technology alone is not enough to successfully repair damaged tissues. Tissue regeneration is an incredibly complex process that requires a broad understanding of physics, biology, anatomy, movement, and imaging.

Prior to your first regenerative shockwave treatment, we perform a diagnostic ultrasound scan. Ultrasound imaging lets us identify the precise area of concern, and helps us to select the right pulse frequency and gauge the size and depth of the targeted tissues. This allows us to select the most appropriate machine, as focal zones and wave types differ for different injuries. We then mark the area to be treated and set our equipment to the appropriate depth and angle, ensuring that the focused shockwaves render the greatest benefit.

Ultrasound guidance enables us to:

Precisely locate the affected tendon or soft tissue
Identify the most affected part of the tissue
Measure the desired depth of penetration
Measure tissue density using sonoelastography, to select the most effective type of shockwave and the pulse frequency
Classify the state of the tissue before and after treatment

Ultrasound guided shockwave therapy is the gold standard for shockwave treatment. Ultrasound guidance ensures that the focused shockwaves precisely reach the intended site of treatment. Diagnostic ultrasound also allows us to visualize any changes in the treated tissues, to help track the healing process. A growing body of research shows that ultrasound guided procedures are 40% more effective than procedures performed blind. Every pathology is unique to the individual patient, and without detailed imaging, the clinician cannot accurately diagnose and treat musculoskeletal disorders. Ultrasound imaging enables us to visualize minute details, such as:

Types of tissues involved – most injuries involve multiple tissue types
Type of tissue pathology
Tissues surrounding the application field that may be affected
Depth and anatomical course of involved tissues to determine shockwave type and penetration depth
Multiple radiologic parameters of tissue quality to determine the type of shockwave and energy used
The ability to image multiple joints, tendons, ligaments, muscles and fascia, to understand the cause of pain, which almost always originates somewhere away from its locus

Advanced Shockwave Therapy at
NYDNRehab

Extracorporeal Shockwave Therapy (ESWT), Myofascial Acoustic Compression Therapy (MyACT), SoftWave Electro-Hydraulic Shockwave, and Extracorporeal Magnetic Transduction Therapy (EMTT) are the most advanced and highly effective non-invasive treatment technologies approved by the FDA for neuromuscular disorders. The latest research shows that using a combination of different types of shockwaves provides the best therapeutic results, often 20-30% greater than using only a single shockwave technology. A combination of focused electromagnetic (FemESWT) and defocused electro-hydraulic (Deh-ESWT) provides the greatest versatility for treating a large variety of musculoskeletal pathologies. Results are even greater when fascial adhesions and densifications are addressed. At NYDNRehab, we combine different shockwave types in the same session, with no extra cost to the patient.

Focused Extracorporeal Shock Wave Therapy (ESWT)

At NYDNRehab, we use three different shockwave machines for focused, defocused, linear and radial shockwave treatment. Each type of shockwave has its own advantage over the others, to address different types of tissues. Most pathologies involve multiple tissue types, and they are all connected. With multiple options for treatment, we are able to vary the depth and width of penetration, zoom in to focus on specific tissues, and zoom out to cover larger areas.

This proprietary technology is based on a unique set of pressure waves that stimulate the metabolism, enhance blood circulation and accelerate the healing process. After treatment, damaged cells gradually regenerate and damaged tissues eventually heal. These non-invasive outpatient procedures represent breakthrough treatment options for a broad range of musculoskeletal conditions.

Extracorporeal Magnetic Transduction Therapy (EMTT)

Radial vs Focused Shockwaves

Focused shockwave therapy penetrates deeper tissues, causing tissue membranes to vibrate and create pressure waves in their surrounding fluids without losing energy. Focused shockwaves target a smaller focal area. Ultrasonography is often used in conjunction with focused shock wave therapy to accurately visualize deep tissues. Focused shock waves are most often used for:

Acute athletic injuries
Bone fractures
Shin splints
Groin pain
Achilles tendon pain
Medial and posterior tibial pain
Ankle sprains
Wound healing

Radial shockwave therapy is the most common form of ESWT, used for a larger treatment area at a more superficial level. Radial shockwaves emit their greatest energy at the skin’s surface, and lose power as their energy penetrates deeper tissues.

Radial shock waves are most often used for:

Superficial tendinopathy
Superficial trigger points
Myofascial pain
Plantar Fasciitis
Greater trochanter (hip) pain
Spasticity management for stroke, cerebral palsy, multiple sclerosis, dystonia and writer’s cramp

Radial and focused shockwaves are often used in combination to treat acute and repetitive overuse injuries in athletes.

Focused Extracorporeal Shock Wave Therapy (ESWT)

EPAT vs ESWT

EPAT radial waves are often advertised as shockwave therapy, but they are not true shockwaves – they are mechanical pressure waves that have only very mild regenerative effects on muscles and fascia.

EPAT has very shallow penetration depth, 3-4 times less than focused shockwaves. Its mechanical waves do not stimulate stem cell production, and its energy waves are dispersed and cannot be focused. EPAT cannot be used near bone surfaces or entheses, as it causes too much pain. EPAT is ineffective for tendon pathologies where the entheses – the transitional cells between tendon and bone – are responsible for generating biological growth factors.

EPAT can be beneficial for fascial collagen remodeling and elimination of fascial densifications, and helps increase the blood supply to superficial muscle tissue. At NYDNRehab, we combine different types of shockwaves supplemented with EPAT, to make the treatment more holistic without additional cost to the patient.

Extracorporeal Pulse Activation Technology (EPAT)

Conditions We Treat with ESWT, EPAT
and EMTT

Trigger points and myofascial pain
Tendon ruptures
Motor disorders
Soft tissue injuries
Fascia densifications and adhesions
Chronic inflammation
TMJ pain
Back and neck pain, and sciatica
Shoulder and rotator cuff pain
Elbow pain

Pelvic disorders and pain
Reproductive disorders
Hip pain
IT band syndrome
Knee pain
Shin pain
Ankle pain
Heel pain
Bone fractures

ESWT for Myofascial Pain

Shockwaves have been used successfully for years to treat bone fractures, tendon ruptures and soft tissue injuries, and it is widely accepted that shockwaves have different effects on different tissue types. Until recently, little research has been done to measure the effects of ESWT on myofascial tissue.

Fascia has unique characteristics compared to other tissue types, and data from research on tenocytes and skin fibroblasts cannot automatically be translated to fascial tissue. Fascia is highly innervated with both sensitive and autonomic nerve fibers, and alterations to fascia can generate myofascial pain that affects movement quality.

The fibrotic component of fascia shares certain characteristics with tendons in the respect that it is highly collagenous. Type 1 collagen is a major component of fascia, and type 3 collagen plays a key role in the early stages of fascial injury repair. But unlike tendon tissue, fascia has gliding and elastic properties that depend on the presence of hyaluronan (HA), a polymer that binds to water, with the capacity to retain up to 1000 times its weight in water.

A recent 2022 study explored the effect of ESWT on fascia, and demonstrated for the first time that shockwaves can lead to in-vitro production of hyaluronan-rich vesicles, immediately after treatment. ESWT has been shown to stimulate an increase in cell proliferation and synthesis, and remodeling of the extracellular matrix.

The researchers observed an immediate release of hyaluronan-rich vesicles, along with type 1 and type 3, as soon as one hour post-treatment. Tissue proliferation increased at 4 hours, and was maintained at 24 hours. They concluded that fascial cells respond to ESWT by regulating and remodeling the extracellular matrix (ECM).

At NYDNRehab, we use a combination of focused and defocused shockwaves to treat myofascial pain, in conjunction with fascial manipulation therapy.

ESWT and Chronic Inflammation

ESWT can be used to reverse chronic inflammation that occurs when the inflammatory response is not completely halted. Chronic inflammation can damage healthy areas of the body, causing chronic pain. ESWT stimulates mast cells to release pro-inflammatory compounds like cytokines and chemokines. This stimulates the regeneration of healthy cells and helps restore normal healing.

ESWT and Tendon Healing

ESWT can help the body to produce more collagen. Collagen is a protein found throughout the body that gives tendons and ligaments their structure. The collagen fibers produced by the body after shock wave therapy are forced into longitudinal structures that make tendons stiffer and denser, stopping and reversing tendon degeneration.

ESWT and Trigger Point Therapy

Trigger points are tightly contracted bands of muscle tissue that are the principal cause of pain in the back, neck, shoulders and limbs. Their dysfunctional sarcomeres contract so tightly that they begin to cut off their own blood supply. This causes a buildup of waste products, which in turn irritates the sensory nerve endings, causing even more pain. This vicious cycle is called a metabolic crisis.

Although the precise mechanisms of ESWT’s effect on trigger points is unclear, it is assumed that the delivered acoustic energy unblocks the calcium pump in the sarcomere, causing the trigger point to release and immediately stopping pain.

ESWT and Motor Disorders

ESWT can be successfully used to treat and manage spasticity after stroke, and in motor disorders such as cerebral palsy, multiple sclerosis, dystonia and severe writer’s cramps.

Exciting New Research Supports Shockwave
Efficacy for Pelvic and Reproductive Disorders

Our years of experience using shockwave therapy have helped hundreds of patients to successfully eliminate musculoskeletal pain and dysfunction. Today, a treasure trove of research is emerging that supports the efficacy of shockwave therapy for treating pelvic and reproductive disorders.

Recent research has found shockwave therapy to have long-term success in treating:

Pelvic disorders are common in both men and women, but patients are often reluctant to seek treatment due to embarrassment. Shockwave therapy provides a safe, non-invasive and effective solution for a broad range of pelvic and reproductive disorders, with minimal discomfort for the patient. Treatment sessions are brief, and many patients report improvement after their very first session.

Combined RegenerativeTechnologies
Bring Fast Therapeutic Results

The human body has its own innate healing mechanisms, but it sometimes needs a nudge to accelerate the healing process. Regenerative technologies help to jump-start healing by stimulating tissue repair at the cellular level. Our outpatient regenerative therapies expedite recovery with minimal discomfort for the patient.

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is used as a regenerative treatment for damaged tendon, muscle and bone tissue. This technology produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.

SoftWave Electro-Hydraulic Shockwave Therapy

SoftWave is a groundbreaking regenerative mechanotransduction technology that accelerates tissue healing. Its patented electro-hydraulic applicator delivers high-speed soundwaves that can penetrate up to six inches in depth. SoftWave’s defocused and linear focused shockwaves recruit maximum stem cells to the treatment site to promote healing. SoftWave’s wider and deeper penetration using defocused energy is a preferred treatment option for a broad spectrum of conditions, ranging from orthopedic injuries to pelvic health.

SoftWave Electro-Hydraulic Shockwave Therapy

Myofascial Acoustic Compression Therapy (MyACT)

MyACT is a new type of focused shockwave technology that allows for deeper compression of the focused waves. Its higher frequency allows for precise neuro modulation under ultrasound guidance, with a special linear head for treating myofascial pain. This innovative shockwave technology transforms the mechanical energy of shockwaves into biochemical signals that precisely target damaged tissues. Its versatile controls let us fine-tune its output levels for precise and personalized patient care.

Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT is a fairly new technology that transmits high energy magnetic pulses to targeted tissues. The magnetic waves synchronize with the body’s own magnetic fields, causing a disturbance that triggers a regenerative response. EMTT waves can penetrate deep tissues up to 18 cm beneath the skin’s surface, to target difficult-to-reach tendons, muscles, bones and nerves.

Extracorporeal Magnetic Transduction Therapy (EMTT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, sometimes called defocused shock wave therapy, is not a true shockwave. It uses mechanical pressure waves to enhance blood circulation, improving oxygen and nutrient delivery to muscle and fascia tissues, but has minimal regenerative properties. We combine EPAT with different types of shockwaves for holistic treatment, without additional cost to the patient.

High Energy Inductive Therapy (HEIT)

HEIT uses electromagnetic fields to penetrate cells, tissues, organs and bones, to reactivate the electrochemical function of cells and cell membranes. HEIT generates a magnetic field 600 times stronger than the field of a normal magnet, to stimulate healing of nerves, muscles and blood vessels.

High Energy Inductive Therapy (HEIT)

Ultrasound Guided Injection Therapies and
Orthobiologic Procedures

Orthobiologic injection therapies use natural/neutral solutions that stimulate cellular repair by either nourishing or irritating the targeted cells. Dr. Kalika teams up with an orthobiologic injections specialist to ensure accuracy via ultrasound guidance, for maximum effectiveness.

Platelet Rich Plasma (PRP)

PRP therapy uses a sample of the patient’s own whole blood, which is spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active factors such as growth factors, cytokines, lysosomes and adhesion proteins. The injected solution stimulates the synthesis of new connective tissues and blood vessels. PRP can help to jump-start healing in chronic injuries and accelerate repair in acute injuries.

Proliferation Therapy, aka Prolotherapy

Prolotherapy uses a biologically neutral solution, often containing dextrose, saline or lidocaine. The solution irritates the affected connective tissue, stimulating the body’s own natural healing mechanisms to encourage growth of new normal ligament or tendon fibers.

Why Choose NYDNRehab for Shockwave Therapy

Dr.Kalika has spent over 20 years refining his approach to diagnostic musculoskeletal ultrasonography. He has extensively studied the qualities of different shockwaves and their effect on different tissue types, and has perfected his approach to local and global shockwave therapy.

Many practitioners who perform shockwave therapy are under-qualified:

They are not certified
They perform blind procedures without imaging.
They apply shockwaves at the locus of pain,without fully understanding the patient’s diagnosis and unique pathology.
They do not understand the principle of tensegrity and the role of fascia in the greater kinetic chain.
They perform more shockwave applications than are safe, effectively breaking down tissue instead of regenerating it.
They promote shockwave therapy with sales pitches that do not match the patient’s diagnostic profile, making promises they cannot deliver.

When applied appropriately by a trained and certified clinician, shockwave therapy is the most effective and broadest regenerative treatment available, but its inappropriate application can be completely ineffective. Shockwaves deliver immediate anesthetic relief to patients, but when performed too frequently, they can destroy tissues instead of healing them.

Don’t settle for shockwave therapy that falls short of its promises. To get the safest, most accurate and effective shockwave therapy in NYC, contact NYDNRehab today!

Our Awards

Shockwave Therapy at NYDNRehab

Is Shockwave Therapy Safe?

Shockwave therapy is a noninvasive FDA-approved treatment method. When delivered by an experienced clinician, ESWT is considered safe, inexpensive, fast and effective. Shockwave therapy spares the patient from the dangers of unnecessary surgical procedures and the negative side effects of medications.

How many shockwave therapy sessions will I need?

The number of shockwave therapy sessions needed to heal your injury will depend on the specifics of your condition and your body’s response to treatment. Most people need between 3-6 sessions, spaced about a week apart. Too many sessions, too close together, can actually cause the tissue to break down instead of heal, so beware of clinics recommending too many or too frequent treatments.

What conditions are most successfully treated with shockwave therapy?

ESWT is especially effective for treating injured tendon tissues in the ankles, knees, hips, shoulders, wrists and elbows. It is also used to treat bone fractures and muscle injuries, along with conditions like plantar fasciitis and carpal tunnel syndrome. It is important to note that shockwave therapy is not a magic bullet on its own, and you may benefit from complementary therapies that enhance the effectiveness of ESWT.

Who should avoid shockwave therapy?

Avoid shockwave therapy if you are pregnant, have a blood clotting disorder, are taking blood thinners, have cancer, or have neuropathy or an active infection in the treatment area. ESWT is contraindicated if you have a pacemaker, or have had a recent steroid injection at the treatment site. You should consult your doctor prior to getting shockwave therapy.

Certificates and Continuing Education

Research at NYDNRehab

June 6-9th 2024Precision and functional application of ultrasound-guided extracorporeal shock wave therapy in neuromusculoskeletal pathologies: A multicenter retrospective study. 26th ISMST World Congress

Feb. 2024The efficacy of extracorporeal shock wave combined with platelet rich plasma in the treatment of knee osteoarthritis with meniscus injury: A retrospective analysis

Jul. 2022TARGETED ULTRASOUND-GUIDED SHOCKWAVE THERAPY OF LOW BACK PAIN USING FOCUSED, DEFOCUSED AND RADIAL SHOCKWAVE

Sep. 2019Comparative Study of Dry Needling under Ultrasound Guidance and Extracorporeal Shock Wave Therapy for Myofascial Pain and Spasticity Management Meeting: 2019 International Congress R. Bubnov, L. Kalika (Kyiv, Ukraine)

Physical therapy and rehab can be time consuming,

and a faulty diagnosis can make treatment a total waste of time.

Failure to accurately diagnose a condition in its early stages can lead to chronic
problems and sometimes devastating results

Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.

Below is a prime example of how ultrasound can take the guesswork out of diagnosis.

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Accurate Diagnosis Is the ONLY way to

Successful Treatment

A bad physical therapy experience is one of the primary causes of unnecessary surgery

At NYDNR, we believe in

medical innovation

We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.