What Is Extracorporeal Shockwave Therapy?

Extracorporeal Shockwave Therapy (ESWT) is innovative biological, highly effective and non-invaisive treatment for many orthopedic disorders of muscle and tendon. ESWT treatment belongs to the new type of treatments call regenerative orthopedics.

Why Is ESWT Considered a Biological Treatment?

ESWT therapy promotes self tissue healing( tissue regeneration) on a cellular level through activation of bodyies own healing responses on a cellular level.

Is ESWT a Really New Treatment ?

ESWT has been used in medicine for nearly 30 years for fragmentation of kidney stones(lithotripsy).

ESWT new application called orthotripsy (treatment of diseased tendons with shockwave)has been used in Europe with much success for nearly 15 years. Recently with multiple new research investigations in the field of regenerative orthopedics and biological treatments different types of ESWT technologies are gaining polpularity in US.

What Kind of Energy Is Used in ESWT ?

ESWT uses sonic(acoustic) or mechanical energy to treat diseased tissues in musculoskeletal system.

How Does ESWT Promote Healing?

  1. The strong mechanical pulse exerts pressure and a tension force on the afflicted
    tissues (damaged cells). The mechanical or acoustic signal is transduced within the cell intors TGF,VEGF AND eNOS) which are the main precursors of tissue healing.
  2. ESWT can remodel damaged tissues by modulating tissue plasticity.
  3. ESWT breaks down pathological deposits of calcium in the soft tissues which is followed by a absorption of the calcium. Excessive deposits of calcium in soft tissue is believed to be the underlying pathological condition for many types of musculoskeletal pain (e.g. painful shoulder tendonosis/tendinitis).
  4. ESWT stimulates osteoblast activity (bone cells) which is responsible for healing and new bone growth.
  5. Lastly, ESWT is thought to diminish pain by stimulating what is known as the “gait control mechanism”.

In summation, acoustic waves that are transmitted through the surface of the skin are spread into the body and the body responds with increased metabolic activity around the area of the pain. This stimulates and accelerates the healing process and is especially useful for those suffering from chronic heel, shoulder, knee (patellar tendon), achilles, elbow and back pain.

Are There Any Side Effects Observed with ESWT?

The only possible side effect observed in 3% of population is mild bruising.

What Are the Indications for ESWT?

  1. Rotator cuff tendinopathy;
  2. Plantar fascitis / fasciopathy;
  3. Tennis elbow (radial epicondilitis;
  4. Golfers elbow (medial epicondilitis);
  5. Tendinosis calcarea (painful limitation of shoulder movement due to calcification of shoulder tendons);
  6. Bursitis (Bursitis is inflammation of a bursa. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees.);
  7. Patellar tendonitis (jumpers knee);
  8. Tibialis anterior syndrome;
  9. Achilles tendonitis;
  10. Achillodynia;
  11. Heel spur;
  12. Various chronic enthesiopathies (painful irritation of tendon attachments due to a degenerative process);
  13. Various sports injuries;
  14. Painful trigger points(acute and chronic painful neck,back, shoulder and etc. due to chronically shortened and thickened muscle tissue).

Many other conditions not listed above

How Is ESWT Treatment Performed?

It is a consensus of the worlds scientific community involved in ESWT research that ESWT SHOULD ONLY BE PERFORMED AFTER TISSUE IMAGING WITH DIAGNOSTIC ULTRASOUND OR MRI.

Targeted therapy with diagnostic ultrasoun is preferred.

What Are the Expected Results?

The beneficial effects of ESWT are often experienced after only 4 treatments. Some patients report immediate pain relief after the treatment, although it can take up to be pain free and/or have significant pain reduction.

What if I Have a Special Health Condition?

The safety and effectiveness of the ESWT procedure has not been determined on people with the following health conditions. Your docto perform the ESWT procedures.

  1. Malignancies;
  2. DVT (Deep Vein Thrombosis;

How Is the Treatment Performed?

Your medical professional localizes the pain region by IMAGING WITH ULTRASOUND. Coupling gel is then applied tor and moved over the pain region in a circular motion.

What Is the Duration of the Treament and How Many Treatments Will I Need?

Treatment sessions take approximately 5-10 minutes depending on the disorder to be treated. Generally, 4 treatment sessions are necessary at weekly intervals.

What Will Happen after the Treatment / Procedure?

You will receive posttreatment instructions from your physician to follow during your recovery.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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