Extracorporeal Shock Wave Therapy

ESWT

Dr.Kalika has been an active member of ISMST (international society of medical shockwave) since 2007 and treated over 3000 patients using shock wave therapy since 2007. Our clinic features the only shockwave machine that combines focused, defocused and radial waves.

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Extracorporeal Shockwave Therapy (ESWT), Extracorporeal Pulse Activation Technology (EPAT) and Defocused Shockwave are the most advanced and highly effective non-invasive treatment technologies approved by the FDA for orthopedic musculoskeletal disorders.

This proprietary technology is based on a unique set of sound 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 regenerative treatment options for a broad range of musculoskeletal conditions.

Having performed thousands of procedures over the years, Dr.Kalika’s experience has shown that successful outcomes of shockwave therapy lie in precise ultrasound guidance and the combination of different types of shockwaves for optimal energy deliverance to different types of tissues.

Some facts about shock wave therapy

While there is no perfect regenerative modality, research shows ESWT to be the leading regenerative treatment, surpassing injections of stem cells and platelet-rich plasma (PRP).

  • Shock wave therapy is completely non-invasive, with no known side effects.

  • ESWT is the best treatment modality for tendon injuries.

  • ESWT is second only to ultrasound guided dry needling for treating myofascial pain and releasing myofascial trigger points.

The advent of new technologies over the past several years has opened a vast range of possibilities for therapeutic, non-invasive and non-pharmacological methods to help patients manage pain and heal damaged tissues.

One promising new therapy that is getting the attention of the medical community is extracorporeal magnetic transduction therapy (EMTT), a non-invasive treatment technology that uses electromagnetic fields to reduce pain and stimulate cellular neogenesis in targeted tissues.

NYDNRehab is pleased to offer this groundbreaking new technology to our patients to treat a variety of conditions, including joint and muscle disorders, bone fractures, athletic injuries and chronic pain conditions.

YOUR BODY’S Ability to heal is greater than anyone has permitted you to believe.

Combined Technologies Bring Fast Therapeutic Results

EPAT, also known as radial, shock wave therapy, uses acoustic pressure waves to enhance blood circulation to targeted tissues. This speeds up the delivery of oxygen and nutrients to damaged tissues and stimulates cellular metabolism, to speed up the healing process.

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.

Defocused waves can encompass larger areas with less concentration and energy.

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Focused, Defocused and Radial Shockwave

  • ESWT and EPAT are often used interchangeably even though the waves they deliver are different. ESWT is a true shockwave energy delivered to the tissues, while EPAT delivers a mechanical pressure wave. At NYDNRehab we use all three types of waves, depending on the nature of the patient’s pain or injury.

  • EMTT enhances the effectiveness of ESWT by helping to reduce inflammation in tissues surrounding the injured area and activating cellular metabolism prior to ESWT treatment. It revitalizes damaged cells and instigates healing, for immediate therapeutic results. EMTT technology is one of our clinic’s latest acquisitions.

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EMTT

Radial vs Focused Shockwave

ESWT can be administered using radial (pressure ), or focused (sound) shockwaves. Our choice is determined based on the specific needs of the patient.

Radial vs Focused Shockwave

Focused shock wave therapy uses a cylindrical coil to generate electromagnetic waves. It penetrates deeper tissues, causing tissue membranes to vibrate and create pressure waves in their surrounding fluids without losing energy. Focused shock wave is used to 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 shock wave therapy is the most commonly used form of ESWT. It is used for a larger treatment area at a more superficial level. It transmits kinetic energy to targeted tissues, creating a radial wave. Radial shock waves 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

  • Fascial adhesions

Radial shock wave therapy is also effective for managing spasticity in conditions such as 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.

The Underlying Science of Shock Wave Therapy

While it may seem counterintuitive, a small amount of damage needs to be done to the body to prompt it to repair itself. Shock wave therapy creates tiny ruptures in the capillaries that feed injured tissues. This prompts the body to start producing new blood vessels to replace the damaged ones. The tiny new blood vessels increase the blood supply to the injured area, increasing the flow of oxygen and nutrients necessary for healing.

Increased nutrient-dense blood flow is necessary for neovascularization to occur, to start and maintain the repair process of damaged tissue. The application of acoustic waves creates capillary micro-ruptures in tendon and bone and significantly increases the expression of growth indicators such as the eNOS, VEGF, PCNA and BMP. These processes stimulate the growth and remodeling of new arterioles. The new blood vessels enhance the tissue’s blood supply and oxygenation, resulting in accelerated healing of muscles, tendons and bones.

Sufficient amounts of collagen are also necessary for tissue repair. Shockwave therapy hastens procollagen synthesis. The newly created collagen fibers are forced into a longitudinal structure, making tendon fibers denser and stiffer.

Trigger points are the principal cause of pain in the back, neck, shoulder and limbs. They are palpable nodules in taut bands of muscle fibers that have extremely contracted sarcomeres. The dysfunctional sarcomeres contract so tightly that they begin to cut off their own blood supply. This causes the build-up of waste products which in turn, irritates the sensory nerve endings, causing even more contraction. This vicious cycle is referred to as a metabolic crisis. Although the precise medical effects of acoustic wave therapy are still unclear, it can be assumed that the delivered acoustic energy unblocks the calcium pump, thus reversing the metabolic crisis and releasing the trigger points.

ESWT and Plantar Fasciitis

ESWT and Plantar Fasciitis

New York Dynamic Neuromuscular Rehabilitation uses several modalities to diagnose plantar fasciitis, including ultrasound and clinical examination. If the case is complicated, we may even perform a thorough gait analysis using advanced technology. Shock and pressure wave therapies are very effective for treating plantar fasciitis, with studies reporting a success rate of about 92 percent. Contact us for a consultation on the benefits of ESWT for plantar fasciitis.

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

Radial vs Focused Shockwave

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.

What are the indications for ESWT?

  • Pain

  • Chronic Tendon Conditions

  • Muscle Pain

  • Myofascial Pain Syndrome

  • Fascial Adhesions And Densifications

  • Stress Fractures

  • Bone Reactions

  • Bone Edema

  • Non-Unions

  • TMJ Pain

  • Back Pain

  • Scar Tissue Formation

  • Skin Conditions

  • Wounds

  • Peripheral Mono-Neuropathy

  • Erectile Dysfunction

Extracorporeal shockwave therapy

Treatable Disorders

Treatable Disorders
  • Rotator cuff tendonitis
  • Plantar fasciitis

  • Tennis elbow (radial epicondylitis)
  • Golfers elbow (medial epicondylitis)

  • Tendinosis calcarea (calcific disease of rotator cuff tendons)

  • Hip bursitis/tendinosis
  • Sheen splints

  • Patellar tendonitis (jumper’s knee)

  • Tibialis anterior syndrome

  • Stress fractures

  • Stress reactions

  • Sesamoiditis

  • Metatarsalgia

  • Achilles tendonitis

  • Achillodynia

  • Low back pain
  • Scar tissue

  • Morton’s neuroma

  • Initial Spondylolysis

  • Hip impingement caused by an Os acetabuli

  • Necrosis of the femoral head

  • Bone bruise of the femoral neck

  • steochondritis dissecans of the medial femoral condyle

  • Osgood-Schlatter disease

  • Nonunion of a distal fibular fracture

  • 4th metatarsal stress fracture

  • Navicular stress fracture

  • Sesamoid Osteochondrosis

  • Painful Os tibiale externum

  • Apophysitis calcanei

  • Heel spurs

  • Hallux limitus

  • Hamstring disorders
  • Tendinosis of peroneal tendons, tibialis posterior

  • Various chronic enthesiopathies (painful irritation of tendon attachments due to overexertion and improper strain, or due to a degenerative process)

  • TMJ
  • Frozen shoulder
  • Bone non-unions

  • Osgood-Schlatters disease

  • Various sports injuries

  • Painful trigger points (acute and chronic painful neck, back, shoulder and etc. due to chronically shortened and thickened muscle tissue)

  • 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)

  • Many other conditions not listed above

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. 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.

The importance of ultrasound guidance for ESWT

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Research at NYDNRehab

01.04.2021 Comparative study of dry needling under ultrasound guidance and extracorporeal shock wave therapy for myofascial pain and spasticity management | Cochrane Library https://nydnrehab.com/Comparative_study_of_dry_needling_under_ultrasound_guidance_and_extracorporeal_shock_wave_therapy_for_myofascial_pain_and_spasticity_management
Comparative 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) https://www.researchgate.net/publication/336115785_Comparative_Study_of_Dry_Needling_under_Ultrasound_Guidance_and_Extracorporeal_Shock_Wave_Therapy_for_Myofascial_Pain_and_Spasticity_Management
Comparative 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) (part2) https://www.researchgate.net/publication/336115785_Comparative_Study_of_Dry_Needling_under_Ultrasound_Guidance_and_Extracorporeal_Shock_Wave_Therapy_for_Myofascial_Pain_and_Spasticity_Management


Testimonials

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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)

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Complete tear of rectus femoris
with large hematoma (blood)

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

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