Our physicians and staff at New York Dynamic Neuromuscular Rehabilitation are now pleased to offer Extracorporeal Shock Wave Therapy, or ESWT and Extracorporeal Pulse Activation Technology or EPAT to our patients who suffer from neuromuscular disorders. Dr.Kalika has been an active member of ISMST (international society of medical shockwave) since 2007 and performed over two thousand procedures for different tendon anatomical locations. Our results with extracorporeal shockwave therapy have been exceptional because we perform targeted treatment under diagnostic ultrasound guidance and combine it with very comprehensive rehabilitation approaches such as eccentric training and biomechanical correction.
Extracorporeal Shockwave Therapy (ESWT) and Extracorporeal Pulse Activation Technology (EPAT) are the most advanced and highly effective non-invasive treatments for neuromuscular disorders approved by the FDA. This proprietary technology is based on a unique set of pressure waves that stimulate the metabolism, enhance blood circulation and accelerate the healing process. Damaged tissue gradually regenerates and eventually heals. This non-invasive office/clinic based procedure represents a breakthrough treatment option for a broad range of musculoskeletal conditions.
ESWT is a regenerative of treatment for tendon, muscle and bone disorders. This technology produces high frequency sound waves which initiate body’s own reparative reaction in case of chronic degenerative tendon condition. It is also very effective treatment for myofascial pain syndrome. ESWT and EPAT are used interchangeably even though the wave delivered to the tissues is different. In first case it is a true shockwave energy delivered to the tissues. In the second case it is mechanical pressure wave which is delivered to the tissues. With exception of small tendons and places where access to tendon is anatomically restricted shockwave and pressure waves have similar effect. Years of research have proved that high energy or low energy waves produce similar effect over different time frame. At DNR we use both technologies depending on the clinical presentation and on the nature of the patient’s injury.
ESWT can be administered using either radial (soft) or focused (hard) shockwaves. Our choice is determined based on the specific needs of the patient.
Radial shock wave is the most commonly used form of ESWT, 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:
Focused shock wave 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. Diagnostic ultrasonography is often used in conjunction with focused shock wave to accurately visualize deep tissues.
Focused shock waves are most often used for:
Radial and focused shockwaves are often used in combination to treat acute and repetitive overuse injuries in athletes.
As with a surprising number of other therapies, a bit of damage needs to be done to the body to get it to repair the injury. In the case of shock wave and pressure wave therapies, tiny ruptures are created in the capillaries that serve the bones and the tendons of the area of injury. This prompts the body to start producing new blood vessels to replace the ones that were damaged. These tiny blood vessels in turn increase the blood supply to the area of the injury. When the blood supply is increased, so is the amount of healing oxygen.
The inflammation of plantar fasciitis can also be reduced by actually increasing the number of substances which cause inflammation. Chronic inflammation occurs when the inflammation response is not completely halted. It can damage healthy areas in the body and can result in chronic pain. The activity of mast cells, which are involved in inflammatory process, may be increased by pervasive acoustic waves. EPAT test Extracorporeal Shock Wave Therapy can stimulate mast cells, which produce inflammatory substances like cytokines and chemokines. These substances can also help the body heal and regenerate healthy cells. The shock and pressure wave therapies can also cause the body to produce more collagen. Collagen is a protein that’s found all over the body that helps give tendons and ligaments their structure. The collagen the body produces after shock wave therapy produces tendons that are stiffer and denser than usual.
In growth of Neovascularization nutrient blood flow is necessary to start and maintain the repair processes of damaged tissue structure. The application of acoustic waves creates capillary micro-ruptures in tendon and bone and significantly increasing the expression of growth indicators such as the eNOS, VEGF, PCNA and BMP. These two processes stimulate the growth and remodeling of new arterioles. The new blood vessels will improve the blood supply and the oxygenation resulting in the faster healing of both tendon and bone.
The production of sufficient amounts of collagen is a necessary precondition of the tissue repair process. Shockwave therapy hastens procollagen synthesis. The newly created collagen fibers are forced into a longitudinal structure. These newly formed tendon fibers are denser and stiff. Trigger points are the principal cause of pain in the back, neck, shoulder and limbs. They are associated with palpable nodules in taut bands of muscle fibers and 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 which then causes yet 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, it reverses the metabolic crisis in the myofilaments and releases these trigger points.
New York Dynamic Neuromuscular Rehabilitation uses several modalities to diagnose plantar fasciitis, including ultrasound and clinical examination. If the case is complicated, we can even analyze the patient’s gait using a computerized video. Patients who wonder about ESWT Extracorporeal Shock Wave Therapy Cost should know that New York Dynamic Neuromuscular Rehabilitation accepts most health insurance plans and will happily set up payment schedules with our patients. The good news about shock and pressure wave therapies are that they are very effective, with studies reporting a success rate of about 92 percent. Contact us for a consultation on the benefits of Extracorporeal Shock Wave Therapy ESWT plantar fasciitis.
Chronic inflammation occurs when the inflammation response is not completely halted. It can damage healthy areas in the body and can result in chronic pain. The activity of mast cells, which are involved in inflammatory process, may be increased by pervasive acoustic waves. Mast cell activation may be followed by the synthesis of chemokines and cytokines. The releasing of pro-inflammatory compounds, when needed, may help to restore the normal healing and regenerative processes.
The production of sufficient amounts of collagen is a necessary precondition of the tissue repair process. Shockwave therapy hastens procollagen synthesis. The newly created collagen fibers are forced into a longitudinal structure. These newly formed tendon fibers are denser and stiff.
Trigger points are the principal cause of pain in the back, neck, shoulder and limbs. They are associated with palpable nodules in taut bands of muscle fibers and 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 which then causes yet 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, it reverses the metabolic crisis in the myofilaments and releases these trigger points.
2. Plantar fasciitis/ fasciopathy
4. Patellar tendonitis (jumpers knee)
10. Stress fractures
12. (acute and chronic neck, back, and shoulder
pain due to chronically shortened
and thickened muscle tissue)
13. Calcific tendosis of the shoulder
14. Shoulder impingement syndrome
15. Tibial stress syndrome
16. Tennis and golfers elbow
19. Illio-tibial band syndrome
20. Bone edema
21. Osteonecrosis
22. Avascular Necrosis
23. Friebergs disease
24. Non-union fractures
25. Hamstring strain and hamstring tendinitis
26. Non-union fractures
27. It band syndrome
28. Tmj pain
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.Successful Treatment
A bad physical therapy experience is one of the primary causes of unnecessary surgery.
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.
Most importantly, we are the only facility in the US where structural medical diagnosis is reflected in functional treatment, and vice versa.
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
