Have you heard of Extracorporeal shock wave therapy (ESWT) or Extracorporeal pulse activation therapy (EPAT)? We hadn’t either. Sheri O’Brien, a PT with whom we share educational material, and a former colleague of Back To Motion, presented to us information about the treatment. She doesn’t do the treatment herself, but she had a patient ask her about it. The PTs at Back To Motion are receptive to different interventions with which we are unfamiliar. Before us was an opportunity to learn about this modality that is based on observations made during war time.
ESWT originated from unfortunate circumstances. During World War II, submarine sailors were injured from the sonic booms from depth charges because the shock waves damaged tissues of internal organs, including the lungs. The mechanisms that altered the tissue were researched and in the 70s shock waves were used for lithotripsy to treat kidney stones. By the 90s practitioners were using the modality to treat painful tendons, ligaments and fascia.
The mechanical effect of ESWT creates air bubbles in the fluids of tissue. The bubbles expand and burst creating shearing forces. The shearing forces cause cell changes. The cellular changes are ones that promote healing and tissue growth.
When patients decide to have the treatment, to be honest, it can be painful. The treatment has side effects. There can be bruising, skin redness, little blood blisters. It’s very rare, but it can cause nerve and blood vessel damage. Geez, that doesn’t sound too good does it! Still, there are many people who swear by the treatment. Often, the listed side effects are rare, especially the grave ones.
Dr. O’Brien reviewed several studies. The studies were not powerful, except for plantar fasciitis and calcific tendonitis. For plantar fasciitis, the subjects experienced a 60% reduction in their pain level following treatment. Two other studies also demonstrated that plantar fasciitis will respond significantly to ESWT. From the other studies reviewed there is evidence that supports ESWT to aid in healing fractures, ACL repairs, lateral epicondylitis and chronic Achilles tendon pain.
At Back To Motion, we don’t do ESWT. We have many other ways (that we think are better) to treat the pain and dysfunction you are experiencing. We thought you might find this interesting.