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What Is Extracorporeal Shockwave Therapy?

Medically Reviewed by Jabeen Begum, MD on October 13, 2022

Extracorporeal shockwave therapy (ESWT) treats chronic tendonitis, plantar fasciitis, and Achilles tendonitis, among other conditions. These conditions mainly affect athletes but can also affect everyday people, especially individuals who lead an active lifestyle and overexert their muscles. You may experience pain and discomfort when these injuries happen. Extracorporeal shockwave therapy can help.

But what is extracorporeal shockwave therapy, and how does it work? 

ESWT is a noninvasive treatment used for several conditions. While it has gained popularity as a method for treating foot- and ankle-related injuries, it has also been used in treating kidney stones. ESWT was first developed as a method to treat kidney stones and gallstones and has been successful in treating those conditions for two decades. 

Additionally, ESWT has been used to treat musculoskeletal conditions, including tennis elbow and bony nonunions. It's based on extracorporeal shock wave lithotripsy (ESWL).

Since their introduction, the extracorporeal shockwave therapy machine devices have been approved by the Food and Drug Administration (FDA) to treat lateral epicondylitis and plantar fasciitis. 

This therapy is typically performed by qualified therapists. It helps patients avoid surgical procedures and steroid injections. 

How Does Extracorporeal Shockwave Therapy Work? 

Shockwave therapy helps to accelerate the body’s normal healing process. It helps speed up the recovery of injured joints and tissue while diminishing pain and discomfort. 

Extracorporeal shockwave therapy works in two ways, either through focused shockwaves or radial pressure waves. Both methods are outpatient, and several treatments may be required to treat your specific condition. 

The focused shockwave method uses a very focused impulse to target affected areas through an extracorporeal shockwave therapy machine. There is no need for anesthesia since the shockwave used is low energy. The patient lays down with the affected area exposed. The doctor applies a special gel to the affected area, which helps deliver the impulses deeper into the skin. 

The ESTW machine is turned on and the instrument, or shockwave gun, is pressed against the affected area. Rapid impulses are then delivered to the patient. Treatment typically lasts between 5 and 15 minutes. While this treatment can be uncomfortable for some, most do not experience any pain.

Once treatment is completed, patients should do their best to limit physical activity for at least two weeks. 

Radial shockwaves are given in much the same way. The main difference between radial shockwaves and focused shockwaves is that radial shockwaves dissipate once they have been discharged and have contacted the skin, while focused shockwaves are a little higher in energy and therefore don’t dissipate when it reaches the skin. Radial ESWT treatment is still relatively new, whereas focused ESWT treatments have been around for several years and can potentially aim higher levels of energy shockwaves into deeper tissue locations. 

Extracorporeal Shockwave Therapy Machine

The first ESWT device to hit the market was the electro-hydraulic device, followed by the piezo-electric device and several electro-magnetic machines. These devices have the same outcome: releasing focused pressure pulses to injured joints and tissue. The main differences between these devices are the focus zones and sound fields. Despite these differences, each of these devices generates shockwaves to promote healing. However, the pressure and shock waves vary in energy and focus.

Does Shockwave Therapy Work? 

Studies are not complete on the effectiveness of shockwave therapy and are currently ongoing. Regardless, the results of shockwave therapy may not reveal themselves immediately, and it may take some time for them to be noticed. 

Shockwave therapy is best used when coupled with another form of therapy, like physical therapy. An injury prevention specialist may be consulted if the injury is related to sports. 

ESWT research has shown that treatment has been performed effectively on several patients. Additionally, there is strong evidence of its success in treating Achilles tendinopathy and relieving the symptoms.

ESWT has expanded its treatment areas over the years. While research is still ongoing, medical professionals hope ESWT therapies can help treat neurological disorders like multiple sclerosis and the effects of stroke. 

ESWT treatments are recommended for at least three weeks for the most significant success rates. However, depending on the individual’s injury, more treatments may be needed.

Does Insurance Cover the Cost of Shockwave Therapy?

While the FDA has approved shockwave therapy as a treatment for several conditions, some insurances have yet to incorporate this treatment into their plans. You’ll need to check with your insurance provider to determine whether shockwave therapy is covered for you. 

Out-of-pocket costs are typically around $250 per treatment. Some providers will offer discounts. 

Side effects and Limitations

Extracorporeal shockwave therapy is safe for most people. Still, some individuals do face some side effects, either from improper use of the therapy treatment or otherwise. The most common of adverse side effects are:

  • Discomfort or pain during therapy treatment
  • Post-treatment pain
  • Red skin
  • Swelling 
  • Numbness
  • Bruising
  • Increased sensitivity (hyperesthesia)
  • Nerve pain (neuralgia)
  • Burning sensation (paresthesia)
  • Nausea and vomiting 
  • Joint disorder 
  • Dizziness 
  • A reaction on the site of the treatment
  • Sweating
  • Damage to blood vessels

Due to the nature of the treatment, the U.S. FDA also restricts the use of ESWT in certain cases. Should any of the following be near the area of treatment, the ESWT can't be used: 

  • Malignant tumors
  • An unborn child
  • Lung tissue
  • Brain
  • Spine
  • Epiphyseal plate
  • Infection
  • Prosthetic devices

Show Sources

SOURCES: 
Academy Foot & Ankle Specialists: “Extracorporeal Shockwave Therapy.”
Boston Children’s Hospital: "Shockwave Therapy."
College of Massage Therapists of British Columbia: “Report on the Use of Extracorporeal Shockwave Therapy in Orthopaedic Conditions.”
Extracorporeal Shock Wave Therapy: "Extracorporeal shock wave therapy (ESWT) – An innovative method for pain treatment."
FootCareMD: "WHAT IS EXTRACORPOREAL SHOCK WAVE THERAPY?"
London Foot & Ankle Surgery: "EXTRACORPOREAL SHOCKWAVE THERAPY OR ESWT."
National Library of Medicine: "Extracorporeal shock wave therapy: an update."
UTSouthwestern Medical Center: "How shockwave therapy helps heal sports and overuse injuries."
Washington State Health Care Authority: "Extracorporeal shock wave therapy (ESWT) for musculoskeletal conditions."

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