FAQs

Physical modalities like Short Wave Diathermy, Ultrasound, Interferential therapy, LASER, etc employed in physiotherapy department produce heat at various depth of the tissues affected in the body and there by relieve pain on temporary measure.

Shock waves do not produce heat but as it travels from one medium to another it produces cavitations and hence structural changes which ultimately leads to tissue healing.

When the shock wave travels from one medium to another (generator of Lithotripter with jelly as a conductor through the skin to the soft tissue/ bone) the interference causes transfer of energy- attenuation and cavitation.

This cause structural changes in the tissue ( cell and cell organelles).This gears up the body to cause reparative process and stimulate healing potential.

The Neovascularization- new blood tissue formation-takes care of inflammation and restores normal tissue (soft tissue/ bone)

Local anaesthesia is not recommended as it causes decrease in efficacy of ESWT/RSWT Short GA/ Regional Anaesthesia is preferred in most cases Shockwaves does produce discomfort / pain depending on the intensity / machine used.

Some patients need regional blocks or narcotic analgesia. For bony tissues- delayed / nonunion of fractures or Avascular Necrosis-usually Spinal anaesthesia is required in lower limbs and regional blocks in upper limbs.

Surgery is invasive. It requires tissue to be cut open and hence results in some damage inadvertently and stiffness. It also requires dressings, suture removal, etc.

The resulting scar may be unsightly and permanent. Shock wave therapy is noninvasive and hence scarless. The safety profile has been approved worldwide and has even FDA approval. With little care one can be back to work very soon. The need for drug support is minimal or nil. In fact it relieves stiffness and restores function.

Orthopaedic consultation which requires a detailed work up. Confirmation of the diagnosis and documentation with imaging like X-rays, Ultrasonography, CT scan or MRI as the case may demand. Medical clearance for the anaeshtesia.

Avoid painkillers especially NSAIDs as it retards healing, which is stimulated by ESWT. Avoid stressful / loading activity. The fractures may require to be braced or supported till there are signs of union.

The healing period for the soft tissues vary from 6- 8 weeks. It may take little longer and need evaluation at regular intervals. The bony healing takes longer, 3-6 months. Avascular Necrosis takes a long time and shows healing progress as late as 12 months or longer.Regular evaluation with x- rays is mandatory.

The success rate varies indication wise and patient wise. Earlier the presentation, the better success rate and sooner the healing. In the heel pain, planter fasciitis has a success rate of more than 90%, where as retrocalcaneal pump bump has less good results and may require more than one sittings. In fracture nonunions hypertrophic variety has better results than atrophic. The overall success rate is 60-70% and still ESWT is the first line of treatment world over as surgical options are not closed.

ESWT is very safe modality of treatment. The side effects are anaesthesia related and Shock wave related. In elderly patients transient hypertension is noted which may be stress related. Local bruise at the site of entry of shock wave is occasionally found which responds to ice theapy. The world lieterature supports the fact that there are no histopathological evidence of any damage to the tendons subjected to treatment. The neurovascular bundles are always avoided with due care. The lung tissues too are avoided due to the risk of rupture of air sacs.

The cost varies according to the number and intensity of the shock waves and disease. But overall it is cost effective as compared to surgery.

ESWT has a very high effectiveness. Most of the patients need only one sitting , but if some one feels that there is a residual component and if time frame is small due to patient traveling from far distance then more than one sitting is indicated at shorter intervals.

The set up for ESWT is something like an operation theatre and includes a Lithotripter machine along with IITV for imaging.It is certainly not Claustrophobic.

The new set up at Bodyline hospitals, has a state of the art and latest device Dornier Compact Sigma lithotripter which has modular head of generator which serves best for orthopaedic indications by moving at various angles of more than 15 positions in the space with isocentric focus.

The newer set up for RSWT( Radial Shock wave therapy) at Shrey hospitals for soft tissue affections is more patient friendly and has a small machine with 3 different probes and essentiallly a minor operation theater set up. No imaging is usually needed during the procedure.