Frequently Asked Questions
What are Shockwaves?
Shock Waves are movements of extremely high pressure caused by, for example, an explosion, an earthquake or a plane breaking the sound barrier.
Extracorporeal Shock Wave Therapy (ESWT) is the application of Shock Waves in medicine.
- Reduction of pain felt by nerve fibres
- Increase of blood circulation in surrounding soft tissues
- Beginning of healing process triggered by stem cells activation
What is the Swiss DolorClast Method?
By delivering a mechanical stress to injured tissues, Shock Waves enable:
- Immediate pain relief
- A healing reaction of the body
Is the Swiss DolorClast Method clinically proven?
Yes, being clinically proven is one of the pillars of the Swiss DolorClast® Method. Many RCTsdemonstrating safety and efficacy of the Swiss DolorClast® Method on different pathologies have been published in the international peer-review literature. Fifteen of these RCTs have been listed in the PEDro database (search for “radial shock wave” atwww.pedro.org.au)
What are the Indications for use?
- Elbow Pain
- Tennis Elbow
- Golfers Elbow
- Shoulder Pain
- Subacromial Pain Syndrome
- Calcifying Tendinitis of the Shoulder
- Hip Pain
- Greater Trochanteric Pain Syndrome
- Knee Pain
- Medial Tibial Stress Syndrome
- Osgood-Schlatter Disease
- Patella Tip Syndrome
- Ankle Pain
- Midbody Achilles Tendinopathy
- Insertional Achilles Tendinopathy
- Back Pain
- Low Back Pain
- Pseudoradicular Lower Back Pain
- Upper Back Pain
- Foot Pain
- Plantar Fasciopathy
- Myofascial trigger points
- Lymphedema, Cellulite
and Wound healing
- Peyronie’s disease
How does Radial Shockwave Therapy work?
Compressed air accelerates a projectile which strikes a fixed applicator. The kinetic energy is converted into a shock wave delivered to the target tissue through the skin. These shock waves are conveyed radially for broad treatment areas.
“Both parameters (Compression phase and Cavitation) may have important consequences for therapeutic bioeffect ” (Perez et al., 2014)
“The contribution of cavitation to the therapeutic effect of radial shock waves was recently shown in an advanced animal model ” (Angstman et al., 2015)
How does Focused Shockwave Therapy work?
The maximum pressure P+ in focused ESWT is usually higher than in radial ESWT
Both focused and radial ESWT can reach an ED+ of 0.4mJ/mm2, which has been clinically proven to be sufficient for almost all ESWT indications on the musculoskeletal system and the skin.
A depression phase (P-) follows, generating cavitation bubbles. These bubbles collapse causing secondary shock waves.
What are the advantages of Swiss DolorClast Radial Shockwave Therapy?
The main advantages are:
- No hospital admission
- No complications
- No medication, therefore no side effects
- No surgery, therefore no risk
- Relief from pain in just eight to ten days
- One plug-and-treat method for many applications
- Saves you time to see more patients (no manual therapy required)
- Finance packages to suit YOU!
- Attract new patients and increase revenue
- 80% success rate
- Offer patient satisfaction in 5-10 minutes
- One method, many indications
- Clinical research can back this up!
Is Shockwave Therapy BUPA Approved/ How can I become BUPA approved?
Can I treat acute pathologies with ESWT?
In general, this is possible. With regard to tendon pathology, it is critical to note that there are no acute tendinopathies, only newly diagnosed ones. Safety and efficacy of radial ESWT for newly diagnosed tendinopathies have already been demonstrated in the international peer-review literature for plantar fasciopathy (Rompe et al., 2010), primary long bicipital tenosynovitis (Liu et al., 2012) and lateral or medial epicondylitis (Lee et al. 2012.
Can I use local anaesthetics in conjunction with ESWT?
It does not harm. However, in case of chronic plantar fasciopathy, it has been shown that repetitive low-energy ESWT without local anaesthesia is more efficient than repetitive low-energy ESWT with local anaesthesia (Rompe et al., 2005). The reason is that local anaesthetics block peripheral nerve fibres including C nerve fibres. However, you cannot block C nerve fibres with local anaesthetics and activate them with shock waves (Maier et al., 2003) at the same time. Furthermore, the application of local anaesthetics limits and may even prevent biofeedback from the patient during the treatment.
Can I combine ESWT with other treatments?
Yes, you can. In case of chronic midportion Achilles tendinopathy, it has been shown that the combination of radial ESWT and eccentric loading resulted in statistically significantlybetter clinical outcome than eccentric loading alone (Rompe et al., 2009a), with radial ESWTbeing as effective as eccentric loading for this indication (Rompe et al., 2007)
What are the contraindications of The Swiss Dolorclast® Method?
Treatment over air-filled tissue (lung, gut) • Treatment of pre-ruptured tendons • Treatment ofpregnant women • Treatment of patients under the age of 18 (except for the treatment ofOsgood-Schlatter disease) • Treatment of patients with blood-clotting disorders (including localthrombosis) • Treatment of patients treated with oral anticoagulants • Treatment of tissue with local tumours or local bacterial and/or viral infections • Treatment of patients treated with local cortisone injections (within the six-week period following the last local cortisone injection).
Can we use shockwave on patients having a pacemaker?
A cardiac pacemaker is not a contraindication for the Swiss DolorClast method. However, direct exposure of a pacemaker and its wires to shock waves must be avoided at all cost. Accordingly, treatment of the left shoulder should be performed with great care in case the patient has a cardiac pacemaker.
Is Shockwave Therapy Painful for the patient? And how can I limit pain after each treatment?
There are several simple and effective methods that can alleviate pain without necessarily involving the ingestion of drugs. Above all, it is important for physiotherapists to warn their patients to restrict and avoid as much as possible the use of the area that has just been treated. This will allow the muscle to rest completely and regenerate faster in an optimal way. Applying ice is also a very effective method in the short and medium-term to reduce the effects of the treatment. Be careful to mention that direct contact with the area can cause a cold burn, the use of a waterproof material in-between is highly recommended. The patient can also buy castor oil or arnica vegetable oil (preferably organic) to be placed on the treated tendon area in the morning and evening to limit inflammation. Small side-note: castor oil has a very thick and greasy texture. So, no need to put a lot, a few drops are enough. Finally, the patient can combine all of this with the application of a thick green clay poultice directly on the painful zone. This should be held under a bandage for about 30 minutes. This can be done several times during the day, at any time. They can buy the clay in a ready-made tube or prepare it themselves using fine clay powder and water. You should also know that castor or arnica oil, as well as the use of green clay, are contraindicated for pregnant women, so please be careful.
Condition Specific FAQ's
Is a "mild thinning" of the supraspinatus tendon a contraindication?
No, mild thinning of a tendon is not a contraindication for careful and mild use of the Swiss DolorClast method. On the other hand, treatment of pre-ruptured tendons is a contraindication. As a general rule, tendons with a tear of more than 50% of the cross-sectional area must not be treated with shock waves. This is because due to pain relief, the tendon could rupture during augmented physical strain.
Women who have had a mastectomy, with or without axillary node clearance often develop a frozen shoulder - either fairly soon after surgery or a few months to a year later. Would ESWT help in this situation?
A real frozen shoulder cannot be successfully treated with shock waves; this indication requires manual mobilization (under general anesthesia). On the other hand, it should be carefully evaluated whether the patient really suffers from a frozen shoulder. If there is only partial immobilization, treatment with the Swiss DolorClast method can substantially improve the situation. Other women may experience pain during shoulder movements because of an incipient or existing secondary lymphedema (due to resection of regional lymph nodes as part of the mastectomy surgery). The Swiss DolorClast is approved for the treatment of primary and secondary lymphedema, and good results were reported by Prof. Sandro Michelini (Rome, Italy).
Is there a risk of lymphedema from ESWT treatment if there is no lymphedema in the first place? If the patient already has lymphedema, would ESWT help? Does the treatment parameter depend on whether the patient has had full axillary lymph node dissection or just the sentinel nodes removal?
Development of lymphedema due to shock wave treatment has never been reported. The treatment of lymphedema with the Swiss DolorClast method has been reported to be efficient and safe in the literature15. The Swiss DolorClast is approved for this indication. It does not matter whether the patient has had full axillary node clearance or just the sentinel nodes removed; what is relevant is the clinical picture (i.e. the development of a secondary lymphedema). As a rule, the earlier the treatment is started, the better the outcome.
15) Michelini S, Failla A, Moneta G, et al.: Treatment of primary and secondary lymphedema with shockwave therapy. Eur J Lymphol 2008;19:10.
Is cording a contraindication or does the treatment help in this case?
Cording (axillary web syndrome) is not a contraindication of ESWT. Whether ESWT is successful in this case needs to be established. No data have been reported on the subject so far.
How soon after surgery can ESWT treatment be performed? After surgery, some patients have to delay radiotherapy treatment as they are unable to lift their arm above their head for treatment. Physiotherapy is a good first option but if there is little or no positive response to physiotherapy, is ESWT a useful tool in conjunction with physiotherapy?
There is no clear answer to this question. In any case, ESWT should not interfere with wound healing (although ESWT could improve wound healing after surgery). On the other hand, ESWT can be applied on those parts of the shoulder and arm that are not directly affected by the surgery itself (such as the deltoid and upper trapezius muscles).
Does radiotherapy play any part in the treatment parameters? What is the timing between radiotherapy and the start of ESWT?
There are no data available to answer this question. Because radiotherapy can damage tissue considerably, no shock waves should be applied to the same tissue during a course of radiotherapy. The time interval between the last radiotherapy session and the first ESWT session should be at least one week in order to prevent potential negative interference between ESWT and healing of radiotherapy-induced tissue damage.
The patient is 8 weeks post-op after a subacromial decompression or rotator cuff repair. Is it OK to have RSWT?
This question cannot be answered without taking the status of the rotator cuff into account. Tendons with a tear of more than 50% of the cross-sectional area must not be treated with shock waves. Accordingly, ESWT after subacromial decompression or rotator cuff repair must be preceded by diligent diagnostic imaging (MRT). If there are no signs of tendon tear of the supraspinatus tendon and rotator cuff, ESWT is possible 8 weeks after subacromial decompression or rotator cuff repair.
A customer was asking about pelvic floor treatment with rESWT. She heard about this treatment for vulvodynia in particular. Can you check for any info/ treatment protocols?
According to Wikipedia, “vulvodynia is a chronic pain syndrome that affects the vulvar area and occurs without an identifiable cause. Symptoms typically include a feeling of burning or irritation. For the diagnosis to be made symptoms must last at least 3 months. The exact cause is unknown but is believed to involve a number of factors, including genetics, immunology, and possibly diet. Diagnosis is by ruling out other possible causes. This may or may not include a biopsy of the area. Treatment may involve a number of different measures; however, none is universally effective, and the evidence to support their effectiveness is often poor. Some of these measures include improved vulvar care, dietary changes, medications, counselling, and, if conservative treatment is not effective, surgery. It is estimated to affect up to 16% of women.” The Swiss DolorClast method is not approved for this condition because there is no data available demonstrating efficacy and safety when treating this condition.
Can we use the Swiss DolorClast on erectile dysfunction?
The Swiss DolorClast has not yet been approved for the treatment of erectile dysfunction. This is because there is no sufficient clinical evidence to predict a good treatment outcome with a high enough probability.