Common Q & A on ESWT:

Q: HOW DOES ESWT TECHNOLOGY PROMOTE HEALING?

A: The effects of ESWT are manifest in many areas particularly those dealing with tissue density such as where tendon attaches to bone and where bone attaches to ligaments. For this reason ESWT is very effective for painful connective tissue pain in such areas as the foot, knee, hip, elbow, back and shoulder.

While ongoing research continues to fully understand the ESWT mechanism, ESWT produces a very strong sonic pulse for a short length of time (approximately 10 milliseconds), which appears to have several effects on the body namely:

1. The strong mechanical pulse exerts pressure and a tension force on the afflicted tissue. This appears to create an increase in cell membrane permeability which increases localized circulation and metabolism both of which promote healing.

2. ESWT breaks down pathological deposits of calcium in the soft tissues which is followed by a absorption of the calcium. Excessive deposits of calcium in soft tissue is believed to be the underlying pathological condition for many types of musculoskeletal pain (e.g. painful shoulder tendonosis/tendinitis).

3. ESWT stimulates osteoblast activity (bone cells) which is responsible for healing and new bone growth.

4. Lastly, ESWT is thought to diminish pain by stimulating what is known as the "gait control mechanism".

In summation, the high-energy acoustic waves that are transmitted through the surface of the skin are spread radially (spherically) into the body and the body responds with increased metabolic activity around the area of the pain. This stimulates and accelerates the healing process and is especially useful for those suffering from chronic heel, shoulder, knee (patellar tendon), achilles, elbow and back pain.

Q: TELL ME ABOUT A TYPICAL ESWT VISIT?

A: In consultation with your family physician, podiatrist (foot doctor) or medical specialist, Physical Therapists at Dynamic Physiotherapy will determine if you are an eligible candidate for ESWT treatment. If it appears you are a likely candidate and will respond favorably to ESWT, a typical visit would consist of a 15-30 minute consult where in addition to necessary paperwork and forms, alternative treatment options would be explained and your condition would be assessed. At this time fees for the treatment will be discussed as well as any other questions you may have.

Assuming you are a candidate, you will be scheduled for treatment where patients typically require 3 separate treatment sessions approximately 7-14 days apart. Some sever conditions may require more than 3 visits. Each treatment session lasts approximately 5 - 15 minutes where the Physical Therapist or his assistant will apply ultrasonic transmission gel to the target area. The ESWT hand piece is then positioned to gently and extensively transmit shock waves over the injured area. The feedback you provide helps our Physiotherapist fine tune the position of the applicator and the intensity of the treatment.

Q: DOES ESWT TREATMENT HURT?

A: Although previous generations of ESWT machines could cause considerable pain, the radial shockwave technology Dynamic utilize's does not generally cause any significant discomfort. Many patients describe their treatment as "strange" or "mildly uncomfortable" but few report any significant or lasting pain. This is demonstrated by the fact that freezing or local anesthetic is generally not required. Depending on your condition, your Physiotherapist may, with the assistance of your podiatrist or family doctor, request a local anesthetic prior to treatment.

Q: ARE THERE ANY POSSIBLE SIDE EFFECTS OR CONTRAINDICATIONS?

A: ESWT should not be used if there is a circulation or nerve disorder, bone tumor, infection, metabolic bone condition, or bone tumor. ESWT should also not be used if there are any open wounds or tumors or if the patient is pregnant. Patients who are on blood-thinning medications or who have severe circulatory disorders may also not be eligible for treatment. Additionally, if your doctor does not believe you are a candidate for ESWT we would also decline treatment. These matters will be discussed with you during your consultation.

After the ESWT treatment patients may experience temporary soreness, tenderness or swelling for a few days following the procedure. Upon completion of your treatment you can return to most regular activities almost immediately. Occasionally pain or discomfort may persist for a few days following treatment but no serious complications or side-effects have been reported.

Q: HOW MANY TREATMENTS DO I NEED TO IMPROVE MY CONDITION?

A: Patients generally require 3 separate treatment sessions approximately 7 - 14 days apart. Generally if a patient is not finding relief after 2 visits they may not respond to this type of therapy. For some conditions, patients may require more that 3 visits.

Q: DOES ESWT REALLY WORK?

A: Provided you are a candidate for this type of treatment, clinical studies suggest there is a 80% - 85% chance this technology will improve your condition. Clinical studies further confirm that 88% of patients treated for calcanial spurs and 95% of those treated for tennis elbow rated the results as "very good" or "good" only weeks after treatment. Numerous clinical trials have been published and are available by study by accessing our research link found on the EMS Medical website www.EMS-medical.com or by accessing the "studies" section of our website.

As one of the premier providers of ESWT in Canada , Dynamic Physiotherapy has likewise found that approximately 7 out of 10 of our patients will see an improvement in their condition following their treatment program. One of the most important factors for success is being able to identify and select which patients and conditions are most likely to benefit from this technology. Given our experience we believe we can provide you with an accurate assessment on your candidacy for ESWT and the likelihood you will seen an improvement in your condition.

Given that ESWT is not for every condition and is not guaranteed to provide relief in every case, it is imperative you carefully consider your treatment options and the costs involved so that you can determine if ESWT is a viable option for you.

Q: WHAT IS YOUR CRITERIA FOR SHOCKWAVE THERAPY?

•  When you have been diagnosed with a condition that ESWT has been demonstrated effective in treating.

•  When there are no significant or serious side effects or contraindications.

•  When surgery is the only other viable alternative.

•  When other conservative treatments have failed or did not work.

•  When you understand the procedure, costs and other factors involved in your program of treatment.

Q: HOW MUCH DOES ESWT TREATMENT COST?

A: In the US , patients pay as much as $3000 - $8000 for similar treatments that often utilize older technology. These fees are necessary since ESWT technology can cost several hundreds of thousands of dollars to purchase with high-maintenance costs also associated with this technology.

Newer ESWT technology used by Dynamic has reduced these costs and improved patient outcomes. At the time of writing, Dynamic Physiotherapy was the first and largest group of Physiotherapists in Alberta to offer ESWT treatments and has successfully treated hundreds of patients. Dynamic does not charge for your initial assessment to determine if you are a candidate for ESWT. If you are a candidate, we are able to provide a 3-treatment package to patients for $250-$350 per visit depending on your condition or if multiple sites are required to be treated. Additional treatments above the 3 treatment package are available at a reduced rate.

Q: ESWT TREATMENT COSTS ARE SIGNIFICANT; WHAT IF I AM ONE OF THE 20% THAT DOES NOT SEE A SIGNIFICANT IMPROVEMENT IN MY CONDITION?

A: As is the case with most medical treatments, Dynamic Physiotherapy cannot guarantee how you will respond to treatment or if you will see a significant improvement in your condition. However, if following your 3rd treatment you and your Physiotherapist have not seen any improvement in your condition additional 1 - 2 treatments will be provided to you at a reduced rate. If following these additional treatments there is still no improvement then unfortunately you may be one of the minority who do not respond favorably to ESWT and your Physiotherapist will suggest other treatment options you may have. We would ask you to carefully consider all factors prior to making your decision for ESWT, as there is a no refund policy in effect.

Q: WHO PERFORMS THE ESWT TREATMENT?

A: Dynamic Physiotherapy has one of the largest ESWT practices in Canada and is among the most experienced practitioners in North America utilizing ESWT. Before choosing a medical professional for this treatment you may want to consider their training, experience and established track record.

In consultation with your family physician, podiatrist or medical specialist, a Physical Therapist from Dynamic Physiotherapy will perform your initial assessment and determine if you are a candidate for ESWT. At Dynamic, our Physiotherapists undergo rigorous training and formal education and as well as post-graduate training in ESWT and are fully qualified to treat your condition. Provided you are an eligible candidate, your treatment sessions will be performed either by a Physical Therapist or one of his assistants which are also fully trained and have vast experience in ESWT.

Q: DO I NEED A REFERRAL TO SEE YOU?

A: Although many of our patients are referred by their family physician, podiatrists or medical specialist, a referral is not necessary. Please contact one of our several clinics located across Alberta for a convenient appointment time.

Q: WHAT ABOUT PRIVATE INSURANCE OR PROVINCIAL HEALTHCARE?

A: In Alberta , ESWT is not covered by the provincial health care plan. Many private insurance plans do provide coverage for physiotherapy or ESWT but may require a doctor's referral first. Please check with your private insurance to determine physiotherapy coverage and any requirements for coverage. Patients will receive a receipt and letter of explanation (where applicable) which can be submitted for insurance re-imbursement and/or a tax deduction. Dynamic Physiotherapy does not direct bill insurance companies.

Q: HOW CAN PAYMENT BE MADE?

A: We accept a variety of payment forms including Visa, MasterCard, cash or cheque.

Q: ARE THERE DIFFERENT KINDS OF SHOCKWAVE THERAPY?

A: There are several different variations of shockwave therapy technology based on the way in which the machine generates the shockwave. The most common methods applied in shockwave generation are electrohydraulic, electromagnetic, piezoelectric and Radial. Each of these forms has different characteristics and advantages or disadvantages. By far the most common or popular in the industry is the radial shockwave therapy. Over the years we have owned, tested or utilized the various available technologies and have found that the radial shockwave produces the most effective treatment for most people for most conditions. As a result, we now own three of these very expensive machines and believe this technology will provide you with the best overall results.

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