ESWT

What Is ESWT (Extracorporeal Shockwave Therapy) and How Does It Work?

ESWT means “extracorporeal shockwave therapy.” In this method, focused high-energy acoustic (sound) waves produced by a special device are delivered from outside the body to the targeted damaged or painful area through an applicator (application head). These sound waves have much higher energy than those used in therapeutic ultrasound.

Although the mechanism of action of ESWT has not been fully elucidated, its main effects are thought to be the following:

• Stimulation of Healing Processes: Shockwaves create a “controlled injury” at the microscopic level in the treated tissue, triggering the body’s natural healing mechanisms. This can lead to increased blood flow to the area (neovascularization), the release of growth factors involved in healing, and accelerated cell renewal.
• Breaking Up Calcifications (Calcium Deposits): Especially in conditions such as calcific tendinitis in the shoulder, shockwaves are thought to mechanically break up the calcium deposits within the tendon, making it easier for the body to absorb them.
• Reduction of Pain: Shockwaves can temporarily block the transmission of pain signals by affecting nerve endings (gate control theory of pain) or reduce pain perception through overstimulation (hyperstimulation analgesia). They may also reduce the release of certain neuropeptides that cause chronic pain.

ESWT technology was first developed from lithotripsy devices used to break up kidney stones, and over time it also began to be used in the treatment of musculoskeletal system problems.

In Which Orthopedic Conditions Is ESWT Used?

ESWT is a method that can be effective especially in chronic (long-term) musculoskeletal problems that do not respond to other conservative treatments (medication, rest, physical therapy, injection). The main areas of use related to Prof. Dr. Murat Bozkurt’s field of expertise are as follows:

• Plantar Fasciitis (Heel Spur Pain): A condition characterized by pain under the heel or on the sole of the foot. ESWT is one of the most frequently and successfully used methods in this condition.
• Achilles Tendinopathy (Achilles Tendinitis/Tendinosis): Pain, swelling, and tenderness in the Achilles tendon.
• Lateral Epicondylitis (Tennis Elbow): Pain on the outer side of the elbow.
• Medial Epicondylitis (Golfer’s Elbow): Pain on the inner side of the elbow.
• Shoulder Calcific Tendinitis: Pain and restricted movement due to calcium deposits in the rotator cuff tendons. ESWT is effective in breaking up the calcium deposits.
• Patellar Tendinopathy (Jumper’s Knee): Pain in the patellar tendon below the kneecap.
• Greater Trochanteric Pain Syndrome (GTPS): Pain on the side of the hip (problems at the attachment site of the gluteal tendons or bursitis).
• Delayed Bone Union / Nonunion (Pseudarthrosis): It can be used to stimulate bone healing in cases where fracture healing is slower than expected or does not occur at all.
• Avascular Necrosis (Early Stage): In conditions where the blood supply to bones such as the femoral head is impaired, its use to increase blood supply together with other treatments (e.g., core decompression) is being investigated, but its efficacy is not yet clear.

Apart from these, its use in other conditions such as stress fractures and hamstring tendinopathies is also being investigated.

How Is ESWT Treatment Applied?

ESWT treatment is usually applied in outpatient clinic or physical therapy unit conditions, by a doctor or a trained physiotherapist/technician:

1. Preparation: The area of the patient to be treated is identified. This can be done by manual examination (palpation) or sometimes under ultrasonography guidance. Anesthesia is usually not required, but some patients may feel mild discomfort, and rarely a local anesthetic cream or injection may be considered.
2. Application: A special gel is applied to the skin of the area to be treated to facilitate the transmission of sound waves. The application head (applicator) of the ESWT device is brought into contact with the skin. When the device is activated, shockwaves are delivered to the targeted tissue through the head at the set energy level and number. During this time the patient may usually feel a mild tapping, clicking, or pricking sensation. The discomfort is generally at a tolerable level.
3. Duration and Number of Sessions: A session usually lasts 10 to 20 minutes. Treatment is usually planned as a total of 3 to 5 sessions, once a week. The number and frequency of sessions may vary according to the condition being treated and the patient’s response.
4. Afterward: After the session the patient can usually return to daily activities immediately. It may be recommended to avoid heavy exercise or overstraining the treated area for a few days.

Benefits and Efficacy of ESWT

• Benefits:
  
  • Non-surgical (Non-invasive): Requires no surgical incision, sutures, or anesthesia.
  • Safe: It is generally a safe method without serious side effects.
  • Minimal Side Effects: Side effects are usually mild and temporary.
  • Quick Application and Recovery: Sessions are short and require no special recovery period afterward; the patient can continue with daily life.
  • Alternative: It can be a good alternative to surgery in chronic conditions that do not respond to other conservative treatments.
  • Repeatability: Repeat sessions can be planned if necessary.
• Efficacy:
  
  • The efficacy of ESWT varies according to the condition treated, the chronicity of the disease, the type of device used, and the application protocol.
  • There is strong scientific evidence demonstrating its efficacy especially in conditions such as plantar fasciitis, calcific tendinitis, and tennis elbow.
  • Promising results are also reported in other tendinopathies (Achilles, patellar, GTPS), but the level of evidence is somewhat lower.
  • It can also be beneficial in bone nonunion problems.
  • It may not be equally effective in every patient. While some patients benefit greatly from the treatment, others may not obtain the expected response.
  • ESWT is generally not a miracle cure on its own; the best results are usually achieved when it is applied together with other treatment methods such as physical therapy, exercise, and activity modification.

Possible Side Effects and Situations Where It Should Not Be Applied

ESWT is generally well tolerated and serious side effects are rare.

• Possible Side Effects:
  
  • Temporary pain or tenderness in the application area during or after treatment.
  • Redness, swelling, or bruising of the skin.
  • Petechiae (small red dots under the skin).
  • Rarely headache or dizziness. These side effects usually resolve on their own within a few days.
• Situations Where It Should Not Be Applied (Contraindications):
  
  • Pregnancy.
  • Bleeding disorders or high-dose use of blood-thinning medications (anticoagulants).
  • Presence of active infection or tumor in the treatment area.
  • Children with open growth plates (application is not made over the epiphyseal line).
  • Application is not made over lung tissue.
  • Application is not made directly over large vessels or nerves.
  • Care must be taken, or application avoided, near electronic implants such as pacemakers (doctor’s approval is required).

ESWT Treatment in Ankara and Prof. Dr. Murat Bozkurt’s Approach

ESWT (Shockwave Therapy) is a modern method used in many orthopedic and physical therapy clinics in Ankara as well, for the treatment of various musculoskeletal system problems. In his approach to this treatment method, Prof. Dr. Murat Bozkurt takes the following principles into account:

• Priority of Correct Diagnosis: He emphasizes that for ESWT to be effective, the underlying cause of the patient’s complaints must first be correctly diagnosed. Applying ESWT without precisely determining the source of the pain is not appropriate.
• Evidence-Based Indication: He bases the treatment decision on the evidence in the current scientific literature. He considers ESWT as an option in specific conditions where its efficacy is more pronounced (e.g., resistant plantar fasciitis, calcific tendinitis, tennis elbow) and usually after other conservative treatments (especially physical therapy) have failed.
• Holistic Treatment Approach: He generally does not see ESWT as a solution on its own. He states that to obtain the best results, ESWT should usually be applied together with a personalized exercise program and physical therapy.
• Patient Selection: He indicates that not every patient is a suitable candidate for ESWT, and that suitability for treatment must be determined after a detailed evaluation.

ESWT (Shockwave Therapy), when applied with the correct indication and in suitable patients, is a valuable treatment option that can provide relief without the need for surgery, especially in conditions such as chronic tendinopathies that do not respond to other conservative treatments. However, it is important to remember that it is not a cure-all and should generally be considered as part of a comprehensive treatment plan. To learn more about ESWT treatment in Ankara and to find out whether it is suitable for you, you can consult Prof. Dr. Murat Bozkurt.

For detailed information and appointments, you can contact Prof. Dr. Murat Bozkurt at 0312 502 70 74.