SWT has gained popularity as an alternative to surgery in the treatment of injuries in sports medicine. SWT has also been shown to be effective for jumper’s knee, tennis elbow, stress fractures, non-union of bones, adhesive capsulitis, trigger point therapy, paraspinal muscle pain, Osgood Schlatters and the relief of fascial pain. this timeline with your patient as expectations and outcomes must be realistically conveyed. Fascia and trigger point pain relief can be immediate. SWT can be used in synergy as well for many conditions, whether it is acupuncture, active release, eccentric loading exercises or whatever the practising doctor decides. A shockwave therapy machine can be leased or purchased. There are numerous accessories that are now available with the basic machine such as special spine heads to relieve paraspinal muscle pain, numerous other heads such as special fascial heads and other heads that can be used for needleless acupuncture, TMJ pain, and other innovative uses. There is also a combination of vibration and shockwave handpieces that have been shown to be very effective in the pain relief of trigger points, swelling, and peripheral edema. There are more than 1,000 clinics in Canada using the device now and chiropractic doctors have found it very advantageous. They have also found that using SWT may promote practice longevity because it saves their hands, elbows and back by using the device. In conclusion, numerous studies have shown that shock-wave therapy is the standard of care for numerous condi-tions, and the use of such a device by practitioners should not be so shocking anymore. For more articles about treatment modalities and techniques visit www.canadianchiropractor.com. Technology and cost SWT has evolved over the years. The original machines have improved from being high-energy, focused devices weighing 200 kg at a cost of $400,000 to radial shockwave devices (produced by air compression) that now cost approximately $10,000 and are as small as a microwave. The originator and most established companies are from Switzerland. Treatments for tendinopathies are very cost effective and affordable. Most treatments last four minutes and most patients only require three treatments, each one week apart (according to published protocols). At four minutes a treat-ment, that helps clinicians see and heal more patients. There may have been some abuse by practitioners treating more than four times, which is certainly not proven in the litera-ture. Soft tissue treatments for fascia, muscles and trigger points last two to five minutes with multiple sites being able to be treated at one sitting. SWT works by creating neovascularization in the affected tissue. Tissue such as the plantar fascia is affected by hyaline degeneration within the tissue (this is not an inflammatory process). Dr. Wang, in his studies, has shown that nitrous oxide, endothelial growth factor is produced intracellularly and helps regenerate the affected tissue. Relief of pain may be immediate and the healing process may take from three to six months to regenerate. It is important to communicate www.canadianchiropractor.ca December 2015 Canadian Chiropractor 33
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