On this page we'll answer the questions:

What is a typical visit like?
Does ESWT hurt?
Is it noisy?
How long is a visit?
What happens after my visit?  Am I laid up?
What are the odds it will help my condition?
How many visits will I need to improve my condition?
When would subsequent visits be scheduled?
Who performs the treatment?
Can I make an appointment for ESWT, or do I need a referral?
What's my next step?


What is a typical ESWT visit like?

Once you've been properly diagnosed with a condition that is likely to respond to Extracorporeal Shock Wave Therapy (ESWT), you may be curious what the visit will be like.   

Your ESWT visit would first consist of some paperwork and an initial consultation and discussion with Dr. Schumacher or another practitioner trained in ESWT technology. 

Your condition would then be assessed through a history and physical examination.

This may include imaging of the damaged tissues through techniques such as ultrasonography, (left) and / or fluoroscopy (right).

 The injured tissue would be identified and located in terms of depth.   The energy wave is then adjusted in strength and tissue depth, depending upon each individual diagnosis and each individual patient. 

We then apply the ESWT hand piece to the injured tissue, (see photo the right), and typically direct 1,500 to 2,000 energy pulses into the damaged tissue.

Does it hurt? 

The previous generations of ESWT machines used in some facilities certainly do hurt--to the extent that they typically require anesthesia.  (More on this on our page "General Information About ESWT".)

However, with the newest generation of machine available anywhere--the Piezoson 100 from the Richard Wolf Company in Germany--we  don't have to use I.V. sedation, or any sort of anesthesia of any kind.

This is beneficial because research now suggests that anesthesia diminishes the effectiveness of ESWT.

While ESWT with the machine we use may be sometimes be described by the patient being "unpleasant" or "uncomfortable," most patients don't feel that the treatment is particularly painful.  This is demonstrated by the fact that anesthesia is almost never required.  The discomfort tends to fade about half way through the treatment, as the nerves tend to become somewhat less sensitive during the procedure.

Some patients do experience soreness, tenderness, or swelling for a day or two afterwards, but this typically isn't severe and it doesn't persist long.


Is it noisy? 

The machine we use is not noisy. 

It does make an audible, "clicking" sound.  The sound is reminiscent of a "Newton's Cradle", one of those desktop games, (pictured on the right),  involving metal balls swinging like a pendulum and striking other metal balls.   Others liken the sound to that of a gas grill being started, though it's not that loud. 

One difference is that the clicking produced by our ESWT machine is much quicker than either of the two examples above--usually about four clicks per second for (typically) about
1,500 to 2,000 shockwaves per visit.   

How long is a visit? 

The initial visit for focused, piezoelectric ESWT usually takes about an hour.   Much of this time is spent in consultation visit with our doctor. 

The actual procedure is usually between 20 and 30 minutes per site treated.  It will take longer if you have several sites that need to be treated.  For example, if both of your heels hurt and require treatment, it will take longer than if just one heel requires treatment. 

What happens after my visit?  Am I laid up?   

No, you're not laid up.  In fact, most patients experience a degree of relief immediately following a treatment and can return to most regular activities almost immediately.  (The instant relief most patients experience is usually a temporary effect; more permanent relief typically begins about 72 hours following treatment.)

While most patients we treat do not experience much in the way of side effects, there are occasional patients who do experience some modest aching, burning or tenderness following shockwave therapy.  But this is usually temporary and it doesn't usually force patients to alter their lifestyle to a significant degree.

Side effects seem to be more common with earlier forms of ESWT technology that cause more trauma to surrounding tissues that the technology we use.  Still, it's generally a good idea to hold off on significant exercise for a short time following the procedure to see how your body responds to the therapy.

What are the odds it will help my condition? 

The odds of success depend upon what tissue is being treated, what condition you have, the severity of your condition, the protocol being used in your treatment, and the way you measure "success". 

Because of these variables, there are a handful of studies (usually quoted by an insurance company trying to find a way to justify not paying for ESWT treatment) that suggest that the effectiveness of ESWT isn't yet proven. 

But the vast majority of recent studies--over 70 studies were presented at the 2006 international shockwave seminar in Brazil alone and over 80 were presented the year before in Vienna--suggest that shockwave is highly effective.

Assuming you have an injury appropriate to extra-corporeal shockwave technology treatment, most recent independent studies suggest somewhere between a 65% and a 95% "success" range, with values around 80% being the most commonly cited number.  And it's important to note that most of these studies have success rates as determined by the patient, himself, in terms of pain and function.

We find that our results with the highly accurate piezoelectric technology, are at least this successful.  However, we typically can't predict which patients will respond successfully to ESWT and which ones won't.

We find that the most important factor in getting a good result with ESWT appears to be in selecting appropriate patients most likely to benefit from this technology. 

How many visits will I need to improve my condition?

It varies, depending upon the specifics of your condition.

As a rule, though, we have found that approximately 20% of our patients only require one visit to resolve their condition.  Some require two visits.  Most require three visits, and we usually schedule three visits for patients visiting us from a distance. 

Generally if a patient doesn't find any significant relief in three visits, he may be one of those whose condition does not respond to this therapy.  

When would subsequent visits be scheduled?

We usually space them out by about a week.  But this may be adjusted as needed, particularly for patients who visit us from out of town or out of the country.  In those cases, we can arrange for multiple visits over a long weekend or spread them over longer time spans. 

Who performs the treatment?

Unlike most ESWT facilities in North America, we have a doctor perform all ESWT treatments.  This is the law in many jurisdiction in Europe, but usually the exception in North America, where technicians are hired to perform the treatment. 

We believe that having a doctor apply the therapy is important because the energy we use needs to be focused at specific tissues, and we believe that doctors are best identifying the tissue level that needs to be treated and making certain that the therapeutic shockwave are directed and calibrated in strength to that particular level. 

For foot conditions, (our specialty), treatments are typically performed by Dr. S. A. Schumacher, a licensed podiatric physician and surgeon board certified by both major boards in the podiatric profession, and one of the most experienced practitioners in North America in piezoelectric extra-corporeal shockwave therapy in general, and in using this machine in particular.  He is a member of the International Society for Musculoskeletal Shockwave Therapy (ISMST) of Vienna, Austria. 

Treatment for other conditions may be performed by other specialists, depending upon the specific condition in question. 

Can I just make an appointment and have ESWT performed or do I need a referral?

Patients need to be properly examined and diagnosed by a medical professional to be certain ESWT will work for you and that you have no contraindications to the therapy.  If you do not have anyone treating your condition, we can arrange to have you seen by a practitioner appropriate to your complaint. 

In fact, if you have a foot condition, you can be assessed on site.  This is because Shockwave Therapy - BC shares our brand-new 3,800 square-foot premises with the Achilles Foot Health Centre, a foot specialty clinic operated by Dr. S. A. Schumacher, (see above).  

If you have a foot-related problem, you may arrange for a preliminary appointment for foot-related problems through that office.  Please feel free to visit the Achilles Foot Health Centre website or call 604-589-5234 to arrange for an appointment. 

What's my next step?

Once you've been properly assessed and diagnosed with a condition that may benefit from ESWT, and after you've tried other forms of more conservative treatment for your condition without success, you may be a candidate for this therapy. 

Feel free to contact our facility at 604.589.5234 and arrange for an appointment. 


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