When you have chronic pain everything you do in your life is affected. Having daily pain is no way to live, especially when the pain is avoidable.

It is a pleasure to share this information about a state of the art solution to a common painful problem. ESWT or Extracorporeal Shock Wave Therapy will make your life more enjoyable with one simple 18 minute procedure.

If after looking through this page of frequently asked questions and answers, you still have any other questions, click here to fill out our email contact and question form and we will get back to you with an answer as soon as possible.

The information on this page will answer the following questions for you:

What is ESWT?
Extracorporeal Shock Wave Therapy or ESWT is an 18-minute non-surgical procedure used to cure chronic plantar fasciitis, Achilles tendonitis, tennis elbow, shoulder tendonitis, and other chronic tendonopathies.

Lithotripsy, a similar shock wave therapy procedure, is used regularly for breaking up and dispersing kidney stones. When urologists found patients who had the kidney stone procedure presented with increased bone density and new tissue growth the possibilities of shock wave therapy were revisited.

ESWT is used internationally for conditions all over the body. In the United States an FDA study was performed for patients who suffer chronic plantar fasciitis with or without the presence of a heel spur. The results were an amazing average reduction in pain of 92% with only one treatment. (This data reflects the results of the patients who participated in a one year follow up study with the Dornier EPOS Ultra machine.)

ESWT benefits patients because their condition can be treated extracorporeally, meaning outside of the body. Because the treatment is non-invasive many of the expenses and risks of surgery are eliminated.

Excellence Shock Wave Therapy uses the Dornier EPOS Ultra for all our Orthopedic ESWT Procedures.

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What is involved in the procedure?
ESWT benefits patients because their condition can be treated extracorporeally, meaning outside of the body. Since ESWT is non-invasive there is no lengthy recovery period, virtually no time off from work or risk of causing further damage as with surgery.

During the treatment you lie back comfortably with the area to be treated resting on the machine on a soft water filled membrane. To ensure patient comfort, a local anesthesia is used for the procedure. The technician will make sure you are comfortable throughout the procedure.

Ultrasound will be used to view and target the damaged location. During the treatment you will be aware of a repetitive clicking sound.

The Excellence Shock Wave Therapy Mobile Treatment Center is luxurious and comfortable. You can read, watch television, enjoy a refreshment and relax while you receive your treatment. We do everything we can to make your experience comfortable, even enjoyable.

In some cases your treatment will be scheduled in the doctor's office or surgical center.

ESWT is a non-invasive procedure. With the local anesthetic you will be very comfortable. If you are nervous or anxious about treatment talk to your doctor or treatment coordinator. We will make you comfortable!

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What kind of recovery can I expect?
The FDA ESWT study using our treatment protocol show an overwhelming success rate. In the study a group of 150 patients was asked to rate their pain level on a scale of 1 to 10. The average pain level before treatment was 7.7. After receiving one ESWT treatment, the patients were asked one year later to rate their pain level again on a scale of 1 – 10. The patients who reported had an average pain score post-ESWT of 0.6. This is a 92% reduction in pain and a much higher rate of success than any non-surgical or surgical procedure. More importantly, ESWT is very safe.

ESWT is forcing your body to create new tissue cells in the damaged area. Expect gradual healing to take place over many weeks.

Though not typical, some have mild soreness or bruising after treatment. Some people have no more pain from day one. Most will have noticeable to significant improvement by the thirteenth week. A second treatment after 16 weeks may be necessary in less than 10% percent of patients.

You avoid getting worse before getting better as you would with surgery. You do not need to plan lengthy time off from work or your life for painful post-procedure recovery.

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When should I consider ESWT?
If you have had ESWT for more than six months and have tried 3 conservative therapies with no results, don’t wait. It's natural to procrastinate, but not a good idea for tendonosis conditions. Continuously using degenerative tendon tissue can cause further damage.

For example, every time that you feel pain when you place weight on your heel or lift something with your arm it's because you are pulling against the tendon fibers. When the condition progresses to a rupture ESWT is no longer an option and the patient has no alternative but invasive surgery.

If left untreated you can also experience new problems. For example, with heel pain in your left foot you may naturally compensate by walking on your toes or limping to protect yourself from pain. These abnormal movements will, in time, cause undue strain to your knees, hips and lower back or worse you end up with the same condition in the other foot. Compensation issues occur whenever you have chronic pain left untreated.

If your pain just started you may be able to avoid ESWT by early intervention. Please feel free to call us and we will recommend a specialist who can help you take care of the problem today.

Take care of yourself. Fix the problem, don't delay.

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I've tried other things but they didn't help. How do I know this will?
Tendonitis sometimes resolves by itself or with the help of treatments such as strapping, physical therapy, anti-inflammatory medications, or cortisone injections. When the condition is new (usually less than 6 months) it is called acute tendonitis. Acute tendonitis is inflammation. All of the treatments used at this stage are meant to rest the area or deal with the inflammation.

Those who do not get better in the "acute" phase have what is called chronic tendonosis. The difference between tendonosis and tendonitis is simple. Tendonitis is an inflammation. Tendonosis is degenerative or damaged tissue. You can use steroid injections repeatedly with no result if the problem has gone beyond inflammation. Surgery was the only option for tendonosis. ESWT treats tendonosis because ESWT forces the damaged tendon to heal.

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What ESWT equipment is used by Excellence Shock Wave Therapy?
We use the Dornier EPOS Ultra. The EPOS is FDA Class 3 approved for the treatment of chronic plantar fasciitis. In our opinion, the Dornier EPOS is the highest quality, most state-of-the-art device on the market.

There are many reasons why Excellence Shock Wave Therapy chose the Dornier EPOS Ultra as our ESWT equipment. Three main technical factors should be of interest to our patients:

1. The Dornier EPOS uses ultrasound during the treatment process. This means the doctor can locate, view, and target the specific area or damage/injury with pinpoint accuracy. Shockwaves are directed exactly where they are needed, and only where they are needed, to ensure a successful treatment.

2. The Dornier EPOS treats plantar fasciitis by sending the shockwaves in through the tendon from the side of the heel. Other equipment sends the shock wave in from the bottom of the heel directing the shock waves up and into the heel bone. This bone impact is painful. Because we do not impact bone we do not need to use unnecessary general anesthesia or IV sedation.

3. The Dornier is a high energy ESWT machine with a wide range of settings and penetration depths. This allows the doctor and the technician to fine tune the procedure to your individual diagnosis. The Dornier treatment is not one size fits all.

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What are the differences between the Dornier equipment used by Excellence Shock Wave Therapy and the Ossatron and Sonocur equipment?
Excellence Shock Wave Therapy has selected the Dornier EPOS Ultra as our equipment of choice because it offers the highest, yet most variable energy output. It also incorporates ultrasound to view the damaged tissue and target the shockwaves directly at and only to the damaged tissue.

The Dornier is capable of performing both low energy and high energy treatments. Excellence Shock Wave Therapy does not perform low energy shock wave therapy for Plantar Fasciitis. Only high energy is FDA tested and approved for Plantar Fasciitis.

High energy ESWT causes cavitation or microtrauma to the tissue. This forces the body to lay down new fibroblast tissue and actually repair the tendon while ALSO affecting pain receptors.
Low energy shock wave therapy affects only the pain receptors. Low energy shock wave therapy can not be performed with a local anesthetic because a local injection has shown to nullify the results of low energy treatments on pain receptors. This means the patient must be able to tolerate the pain of the treatment. Once tolerance has been reached the energy level can not be increased. Multiple treatments are required to affect the pain receptors with low energy shock wave therapy.

Discover more details about the differences between Dornier and Ossatron equipment.

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How do I know ESWT is right for me?
Your Certified Excellence Shock Wave Therapy practitioner will perform a thorough examination and order any necessary diagnostic tests to determine your best course of treatment for your condition. Though this website focuses on ESWT, it is the goal of every doctor in the Excellence Shock Wave Therapy Group to provide the best possible treatment for your pain. We will refer you to a physician who will make a complete diagnoses and treatment plan. The doctor may recommend ESWT or another course of treatment. You will not have to guess if ESWT is right for you. The Doctor can help you make your treatment decisions based on your individual condition.

If ESWT is right for you we do not need to delay. We know you are in pain and will make every effort to schedule your treatment quickly and at a time convenient to your schedule. The sooner you receive treatment, the sooner you are enjoying your hobbies and active lifestyle again!

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Why doesn't my orthopedic surgeon or podiatrist do this procedure?
There are several reasons. This procedure is relatively new to the United States. The physicians certified by Excellence Shock Wave Therapy in ESWT are truly state-of-the-art practitioners. You may find many physicians are not even familiar with this treatment. You are encouraged to share this information with your physician and have him or her contact us for physician-oriented information. We welcome this communication!

Additionally, this technology costs over a half million dollars to offer in a practice. This investment is simply not affordable. Excellence Shock Wave Therapy owns the equipment and trains physicians in the technology and practice of ESWT. Doctors who offer this treatment are proving they try to avoid unnecessary surgery and hospitalization for their patients.

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I have had this problem for a long time. Is it too late for me?
No! The chronic sufferer has new hope with ESWT. Long term sufferers finally have a non-surgical treatment option. If you have "tried everything" don't be discouraged, this is a new weapon against your pain!

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What is the American Podiatry Medical Association's opinion on Surgery vs ESWT?
Taken from APMA article, "Surgical Treatment vs. ESWT"
published August 26, 2003

A review of the literature to compare surgical treatment of plantar fasciitis via either an open approach or an endoscopic plantar fasciotomy (EPF) against ESWT was performed.  No studies presently exist that randomize patients between surgical and ESWT treatments; therefore, direct comparisons between these types of treatment cannot be made.  However, the literature demonstrates that success rates for surgical treatment, either via an open approach or an EPF, are between 60-90%.  According to the literature, the complication rate associated with surgical procedures is higher than that associated with ESWT.  Complications for open procedures can be as high as 15-20%.  In one study, patients undergoing surgical treatment via percutaneous plantar fasciotomy experienced a 17% complication rate.  In general, complications with EPF are lower.  Studies demonstrate that complications associated with ESWT are minimal.  In one study, of 302 patients treated, 13 related complications occurred.  Complications identified in the surgical treatment of plantar fasciitis include, among others, infection, neuritis, scar problems and lateral column instability.  The primary complication associated with ESWT is bruising, although other adverse events are possible.  

In terms of recovery, there is a substantially shorter recovery time with ESWT as compared to traditional heel surgery.  In most cases, patients are able to immediately return to work following ESWT and typically resume full activities within 2-3 weeks of treatment.  Open surgical treatment typically requires a more prolonged recovery, including 2-6 weeks of non-weight bearing, followed by partial to full weight bearing.  In most cases, treatment with ESWT allows patients to get better quicker with fewer complications.

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