Shock waves are audible, high-energy sound waves.  Since approximately 1980 they have been incorporated into the medical world, initially used to obliterate kidney stones to ease the passing of the material.  The modern inception of this technology has branched to provide therapy to the painful body regions, where stimulated self healing mechanisms occur.
What is Shockwave Therapy?
The two primary styles of Shockwave therapy available to the public today are:

1. Extracorporeal Shock Wave (Electrohydraulic, Electromagnetic, Piezoelectric technologies)
2. Radial Shockwave (usually not considered true extracorporeal shockwave therapy--but more of a pressure wave therapy since the impulses don't break the speed of sound)

Here at AYH we are fortunate to have the newest technology at our disposal in the form of the PiezoWave from German Medical experts Richard Wolf Industries.  True Extracorporeal Shock Wave is considered a superior, more efficient form of Shock Wave.  Examples include the 2010 Institute of Sports Medicine Frankfurt  "Comparison of radial versus focused extracorporeal shock waves in plantar fasciitis using functional measures" study where they concluded "... evidence for focused extracorporeal shock wave treatment being superior to radial extracorporeal shock wave therapy for recalcitrant plantar fasciitis."
The PiezoWave combines two types of orthopaedic applications:

1. ESWT (Extracorporeal Shock Wave Therapy)
2. TPST (Trigger Point Shock Wave Therapy)

ESWT has been used successfully in the treatment of chronic pain since the early '90s. ESWT & TPST are highly efficient, non-surgical treatments for chronic pain in the musculoskeletal system. 
The PiezoWave offers a significant expansion of the range of applications for myofascial pain syndrome. The extracorporeal, focused shock wave allows precise diagnosis and therapy of active and latent trigger points. Trigger points are thickened, pain-sensitive points within a usually tense muscle. They can cause a variety of pains – even well away from their own location.  As a powerful system for pain therapy, it significantly expands the range of application in cases of myofascial pain syndrome:

• Cervical spine
• Upper extremities
• Pectoral girdle
• Hip region
• Thoracic and lumbar spine
• Lower extremities
  
  Thanks to the wide range of applications of shock wave therapy it is an invaluable resource for any progressive rehabilitation practice.

• Neck muscles
• Shoulder muscles
• Back muscles
• Buttock muscles

Why Consider ESWT?
ESWT has a proven success rate that is equal to or greater than that of traditional Medical or Surgical methods without the risks, longer recovery time, and common and/or potential complications.  ESWT does not require anesthesia, requires minimal  time commitments, patients receiving foot or knee treatment can weight bear immediately, and it is normal to return to normal activity within a few days of the procedure (important for athletes training through injuries on strict schedules).
Benefits of ESWT

1. Does not require anesthesia
2. Patients can be treated on both sides at the same time if the condition requires
3. Patients are immediately full weight bearing
4. Fast, safe and effective
5. Even chronic condition patients are evaluated for success within 12 weeks from the last visit
6. Decreases pain and increased function
7. No incision or penetration of the skin required
8. No risk for infection at the treatment site
9. No scarring of the skin or soft tissue from treatment
10. Concurrent treatment options possible if not recommeded after discussion
11. Future treatment options are not limited
12. Cost effective treatment; no prolonged periods of time off work
13. Eliminate the need for medication, cortison, or repeated injections
14. Commonly used when all other methods have failed
15. Opens options for athletes who want to return to their sport and suffer from chronic pain

How do Shockwaves Work?
The body's healing process is accelerated by activating the body's inate healing responses.  Aside from helping break down thickened, inflexible scar tissue, the shock waves stimulate new blood vessel formation (neovascularization) to the injured area leading to improved circulation and metabolic processes.  Once this occurs the body will even begin to re-absorb irritative calcium deposits from the affected tendons.  This forces the damaged tissues to progressively regenerate, eventually healing properly.
The root of the Wolf PiezoWave unit is the powerful piezoelectric shockwave produced through focused sonic energy from thousands of small crystals embedded in the applicator head.  The unit is simple to operate, all treatment parameters easily set and monitored with precision.
At the applicator head exact depth of penetration can be varied by use of varied thickness gel pads.  The large emitter of the applicator head allows for focused energy at a set depth, NOT at the skin layers where a patient would sense unnecessary treatment pain.  The Intensity of the impulses can be varied greatly over a 20 point scale, thus allowing both high levels of treatment efficiency while maintaining patient treatment comfort without freezing or sedation.
Common Conditions Treated by Shockwave Therapy

1. Plantar Fascitis / Heel Pain / "Heel Spur"
2. Elbow Tendinitis i.e. Tennis or Golfer's elbow
3. Chronic shoulder pain i.e. Calcific Tendinitis of Rotator Cuff muscles
4. Achilles tendon pain / calcification
5. Patellar tendonitis / Jumper's knee / Osgood-Schlatters disease
6. Trigger points / Chronic muscle tension
7. Chronic neck and back pain (Whiplash, Disc Injury, Sprain/Strain)

• Shoulder
• Elbow
• Knee
• Foot

What are the Expected Results?
Benefits of ESWT are often experienced after only 3 to 5 treatments with some patients reporting immediate relief after the treatment.  In some difficult cases it can take approximately 4 weeks to see the desired pain relief to begin, then between 9 to 12 weeks to resolve.  Scientific studies have shown the most significant tissue healing occurs in the 6 - 9 week window.  The effects of the treatment are accumulative, so even after the last treatment is performed benefits will continue to appear for weeks afterward as the treated tissues heal.  This procedure aims to eliminate pain, regain normal range of motion/mobility, subsequenly restoring exercise tolerance and quality of life.
How is the Treatment Performed?
After a thorough history and physical examination is performed to identifiy the pain region(s), a small amount of ultrasound gel is applied to the skin over the area.  Then the Piezowave treatment head will be place on the region to generate the shock waves.  After a few test impulses to best isolate the exact "spot", the applicator will be focused there for the duration of that point's treatment at a frequency and intensity comfortably tolerable to the patient.
The shock waves are sonic (sound) energy upon impact of the immobile body tissues, thus creating the desired results discussed above.  Each treatment session focuses on providing 1500-2000 impulses, so treatment time can vary depending on the condition and patient treatment tolerance.   One treatment every 7 days (no more than 10 days) is generally recommended, allowing the body to recover between sessions.  This interval is then generally recommeded for 3-5 weeks, baring exceptional cases.
NOTE: There is no contra-indication to being concurrently treated with other modalities to expidite patient results.  Sports medicine examples could include a patient using Active Release Techniques® or Graston® to treat the scar tissue of a case of Tennis Elbow, Shockwave to isolate the difficult root to the problem, and Acupuncture to moderate the pain and further enhance the body's healing response.
What are the Possible Side Effects/Complications?
The extracorporeal wave has virtually no risks or side effects. In some cases patients may experience some minor discomfort, which may continue for a few days. Similar to what you may experience after a full days work or intense exercise.