# Extracorporeal Shockwave Therapy (ESWT)



## vickster (1 Jul 2017)

I've been referred by specialist for this on my foot which is still being a pita 9 months on. Any experiences?


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## vickster (2 Jul 2017)

Guessing not with 100 views and no replies


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## midlife (2 Jul 2017)

Only ever come across it to break up kidney stones (lithotripsy). Is Megapulse / therapeutic ultrasound different?


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## vickster (2 Jul 2017)

midlife said:


> Only ever come across it to break up kidney stones (lithotripsy). Is Megapulse / therapeutic ultrasound different?


Sounds like it's a similar / same thing, now adapted for soft tissue issues

https://www.physiocare.co.uk/physiotherapy/shockwave-therapy/evidence/


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## vickster (18 Jul 2017)

I'm guessing no one has had this done for plantar fasciitis. My first treatment (of three) is this evening

Foot actually feeling a bit better. Probably due to the oral steroids prescribed by the rheumatologist


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## velovoice (18 Jul 2017)

Please let us know how you get on.


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## vickster (18 Jul 2017)

Full check over by the new Physio, then the actual ESWT. 4 minutes, the painful side of uncomfortable but not as bad as I expected. Not tickly thank God!!

No specific soreness now. Allowed to cycle to work tomorrow but no longer ride (shame as I have afternoon off work  )

Physio concurs that I do have extremely tight calves. More stretching needed esp after cycling

She did ask if the surgeon had mentioned a gastroc release. Yes, but not something I'm entertaining right now. Wouldn't be able to do anything like that anyhow until my next work contract ends in Feb

In the meantime, two more ESWT sessions. Stretching. Physio reckons a few deep sports massages in conjunction with stretching could help. Apparently more relief from the ESWT is felt at around 3 months post


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## Stephenite (19 Jul 2017)

I've had this treatment for PF. I'm not sure it did any good tbh. I think the physiotherapist used Electro Shockwave Therapy as a cure all. After half a doven sessions he sent me away dating he couldn't do anything for me. Six months later i was back at the same clinic, but this time with a different physio. His thing was dry-needling. No improvement. But the second physio sent me for an ultrasound examination with an "Expert". This "Expert" said what was needed was a cortisone shot in the, actual, fascia. I said i'd think about it, and didnt return. The ultrasound examination showed that i had 'crushed heels'. The fat pad under the heel had been mushed. Now this had probably been mushed earlier in my life when i was a rufty-tufty labourer type, or had been mushed under the ESWT. Not possible to tell.

I had joked with the electro-shockwave physio about the efficacy of the treatment for headaches. He didnt laugh... in a wierd way.

I think if you suffer from chronic PF it's all about finding a way to live with it than finding a cure. Stretching, correct diet (magnesium etc), INSOLES, INSOLES, INSOLES.


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## vickster (4 Sep 2017)

Turns out I have degeneration in one of the joints in my midfoot, diagnosed via a super sensitive CT scan (not seen on MRI 6 months ago). Having an injection into the culprit (under sedation as apparently the joint space is v small and injecting hurts like mad)

On the plus side, the PF seems to be resolving, my heel isn't so sore, the rest of the foot just hurts when walking.

Rheumatologist thinks I might be developing inflammatory arthritis 

Fortunately, cycling is broadly ok still


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## presta (14 Sep 2017)

I read about it in connection with tennis elbow, there's not much evidence that it does anything apparently.


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## vickster (14 Sep 2017)

presta said:


> I read about it in connection with tennis elbow, there's not much evidence that it does anything apparently.


I tried everything for tennis elbow, physio, acupuncture, steroid, PRP etc (ESWT wasn't offered/available), had to have surgery in the end. When the surgeon went in the tendon was hanging by a thread and would never have healed on its own.

I'd still try everything else first, as the pain after the op was awful for a few weeks! I came to hate clothes with sleeves (it was unfortunately November)


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## presta (20 Sep 2017)

vickster said:


> I tried everything for tennis elbow, physio, acupuncture, steroid, PRP etc (ESWT wasn't offered/available), had to have surgery in the end. When the surgeon went in the tendon was hanging by a thread and would never have healed on its own.
> 
> I'd still try everything else first, as the pain after the op was awful for a few weeks! I came to hate clothes with sleeves (it was unfortunately November)


So far, the only thing that's happened since I developed TE in Aug 2016 is that I developed TE in the other arm in March 2017. First the left from lifting a rucsac on holiday, then the right just from doing housework. From what I had read, I thought that surgery just entailed cutting out the damaged tissue rather than sewing anything back together. I've been told that steroids are anything much other than a placebo. How long were you lumbered with it for? Have you recovered full strength since?


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## vickster (20 Sep 2017)

presta said:


> So far, the only thing that's happened since I developed TE in Aug 2016 is that I developed TE in the other arm in March 2017. First the left from lifting a rucsac on holiday, then the right just from doing housework. From what I had read, I thought that surgery just entailed cutting out the damaged tissue rather than sewing anything back together. I've been told that steroids are anything much other than a placebo. How long were you lumbered with it for? Have you recovered full strength since?


Symptoms for over a year before the op.
Lots of Physio, acupuncture, exercises,

Steroid injection helped for maybe 3 months. Never had oral steroids, only NSAID

I had PRP injection which according to specialist helps in 80%+ (he had it done effectively himself). Really didn't help and I had to have the surgery (I could barely lift anything, pull anything, pretty bad as I was doing loads of long haul work travel that year). I had the op about 3 days after getting back from Japan!

My tendon was detached, cleaned up and reattached with stitches and a biosbsorbable screw as I understood it. It was barely hanging on by a thread though. It was an open op, 2 inch scar. I also needed a follow up op to remove a lump of scar tissue around the internal stitches. Think surgeon does keyhole now, new technique in last 5 years...not sure though as website not updated

http://www.thelondonshoulderpartnership.co.uk/elbow-information/24/common-extensor-origin-release

Strength, yep, not that I'm very strong! And I do have quite a few other joint issues (recent diagnosis of possible inflammatory arthritis, which often seem to end up chronic

My surgeon has good info on the op on his website (London shoulder partnership). 

http://thelondonshoulderpartnership.co.uk/elbow-information/elbow/tennis-elbow



Note all treatment was done privately through work insurance, NHS probably wouldn't cover nearly as much like the PRP

Sounds like you need to find a good private sports Physio and to try to rest. Daily heat and icing can help.

Good luck!


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## presta (21 Sep 2017)

Thanks Vickster, there's more there than I've got out of the NHS in 13 months, I hadn't heard of PRP. It's tricky resting when you have to keep carrying things isn't it, fetching the groceries home from Tesco seems to be enough to keep aggravating mine. I also think the reason I have TE in the first place is that my arms have become unfit after a protracted period of inactivity, catch 22. Do you have any idea how much the operation costs if you don't have insurance?


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## vickster (21 Sep 2017)

presta said:


> Thanks Vickster, there's more there than I've got out of the NHS in 13 months, I hadn't heard of PRP. It's tricky resting when you have to keep carrying things isn't it, fetching the groceries home from Tesco seems to be enough to keep aggravating mine. I also think the reason I have TE in the first place is that my arms have become unfit after a protracted period of inactivity, catch 22. Do you have any idea how much the operation costs if you don't have insurance?


Where are you in the UK? Hospital costs do vary, guess would be £4k if keyhole (more probably if open, as it involves an overnight stay). Plus rehab costs. Should be able to find something on fees on local private hospital website

My elbow was done here, I would think shoulder costs would be broadly representative. Costs can vary quite heavily depending on the surgeon

https://www.parkside-hospital.co.uk/patient-information/self-pay-patients/price-list/

Don't even consider op until you've tried everything first. Have you seen a specialist and had full diagnostics like ultrasound?
I'd get a private consult from an elbow specialist and take it from there. Probably around £250 plus any tests

Use a backpack to go to the supermarket or a car 

There are some really simple elbow stretches and strengthening stuff you can do in front of the TV. See a Physio 

Info about PRP, interestingly from an NHS hospital

http://www.royalberkshire.nhs.uk/pa...aedics-platelet-rich-plasma-prp-injection.htm

It was pretty painful, injecting a reasonable amount (4ml IIRC) of gloopy stuff into a tiny tendon


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## presta (21 Sep 2017)

Yes, I'd considered using the rucsac for the shopping, but it was lifting the rucsac onto my back that caused the TE in the first place. I've just been carrying smaller loads more frequently (Tescos have noticed, they've stopped sending me money-off vouchers completely!). It's tempting to think there's an improvement after I've been careful for a while, but then I carried a heavier load on Monday and it's as bad as ever now. There's no car, and I have a problem lifting the bike and squeezing the brake levers. I haven't been able to cycle much for years, so the loss of strength probably made me vulnerable to getting TE. If it's as much as £4k (per elbow?) that's out of the question. I had an ultrasound on the left elbow last April, but as the right one developed in between the referral and the appointment, the right side is just self-diagnosed (but worse than the left). The GP said I'd benefit from physio, but told me I'd have to go private if I wanted it.


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## vickster (21 Sep 2017)

presta said:


> Yes, I'd considered using the rucsac for the shopping, but it was lifting the rucsac onto my back that caused the TE in the first place. I've just been carrying smaller loads more frequently (Tescos have noticed, they've stopped sending me money-off vouchers completely!). It's tempting to think there's an improvement after I've been careful for a while, but then I carried a heavier load on Monday and it's as bad as ever now. There's no car, and I have a problem lifting the bike and squeezing the brake levers. I haven't been able to cycle much for years, so the loss of strength probably made me vulnerable to getting TE. If it's as much as £4k (per elbow?) that's out of the question. I had an ultrasound on the left elbow last April, but as the right one developed in between the referral and the appointment, the right side is just self-diagnosed (but worse than the left). The GP said I'd benefit from physio, but told me I'd have to go private if I wanted it.


Yes would be per elbow, would be two ops with recovery time between

I'd pay for the Physio. About £40-50 a session. Find a sports Physio who does ultrasound/dry needling, acupuncture as well as deep tissue massage


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