In Western medicine we are most familiar with treatment via medication or surgery. For chronic musculoskeletal problems(MSK) sometimes physical therapy may be recommended

if drug therapy fails and before surgery. The latter is a form of ‘Physical Medicine’, the application of some external force to the body inorder to effect some diminishing of symptoms and/or speed healing. Massage therapy is ancient. The adage ‘RICE’ / rest, ice, compression, elevation is still commonly employed for a sprained, swelling ankle. At physical therapy the therapist may apply electrical stimulation or deep heat through ultrasound to the injured tissue.

Shockwave’ for chronic MSK problems was originally developed in Europe decades ago. It involves not an electric shock but pressure wave pulses of specific frequency and intensity sent through the targeted tissue. When first used in the U.S the device was the size of a large cabinet and cost a quarter million dollars and therefore was often rented for a session and brought to the doctor’s office. The energy pulses were quite high intensity so the therapy was performed under some form of anesthesia and in one session.

Fast forward to today and the types of devices have expanded and the size and cost of the machines have dramatically diminished. Today the more common device in North America produces a ‘radial’ pressure wave ( EPAT, by Curamedix). This type of wave is most effective with soft tissue; chronically inflamed ligaments around joints, tendons and peripheral nerves ( Morton’s Neuroma in the foot). ‘Focused’ shockwave(FSW) is similar to the original device but lower intensity. It is most effective where soft tissue is anchored to bone; chronic inflamed areas of tendon or ligament ‘insertion’ to bone ( chronic plantar fasciitis, insertional achilles/peroneal/tibial tendonitis in the foot). These devices are table top in size and require no anesthesia and treatment is delivered over 3 -5 sessions lasting 10-15 minutes with intensity adjustable to the patient’s tolerance during each session.

Dr. Horowitz has experience with both EPAT and FSW devices and now has both available in his Bowie office. He uses devices from Curamedix/ Storz from Germany. These are the devices used in most research studies in the US and their effectiveness in treating chronic MSK problems is impressive. In his experience, Dr. Horowitz often finds that combining both EPAT and FSW brings the best results.

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