Extracorporeal Shockwave Therapy (ESWT): Mechanical mechanotransduction for refractory epicondylalgia

Q1. What is Extracorporeal Shockwave Therapy (ESWT) for the elbow?

Extracorporeal Shockwave Therapy (ESWT) is a non-surgical, non-invasive treatment that uses high-energy acoustic (sound) waves to treat chronic elbow tendon problems. \"Extracorporeal\" simply means the treatment is delivered outside the body. In our clinic, Dr. Veillette uses ESWT to target damaged tendon tissues, helping to reduce pain and kick-start your body's natural healing process without the need for surgery or injections.

Q2. What does \"refractory epicondylalgia\" mean?

\"Epicondylalgia\" is the medical term for pain where the tendons attach to the elbow bone, commonly known as tennis elbow (lateral epicondylalgia) or golfer's elbow (medial epicondylalgia). The word \"refractory\" means the condition has lasted for a long time (usually more than six months) and has not improved after trying standard conservative treatments like rest, ice, braces, physical therapy, or anti-inflammatory medications.

Q3. How does ESWT work to heal the elbow? What is \"mechanotransduction\"?

ESWT works through a biological process called \"mechanotransduction.\" The shockwave device sends physical, mechanical pulses of energy through your skin into the damaged elbow tendon. Your cells sense these mechanical vibrations and convert them into chemical signals that trigger healing. This process:

• Increases blood flow by promoting the growth of new, healthy blood vessels.
• Stimulates collagen production, which is the main building block needed to repair torn or worn-out tendon tissue.
• Temporarily overstimulates nerve endings to help reduce chronic pain.

Q4. What are the main benefits of ESWT for chronic tendon pain?

Choosing shockwave therapy offers several major advantages, particularly for patients looking to avoid invasive procedures. The primary benefits include:

• No surgical incisions, stitches, or scarring.
• No need for local or general anesthesia.
• A very low risk of complications compared to surgery or repeated steroid injections.
• Little to no downtime, allowing you to return to daily activities quickly.
• Long-lasting pain relief by treating the root cause of the injury, not just masking the symptoms.

Q5. What happens during a typical shockwave therapy session?

A typical session is performed in our office and takes about 10 to 15 minutes. First, a coupling gel is applied to your elbow to help the sound waves travel smoothly into your skin. Dr. Veillette or a trained therapist will place the hand-held shockwave applicator against the gel-covered skin, targeting the exact area of your pain. The device will make a repetitive clicking sound as it delivers the pulses. We will start with a low energy level and gradually increase it based on your comfort.

Q6. Does Extracorporeal Shockwave Therapy hurt?

You may feel some mild to moderate discomfort or a deep, throbbing sensation during the treatment, but it is generally well-tolerated. The discomfort is a sign that the shockwaves are targeting the damaged tissues. Because there are no needles or cuts, we do not use numbing medicine, as numbing can actually reduce the effectiveness of the healing process. We will constantly check in with you during the session and can adjust the settings of the machine if the treatment feels too intense.

Q7. What is the typical treatment schedule or protocol?

For refractory epicondylalgia, most patients require a series of 3 to 5 treatment sessions. These sessions are usually spaced about one week apart. Spacing the treatments allows your elbow tissues to rest, adapt, and begin the healing process between sessions. Dr. Veillette will evaluate your progress after each session to customize the plan to your specific needs.

Q8. How soon can I expect to feel improvement after ESWT?

Many patients experience temporary pain relief shortly after their first session due to the numbing effect on the local nerves. However, the true healing process takes time. Because mechanotransduction stimulates your body to build new blood vessels and repair the tendon fibers, the most significant and lasting improvements typically occur between 6 to 12 weeks after your final treatment session.

Q9. Who is a good candidate for this treatment?

You may be a good candidate for ESWT if you meet the following criteria:

• You have been diagnosed with chronic tennis elbow or golfer's elbow.
• Your elbow pain has persisted for at least 3 to 6 months.
• You have tried other conservative treatments (such as rest, stretching, braces, or physical therapy) without success.
• You want to explore non-surgical options before considering surgery.
• You do not have any of the major health conditions that would make ESWT unsafe for you.

Q10. Are there any conditions or situations where ESWT should not be used (contraindications)?

While ESWT is very safe for most people, it should not be used if you have certain medical conditions. Contraindications include:

• Being pregnant.
• Having a cardiac pacemaker or other implanted medical device.
• Taking prescription blood thinners or having a known bleeding disorder.
• Having an active infection or open wound in the elbow area.
• Having a history of bone cancer or tumors in the arm.
• Having received a corticosteroid (cortisone) injection in the same elbow within the past 6 weeks.

Q11. What are the potential side effects or risks of shockwave therapy?

ESWT has a very strong safety profile, and serious complications are extremely rare. The most common side effects are mild, temporary, and resolve within a few days. They include:

• Mild redness or swelling in the treated area.
• Temporary bruising or small red spots on the skin.
• A brief increase in elbow soreness or throbbing pain for 24 to 48 hours after treatment.
• Mild numbness or a tingling sensation in the arm.

Q12. How should I prepare for my ESWT appointment?

Preparing for your session is simple and straightforward:

• Wear comfortable clothing with sleeves that can easily be rolled up to expose your elbow.
• Avoid taking anti-inflammatory medications (such as ibuprofen, Advil, Aleve, or Motrin) for at least 5 to 7 days before your treatment. These medications can block the natural inflammatory response that ESWT uses to stimulate healing.
• Tell Dr. Veillette about all medications you take and if you have had any recent cortisone injections.

Q13. What should I do (or avoid doing) after a shockwave therapy session?

To get the best results from your treatment, we recommend following these post-session guidelines:

• Rest your arm from heavy lifting, squeezing, or repetitive actions for 24 to 48 hours.
• Avoid using ice packs or taking anti-inflammatory medicines (like Advil or Aleve) for pain, as they can interfere with the healing process we want to trigger. Use acetaminophen (Tylenol) if you need pain relief.
• Drink plenty of water to support cellular recovery and tissue healing.
• Gently move your elbow through its normal range of motion; do not keep it stiff or completely immobilized.

Q14. Can ESWT be combined with other elbow treatments, like physical therapy?

Yes, ESWT is highly effective when combined with a structured physical therapy or home exercise program. While the shockwaves stimulate the biological repair and tissue remodeling, targeted stretching and strengthening exercises (such as eccentric loading) help rebuild the tendon's strength and flexibility. Dr. Veillette often coordinates ESWT with a personalized rehabilitation program to ensure optimal, long-term recovery.

Q15. Why is ESWT considered a good option before thinking about elbow surgery?

Surgery for chronic tennis elbow or golfer's elbow is generally reserved as a last resort. ESWT provides an excellent middle-ground option because it is highly effective—studies show success rates between 60% and 80% for chronic cases—without the risks of surgery, such as infection, nerve damage, or prolonged recovery times. It is a safe, office-based alternative that allows you to remain active and work toward recovery without undergoing an operation.

We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.