Shockwave Q&A with Stacey Roberts

Stacey Roberts is an expert on shockwave therapy and joins Herman & Wallace to present her course Shockwave Treatment: Therapeutic Interventions in Pelvic Health & Demystifying the Research. Over the last year, Stacey Roberts has been analyzing shockwave research extensively to develop clear and concise therapeutic applications in the rehabilitation setting for pelvic health, sexual health, and muscular-skeletal patients. She is finding extraordinary results with her patients using this modality in her practice.

Stacey sat down with us at The Pelvic Rehab Report to answer some of the most asked questions that she gets about shockwave therapy.

What is a Shockwave?

A shockwave is an interesting phenomenon and can be both natural and manmade. The Encyclopedia Britannica defines a shockwave as "a strong pressure wave in an elastic medium such as air, water, or a solid substance, produced by supersonic aircraft, explosions, lightning, or other phenomena that create significant changes in pressure.”

What is Shockwave Therapy?

Shockwaves used in therapeutic settings are produced by modalities that create supersonic waves. These waves penetrate the human tissue and can travel to areas of the body, producing a biological effect. The first therapeutic use of shockwave therapy was lithotripsy. This procedure was first used in the 1970s and utilizes high-energy high-intensity shockwaves to break apart kidney stones without surgical intervention.

Clinics now use low-intensity focused and unfocused shockwaves to exhibit a form of energy within the tissues. The shockwaves are made up of 3 phases: a mechanical phase, a chemical phase, and a biological phase. A true shockwave device impacts the tissue and can increase blood flow, activate connective tissue, modulate the inflammatory response, and contribute to pain relief.

Is there just one type of Shockwave device?

No, there are 3 types of true shockwave devices.

• Electrohydraulic (deepest penetration)
• Electromagnetic (minimal to moderate penetration)
• Piezoelectric (minimal penetration)

Why is Shockwave therapy beneficial?

When a true shockwave device is used, patients often note faster improvement than with manual therapy alone or with other standard modalities such as ultrasound, laser, and radial wave therapies.

In my experience, the depth of penetration also allows my skills as a manual therapist to be used more effectively. By using shockwave therapy, I can now treat an area in 5 minutes that previously would have taken 10-15 minutes. It also tends to be much more comfortable for the patient.

Are radial, pneumatic, or EPAT true shockwave devices?

No, they have been lumped in under the Shockwave umbrella but do not produce the force or effect of a true shockwave. These devices have therapeutic value for superficial musculoskeletal injuries including plantar fasciitis and lateral epicondylitis. However, the energy produced by the mechanical pounding of the tissue from a radial wave device does not produce a shockwave.

The energy produced by radial pneumatic devices disseminates just below the surface of the skin. An electrohydraulic shockwave device can produce energy up to four to six inches from its point of contact, making this particular type of shockwave device is especially useful for pelvic floor therapy.

Electromagnetic shockwave devices can penetrate approximately two inches. This is approximately the same depth as the piezoelectric shockwave device.

I see ESWT in the research a lot. Is that shockwave therapy?

ESWT stands for Extracorporeal Shockwave Therapy. This is a common abbreviation used in the literature that originally was meant to label shockwave devices. However, other non-shockwave devices, such as radial devices, also use ESWT in research studies.

In the true sense of the word, and shockwave definition, a radial device is NOT a true shockwave. There is much confusion in the research that takes time to unravel, so I have dedicated a portion of the Shockwave course to tease out the differences. Many clinicians own a radial device and were told that it was a shockwave device. Unfortunately, that is not completely accurate, according to the International Society for Medical Shockwave Treatment.

What can be treated with true Shockwave therapy related to Pelvic Rehab?

True shockwave therapy has shown to be beneficial for the following issues:

• Erectile Dysfunction
• Peyronie’s Disease
• Chronic Prostatitis
• Chronic Pelvic Pain
• Incontinence 
• Urgency
• Cystitis
• Vaginismus
• Vulvodynia
• Vestibulodynia
• Persistent Genital Arousal Disorder (PGAD)

Other areas of research:

• Dysmenorrhea 
• Endometriosis
• Testicular Pain and Dysfunction
• Premature ejaculation 
• Urinary retention

How is shockwave different from ultrasound?

A wave produced by ultrasound is a sinusoidal wave versus a shockwave that has a strong positive pressure followed by a longer negative pressure wave. See chart:

This results typically in larger cavitation bubbles around the cellular structures and fewer treatments to reach patient goals. Continuous ultrasound produces its effect by heating the tissue, whereas a shockwave device does not cause any heating of the tissue to produce its therapeutic effect.

Is shockwave therapy covered by insurance?

Like other valuable modalities, insurance does not typically cover low-intensity shockwave therapy. However, in times of decreasing reimbursement, patients are increasingly more than willing to pay out of pocket for treatments that result in positive outcomes in shorter periods.

Why should I take your course Shockwave Treatment: Therapeutic Interventions in Pelvic Health & Demystifying the Research?

You should take this course if you are interested in:

• Learning how one of the most effective non-invasive treatment modalities of our time related to pelvic and sexual health produces its results
• Understanding how this modality produces its results and how it is being utilized in clinics to improve treatment outcomes related to pelvic health
• How this modality can enhance results when combined with manual treatment techniques
• How to review the research efficiently without combing through data that may or may not be actual Shockwave research
• Being able to differentiate one machine from another to make an educated decision on which shockwave device may fit into your clinic
• What questions to ask company sales reps that are selling devices to make sure you are talking about a true shockwave device

If you would like to learn more about incorporating shockwave therapy into your daily practice, then join H&W Shockwave Treatment: Therapeutic Interventions in Pelvic Health & Demystifying the Research. This course is scheduled for February 20th and June 26th of 2022.