Scott Webb (Host): If you've been suffering for a while from something like plantar fasciitis and have exhausted all means of therapy and treatment, you may want to see my guest today to discuss shockwave therapy. Board-certified sports medicine specialist Dr. Blake Averill is here again. He practices at Franciscan Health. And today, he's going to discuss the benefits of extracorporeal shockwave therapy in the treatment of injured tissue.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's nice to have you back on the podcast. Today, we're talking shockwave therapy. And I told you I'm excited to learn about this. My daughter's an athlete. She's never had shockwave therapy, but she might. So, we're going to talk about, you know, how it's used to treat injured tissue and all that good stuff. So, let's start there. What is focused extracorporeal shockwave therapy?

Dr. Blake Averill: It is something that we use to help, like you mentioned, heal the tendon. So, what's great about it is it is a non-invasive option. There are no needles, no pokes, no cuts, no stitches, no sutures. We are able to take energy waves, put them into an area, and actually help heal up the tendon.

Host: Yeah, it's very cool. I told you that I watched a couple YouTube videos, a little sneak peek before we got on. I was like, "What is this and how does this work?" Because it sounds really cool. So then, let's talk about the conditions that shockwave therapy is used for.

Dr. Blake Averill: So, we generally use them for more chronic issues. So when you have a friend who says, "I've had my elbow hurting since, you know, 1998" or, "I've had this, you know, plantar fascia or foot pain for ten years," it does a really good job of treating these chronic issues. And I do want to pause a second just to educate the patients a little bit, because we hear the term tendonitis a lot, right? You've heard tendonitis.

Host: Sure.

Dr. Blake Averill: And so, that is really more of that first few weeks after an injury when everything is really inflamed and angry. But what happens is our body is not a perfect machine. So, sometimes it's not able to heal appropriately or heal correctly the tendonitis of injury that occurred.

Host: Okay.

Dr. Blake Averill: And what happens is that shifts more into a tendinosis, which is this chronic scarring, degenerative—I use the term like a crisscross pattern, right? And so, you have this damaged tendon that is just going to hurt until you're able to fix that damaged tendon. And that's where we come on board is physical therapy is still a cornerstone, because a lot of those tendinosis issues, a lot of that damage can still be fixed with physical therapy alone.

Host: Okay.

Dr. Blake Averill: Your chance of healing, it can be increased with shockwave or just doing shockwave alone if therapy hasn't helped.

Host: Right. Yeah. And as somebody who has suffered from plantar fasciitis in both of my feet somewhat recently, now I would know if I had just reached out to my provider instead of suffering and trying all these home remedies, I might've been able to heal faster. Oh, I did watch videos, but not everybody has watched the videos. I want to have you explain, like, how does shockwave therapy work?

Dr. Blake Averill: Yeah. So, there's a machine we have in the office that's able to take high-powered energy waves, right? Think like ultrasound, but much stronger. And it's able to transfer those energy waves into the tendon cells. So, what's nice is the machine, we just place it on top of your skin. That's where we get the term extracorporeal. It means it's outside of your body. We just place it on the skin. And then, the energy is transferred through there. What's really fascinating to me is you do feel a sensation while it's going on, but you only feel that sensation when we're over an area of damaged tendon.

Host: So, that's kind of how you know it's working, right?

Dr. Blake Averill: Correct. So for instance, with your plantar fascia example, I did one yesterday where I was moving along his plantar fascia, and he said, "I don't feel anything. I don't feel anything. Yep, I feel it right there."

Host: I feel that.

Dr. Blake Averill: Yes. But we don't want there to be too much pain. This is something that it's not a grin and bear it or the more is better. We want the patient to describe the sensation as a three or four out of 10 intensity or a mild to moderate intensity. We want to have enough energy that we know it's there, but not enough that you're feeling pain, that you're gritting, that you're having to endure something.

Host: Tears are running down your face. Yeah, it's very cool. And I'm glad we're talking about this today and glad to share with folks the different conditions or injuries that it can help treat. So give us a sense then, what can folks really expect maybe during and after a shockwave treatment session?

Dr. Blake Averill: For this to work fully, most of the times you need three to five sessions of this. Each session lasts between 15 and 20 minutes. And then, a perfect timeframe would be once a week or every other week if we need to. And the great part about this is you will know after the first session if you're going to see benefit. It's something that is noticeable for people even that day of. I have patients who stand up and walk around and say, "Wow, my plantar fascia doesn't hurt." And it's not an immediate 100% relief, but it should be noticeable, right? Thirty, forty percent. You come back the next week, we do another treatment, and it keeps going higher and higher and higher till we get that full response.

Host: Yeah. Yeah, that's amazing. Not only are folks awake during this procedure, right? So, they can tell you what's going on, they can give you their pain on the pain scale, and then they can stand up and you get that immediate, you know, reaction and gratification like, "Yes, that worked. I'll be seeing you next week, Doc."

Dr. Blake Averill: Yes. That feedback is critical. And it also allows you to do more, right? Especially for, I think, a lot about Achilles rehab. Sometimes those exercises from your physical therapist can be quite painful and difficult do, and you don't want to do them when it hurts. That's just human. But shockwave can decrease your pain, allow you to do your rehab more, and then the healing that's triggered by the shockwave plus the exercises, you get a really, really good chance of healing this for good.

Host: Yeah, I was just trying to give folks a sense like, you know, can it be one-stop shopping? We come in and go, "You know, that worked so well on my foot, Doc. Let's try it here. Let's try it there." Is that how that works?

Dr. Blake Averill: It definitely can. We have a lot of evidence for most of the conditions that we treat, like plantar fascia, Achilles, patellar and quad tendon, you know, glutes, rotator cuff, elbow. But because it is so non-invasive and so low risk, there are still conditions where I say, "Hey, I've not done on this before, but I can guarantee you it's safe, so let's try it and see."

Host: Right. This might work. It might not, but let's give it a shot.

Dr. Blake Averill: Right. And you know after one, right? You're like, "Oh, okay. I know today, I know tomorrow, if this feels great, awesome. Let's come back for another one or two and get all the way there."

Host: That's great. So broadly here, what are the major benefits? Obviously, healing and feeling better, getting back to pickleball, whatever it might be. But l'll have you talk about like the major benefits that folks can expect.

Dr. Blake Averill: Yeah. So, what's great about shockwave is we are really trying to help our body help itself, right? We are able to trigger a whole new healing response. So when you actually dig into the studies, we see that there's new blood flow, new growth factors. There's actually a turning down of your pain hormones and of your nerve sensitivity. So, we're able to get this combination of pain relief while also triggering something that can truly fix or heal the damage that's being done.

Host: Yeah. So, treating the symptoms and the root cause of those symptoms, right? That's amazing. Let's just finish up here. And this has been good stuff. I love learning about new things, and shockwave just sounds cool and it is undeniably cool and helpful, right?

Are there any conditions though that would make someone ineligible or not eligible for this treatment? I know you said that the jury's maybe still out on certain things, certain body parts, but in general, are there some that you know of that are like, "Yeah, we've tried this and it didn't work for most folks"?

Dr. Blake Averill: Couple things just from a safety perspective. You cannot have shockwave done if you're pregnant. The energy waves can actually harm the fetus' ears. Or the focused shockwave that we have, it actually cannot be done over lung fields because the power is so strong. It could cause to the lungs. There is a separate type which we could get into at a later podcast called radial pressure wave.

Host: Yeah, let's do that. Yeah, in the future for sure.

Dr. Blake Averill: It doesn't get as deep, so you can do it over lung fields. So, people have a lot of, you know, back pain, a lot of shoulder blade, shoulder pain. So, those are the two from a safety perspective.

From a perspective that it just hasn't worked as well, that can be more acute injuries. So if it's only been two to three weeks, your body's already trying to heal it. It's already doing the same things we're trying to get the shockwave to start. So, it's not as useful in that acute setting. And then, some of it's just based on pain. So, there's even some good evidence that stress fractures or poorly healing fractures respond well to shockwave treatments. But when you do it over bone, it can be quite painful, so we're limited that way.

Host: Okay. Yeah, so some limitations. Some folks, it may be too soon or not appropriate for. But in general, obviously a lot of benefits, helping a lot of folks, and good to learn more about this from you today. So, thank you so much.

Dr. Blake Averill: No problem. Thanks for having me. Always happy to talk to patients about it. Like, I tell them education is key. We've got lots of handouts and flyers. So if you're curious, please reach out to our team, we've also got lots of other cool tricks, as I say, to help you feel better. So, you know, don't be scared to come see us.

Host: Right. This is just one of the many tools in the toolbox and good to learn more about this. Thanks. I appreciate it.

Dr. Blake Averill: No problem. Thanks for having me.

Host: And for more information about sports medicine services, visit franciscanhealth.org/sportsmedicine. and if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.