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Can I combine ESWT with other conservative types of treatment?

Yes, you can. In case of chronic midportion Achilles tendinopathy, it was shown that the combination of radial ESWT and eccentric loading resulted in a statistically significant improvement in clinical outcome compared to eccentric loading alone (Rompe et al., 20097), radial ESWT being as effective as eccentric loading for this indication (Rompe et al., 20078). The same was shown for the combination of radial ESWT and plantar fascia-specific stretching in case of chronic plantar fasciopathy (Rompe et al., 20159).

7) Rompe JD, Furia JP, Maffulli N. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion Achilles tendinopathy: a randomized controlled trial. Am J Sports Med 2009;37:463-470.
8) Rompe JD, Furia JP, Maffulli N. Eccentric loading compared with shock wave treatment for chronic insertional Achilles tendinopathy. A randomized, controlled trial. J Bone Joint Surg Am 2008;90:52-61.
9) Rompe JD, Furia J, Cacchio A, Schmitz C, Maffulli N. Radial shock wave treatment alone is less efficient than radial shock wave treatment combined with tissue-specific plantar fascia-stretching in patients with chronic plantar heel pain. Int J Surg 2015;24:135-142.

Can I use cryotherapy to ease the pain (if any)?

No clinical study has been conducted on the combination shock waves and cryotherapy. However, Dr. Marc Rozenblat (Centre Coralis, Ozoir La Ferrière, France) reported at the 2008 ATRAD congress (Berlin, Germany) the combination of shock wave therapy using the Swiss DolorClast method and neurocryostimulation was successful in approximately 7000 cases.

Do you have clinical proof for your device?

Yes, being clinically proven is one of the pillars of the Swiss DolorClast method. Many randomized controlled trials (RCTs) demonstrating efficacy and safety of the Swiss DolorClast method on different indications have been published in the international peer-review literature. So far, 26 RCTs have been published on the Swiss DolorClast method, 15 of which have been listed in the PEDro database (search for “radial shock wave” at

Can we carry out the treatment in 1 session instead of 3 by applying 6,000 shocks? (as with focused devices)

This has not been tested in a clinical study. With regard to focused shock waves, no study listed in the PEDro database has tested the hypothesis that the application of 6,000 shocks in a single session is as effective as (or more effective than) the application of 2,000 shocks in three sessions.

Can we use shock waves only on athletes?

ESWT has been developed to be conducted on athletes and non-athletes. The vast majority of RCTs on the Swiss DolorClast method were performed on non-athlete patients.

Does castor oil offer better transmission than standard contact gel for ESWT treatments?

Yes, castor oil is better than standard contact gel according to Maier et al., 199910, “Castor oil decreases pain during extracorporeal shock wave application”. However, it is recommended to use the standard contact gel provided with the device.

10) Maier M, Staupendahl D, Duerr HR, Refior HJ.: Castor oil decreases pain during extracorporeal shock wave application. Arch Orthop Trauma Surg 1999;119(7-8):423-427

Can I use shock wave therapy with the presence of a metal implant, for example on the hip after a hip replacement?

The presence of metal implants or prostheses is not a contra-indication to the use of shock wave therapy.
In the case of a hip, lots of our DolorClast referrals have post-surgery hip replacement. Then, shock wave therapy is combined with normal rehabilitation exercising for treating trochanteric hip pain or related issues. However, we see surgeons recommend about 12 weeks with a treatment post surgery.

Clinical reference study: 
Extracorporeal shock wave treatment for pain following hip replacement
November 2008, Journal of Clinical Rehabilitative Tissue Engineering Research 12(48):9533-9536

Influence of the setting: frequency

Most clinical studies have been conducted with a frequency ranging from 6 to 10 Hz. Recent studies now use a frequency ranging from 10 to 15Hz. The influence of the frequency has not yet been clinically assessed except for its influence on treatment duration.
The trend is to treat tendinopathies with a frequency in the range of 10 to 12Hz, enthesiopathies with a frequency in the range of 12 to 15Hz, and muscle with a frequency in the range of 12 to 20Hz, depending on the skin surface above the indication and the number of impulses.

Influence of the setting: number of pulses

Schmitz et al. (20152) showed that a good protocol is 2,000 impulses per treatment. Nevertheless, this is for a high energy per pulse, sticking to the painful point. The modern approach to shock wave treatment tends to increase the number of impulses to 2,500-4,000 depending on the skin surface above the indication to be treated, and moving around the painful spot.

2) Schmitz C, Császár NB, Milz S, Schieker M, Maffulli N, Rompe JD, Furia JP. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. Br Med Bull 2015;116:115-138.

Influence of the setting: applicators

The diameter and therefore the weight of the applicator influence the energy flux density and the cavitation field delivered. As a rule of thumb, the smaller the diameter, the higher the intensity and the smaller the cavitation field. Keep in mind that the maximum energy density is at the tip of the applicator.