PHS RADIAL SHOCKWAVE

• lungs, heart, brain, eyes, and other organs
• wounds, infected areas, skin tumors, open sores, or sutures from recent surgery

• use in the presence of malignant tumor
• in the region of a fetus or pregnant abdomen

• swollen or inflamed areas or skin eruptions
• clotting disorders or unexplained calf pain

• Growth plates

• regions near large nerves, vessels (brachial plexus) 
• clotting disorders or unexplained calf pain

• do not use in the presence of unexplained pain
• discontinue immediately if a patient reports significant or unexpected pain

• Directly over corticosteroid injections sites in less than 6 weeks

• Never use this device on children, or anyone who cannot give verbal consent or warnings about pain.

www.shockwavetherapy.org

***The vast majority of shockwave manufacturers recommend treating along the full spine, and there are numerous studies examining shockwave efficacy in these areas. None the less, the decision to treat along the spine or in the proximity of organs should be carefully considered by each clinician.

Treatment expectations: 

1. Shockwave therapy is a non-invasive treatment option for various musculoskeletal conditions that uses high-energy sound waves to stimulate healing.
2. Before starting the treatment, the patient's medical history should be reviewed, and a physical examination should be conducted to determine the suitability of the treatment.
3. The treatment involves applying a probe to the affected area and delivering shockwaves to the tissue using a machine.
4. The intensity of the shockwaves can be adjusted based on the patient's tolerance and the severity of the condition.
5. The treatment session usually lasts less than 15 minutes, and the number of sessions required depends on the condition being treated. The average amount of visits is 6 with an average frequency of 1-2 times per week. Larger treatment areas may require more visits.
6. The patient may experience mild discomfort during the treatment, but it should not be painful.
7. After the treatment, the patient may experience some soreness, swelling, or bruising, but this usually resolves within a few days.
8. The patient should avoid any strenuous activity or exercise for 24 hours after the treatment.
9. Shockwave therapy is generally safe, but there are some potential risks, including skin injury, nerve damage, and pain.
10. Patients should discuss the risks and benefits of the treatment with their healthcare provider before undergoing shockwave therapy. 

Basic Operation:

Insert the three plugs to the matching ports on the back of the console (Figure 3.1). Plug the power cord into a power strip or ac100-240V wall outlet. Press the switch on the back of the console to turn on the system. The software will load for a few seconds, and then a touch screen interface will appear with icons for each joint region. Press the switch on the back of the console to turn off the device when it is not in use.

Treatment Parameters:

Treatment parameters are suggested for each region based on estimated tissue depth.  Settings should be recalibrated for each patient based on their pain tolerance. A relative pain rating of less than 5/10 OPS (similar to deep massage discomfort) is usually appropriate.  Most patients will tolerate more energy (MJ) than the default settings suggest.  Settings can only be adjusted while in this default safety mode.  

Increasing the Hz and decreasing the MJ generally reduces discomfort and therapeutic energy. Increasing the MJ and decreasing the generally increases discomfort and therapeutic energy.

The adjustable range of frequency and energy in each mode is as follows:

When frequency is set at 1 - 8Hz, the energy can be set at 60 - 210MJ;

When frequency setting is 9 - 15 Hz, the energy can be set to 60 - 190- (frequency-9) x10 MJ;

When the frequency is set at 16Hz, the energy can be set at 60 - 130 MJ.

Firing Mode:

To transition into treatment or firing mode, press the yellow button in the bottom right corner of the screen. When the button turns red and says “ready,” you can fire the shockwave by pressing the foot pedal. Firing will stop when your foot is removed from the pedal. Only fire the shockwave when it is in contact with the skin of the treatment area. Firing into the air increases the wear on the treatment handle.

Coconut oil or ultrasound gel is recommend over lotion, as lotion may splatter. Lubricant is required because it creates a better surface contact and directs the energy into the tissue rather than the air gaps.

To readjust the settings, simply press the ready button in the bottom corner of the screen to return to safety mode. Once the settings are adjusted, press the button again to return to firing mode.

Attachment Heads: 

It is recommended that new providers become acquainted with shockwave therapy by testing sensitivity to the protocols with the 36mm head pre-installed on the device. This attachment head has the widest diameter, and is generally less painful. It is also easier to cover wider treatment areas. As the diameter of each treatment head decreases, the therapeutic energy and discomfort will increase. The 15mm head is most commonly studied in the literature, and arguably most versatile for all regions. The 8mm head is the smallest and greatest energy concentration. If the target tissue is deep and focal, the 8mm head may be most effective. Alternatively, the concave version of the 15mm head focuses the greatest energy a few mm deeper than the convex 8mm head and may achieve better results. There are two protruding head attachments for IASTM that also allow you to push deeper into the soft tissue to reach your target.

Additional resources for shockwave settings and attachments:

www.shockwave.education

Ending treatment:

When the number of shockwaves reaches the pre-selected value of 2500, the first treatment is finished. At this time, the fan will continue to run for up to 5 minutes. You may turn off the device before the fan has stopped, but if the device has been used for multiple sessions it is best to let the fan run for a full 5 minutes. Total shocks per session range from 500 to 5000 in the literature, with most recommendations ranging between 2000-4000 shocks.

Detailed guidelines for shockwave applications and dose:

www.shockwavetherapy.org

Warranty:

This product includes a 2 year comprehensive warranty, and 30 day return policy. All shockwave machines require replacement of moving parts every 2 million shocks, or roughly 2 years.  Handles often last much longer than 2 million shocks, however.  Our maintenance costs are roughly 50% of other FDA registered brands.