Shockwave Therapy (EPAT): A Non-Surgical Treatment Option for Pain

Extracorporeal Pulse Activation Technology (EPAT®) is an FDA approved, non-invasive treatment option that relieves pain associated with many musculoskeletal conditions like frozen shoulder and plantar fascitis. Treatment doesn't leave scars, requires no anesthesia, and has no down time. Immediately following the simple procedure most people are able to get on with rest of their day. 

Brian Nathanson, DC, above, using EPAT in his Connecticut office to treat the arm of a patient.

What Is EPAT?

Charlotte Morello was frustrated. After 18 months of physical therapy and other treatments meant to improve her range of motion and lessen the pain from adhesive capsulitis (better known as “frozen shoulder”),  her problems weren't improving.

The married mom of two had tried acupuncture, topical ointments to reduce the inflammation, and cortisone injections, too. Nothing brought lasting relief and she was in constant pain. The pain was so severe it woke her up at night and even worse, prevented her from participating in her favorite activity—playing golf!

Then she heard about EPAT® (Extracorporeal Pulse Activation Technology), a non-invasive technology used by health care providers to treat acute and chronic musculoskeletal pain.

Also known as Extracorporeal Shock Wave Treatment (ESWT), it is cleared by the US Food and Drug Administration (FDA) and used widely in Europe to treat painful conditions like frozen shoulder, tennis elbow, carpal tunnel syndrome, and plantar fasciitis.

The treatment uses acoustic pressure waves–basically shock waves—to enhance blood circulation and speed up the healing process.

The use of shock waves in medicine is nothing new. it goes back to the 1940s, but they were not used clinically until the 1960s, when treatments were developed to disintegrate kidney stones and gallstones without damage to the surrounding tissue.

The technology continued evolving and expanding to other uses in a wide range of medical disciplines as seen today.1

How Does EPAT Work?

Four or five treatment with the EPAT® device will be necessary for most people (but some require less). Each treatment takes 10 to 15 minutes, depending upon the area being treated, and many people experience immediate pain relief says Elise B. Hamann, director of sales at CuraMedix, which distributes the device. 

Treatments take place in an office. First, a gel is applied to the injured or painful area. Then a handheld device is used to emit a series of pulses to the area. The strength of the pulses is gradually increased (as tolerated by the patient) until a therpeutic level is reached, 

Morello, who was living in Connecticut at the time, received several EPAT® treatments from Brian Nathanson, DC, a chiropractor in Norwalk, Connecticut, and experienced lasting relief.

“The treatment isn’t pleasant but it doesn’t hurt any more than frozen shoulder, and it is very quick,” she says. “After my first visit, I felt good but after the third visit, I felt even better,” Morello recalls.

“EPAT is basically regenerative medicine,” explains Dr. Nathanson, who provides treatment with EPAT at his office. “It uses shock waves to help the injured tissue to regenerate.”

“EPAT is like ultrasound on steroids,” he adds. “Ultrasound gel is applied to the area, and then you hear a little tapping noise as the device moves around the area. Deep vibrations go through the body.”

Alejandro Badia, MD, FACS, a hand and upper limb surgeon and founder of the Badia Hand to Shoulder Center in Doral, Florida says there are many benefits to the procedure. “For frozen shoulder, the treatment not only breaks up the fibrous tissue that is restricting the movement of shoulder but it stimulates blood flow which facilitates pain relief and healing, too,” he says.

How Do I Know if EPAT Will Help Me? 

How well you will respond to the technology depends on various factors.

“It depends on the issue that is causing you pain, how long you have been suffering, what treatment you’ve had to date, as well as your general physical health,” Hamman explains. “Everyone is different.”

Whether or not EPAT will work for your frozen shoulder may depend on how severe a case you have, Dr. Badia says. “If you are not getting any relief from oral anti-inflammatory medicines and physical therapy, you may have a severe case of frozen shoulder,” he says. “For some people, arthroscopic surgery may be recommended if other treatments are not helping.”

People with diabetes who received ESWT showed an improvement in pain and range of motion, according to a randomized controlled trial in The Journal of Shoulder and Elbow Surgery published in 2020.2

“The research found that people participating in physical therapy who got the shock wave treatments had less pain after the first 12 weeks compared to people treated with a cortisone injection,” says Gregory Gasbarro, MD, an orthopedic shoulder surgeon at The Shoulder, Elbow, Wrist and Hand Center at Mercy Medical Center in Baltimore, MD.

But, he adds, “The natural history of frozen shoulder is improvement over time, sometimes on the order of months to two years. This study did not follow patients beyond three months.”

The Downside of EPAT

Dr. Gasbarro says that there can be mild side effects with the treatment, such as pain and swelling at the site. “But these are minor downsides,” he says. “The biggest downside is that it is not covered by insurance.”

Typically, healthcare professionals charge around $150 to $200 per treatment, Hamann says. “A series of three to five treatments, once a week, costs an average of $450 to $750 for the series.”

“I think it is an option if someone is willing to pay the money for it,” says Dr. Gasbarro. 

Morello, who now divides her time between Florida and Vermont, says the money she spent on EPAT treatments was well worth it.

“After my fifth visit, I had no pain in my shoulder,” she says. “And I never had frozen shoulder again.”


Updated on: 08/18/21
Continue Reading:
Frozen Shoulder: Causes, Symptoms, and Treatments