1. What are regenerative therapeutics?

Regenerative therapeutics harness the body’s natural healing abilities, and we believe they represent the future of musculoskeletal care.

Unlike traditional orthopedic approaches—which often rely on symptom management through medications like NSAIDs or corticosteroid injections, or even joint replacement—regenerative orthopedic care aims to repair and restore damaged tissues at the source. This approach addresses the root cause of pain and dysfunction in a more natural, minimally invasive way.

2. What is Extracorporeal Shockwave Therapy (ESWT)?

ESWT is a non-invasive treatment that uses high-energy sound waves to stimulate healing in damaged tissues, reduce pain, and improve mobility. It’s commonly used for chronic musculoskeletal conditions like tendinitis and plantar fasciitis.

3. What conditions can ESWT treat?

ESWT is effective for a variety of conditions. See our “Conditions” tab above for a more exhaustive list. Some of the conditions treated include:

• Plantar fasciitis

• Achilles tendinopathy

• Tennis elbow

• Golfer’s elbow

• Rotator cuff tendinitis

• Patellar tendinopathy (jumper’s knee)

• Muscle trigger points

4. How does ESWT work? How does it initiate healing?

ESWT kickstarts the body’s natural healing cascade by delivering targeted acoustic waves that cause controlled microtrauma to the affected tissue. In addition to breaking down calcified deposits and reducing pain signals from sensory nerves, this stimulates the healing cascade, which is a regenerative response that promotes inflammation, cellular repair and regeneration, increased blood flow, and tissue remodeling, which is essential for long-term recovery and pain reduction.

The steps of the healing cascade are four-fold and are as follows. 1) The shockwaves create controlled micro-damage and a mechanical stimulus to tissues, mimicking an injury and alerting the body to initiate repair without causing real structural harm. 2) For up to 4 days, the targeted area will be in the inflammatory phase and the body will clean debris in the targeted area and initiate repair. During this time, damaged cells release pro-inflammatory mediators (e.g. interleukin-1), immune cells such as macrophages and neutrophils clear debris, platelets migrate to the targeted area and release growth factors (such as vascular endothelial growth factor), and blood vessels dilate to increase blood flow. 3) From approximately days 4-21, the targeted area will be in the proliferative phase, which involves the building of new tissue. Fibroblasts start producing new collagen (mainly type III), angiogenesis (new blood vessel formation) improves nutrient delivery and oxygenation, and stem cells may also be activated to enhance regeneration. 4) The remodeling phase, which lasts from approximately day 21 to up to a year, involves refining the tissue. Type III collagen is gradually replaced with stronger type I collagen. Collagen fibers realign along the lines of stress. Overall, during this phase, the regenerated tissue regains strength, elasticity, and functional integrity.

5. Is the treatment painful?

Some discomfort is normal during the procedure, especially in more sensitive areas. However, the intensity can be adjusted to your comfort level. Many patients describe it as a “tapping” or “pulsing” sensation.

6. How many sessions will I need?

Typically, 4-6 sessions are recommended, spaced about 1 week apart. The exact number depends on the condition being treated and how your body responds.

7. Do I need to stop taking any medications before or after ESWT?

Because ESWT relies on the body’s natural inflammatory response to jumpstart tissue healing, any medication that inhibits inflammation should be stopped for a period of time before treatment and after treatment. Nonsteroidal anti-inflammatory drugs, or NSAIDs (e.g., ibuprofen, naproxen), should be stopped at least 5 days before treatment. The soonest that NSAIDs can be resumed is 6 weeks after treatment, but our goal is always to wean patients off NSAIDs completely (if tolerated) after ESWT. If a patient recently completed a course of corticosteroids (either oral, intravenous or intra-articular), we like to wait 6 weeks before administering ESWT. If a patient is on oral corticosteroids (e.g., prednisone) for a chronic condition, this represents a relative contraindication to ESWT (see #12 below). Acetaminophen (Tylenol) is a suitable oral pain management alternative in the post-ESWT healing phase, as this medication does not interfere with inflammation or healing.

8. How long does each session take?

Each ESWT session usually lasts between 10 to 15 minutes, depending on the treatment area and the condition being addressed.

9. Are there any side effects?

Side effects are rare but may include mild swelling, redness, bruising, or temporary soreness at the treatment site. These usually resolve within a few days.

10. When will I feel results?

Many patients notice improvement after the first treatment, but most experience relief gradually over several weeks as the body heals.

11. Is ESWT safe?

Yes, ESWT is FDA-approved for several musculoskeletal conditions and has a strong safety profile when performed by trained professionals.

12. Who should not receive ESWT?

ESWT should not be used in individuals who:

• Are pregnant or expecting to become pregnant (can potentially affect fetal development)

• Have blood-clotting disorders or take blood thinners (increased risk of bruising or internal bleeding at treatment site)

• Have a pacemaker or other implanted electronic device near the treatment area (might interfere with device function)

• Have tumors (may stimulate unwanted metabolic activity), infections (can worsen inflammation or spread infection), or open wounds/skin lesions (risk of further irritation or delayed healing) in the treatment site

Additionally, ESWT should be used with caution in individuals who:

• Are under 18 (might affect growth plates)

• Received cortisone injection therapy, or a course of oral or intravenous corticosteroid medications for an acute medical condition, within the last 6 weeks [might increase risk of a) tissue damage as corticosteroids temporarily weaken tendons and soft tissues and b) blunted healing response as corticosteroids suppress inflammation and ESWT relies on controlled inflammation to jumpstart tissue repair]

• Are on oral corticosteroid therapy for a chronic condition — same risks as above (in this case, risk vs. benefit should be assessed for each patient, care should be coordinated with prescribing physician, and alternative treatments such as physical therapy should be considered)

• Have severe neuropathy or loss of sensation (may not be able to report pain or discomfort accurately)

• Have poor vascularization or circulatory disorders (may have impaired healing response)

13. What are the payment options for ESWT? How much does it cost?

Midwest Regenerative Therapeutics is a fee-for-service practice. We practice direct care, which is a healthcare model that allows patients to receive medical services without involving insurance. Traditional insurance-based care often comes with hidden costs and administrative burdens that push medical practices to prioritize patient volume over personalized attention. Worse yet, the reality is that treatment decisions under a traditional insurance-based model are often influenced more by what insurance will cover as compared to what is truly best for the patient’s individual needs. With our direct care model, we have the privilege to work for you, not the insurance company. Thus, we are able to focus on fewer patients, giving each individual the time, attention, and care they truly deserve. This approach leads to enhanced communication, stronger patient-provider relationships, and more coordinated, high-quality care. ESWT is not currently covered by insurance, so your insurance company will not be billed. For ESWT sessions, we accept checks, cash (with a discount), or credit card. The cost of your ESWT treatment will ultimately depend on which service you qualify for and how many body parts need to be treated. Each patient will have a different treatment plan based on their needs, sometimes also including prescribed therapeutic exercises and stretches and other services such as diet and exercise recommendations. Costs will vary accordingly. Other services such as the initial phone consultation and initial in-person assessment are complimentary.

14. What other services do you offer?

To truly support healing, we focus on treating the whole person—not just the painful condition. Our approach to comprehensive care means we look at all aspects of your health that may be contributing to your pain, including:

• Sleep quality

• Nutrition and diet

• Weight management

• Stress levels

• Physical activity

By addressing these key areas, we aim to create lasting relief and support your overall well-being.