MARIN SHOCKWAVE
Acoustic Wave Therapy Services
Client Education & Treatment Guide
ESWT • EMTT • EPAT
This guide explains the technologies used at Marin Shockwave, how they work, what to expect during and after treatment, and how to care for yourself between sessions. Please read this document carefully and bring any questions to your practitioner before your first treatment.
1. Extracorporeal Shockwave Therapy (ESWT), “Focused Shockwave”
What Is ESWT?
Extracorporeal Shockwave Therapy (ESWT) uses high-energy acoustic (sound) waves generated outside the body and focused precisely on injured or painful soft tissue. "Extracorporeal" simply means the energy originates outside the body. The waves are not electrical shocks — they are mechanical pressure pulses similar in nature to ultrasound but at much higher energy levels.
How Does It Work?
When acoustic shockwaves reach targeted tissue, they produce several biological responses:
▪ Microtrauma stimulation: The waves create controlled micro-disruption at the cellular level, triggering the body's natural healing cascade — the same process that occurs when tissue repairs itself after injury.
▪ Neovascularization: New blood vessel formation is stimulated, increasing circulation and delivering oxygen and nutrients to damaged tissue.
▪ Collagen synthesis: Fibroblast activity increases, promoting the production of new collagen — the structural protein essential for tendon, ligament, and soft tissue repair.
▪ Calcification breakdown: ESWT can break down calcific deposits in tendons (e.g., calcific tendinitis of the shoulder), which are then reabsorbed by the body.
▪ Pain modulation: Shockwaves reduce the concentration of Substance P, a neurotransmitter associated with pain signaling, producing a lasting analgesic effect.
What Conditions Is ESWT Commonly Used For?
▪ Plantar fasciitis and heel pain
▪ Achilles tendinopathy
▪ Patellar tendinopathy (jumper's knee)
▪ Calcific tendinitis of the shoulder
▪ Lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer's elbow)
▪ Hip greater trochanteric bursitis / gluteal tendinopathy
▪ Hamstring, quad, and proximal tendon injuries
▪ Chronic myofascial trigger points
What Does a Session Feel Like?
During treatment you will feel rhythmic pulses or thumping sensations at the treatment site. Intensity is adjusted to your tolerance. Some discomfort is normal and expected — a mild to moderate aching or pressure sensation is typical. Most clients rate the sensation as 3–6 out of 10 on a pain scale. Immediately after treatment the area often feels warm or tender, similar to the sensation after deep tissue work.
2. Electromagnetic Transduction Therapy (EMTT)
What Is EMTT?
Electromagnetic Transduction Therapy (EMTT) delivers high-frequency, high-energy electromagnetic pulses deep into targeted tissues — typically reaching 18 cm or more below the skin's surface. Unlike transcutaneous electrical nerve stimulation (TENS) or traditional magnetic therapy, EMTT operates at a significantly higher energy output, making it capable of reaching deep joint structures, tendons, and bone.
How Does It Work?
EMTT creates oscillating electromagnetic fields that interact directly with charged ions and molecules within cells:
▪ Ion transport activation: Electromagnetic pulses influence the movement of calcium, potassium, and sodium ions across cell membranes, restoring normal cellular function in compromised or chronically inflamed tissue.
▪ Mitochondrial stimulation: Cellular energy production (ATP synthesis) is enhanced, accelerating tissue repair and regeneration.
▪ Anti-inflammatory effect: EMTT modulates pro-inflammatory cytokines, reducing chronic inflammation at the cellular level — addressing one of the root drivers of chronic musculoskeletal pain.
▪ Nerve regeneration: Electromagnetic fields support peripheral nerve repair and can reduce neuropathic pain patterns.
▪ Deep tissue reach: Because electromagnetic energy penetrates far deeper than surface acoustic devices, EMTT is particularly effective for deep joint pathologies including hip, shoulder, and spinal structures
What Conditions Is EMTT Commonly Used For?
▪ Osteoarthritis of the hip, knee, shoulder, and small joints
▪ Deep tendon pathologies (rotator cuff, hip flexors, deep gluteals)
▪ Stress fractures and bone healing support
▪ Avascular necrosis (adjunct support)
▪ Chronic low back pain and sacroiliac joint dysfunction
▪ Neuropathic and radicular pain syndromes
▪ Post-surgical tissue recovery
What Does a Session Feel Like?
EMTT is typically very well tolerated. Most clients describe a warm, pulsing sensation or mild tingling deep within the treatment area. There is generally little to no surface discomfort. The applicator is held near — but not always touching — the skin, and sessions are quiet and non-invasive.
3. Extracorporeal Pulse Activation Technology (EPAT), “Radial Shockwave”
What Is Radial Shockwave?
Extracorporeal Pulse Activation Technology (EPAT) — also known as radial shockwave or pressure wave therapy — uses pneumatically generated pressure waves delivered through a handheld applicator to the surface of the skin. Unlike focused ESWT, EPAT pressure waves are dispersed over a broader area, making them ideal for treating wider regions of soft tissue, fascial layers, and superficial musculature.
How Does It Work?
EPAT pressure waves interact with soft tissue through several mechanisms:
▪ Mechano-transduction: Physical pressure signals are converted into biochemical responses at the cellular level, stimulating fibroblasts and tenocytes (tendon cells) to produce structural repair proteins.
▪ Enhanced microcirculation: Pressure waves dilate capillaries and improve local blood flow, delivering growth factors and clearing metabolic waste from damaged tissue.
▪ Fascial release: Repeated pressure pulses break up fascial adhesions, scar tissue, and fibrotic buildup that restrict movement and cause chronic pain.
▪ Lymphatic drainage: Stimulation of the lymphatic system reduces local swelling and edema that contribute to pain and stiffness.
▪ Gate control pain modulation: EPAT stimulates large-diameter nerve fibers that "close the gate" to pain signals, providing immediate symptomatic relief during and after sessions.
What Conditions Is RADIAL SHOCKWAVE Commonly Used For?
▪ Plantar fasciitis and arch pain
▪ Myofascial pain and trigger point release
▪ IT band syndrome and lateral knee pain
▪ Shin splints (medial tibial stress syndrome)
▪ Chronic muscle tightness and restricted range of motion
▪ Post-exercise recovery and performance optimization
▪ Cellulite and connective tissue remodeling
▪ Scar tissue mobilization
What Does a Session Feel Like?
EPAT produces a rhythmic, tapping or drumming sensation on the skin. It is generally milder than focused ESWT and is described by most clients as firm pressure with occasional sharp sensations over tight or tender areas. The applicator is moved continuously during treatment, like a massage tool, and gel is applied to the skin to facilitate smooth wave transmission.
4. Contraindications, Cautions & Possible Side Effects
⚠ IMPORTANT: Please inform your practitioner of any health conditions, medications, implants, or recent procedures before each session. Some contraindications are absolute (treatment must not proceed) while others are relative (treatment may proceed with modification and caution).
Absolute Contraindications — Treatment Must NOT Proceed
The following conditions prevent treatment with one or more of these technologies:
Condition Details
Pregnancy
ESWT and EPAT must not be applied over the abdomen, pelvis, or low back during any stage of pregnancy. EMTT is contraindicated in full during pregnancy.
Active Cancer / Malignancy
Do not treat directly over or adjacent to a known or suspected tumor site. Systemic active cancer is a contraindication for all modalities.
Pacemaker or ICD
EMTT is absolutely contraindicated with any implanted cardiac device (pacemaker, ICD, loop recorder). ESWT and EPAT may be used away from the implant site with caution.
Implanted Nerve Stimulators
EMTT must not be used in patients with spinal cord stimulators or deep brain stimulators.
Blood Clotting Disorders
Active coagulopathy, hemophilia, or therapeutic anticoagulation (e.g., warfarin, heparin drip) — all three modalities are contraindicated over affected areas.
Active Deep Vein Thrombosis
Do not treat limbs with known or suspected DVT.
Open Wounds / Active Infection
Do not apply any device over open skin wounds, active skin infection, or cellulitis.
Bone Tumors / Epiphyseal Plates
ESWT and EPAT must not be applied directly over bone tumors or growth plates in skeletally immature patients (under 18 years).
Recent Corticosteroid Injection
Avoid ESWT and EPAT to the same site within 6 weeks of a corticosteroid injection due to increased risk of tendon rupture.
Relative Contraindications & Cautions — Discuss with Practitioner
These conditions require careful assessment. Treatment may be modified or deferred:
⚠ Antiplatelet medications (aspirin, clopidogrel): Increased bruising risk; intensity may be reduced.
⚠ NSAIDs (ibuprofen, naproxen): May blunt the inflammatory healing response that makes ESWT effective. Ideally avoid NSAIDs for 48 hours before and after treatment.
⚠ Metal implants near treatment site: ESWT and EPAT can be used with caution near (not directly over) metal hardware. EMTT requires individual assessment.
⚠ Nerve damage or reduced sensation at treatment site: Risk of over-treatment due to impaired feedback.
⚠ Diabetes with peripheral neuropathy: Reduced tissue healing capacity; treatment is possible, but expectations should be adjusted.
⚠ Acute inflammatory flare-ups (e.g., gout, rheumatoid flare): Defer treatment until flare subsides.
⚠ Hyper-acute tissue injuries (within 48 hours of injury): Allow initial inflammatory phase to stabilize before commencing shockwave.
⚠ Skin hypersensitivity or dermatological conditions over treatment area: Eczema, psoriasis, or open lesions — treat surrounding tissue only.
⚠ Epilepsy: EMTT should be used with caution due to electromagnetic fields; discuss with physician.
⚠ Children under 18: Not recommended without physician referral due to growth plate concerns.
Possible Side Effects & Temporary Reactions
Acoustic wave therapies are considered safe and non-invasive. However, the following temporary effects may occur:
Soreness
Mild to moderate soreness at the treatment site is very common and expected. It typically peaks 24–48 hours post-treatment and resolves within 3–5 days.
Redness / Erythema
Skin reddening over the treated area is normal and usually resolves within a few hours.
Bruising
Superficial bruising may occur, particularly with ESWT at higher intensities or with clients on blood thinners. Generally mild and self-resolving within 5–10 days.
Swelling
Mild local swelling is part of the normal healing response. Elevate and apply ice if significant.
Tingling or Numbness
Temporary tingling or mild numbness during or shortly after EMTT or ESWT is not uncommon and typically resolves within hours.
Symptom Flare
A temporary increase in pain or discomfort ('healing crisis') within 24–72 hours of treatment is a recognized and generally positive sign that the tissue is responding. This usually settles and is followed by progressive improvement.
Fatigue
Some clients report general fatigue following treatment, particularly after EMTT sessions. Rest is encouraged.
Dizziness
Rarely, clients may feel lightheaded during or after treatment. Remain seated for a few minutes before standing.
Skin Irritation
Gel or pressure from the applicator may occasionally cause minor surface irritation in sensitive individuals.
5. Expected Results & Treatment Timeline
What Kind of Results Can I Expect?
Acoustic wave therapy has a strong evidence base for reducing chronic musculoskeletal pain and improving function. Results vary depending on the condition, its duration, tissue health, lifestyle factors, and the number of treatments completed. Most clients experience:
▪ Progressive reduction in pain and tenderness at the treatment site
▪ Improved range of motion and functional mobility
▪ Reduced stiffness, particularly in the morning or after rest
▪ Improved tissue resilience and load tolerance over time
▪ Long-lasting relief — studies show benefits continuing to improve for 3–6 months post-treatment
ℹ Important: These therapies stimulate the body's own healing processes. Unlike pain
medication, results are not immediate — they build progressively over the treatment course
and continue developing in the weeks and months following treatment completion.
How Many Treatments Are Typically Needed?
Treatment protocols are individualized based on the condition and tissue response. General guidelines:
Plantar Fasciitis
3–5 sessions | Once weekly | Most clients report significant improvement by session 3
Achilles Tendinopathy
4–6 sessions | Once weekly | Chronic cases may require up to 8 sessions
Calcific Tendinitis (Shoulder)
3–5 sessions | Once weekly | Calcium deposits may require additional sessions to fully disperse
Lateral/Medial Epicondylitis
3–5 sessions | Once weekly | Combined ESWT + EPAT often yields faster results
Patellar Tendinopathy
4–6 sessions | Once weekly | Athletes may require more sessions for return-to-sport
Hip / Gluteal Tendinopathy
4–6 sessions | Once weekly | EMTT may be combined for deep tissue access
Myofascial / Trigger Points
3–5 sessions | Once or twice weekly | EPAT often primary modality
Osteoarthritis (EMTT)
6–10 sessions | 2–3 per week | Cumulative electromagnetic dose is key to efficacy
Chronic Low Back Pain
5–8 sessions | Once or twice weekly | Combined ESWT + EMTT protocol
Post-Surgical Recovery
As directed | Per practitioner guidance | Varies significantly by procedure and tissue status
The Healing Curve — What to Expect Week by Week
Understanding the typical healing trajectory helps set realistic expectations:
Sessions 1–2
Initial stimulation phase. Some clients notice mild improvement, others experience a temporary symptom flare as the tissue healing response is activated. This is normal and expected.
Sessions 3–4
Most clients begin to notice meaningful pain reduction and improved movement. The healing cascade is well underway. Morning stiffness often improves noticeably.
Sessions 5–6
Significant functional gains for most conditions. Tissue remodeling and collagen synthesis are active. Load tolerance increases.
Weeks 4–12 post-treatment
The healing process continues to progress even after the treatment course ends. Many clients report their best results 4–8 weeks after the final session.
3–6 Months
Maximum therapeutic benefit. Studies show durable long-term outcomes for the majority of clients who complete the recommended protocol.
When Should I Contact My Practitioner?
⚠ Pain significantly worsens and does not begin to improve within 5–7 days of treatment
⚠ You develop swelling, redness, or warmth suggesting possible infection
⚠ You experience severe bruising or skin breakdown
⚠ Numbness or tingling persists beyond 48 hours
⚠ You begin new medications (especially blood thinners or corticosteroids) between sessions
6. Aftercare Instructions
Immediately After Treatment (First 24 Hours)
The tissue has been actively stimulated and the healing response is beginning. Support the process:
✔ Hydrate well — drink at least 8 glasses of water to support cellular metabolism and lymphatic clearance.
✔ Rest the treated area — avoid high-load or high-impact activity on the treated tissue for 24–48 hours.
✔ Light walking is acceptable and encouraged unless otherwise directed.
✔ Ice may be applied for 10–15 minutes if significant soreness or swelling is present (do not apply directly to skin).
✔ Gentle range-of-motion exercises are permitted if they do not cause sharp pain.
✔ Elevate the treated area if swelling develops.
✖ Do NOT apply heat, hot baths, saunas, or steam rooms for 24 hours — heat can exacerbate inflammation.
✖ Do NOT take anti-inflammatory medications (NSAIDs such as ibuprofen or naproxen) — these blunt the healing response that shockwave is designed to trigger. Acetaminophen / paracetamol is acceptable for pain if needed.
✖ Do NOT receive massage, deep tissue work, or additional manual therapy directly on the treated area for 24–48 hours.
✖ Do NOT participate in high-impact sport, heavy loading, or strenuous exercise on the treated area.
✖ Do NOT apply topical anti-inflammatories (diclofenac gel, etc.) to the treatment site for 24 hours.
Days 2–7 After Treatment
The tissue continues to remodel and heal. Gradually reintroduce activity as tolerated:
✔ Low-impact cardiovascular activity: swimming, cycling, elliptical, walking — generally well tolerated from day 2 onward.
✔ Light stretching and mobility work for the treated area is encouraged.
✔ Strengthening exercises may be resumed at reduced intensity — listen to your body and avoid sharp pain.
✔ Continue good hydration throughout the week.
✔ Sleep and rest are important — tissue repair accelerates during sleep.
✖ Avoid heavy resistance training targeting the treated area until soreness resolves (typically by day 4–5).
✖ Avoid explosive, high-impact, or plyometric activities (running, jumping, sprinting) for at least 5–7 days post-treatment or until soreness has fully resolved.
✖ Avoid prolonged static loading on the treated area (e.g., standing for hours on a treated foot/leg) in the first few days.
✖ Avoid alcohol in excess — it impairs tissue healing and increases systemic inflammation.
Activities
Acceptable Immediately After Treatment
✔ Light walking on level ground
✔ Gentle stretching (pain-free range)
✔ Normal daily activities (desk work, driving, light household tasks)
✔ Swimming (non-competitive, gentle pace) — from day 1 if no open skin
✔ Adequate rest and sleep
Avoid Immediately — Acceptable After 48–72 Hours
⚠ NSAIDs or topical anti-inflammatories on the treatment site
⚠ Heat therapy, hot tub, sauna, or steam
⚠ Deep tissue massage or manual therapy directly on the site
⚠ High-impact sport or activity
⚠ Heavy resistance training targeting the treated tissue
Avoid for 5–7 Days
✖ Running, jumping, plyometrics on a treated lower limb
✖ Overhead throwing or serving with a treated upper limb
✖ Competitive sport or high-intensity training targeting the treated area
✖ Any activity that reproduces sharp, worsening pain at the treatment site
7. Return to Normal Activities
General Timeline
Most clients follow a progression similar to the following. Individual timelines vary based on condition severity, tissue response, and activity level:
Timeframe: Activity Level
Day 1–2
Normal daily activities, light walking, desk work, driving. Avoid exertion and heat.
Day 2–4
Add gentle stretching, non-impact cardio (cycling, swimming), light functional movement.
Day 5–7
Resume moderate activity as soreness permits. Begin progressive loading if pain allows.
Week 2
Most clients can return to recreational sport at reduced intensity. Avoid explosive movements if still tender.
Week 3–4
Progressive return to full training volume and intensity for most musculoskeletal conditions. Monitor for pain response.
Week 4–8
Full return to sport and high-level activity for most clients. Healing continues to improve even at full activity.
Post-Treatment Follow-Up
Schedule a reassessment 4–6 weeks after your final session to evaluate outcomes and determine if additional sessions are beneficial.
Optimizing Your Recovery Between Sessions
Your results depend not only on the treatments but also on what you do between sessions:
▪ Perform any prescribed home exercises consistently — eccentric loading protocols are particularly effective for tendinopathies when combined with shockwave therapy.
▪ Maintain a nutrient-rich diet with adequate protein to support collagen synthesis (aim for 1.2–1.6g protein per kg body weight daily during active tissue repair).
▪ Prioritize sleep — growth hormone and tissue repair are highest during deep sleep stages.
▪ Limit or avoid alcohol, smoking, and excessive caffeine, all of which impair tissue healing.
▪ Manage systemic inflammation through diet (reduce processed foods and sugar), stress management, and adequate recovery.
▪ Address biomechanical contributors with appropriate footwear, orthotics, ergonomic modifications, or corrective exercise as recommended.
ℹ Remember: Marin Shockwave does not diagnose or prescribe medical treatment. The
information in this guide is educational and supportive in nature. Always consult your
physician, physiotherapist, or licensed healthcare provider for medical diagnosis and
management of any injury or health condition.
MARIN SHOCKWAVE • Client Education & Treatment Guide • ESWT | EMTT | EPAT
This document is for educational purposes only and does not constitute medical advice, diagnosis, or treatment.