"Football doctor" Dr. Geronikolakis discusses his experience with the use of shockwave therapy and its advantages in an interview with LiKAMED.

Dr. Geronikolakis, you have been in practice as a specialist in orthopaedics, trauma surgery and sports medicine for many years and among other treatments you use shockwave therapy for your patients. What do you think of this therapy?

I consider that shockwave therapy is an excellent method for the successful treatment of many types of disease and injury. It is non-invasive, which means that it does not injure the outside surface of the body, it does not use radiation and it is virtually free from any other risks or side effects. In my view it should only be used in the presence of the correct indications. However, not only where conservative treatment has reached the end of its resources but in many cases much earlier.

Is it true that shockwave therapy can eliminate the need for surgery in some cases?

It is certainly true that the patient is not guaranteed an improvement in health and there will also always be patients who do not benefit from shockwave therapy to the extent to be hoped for. But I have often found that with the use of shockwave therapy I have been able to avoid not only surgery but also other more expensive and even more risky treatments. However, I must emphasise once again that there must be the indication for shockwave therapy and that the general symptoms must be carefully considered with reference to time and all potential subsequent problems.

What are the advantages of shockwave therapy?

The special applicator is used to "shoot" the diseased or injured area, which has been previously located and assessed with standard diagnostic procedures, with shortwave, high-energy pressure waves. The shockwaves achieve their biological effect by the release of energy, which can not only inhibit pain and inflammation but also stimulate regeneration of the affected tissues and subsequent long-term healing.

What are the risks and side effects of shockwave therapy?

Shockwave therapy is a treatment method that is virtually free from risk and has very minor side effects. In particular, it is non-invasive (therefore no risk of infection) and does not use radiation. In rare cases it can cause localised bruising under the skin or a temporary increase in pain, which in most cases quickly disappears.

How quickly does shockwave therapy take effect?

In very many cases patients can perceive an improvement in their symptoms during the treatment series, that is after the first treatments. However, the body and the stimulated regeneration processes need time and the results of the shockwave therapy are not evaluated until 4-6 weeks after the last treatment session.

What medical indications do you consider appropriate for shockwave therapy?

The following orthopaedic diseases can be successfully treated with shockwave therapy: tenson (attachment) problems (e.g. patella tendinitis, heel and Achilles tendon problems with or without heel spurs, tennis elbow, golfer elbow), bursitis (e.g. bursitis trochanterica at the hip), ossification and calcifications (e.g. calcified shoulder), muscular tension (e.g. myogelosis), periosteum irritation (e.g. tibial syndrome), circulation disorders in the bone (e.g. fatigue fractures, bone oedema, stress reactions, bone necroses, osteochondrosis dissecans), delayed or malfunctioning fracture healing (e.g. pseudoarthroses) and many more.

Is shockwave therapy painful?

Shockwave therapy can be and indeed should be painful, but the level of pain is always maintained within a range that is bearable for the patient.

You can set different modes in your shockwave device to improve the tolerance and sensitivity to pain of your patient. In addition, a new, innovative HD ceramic projectile is being used to trigger the shockwave. Its characteristics generate the shockwave with a very short and fast rise time and this reduced negative pulse component should also improve the tolerance of the patient. What is your experience and how is the feedback from your patients?

These features do definitely improve the tolerance of the patient, which means that we can achieve greater energy value into the individual cells of the treated tissue and get better results.

You have been treating a great many athletes from different types of sport from amateurs to professionals. You know how painful injuries can be and the great importance of effective treatment. When did the idea of using shockwave therapy to treat athletes come to you?

Right at the beginning of my professional career shockwave therapy was a component of conservative treatment and it was a very good option for treatment not only for athletes but also for any patient with the right indications. Particularly in athletics it is important to avoid restrictions or even downtime resulting from injury and quick treatment that is as effective as possible is essential. This is where the real advantages of shockwave therapy become clear.

Do you consider shockwave therapy an established form of treatment in the athletic field today?

Absolutely.

You have many footballers among the athletes that you treat. You are also known as "the football doctor", and you have been the association doctor for the Württemberg football association, team doctor with the VfB Stuttgart and U18-U20 national team doctor for the German Football Association. What are the major specific indications or the most common problems that you treat with shockwave therapy? What are the results `with the treatment of footballers?

The major indications for footballers are primarily tendon insertion problems, periosteum irritation, bone oedemas or muscular problems and as with other patients and athletes from other sports the results are also very good with footballers.

In addition to your work in your practice you are often travelling to treat athletes on site. How good must modern EST devices be for mobile use to meet your requirements?

It is certainly true that you don't run on to the field with the shockwave therapy device if someone is injured during a game or during training. However, mobile shockwave therapy devices have the advantage that they can be taken to training camps, to away games, and to competitions and tournaments where you are ready for action on site for several days and during several games or competitions at short intervals.

What innovations would you like to see in future with shockwave therapy in the field of exercise or athletics?

I am very satisfied with the current state of the technology. I assume that the devices will continue to become more compact and portable over time. There will certainly also be continuing research into greater improvements in patient tolerance. I think that this device represents a great step forward in this field.

How important for you is the personal contact with the manufacturer of the devices and what is the role of service for the devices?

Personal contact with the manufacturer makes direct exchange of information and experience much easier and faster. Good and fast service for devices is also very important, because technical problems that interfere with unrestricted use of the device can be resolved very quickly in order to avoid interruptions in ongoing treatment series.