ESMA Therapy

    Last updated date: 08-Jun-2023

    Originally Written in English

    ESMA Therapy

    ESMA Therapy

    ESWT, which was initially developed to treat kidney stones, is now used to treat several chronic orthopedic disorders, including osteonecrosis of the femoral head, plantar fasciitis, lateral epicondylitis (tennis elbow), calcific tendinitis of the shoulder, and other tendinopathies. Declared to be a non-invasive and safe treatment, it has been used as a surgical procedure substitute, particularly in clinics in Europe. Shock waves that are naturally produced can be seen in lightning and thunder, explosions, and supersonic aircraft. Pressure amplitudes may dramatically increase as a result of them. Sometimes, this pressure might cause ear membrane damage and break windows. The pressure and energy emitted are typically measured in megapascals (MPa) and kilopascals (kPa), respectively. Twenty years ago, studies on animals showed that shock waves might activate osteoblast cells and promote bone growth. After being exposed to the shock waves, fractures that were delayed or non-union healed more quickly. The revolutionary idea of orthopedic Extracorporeal Shock Wave Therapy (ESWT) was first introduced in this and other research papers released in the 1980s and early 1990s. Before it, kidney stone lithotripsy was the principal application for shock waves. Recently, a new technique (ESMA therapy) using ESWT in conjunction with hydrotherapy is used to treat different orthopedic conditions.


    What is ESMA Therapy?

    ESMA therapy is the use of extracorporeal shock wave therapy (ESWT) and orthopedic hydrotherapy (aquatic or water therapy) to maximize the management of nerve, muscle, and joint disorders.


    What is Extracorporeal Shock Wave Therapy?

    Extracorporeal Shock Wave Therapy

    Extracorporeal (outside the body) shockwave therapy (high-energy sound waves) is a non-invasive method for treating the underlying causes of chronic pain) without the use of drugs, surgery, or other invasive procedures.

    In the tissue that is being treated, the treatment induces a reaction that mimics inflammation. The body subsequently reacts by boosting the metabolism and blood supply to the injured area. In turn, this quickens the body's natural healing processes. The shockwaves disintegrate calcifications and injured tissue. This technique has been judged safe by the National Institute for Health and Care Excellence (NICE). Studies show this treatment has a 50% to 70% success rate. Three to six treatments are typically needed, each carried out weekly. Each treatment lasts between ten and fifteen minutes.


    What is Hydrotherapy?


    Any technique that uses water to treat different physical problems is known as hydrotherapy. It may also be referred to as balneotherapy, pool therapy, aquatic therapy, or water therapy. You can utilize a specific tank or pool for hydrotherapy, or it might be as easy as having a warm bath at home. In addition to pressurized jets, hot and cold temperatures, and ice packs, hydrotherapy also refers to these methods.

    Since the beginning of recorded history, medical professionals have used water to treat injuries and disorders. Hydrotherapy has been examined by medical professionals as an evidence-based treatment for specific diseases and symptoms over the past 20 years. According to studies, hydrotherapy can be an excellent way to treat symptoms including muscle discomfort and stiff joints. Since hydrotherapy is a complementary (naturopathic or nonpharmaceutical) form of treatment, the US Food and Drug Administration (FDA) does not have any control over it.

    Hydrotherapy is occasionally sold as a cure in inaccurate ways, even though there are real benefits that specialists have researched. It might even be dangerous. Because of these risks, it's crucial to consult your doctor before beginning any new therapy for the management of your symptoms or diseases. Make sure you receive hydrotherapy from a recognized clinic and provider if you decide to use it.


    Benefits of Hydrotherapy

    Benefits of Hydrotherapy

    • It is a highly successful strategy for managing chronic pain.
    • In addition to encouraging relaxation, it aids in releasing tense, tight muscles. Additionally, it speeds up metabolism and digestion. Hydrotherapy increases skin and muscle tone while hydrating body tissues.
    • The immune system is boosted by hydrotherapy, which increases its effectiveness.
    • It increases the blood flow to several body organs.

    For many years, hydrotherapy has been utilized to treat a variety of medical conditions. The fact that it is natural and has no significant adverse side effects is one of its main advantages. You can avoid taking drugs or having expensive procedures by using hydrotherapy and other aquatic physiotherapies. However, it is advised to seek expert medical advice if symptoms continue despite treatment.


    ESMA Therapy Indications

    ESWT Indications

    ESWT Indications

    In the upper limb, ESWT is highly beneficial in the treatment of calcific tendinitis of the shoulder because the treatment waves can break up an acute build-up of a calcium deposit in the rotator cuff tendons. Additionally, tennis elbow and golfer's elbow, which are conditions that are typically resistant to conventional treatments like physiotherapy and cortisone injections, can be successfully treated with the ESWT waves.

    Greater Trochanteric Pain Syndrome, which manifests as crippling pain on the outside of the hip, can be treated with ESWT around the hip and knee. Additionally, it is used to treat Osgood Schlatter's and Patellar Tendon Pain in the area at the front of the knee. ESWT is suitable for two main foot and ankle problems. This is plantar Fasciopathy (also known as fasciitis), which is a highly frequent and excruciating condition caused by irritation of the plantar fascia, a robust ligament-like tissue located beneath the heel. The second problem is Achilles Tendinopathy, which can occur non-insertionally within the tendon's body or insertionally at the point where it attaches to the heel bone's back.


    Hydrotherapy Indications

    Hydrotherapy Indications

    No one requires hydrotherapy. It is not a recommended course of treatment for any illness, ailment, or symptom. Experts are learning what it is and isn't successful at treating it as it is studied more and more. If you're considering hydrotherapy, talk to your healthcare physician about the potential benefits, the best types of water therapy for you, and what you should know before beginning.

    The main purpose of hydrotherapy is to treat ailments including pain and stiffness. As part of your comprehensive treatment or symptom management strategy, your healthcare physician might advise a type of hydrotherapy. People who have these symptoms may find relief through hydrotherapy:

    • Pain.
    • Stiffness.
    • Bruising.
    • Swelling.
    • Muscle ache.
    • Painful period.

    Using water in various forms and temperatures can help people with a variety of disorders feel better. People with the following conditions may get symptomatic improvement with hydrotherapy:

    It's crucial to keep in mind that none of these conditions can be cured by hydrotherapy. It shouldn't replace any treatments or medications that your doctor has prescribed for you. Hydrotherapy typically improves people's health by temporarily reducing pain, stiffness, and edema. Finding safe means to feel better is never a bad thing, but hydrotherapy won't be able to treat any problem, especially more severe chronic illnesses.


    How Does ESWT Work?

    ESWT Work

    In general, ESWT has the opposite effect of steroid injections, which are most effective for inflammatory disorders by reducing the inflammatory response to a healing lesion.

    A non-invasive device is used in shockwave therapy to provide sound wave energy to the injured area. The waves instantly reduce the pain by desensitizing the target area's nerve endings. This is followed by a controlled microscopic trauma to the area to encourage fresh blood flow and give healing growth factors to the wound. ESWT stimulates the early stages of healing by triggering a modest inflammatory response within the target structure. For three months before therapy, the target structure should not have received any steroid injections. Additionally, non-steroidal anti-inflammatory drugs should be avoided for two weeks before and throughout the course of treatment.

    Usually three, maybe four, sessions to the affected area, a week between each one and the other. If the condition relapses, a second course can be given later. Each session lasts 15 to 20 minutes and is conducted by a qualified nurse practitioner.


    How Does Hydrotherapy Work?

    Hydrotherapy Work

    To promote healing, hydrotherapy relies on its mechanical and thermal effects. It makes use of the body's response to stimuli that are cold or hot, the pressure that water exerts, the prolonged application of heat, as well as the sensation of the water. Nerves then transmit these sensations and outcomes further into the skin.

    As a result, these sensations improve digestion, circulation, and blood flow, lessen pain sensitivity in the body, and boost the immune system, which influences the release of stress hormones. In most cases, heat is used to soothe and relax the body while reducing internal organ activity.

    But cold is utilized to energize and stimulate, which raises the body's internal activity. Consequently, you should take a hot bath if you have stiff muscles and are experiencing anxiousness. Shower with hot water first, then take a quick cold shower if you're feeling stressed out and exhausted. The body and mind are stimulated by this.

    You feel somewhat weightless when submerged in water, such as a pool or a bath. The body is temporarily liberated from the effect of gravity thanks to the water. Additionally, as water kneads your body, it produces a hydrostatic effect and a massage-like effect. Flowing water stimulates the touch receptors on the skin. This result improves blood flow while relaxing muscle tension.


    What Happens After ESMA Therapy?

    ESMA Therapy

    • After the treatment, you often feel less discomfort or none at all, although it's possible that mild pain can return in a few hours. Paracetamol and other over-the-counter pain relievers are acceptable, but anti-inflammatory drugs should be avoided.
    • Ice therapy should also be avoided during your treatment because it can impair the body's ability to recover.
    • After this therapy, you can load normally, but you must gradually resume your normal activities. Your consultant will give you advice on the number of activities you can engage in after the procedure.

    Following treatment, you are safe to resume your regular everyday activities, such as driving and walking. You should wait 24 hours before exercising the treated area, but after that, you can resume your normal activities. As a result, you should expect some slight pain in the treated area 2-3 days after treatment. However, there shouldn't be a lot of discomfort or pain. You should get in touch with the prescribing physician if it does.

    There are two ways to do this: clinically and by imaging. To establish a visual record of diagnosis and progress, doctors generally perform an ultrasound scan as a baseline at the beginning of treatment and another at the end. Pre- and post-treatment assessments of pain intensity and function are part of clinical evaluation.


    Hydrotherapy Recovery

    There should be little to no recovery time after hydrotherapy. Following the procedure, you should be able to immediately resume all of your regular activities. If you are undergoing hydrotherapy as part of a treatment plan for an accident, burn, or a particular condition, follow your healthcare provider's advice regarding the next steps.


    Hydrotherapy Risks

    Hydrotherapy Risks

    In general, hydrotherapy is safe. However, there are several risks and reasons to completely avoid it, such as:

    • Overheating. The most typical side effect of hydrotherapy is this. Keep an eye on how much time you spend in warm water. Stop your hydrotherapy treatment and seek assistance if you feel faint, hot, or like you might pass out.
    • Increased blood pressure. Blood pressure can occasionally be affected by heat. Consult your doctor to determine whether hydrotherapy is safe for you if you have elevated blood pressure or any other cardiovascular condition.
    • Infections. The water used for hydrotherapy must be hygienic and safe. The CDC gives detailed instructions on how to keep tanks and pools clean. The risk of infection remains even when a facility adheres to these guidelines. Keep open wounds away from the water.
    • Seizures. Hydrotherapy should be avoided by anyone with a history of epilepsy and seizures. It might make some people more susceptible to seizures. Additionally, having a seizure when submerged in water is very risky.

    In general, hydrotherapy may be risky if you have a disease that makes you more susceptible to infections, lung issues, or heart issues. Diabetes, heart failure, compromised immune system, and the ability to heal wounds are a few examples of these disorders. Consult your healthcare physician before beginning hydrotherapy if this relates to you.



    Extracorporeal shockwave therapy is a straightforward procedure that involves treating painful lesions from outside the body using high-energy shockwaves. Instead of using a spine corrector, manipulation therapy uses the skilled, targeted hands-on techniques of qualified manipulation therapists to relieve pain. Due to its effectiveness in reducing pain, the therapy has received a lot of attention recently. The benefits of these two therapies have been combined into a novel ESMA therapy that has been developed and used by many hospitals.