Sports injuries can be painful and often require surgery to repair, leading to a lengthy down time. Fortunately, EPAT Shockwave Therapy for non-surgical sports medicine injuries helps athletes heal and recover more quickly, often without the need for surgery.
Dr. Scott Duke graduated from the New York College of Chiropractic, received a Bachelor of Science in Kinesiology from the University of Maryland, and a Bachelor of Science degree in Human Anatomy from the National College of Chiropractic in Chicago.
In addition to being an author and the creator of the Run Smart New York series of free clinics for runners and athletes, Dr. Duke is also the owner of Duke Chiropractic in New York and an expert in the field of Sports Medicine and Spinal Rehabilitation.
We were fortunate to interview him about his practice and his strategies for treating athletes and helping them heal more quickly.
Dr. Duke, How Would You Describe Your Chiropractic Sports Medicine Practice?
Dr. Duke: I have a group practice where there are a number of doctors inside the office and we specialize in non-surgical sports medicine. Our patients come in and basically say, being injured is simply not an option.
We provide strategies for them to stay active and recover quickly, even while they’re injured. We apply techniques that accelerate the healing process; the same ones that we would apply to an Olympic athlete.
We feel like you don’t have to be an Olympian in order to be treated like one. The modalities that we apply really help speed recovery.
In your practice do you only see athletes or do you also see other people that might suffer from things like neck, back injuries and other issues?
Our practice is a combination of many different patients not just athletes. For instance, we get referrals from Hospital for Special Surgery, Beth Israel, NYU, pain patients and we try to provide them relief from their chronic conditions.
We also have a tremendous number of referrals for people who have spinal pain. We try to provide them with alternatives to injections and medications. We also see a lot of baby boomers who just want to stay active.
There has been a shift in how people are trying to stay active, and there is what we call regenerative medicine. People who are now having hip replacements and knee replacements, we’re helping them increase the range of motion and strength that they weren’t able to achieve following the surgery with conventional physical therapy modalities. So there’s a lot of different patient clientele who come in.
I feel fortunate that I have had the privilege of working on some of the fastest, world class endurance athletes on the planet. In my practice we just simply take what we learned from those athletes and apply it to all the local runners and triathletes and the different clubs within New York City. It’s a Mecca for endurance athletes.
I have also taken several years of my life and created a book called “Back in Action” in order to give people management and self-techniques to use in their house in order to stay mobile. And help create more fluid inside their spine and prevent it from degenerating.
You recently incorporated something called EPAT Shockwave Therapy into your practice. What exactly is Shockwave Technology, and for what kind of conditions are you using this technology in your practice?
EPAT Therapy, also known as Shockwave Technology, is a very innovative approach to treating chronic muscle and tendon problems. It was originally called pressure wave therapy. It is basically a fancy way of saying a radial shockwave. It is a cost effective non-surgical way to help heal tendons and muscle tears.
A lot of patients make this mistake where they commonly let their doctors inject cortisone into the area. There has been a paradigm shift about how to treat these chronic tendon problems because now they’re considered degenerative, they’re not inflamed.
The tendons don’t heal because they fill in with this scar tissue as a result when you’re moving around, they rip and tear, and then it just creates more scar tissue. So when you inject cortisone in that area, the tissues weaken until they finally rip.
Now the emerging research in regenerative medicine is where rehab doctors want to do exactly the opposite. We want to jumpstart the healing process of these chronic tendon problems by destroying the scar tissue and helping it heal itself. It’s a nice way to repair without having to do surgery.
A Shockwave device uses compressed air to send a projectile that strikes the underside of a metal applicator. The force of impact produces a deep pressure wave in the transmitter and it delivers this impulse deep within the tissue, and it creates a shockwave. It destroys the scar tissue and starts to create new blood vessels, so that circulation improves.
The old and damaged tissue is now removed from that area. It stimulates this neurochemical reaction that helps reset your pain patterns, like an analgesic so to speak, and the cells become more permeable.
That means that it allows new growth factors and collagen to enter the cells, and it helps essentially, build back brand new, elastic tissue. So there are no needles, and there is no anesthesia.
One of the best things about the treatment is that there is no lost time from movement or exercise. Patients can look at Shockwave as a very cost effective, non-surgical way to heal tendons and muscle tears.
You have a very successful practice and you work with a lot of world-class athletes and runners. People are knocking on your door all the time saying, hey try this, buy that. Why did you decide to incorporate EPAT Shockwave Therapy Technology into your practice?
I try to have anything possible in my practice that helps accelerate the healing quality of my patients. I also have colleagues in many areas of the country who deal with elite athletes and I found out that they were using EPAT Shockwave Therapy in the training gyms for football teams, and soccer teams.
Chronic tendon problems can take months to heal and after my colleagues told me how radial shockwave therapy can really accelerate the healing I started doing my own research. The research is plentiful and it’s been around for quite some time.
From what I understand, it originally started inside hospitals where the patient had kidney stones and they didn’t want to do surgery so they would do this shockwave therapy to destroy the kidney stone.
Then they got smart, and they started using it on calcium deposits like in the heel such as plantar fasciitis, frozen shoulder and many other things.
What are some of the conditions that you most frequently find patients needing help with that you might utilize EPAT Shockwave Technology on?
We use it on a lot of things. One area is regenerative medicine for the spine. We have patients who have degenerative injuries to the spine, where they’re going to the hospitals and seeing pain management doctors. What they are getting for the most part for that is what is called transforaminal cortisone and epidural injections.
What we are finding is that the bone spurs (exostosis) and the scar tissue deep within the spine could be broken up with this radial shockwave. We are also using it on hip and knee replacements to help the patient break down the existing scar tissue.
One thing to remember is that a lot of times people will replace the hardware, like their knee or their hip. But the muscles and the tendons were abnormal for so many years that there is a lot of scar tissue in there. This means when they go through the conventional process of rehab, because those muscles were so weak to begin with, they can’t possible get strong again.
So now the radial shockwave helps break down that scar tissue and improves new muscle growth in that area. So we use it for that.
With our athletes we are using it on many things. It’s a plethora, the Achilles tendon, bursa at the heel, plantar fasciitis. A big one in our area is upper hamstring tears.
Others include the patella tendon or the knee cap, IT band, frozen shoulder, tennis elbow the list goes on and on.
We also have patients who unfortunately undergo surgical intervention for the spine. And they feel better after because they had spinal stenosis and they remove the lamina. It’s called a laminectomy, and then they feel much better.
However, within three to five years, that patient starts to develop what’s called neurofibrosis. We can use the radial shockwave therapy to break down that fibrotic scar tissue without having to have another surgery.
With my patients who have chronic back pain, sciatica, and have visited physiatrists and pain management doctors for their epidural injections, having the EPAT Shockwave therapy is another tool that’s been tremendously beneficial. Because now we can combine our soft tissue expertise of active relief technique, Graston instrumentation, plus the radial shockwave and the conventional joint manipulation associated with chiropractic care.
For those patients who don’t qualify for joint manipulation, and many don’t, we are able to provide them with something called spinal decompression. It is a way to decompress or lengthen the spine just enough to reduce the pressure within the spinal canal.
Spinal decompression is a very easy way to comfortably lengthen the spine and reduce the pressure to negative values. When you do that, it creates a vacuum effect that pulls fluid into the disc so it helps regenerate injured discs and cartilage. It opens up the space just enough to kind of take a bone that maybe has stenosis and hitting the nerve and release the pressure on the nerve.
I now feel like with the addition of Shockwave technology combined with all of these other modalities I have a very comprehensive way of helping people with chronic pain, especially spinal pain.
You work with people that long distance run, or running is a big part of their life. Everybody is looking for a quick recovery. How long does EPAT Shockwave technology work? Do you realize fairly quick results from? Is it something you can feel after a few treatments?
Most of our patients say that they feel results within the first two treatments. We get emails, we get text messages saying, “Thank you, I’m feeling great.”
I often have to convince them that they still have to make a commitment to come in once a week for the next three to six weeks. Because if you do it, you will feel better. But if you don’t repeat the process, that scar tissue just comes right back. We have to really destroy all of it.
We also do it on the patients who really have “chronic, it just doesn’t go away” type of injuries.
Now that we have Shockwave we can accelerate the healing process much faster than we were able to do before.
In your work with runners, what are some of the most frequent issues you see that runners face?
The biggest are the knee cap and the IT band. It’s that big fascial band that runs from the side of the hip to the outer part of the knee. It gets short and tight, the knee cap starts to grind, and it creates inflammation and bursitis.
The IT band, is not a muscle and it’s not a tendon. It’s a cross between a muscle and a tendon. We found that Shockwave works really great on the IT band and the knee cap tendon.
The next one after that I would say would be the hamstring. That upper hamstring is really chronic. The Olympians don’t have much of that because they just take better care of their other bodies and they’re able to.
However, the general population, if you over stride, or if you take on a hill too quickly, or if you’re a triathlete, and you’re really motoring with your bike, the hamstring gets under tension. The micro tears build, and then eventually, you start ripping and tearing from the bone that you sit on. They call it the ischial tuberosity, that’s the toughest area.
I have seen orthopedic surgeons perform something called PRP, platelet rich plasma. They take some of your blood and they put it in a centrifuge. They take out the platelets, and they inject it back into the tissue because it has a tremendous amount of growth factors, and it helps repair the area.
However, on the hamstring, it doesn’t work that well, and it’s really painful. So, the EPAT therapy has been really helpful for that.
Another injury that plagues triathletes and runners alike are the Achilles tendon and the plantar fascia.
The plantar fascia is just horrible; it is like you’re walking on a marble. Most people feel that it is just an inflammation, but until they have an MRI, they don’t realize that they could have a rip or a tear in that tissue. It then can pull so tight that it starts to create a bone spur.
The Shockwave therapy helps disintegrate the bone spur at the same time as it helps regenerate some normal elastic tissue down there. When combined with the expertise of using the rehab treatments we provide, the outcomes have been really very, very good.
We provide what’s called a very focused visit where we use ART, Graston, Shockwave therapy, heat, ultrasound, and stretch. And we repeat it, so we do double of everything, and then we send our patients on their way. That’s a good office visit.
What would you say to someone who is an avid runner that might experience some of the issues you have discussed in this interview as a reason to explore using Shockwave Therapy Technology to address their injury?
It’s pretty clear things are changing all the time. It went from athlete care to regenerative medicine and the paradigm shift away from injecting cortisone into the area.
I find that most of the patients who have these chronic injuries have explored injections, conventional physical therapy, strength training and stretching, but it doesn’t work. It just doesn’t cut it.
Going for a running evaluation where they tell you everything that’s wrong with your technique, that doesn’t do it either. That’s not what caused these injuries.
What caused these injuries is pretty simple. Usually it’s a buildup of too much volume too quickly or that they simply didn’t warm up, and they sprinted, and there is micro trauma.
If I had these injuries, I’d be seeking any alternative to avoiding injections and then surgery and trying to enjoy my sport again. Shockwave therapy is one of the best ways you can do it.
This video outlines using EPAT Therapy vs. Cortisone.
In addition to utilizing new technology like EPAT Shockwave I know that you have several instructional videos and a lot of information on a few websites, especially as it pertains to running. What kind of information are you providing on these platforms?
In our practice, because we are a non-surgical sports medicine practice, it covers a lot of areas. I’ve always felt like it is very important that we have to give back to everybody, including techniques and home management of how to prevent these injuries from ever occurring in the first place.
So I put together a website RunSmartNY.com. On the website the doctors in my practice and myself put together YouTube videos that quickly explain how to use foam rollers, how to use massage balls and different tools to help break down the connective tissue that’s short and tight.
We also show the most important stretches any athlete can do, the most important strength exercises that people need to do to help them with their posture and much more.
It is important to note that people don’t just have running, cycling, and triathlon injuries. We have people who take CrossFit classes, boutique gym classes and all sorts of things.
Now in addition to my conventional office website I have this web site that offers all this free advice.
We also put together an app in the Apple app store. It’s called W.E.Run, and essentially it’s warm up exercises for runners. It is really for anyone who is going to participate in any kind of sport or activity. It provides them with a two to four minute routine of movements that lubricate the joints, and starts to wake up the connective tissue to help prevent injuries in the first place.
Although we treat a lot of people in the office, I’m also trying to educate the general population about how not to get injured.
To find out more about Dr. Scott Duke, visit the Duke Chiropractic website or call the office at (212) 481-0066.