In search of a new revenue source? Consider shockwave therapy

The effective, sustainable new cash revenue source for your practice

I WAS IN MY SECOND YEAR OF CHIROPRACTIC SCHOOL and my Diversified Technique instructor proclaimed enthusiastically, “The key to success in this line of work is to find a need and fill it and provide a better service.” 

Thirty years later, I can say that this idea has been a valuable guiding principle. However, I found most actionable steps are either filling needs or providing better services. It was rare for me to find a concept that would do both. That is, until now.  

Two years ago, I decided to add Extracorporeal Shockwave Therapy (ESWT) to my practice after a single treatment produced a significant result on my wife’s hip pain.  

Fulfilling the needs of patients

If your practice is like mine, you have patients come in with all manner of musculoskeletal pathologies that do not directly involve the spine. I would like to focus on knee arthritis due to its prevalence in our society and in my clinic.   

You have patients right now in your clinic who are suffering with knee issues. Many of these patients have been to their orthopedic, and with few exceptions, they are offered the following solutions:  

• NSAIDS
• Cortisone injections
• Some type of gel injection 

Most orthopedic doctors will admit the gel injections only last 4-6 months.² When the arthritis progresses enough, the patient is then offered a knee replacement surgery. The medical approach falls short of meeting the needs of a patient who has knee pain that does not require surgery. 

Although multimodal conservative therapy is widely advocated and unanimously supported by knee osteoarthritis treatment position statements, this regimen is successful in less than 50% of patients after 12 weeks and, over one year, results in statistically significant, but practically minor improvements (Scand J Rheumatol. 2011;40:225–31). 

It has been established that only 10-30% of patients who have knee osteoarthritis will ever need surgery.¹ Therefore, between 70-90% of patients with knee pain will never be offered surgery. They will only be encouraged to continue the ineffective conservative treatment by their orthopedic. This conservative treatment has less than a 50% success rate. This presents a tremendous need that is not currently being met and an opportunity for chiropractors to serve these patients.  

Provide a better service

Most patients have never heard of Extracorporeal Shockwave Therapy. For that matter, most physicians I speak with have never heard of it.  

ESWT will allow you to treat the cause of conditions by doing what chiropractors normally do: Use kinetic energy to assist patients’ healing. ESWT is a cutting-edge treatment that uses shockwaves to break up calcifications and adhesions, enhance collagen synthesis, release growth factors, and stimulate the body’s healing process to reduce pain and help patients with strength and mobility.  

Most of the time, the patient feels a dull, achy sensation that abates after the pathology underneath has been addressed. This therapy enhances blood circulation and accelerates the healing of stubborn musculoskeletal conditions in bones, tendons, ligaments and muscles. ESWT has undergone extensive clinical studies³ and is cleared by the U.S. Food and Drug Administration. For a majority of patients, it has no side effects or risks.  

Numerous randomized clinical trials show good-quality evidence that the use of ESWT for treatment of knee OA had a beneficial effect on pain relief and physical function improvement for up to 12 months.⁴ Can you think of any of your patients who would like to feel improvement in their knee pain for 12 months? But here is the best part: It’s not just for knee pain; it can be used anywhere on the musculoskeletal system with a few exceptions. Studies have shown it is completely safe to use on conditions that were previously difficult to treat. In fact, some of my best results have been on patients who would be contraindicated for other modalities like stasis ulcers, osteoporosis or fractures. 

Sustainable cash model

Once you decide you want to start expanding your practice with shockwave, I do have some pointers on making this a profitable enterprise.  

Buy a good-quality machine from a manufacturer with a history of quality and integrity. Right now, you will invest between $13,000-$80,000. I purchased a great machine that costs $36,000.  

You will need to undergo some training by a reputable organization; training is important to provide successful outcomes for your patients. Since chiropractors are well-versed in anatomy, a weekend course should be sufficient. Try to avoid training that is tied to a specific manufacturer. Learn the basic science of shockwave; this will help you avoid buying into propaganda.  

A knowledgeable, well-trained doctor is more important than the most sophisticated machine. Bring your top chiropractic assistant to these trainings, as well, so he or she can assist you with established patients.  

The average cost is $150 per treatment. It is not covered by insurance. There is no CPT code. Most patients require 6-10 treatments.  

ESWT will sell itself. I offer a reduced-rate trial session for patients to test it out. We offer a discount if they buy all of their sessions up front. By the time the patient walks up to check out after their trial session, they are convinced.   

ESWT will allow you to offer your patients a safe, effective treatment they can feel and often gain relief from in just minutes. Millions of people need this therapy. ESWT will set you apart from other providers and provide you a sustainable, ethical and rewarding revenue source for your practice.
As Peter Drucker says, “An entrepreneur is the one who always searches for changes, responds to it and exploits it as an opportunity.”

PETER BROCKMAN, DC, is the clinic director at South Lake Wellness and Injury Center, with a Bachelor of Science degree in Microbiology from the University of South Florida. He attended Cleveland Chiropractic College of Los Angeles, where he received a Doctorate in Chiropractic. He is also a graduate of the San Diego Spine Research Institute and is certified in treating whiplash and brain traumatology. Learn more at southlakewellnessinjury.com.

REFERENCES 

¹ Knee osteoarthritis has doubled in prevalence since the mid-20th century. Ian J. Wallace, Steven Worthington, David T. Felson, +4, and Daniel E. Lieberman danlieb@fas.harvard.edu. Edited by Osbjorn Pearson, University of New Mexico, Albuquerque, NM, and accepted by Editorial Board Member C. O. Lovejoy July 12, 2017 (received for review March 7, 2017). August 14, 2017. 114 (35) 9332-9336

² 16. Snijders GF, den Broeder AA, van Riel PL, et al. Evidence-based tailored conservative treatment of knee and hip osteoarthritis: between knowing and doing. Scand J Rheumatol. 2011;40:225–31.  

³ Meta-Analysis : Int J Surg. 2020 Mar;75:24-34. doi: 10.1016/j.ijsu.2020.01.017. Epub 2020 Jan 21.  The efficacy and safety of extracorporeal shockwave therapy in knee osteoarthritis: A systematic review and meta-analysis. Huanzhi Ma 1, Wei Zhang 1, Jun Shi 1, Dongsheng Zhou 1, Jian Wang 2  Meta-Analysis  Clin Rehabil Meta-Analysis  

⁴  Pain Med  2020 Apr 1;21(4):822-835. doi: 10.1093/pm/pnz262. Efficacy and Safety of Extracorporeal Shockwave Therapy for Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis. 2019 Sep;33(9):1419-1430. doi: 10.1177/0269215519846942. Epub 2019 May 8. 

Clinical efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a systematic review and meta-regression of randomized controlled trials. Chun-De Liao 1 2, Jau-Yih Tsauo 1, Tsan-Hon Liou 2 3, Hung-Chou Chen 2 3 4, Shih-Wei Huang 2 3 5