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Official Announcement Regarding Modification of Cost and other Changes Due to improvements in accessibility and advancement in Shockwave (ESWT) technology, we are now able to provide the PNSBDS protocol at a reduced cost. A majority of the prior costs were associated with operating older ESWT technology. As with other forms of technology, such as computers and televisions, advancement occur regularly. This allows improved models to replace older models, often at a reduced price to the consumer (e.g. Plasma television cost and resolution from 2006 versus 2012). The ESWT units used in the PNSBDS protocol are being replaced with more powerful, more efficient, less painful and less expensive models (with lower operating costs). Key Points: 1) Dr. Andrew, founder of the PNSBDS Protocol, has been effectively operating ESWT technology since 2007 at three separate clinics (Toronto, Ottawa and recently Cornwall). At a busy Ottawa clinic, approximately 15-20 patients per day are successfully treated with ESWT. 2) Dr. Andrew is the preferred ESWT practitioner for the AIM Group of Ottawa (Medical Chronic Pain Clinic), and receives numerous medical referrals from Chronic Pain Specialists for his opinion and expertise in treating Chronic Pain (with ESWT, among other treatments). The AIM group is a large network of established Chronic Pain Management centres, employing Medical Doctors (Pain Specialists), Physiotherapists, Chiropractors, etc. 3) Dr. Andrew is involved in training other therapists in the Ottawa area in the use of ESWT. 4) ESWT is integrated into the official core curriculum at CMCC (Canadian Memorial Chiropractic College), with official training by Dr. Gordon, MD (Orthopedic Surgeon, and leader in the field of ESWT treatment and research) (see below for further reference). 5) Dr. Andrew has received additional training and up-dates at Shockwave Therapy Seminars, the most recent being in Toronto in April 2012. Here, Dr. Gordon and other Orthopedic surgeons reviewed new research, technology, techniques and methods. Thus, Dr. Andrew utilizes the most current Evidence-Based (EBM) approach to ESWT.

6) Shockwave therapy should be administered by a qualified health professional formally trained to utilize the equipment safely. In the US, these professionals include Medical Doctors, Doctors of Chiropractic, Physiotherapists, and Doctors of Osteopathy. 7) Massage therapy does not incorporate ESWT training into their twelve month training program. Currently, Massage Therapy training does not require a Bachelor of Science to enroll in Massage therapy courses (Grade 12 is the entrance requirement). In Canada, ESWT is currently in a ‘grey’ area of scope of practice, which means those not formally educated to operate these devices can purchase them and operate them. This will likely change in the near future. 8) ESWT should be performed by therapists formally trained in the usage of the device, well-versed in the research, and utilizing an Evidence-Based approach. Legislation in the USA reflects this fact. 9) Any other therapist working outside of official guidance and endorsement of Dr. Andrew is not utilizing the PNSBDS protocol, but rather some fragment of it (despite various claims to the contrary, among other erroneous claims of proficiency). 10)A Doctor of Chiropractic undergoes rigorous training to diagnose and treat musculoskeletal conditions (and requires an undergraduate degree of 4 years prior to entrance, totaling 8 years of study):

"A recent study described U.S. Chiropractic curricula as an average of 4820 classroom and clinical hours, with about 30% spent in the basic sciences and 70% in clinical sciences and internship[vi]. Medical school curricula average about 4670 hours with a similar breakdown.  Compared with medical students, chiropractic students spend more hours in anatomy and physiology but fewer in public health and pharmacology[vii]. Both

programs have similar hours in biochemistry, microbiology, and pathology[viii]. Canadian chiropractic curricula are at least as stringent U.S. standards, having also been accredited by the Council on Chiropractic Education". - 11) The PNSBDS protocol is the culmination of 8 years of formal educational training, personal experience and research (from the perspective of a prior sufferer). The protocol itself is complex, requiring a multi-faceted approach addressing all causal variables. Treatment is a sophisticated combination, requiring a multitude of various methods, the effects of which are cumulative. Sadly, should the treatment protocol be fragmented into the individual parts, the rate of success with be drastically lowered. Again, it is this reductionistic fragmentation of treatments which is partially responsible for the poor treatment success rates of conventional therapies. ESWT (shockwave therapy) is but one component, and the whole of the protocol “is greater than the sum of it’s individual parts”. Sincerely, Dr. Kirk Andrew, BHSc (Hon), CSCS, DC Doctor of Chiropractic, Certified Strength and Conditioning Specialist, Personal Trainer Specialist, Certified Active Release Techniques Practitioner. Formally Educated and Trained ESWT Practitioner.

References: [vi] Coulter I, Adams A, Coggan P, Wilkes M, Gonyea M. A comparative study of chiropractic and medical education. Altern Ther Health Med. 1998;4:64-75. [vii] Meeker, W.C. et al. Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine, Ann Intern Med. 2002;136:216-227. [viii] Meeker, W.C. et al. Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine, Ann Intern Med. 2002;136:216-227. See next page regarding ESWT training as part of the core curriculum of Chiropractic Education.

PNSBDS Protocol Announcement  
PNSBDS Protocol Announcement  

Clarification regarding costs associated with treatment