What Is Shockwave Therapy? Uses, Benefits, and What to Expect

What Is Shockwave Therapy?

Shockwave therapy is a non-invasive medical treatment that uses high-energy acoustic pressure waves to stimulate healing in damaged or painful tissue. Also known as extracorporeal shockwave therapy (ESWT), the technology was originally developed in the 1980s to break up kidney stones (a use it still has — called lithotripsy) and was adapted for musculoskeletal conditions in the 1990s. The U.S. Food and Drug Administration has registered ESWT devices for the treatment of chronic plantar fasciitis since 2000 and for chronic lateral epicondylitis (tennis elbow) since 2003. Today it is used worldwide for a wide range of chronic tendon and connective-tissue conditions.

At Spectrum Therapeutics in Wayne, NJ, Dr. Rob Letizia, DPT uses shockwave therapy as part of a comprehensive treatment approach for patients with chronic pain conditions that have not fully responded to traditional physical therapy alone. New Jersey's direct-access law allows patients to begin shockwave therapy without a physician referral, and Spectrum offers same-week initial evaluations for residents across Passaic and Bergen counties.

Shockwave therapy delivers high-energy acoustic waves to injured or painful tissue through a handheld applicator placed on the skin. These acoustic waves create a controlled microtrauma at the cellular level that triggers the body's natural healing response, including increased blood flow, new blood vessel formation, collagen production, and the breakdown of calcified deposits. The result is accelerated tissue repair and significant pain reduction in conditions that have become chronic or stalled in their healing.

There are two main types of shockwave devices used clinically: focused (high-energy) shockwave, which concentrates the acoustic energy at a specific tissue depth, and radial (lower-energy) shockwave, which spreads the energy across a wider, more superficial area. Modern devices like the StemWave system used at Spectrum Therapeutics combine elements of both to handle a broader range of musculoskeletal conditions.

How Does Shockwave Therapy Work?

Shockwave therapy works through several biological mechanisms that promote tissue healing. The acoustic waves increase blood circulation to the treated area, which delivers oxygen and nutrients essential for repair. They stimulate the production of collagen, the primary structural protein in tendons, ligaments, and other connective tissues. They trigger the release of substance P, a neuropeptide involved in pain signaling, which initially increases and then decreases — resulting in long-term pain reduction. They break down calcified deposits that form in chronically inflamed tendons. And they stimulate the formation of new blood vessels in areas with poor circulation, a process called neovascularization driven by the upregulation of vascular endothelial growth factor (VEGF).

The underlying biology is called mechanotransduction: the conversion of a mechanical stimulus (the acoustic wave) into a biochemical response inside the cell. The pressure wave deforms the cell membrane and cytoskeleton just enough to activate signaling pathways that the body uses for healing — the same pathways that exercise activates, but delivered as a concentrated, targeted dose. In tendons specifically, shockwave activates resident tenocyte stem cells (so-called "tendon-derived stem cells") that contribute to building new collagen. In bone, it stimulates osteoblast activity, which is why ESWT is also used to treat non-healing fractures.

During a shockwave therapy session at Spectrum Therapeutics, Dr. Rob Letizia applies a gel coupling medium to the skin over the treatment area and then delivers focused acoustic waves using a specialized device. A typical session takes 5 to 10 minutes per treatment area and involves 2,000 to 3,000 impulses. Most patients require 3 to 5 sessions spaced one week apart for optimal results. The intensity (energy flux density) is calibrated to your specific condition and pain tolerance, with progressive ramping over the course of treatment.

What Conditions Does Shockwave Therapy Treat?

Plantar Fasciitis

Plantar fasciitis is one of the most well-researched applications for shockwave therapy. Clinical studies show that shockwave therapy produces significant pain reduction in 60 to 80 percent of chronic plantar fasciitis patients who have failed other conservative treatments. The acoustic waves break down scar tissue in the plantar fascia, stimulate new blood vessel growth in the heel, and promote collagen remodeling. Dr. Rob Letizia combines shockwave therapy with targeted stretching, intrinsic foot strengthening, and progressive loading exercises for plantar fasciitis patients who have not responded to 3 or more months of standard treatment.

Chronic Tendinopathy

Chronic tendon conditions including Achilles tendinopathy, patellar tendinopathy (jumper's knee), lateral epicondylitis (tennis elbow), and rotator cuff tendinopathy respond well to shockwave therapy. These conditions involve degeneration of the tendon tissue rather than acute inflammation, and shockwave therapy works by stimulating the biological processes needed to regenerate healthy tendon. At Spectrum Therapeutics, shockwave is typically introduced when a tendon condition has persisted for more than 3 months despite consistent exercise-based physical therapy.

Calcific Shoulder Tendinitis

Shockwave therapy is particularly effective for calcific tendinitis of the shoulder, a condition where calcium deposits form within the rotator cuff tendons causing significant pain and restricted movement. The acoustic waves can break down these calcium deposits, allowing the body to reabsorb them. Research shows that shockwave therapy produces complete or partial resolution of calcium deposits in 50 to 70 percent of patients within 3 to 6 months of treatment. It is also used for chronic rotator cuff tendinopathy and adhesive capsulitis (frozen shoulder) that has plateaued with traditional treatment.

Hip Bursitis and Gluteal Tendinopathy

Greater trochanteric pain syndrome — which includes hip bursitis and gluteal tendinopathy — is another condition that benefits from shockwave therapy. These lateral hip conditions often become chronic despite exercise therapy, and shockwave can provide the stimulus needed to restart the healing process. Dr. Rob Letizia combines shockwave treatment with targeted hip abductor strengthening for patients with persistent lateral hip pain.

Knee Conditions

Knee conditions including patellar tendinopathy (jumper's knee), iliotibial band syndrome, and chronic knee pain associated with osteoarthritis can benefit from shockwave therapy. The treatment reduces pain and improves function by promoting tissue healing and modulating pain signaling in the affected area.

Shin Splints (Medial Tibial Stress Syndrome)

Chronic shin splints — particularly the medial tibial stress syndrome variant common in runners — respond well to focused shockwave therapy when conservative measures have failed. The treatment addresses both the soft-tissue component (posterior tibialis tendon) and the periosteal involvement that drives pain in advanced cases.

Muscle Trigger Points and Myofascial Pain

Shockwave therapy is effective for treating chronic muscle trigger points and myofascial pain that has not responded to manual therapy alone. The acoustic waves penetrate deeper into muscle tissue than manual techniques can reach, breaking up contracted muscle fibers and improving blood flow to the affected area. This is particularly useful in chronic neck and upper-trapezius tension patterns.

If you are dealing with a chronic pain condition in Wayne, NJ or elsewhere in Passaic or Bergen County, call Dr. Rob Letizia at (973) 689-7123 to find out if shockwave therapy is right for you.

Does Shockwave Therapy Actually Work? What the Research Says

Shockwave therapy is supported by a substantial body of clinical research. Systematic reviews and meta-analyses published in peer-reviewed journals — including the American Journal of Sports Medicine, the British Journal of Sports Medicine, and the Journal of Orthopaedic & Sports Physical Therapy — consistently demonstrate its effectiveness for plantar fasciitis, calcific tendinitis of the shoulder, lateral epicondylitis, and various tendinopathies. The evidence is strongest for conditions that have been present for more than 3 months and have not responded to standard conservative treatment. As of 2026, more than 200 randomized controlled trials and over 30 systematic reviews have evaluated ESWT for musculoskeletal applications.

Success rates vary by condition but generally range from 60 to 80 percent for chronic conditions. For chronic plantar fasciitis specifically, the strongest meta-analyses (Aqil et al., Yin et al.) report 60-83% improvement in pain and function at 12 weeks compared to sham. For calcific shoulder tendinitis, focused ESWT has been shown to outperform both subacromial cortisone injection and physiotherapy alone at 6 and 12 months in head-to-head trials.

It's worth being honest about what the research doesn't show: shockwave therapy is not a magic wand for acute injuries, and the evidence for its use in osteoarthritis pain (versus structural change) is more modest — beneficial but not dramatic. Many patients experience noticeable improvement after 2 to 3 sessions, with maximum benefit occurring 4 to 6 weeks after the final treatment as the underlying tissue continues to remodel. Dr. Rob Letizia at Spectrum Therapeutics evaluates each patient individually to determine whether shockwave therapy is appropriate for their specific condition and stage of healing.

Shockwave Devices: StemWave vs. SoftWave vs. Other ESWT Brands

You will see various shockwave devices marketed under different brand names. The differences matter less than most clinic websites suggest — what matters far more is the operator's clinical judgment about where to apply the energy, how much to apply, and how to combine it with manual therapy and exercise. That said, here is a candid breakdown of the major devices on the U.S. market in 2026:

StemWave

The StemWave system used at Spectrum Therapeutics is a current-generation FDA-registered device that combines focused and radial acoustic wave delivery in a single applicator. It allows the clinician to vary depth, intensity, and pulse pattern in real time during a session. Spectrum has delivered 500+ treatments using the StemWave platform, building protocols specific to each commonly-treated condition.

SoftWave

SoftWave (TRT/UltraMed) is another current-generation device popular in chiropractic and integrative medicine clinics. It uses a wider beam (called "unfocused") and is heavily marketed around claims of stem-cell activation. The marketing is louder than the evidence — stem-cell activation does occur with any focused or unfocused ESWT, and there is no head-to-head clinical evidence that SoftWave produces superior outcomes to other modern ESWT devices for any specific condition. It is a perfectly capable machine when operated by a skilled clinician.

Storz Duolith / EMS Swiss DolorClast / Chattanooga Intelect

These are the older clinical workhorses — focused or radial ESWT devices that have been used in European and U.S. clinics for 15+ years. Most of the published research on ESWT was performed using these devices. They produce excellent outcomes when used correctly. They are typically found in larger orthopedic practices, sports medicine clinics, and academic centers.

The honest takeaway on devices

If you are considering shockwave therapy, prioritize the clinician over the brand of machine. A Doctor of Physical Therapy with 25+ years of experience, a thorough clinical evaluation, and a treatment plan that integrates shockwave with hands-on manual therapy and progressive exercise will outperform a fancier device used as a standalone "machine treatment" by an inexperienced provider every single time. ESWT is a tool, not a cure — its effectiveness depends on the clinical reasoning behind how it is used.

Is Shockwave Therapy Painful?

Shockwave therapy produces a sensation that most patients describe as intense but tolerable. You will feel a rapid tapping or pulsing sensation against the skin as the acoustic waves are delivered. Some treatment areas — particularly bony prominences like the heel, the lateral epicondyle of the elbow, and the greater trochanter of the hip — are more sensitive than others. The intensity can be adjusted in real time based on your comfort level, and protocols typically ramp up over the course of the session as the tissue acclimates.

The treatment itself typically lasts only 5 to 10 minutes per area. Most patients experience some soreness in the treated area for 24 to 48 hours after the session, similar to post-exercise soreness. This is a normal — and in fact expected — part of the healing response and resolves on its own. Patients often describe the day-after soreness as evidence that "something is working." A small minority experience a brief flare in their primary symptoms 48-72 hours after the first or second session before improvement begins; this is also expected and not a reason to discontinue treatment.

How Many Shockwave Therapy Sessions Do I Need?

Most conditions require 3 to 5 shockwave therapy sessions spaced one week apart. Some patients notice improvement after a single session, while others see the most dramatic changes after the third or fourth treatment. The full benefit of shockwave therapy continues to develop for 6 to 12 weeks after the final session as the biological healing processes stimulated by the treatment continue to work. This is one of the more counterintuitive aspects of shockwave: the treatment itself is brief, but the tissue change unfolds slowly over weeks.

At Spectrum Therapeutics, shockwave therapy is always combined with a targeted exercise program to maximize results. The shockwave stimulates the healing process, and the exercises ensure that the new tissue is strong, functional, and resilient under load. This combined approach produces superior outcomes to either treatment alone — and frankly, shockwave used in isolation, without an integrated rehabilitation program, is one of the more common reasons patients report disappointing results from other clinics.

Shockwave Therapy Cost and Insurance Reality in NJ

Most insurance plans in 2026 — including Aetna, Horizon BCBS, Cigna, Oxford, UnitedHealthcare, and Medicare — do not cover shockwave therapy for musculoskeletal conditions. The reasons are bureaucratic rather than scientific: ESWT for musculoskeletal applications often falls into a CPT-code gray zone, and many insurers continue to classify it as "experimental" or "investigational" despite the substantial clinical evidence supporting its use. Coverage policies do change, and HSA and FSA accounts typically do reimburse shockwave therapy when it is performed by a licensed physical therapist with a documented condition.

At Spectrum Therapeutics in Wayne, NJ, shockwave therapy is offered as a cash-pay service at a competitive per-session rate. Dr. Rob Letizia discusses all costs upfront during your initial evaluation so there are no surprises. The total cost depends on how many sessions your condition requires (typically 3 to 5).

It is worth putting that out-of-pocket cost in context. The economically rational comparison is not "shockwave vs. free" — it is "shockwave vs. the realistic alternatives":

• 3-5 cortisone injections over 12 months: $200-500 each, plus the cumulative tendon-weakening side effect that increases the risk of eventual tendon rupture.
• Surgery for chronic plantar fasciitis or rotator cuff repair: typically $5,000-15,000 out-of-pocket after insurance, plus 6-12 weeks of post-operative recovery and rehabilitation.
• Six more months of standard physical therapy for a condition that has already plateaued: $2,000-3,000 in copays plus another $0-2,000 in over-the-counter management, with the same condition still unresolved at the end.

For a chronic condition that has resisted 3-12 months of other treatment, shockwave therapy often pays for itself by resolving the underlying problem rather than managing the symptoms indefinitely. Dr. Rob Letizia is candid about cases where shockwave is unlikely to help, so you are not paying for treatment that is not the right fit.

Who Shouldn't Get Shockwave Therapy? (Contraindications)

Shockwave therapy has an excellent safety profile, but it is not appropriate for every patient or every condition. The following are absolute contraindications — patients in these situations should not receive shockwave therapy:

• Pregnancy — energy delivery near the abdomen or pelvis is not recommended.
• Implanted electronic devices — pacemakers, implanted cardioverter-defibrillators, and similar devices can be disrupted by acoustic energy.
• Active malignancy or known tumor at the treatment site — shockwave promotes blood vessel formation and tissue activation that is contraindicated near active cancer.
• Active infection at or near the treatment area.
• Open wounds, recent skin grafts, or unhealed surgical incisions over the treatment area.
• Severe coagulopathy (uncontrolled blood clotting disorders). Patients on stable anticoagulant therapy (warfarin, DOACs) are usually fine to treat after a careful risk discussion.

Relative contraindications — situations that require additional clinical judgment but do not absolutely rule out treatment:

• Children with open growth plates in the proposed treatment area. Shockwave can be used in pediatric and adolescent patients but with careful targeting away from physes.
• Recent cortisone injection in the treatment area within the past 6 weeks. Cortisone temporarily weakens the tendon; combining with shockwave too soon increases rupture risk.
• Severe peripheral neuropathy with loss of protective sensation in the treatment area.
• Acute (less than 6 weeks) injuries. Shockwave is best for chronic, plateaued conditions; acute injuries usually respond to standard rest, manual therapy, and progressive loading.

A thorough screening — including a review of your medications, medical history, and current condition — is performed at your initial evaluation at Spectrum Therapeutics before shockwave is recommended. If you are not a good candidate, Dr. Rob Letizia will tell you so directly and recommend a more appropriate treatment path.

Shockwave vs. Cortisone vs. Surgery vs. PT Alone: How to Decide

For chronic musculoskeletal pain, you typically have four reasonable treatment paths. Choosing among them depends on your specific condition, how long you've had it, your activity goals, and your tolerance for side effects. Here is the framework Dr. Rob Letizia uses with patients:

Physical therapy alone is enough when…

The condition is acute (less than 6-8 weeks), the tissue is responding to graded loading, your symptoms are improving session over session, and your goal is full functional return without time pressure. Most acute injuries — including muscle strains, recent ligament sprains, and early-stage tendinopathies — resolve fully with skilled PT alone, given consistent attendance and a 6-to-12-week timeline.

Add shockwave therapy when…

The condition has been present for 3+ months, has plateaued despite consistent exercise-based PT, involves a chronic tendinopathy or calcific deposit, and you want to avoid both injections and surgery. This is the sweet spot for ESWT. Plantar fasciitis, calcific shoulder tendinitis, jumper's knee, tennis elbow, and Achilles tendinopathy that haven't budged with traditional rehab — these are conditions where shockwave often unlocks the healing the body has been unable to complete on its own.

Cortisone injection is reasonable when…

You have an acute inflammatory flare requiring short-term function (a one-week deadline at work, an upcoming wedding), the symptoms are clearly inflammatory rather than degenerative, and you understand the trade-off: cortisone provides 3-6 weeks of strong relief but weakens the tendon in the process and tends to leave you in worse structural shape long-term. It is a short-term tool, not a treatment plan. After 1-2 cortisone injections, it stops being a reasonable option for chronic tendon conditions.

Surgery is the right path when…

There is structural failure that conservative care cannot address — a complete tendon rupture, a high-grade ligament tear with persistent instability, a severe disc herniation with progressive neurological deficit, or a meniscal injury with mechanical locking. Surgery is also reasonable after a fair trial (typically 6-12 months) of every appropriate conservative option (PT + shockwave + activity modification) has not produced sufficient improvement. Modern orthopedic surgery is excellent at fixing structural problems; it is not the right tool for tendon degeneration that has not been given a real chance to heal biologically.

The decision framework in one line

Choose the lowest-risk, most-reversible option that has a reasonable chance of resolving your specific problem. Shockwave therapy fits that criterion for most chronic tendon conditions: it is non-invasive, has minimal side effects, and addresses the underlying biology of the problem rather than masking the symptoms.

What Are the Side Effects of Shockwave Therapy?

Shockwave therapy has an excellent safety profile. The most common side effects are temporary soreness or tenderness in the treated area for 1 to 2 days, mild redness or swelling at the treatment site, and occasional small bruising. These effects are mild and resolve on their own, and they are part of the expected biological response to treatment.

Less common side effects include a transient flare of the primary symptoms 48-72 hours after the session (which usually precedes improvement), brief numbness or tingling in the treatment area, and small skin abrasions if the gel coupling medium is insufficient. Serious side effects — including tendon rupture, deep tissue injury, and significant nerve damage — are extremely rare when the treatment is performed by a properly trained clinician using current-generation equipment with appropriate energy settings.

As covered above, shockwave therapy is not recommended for patients who are pregnant, have a pacemaker or other implanted electronic device, have active cancer or infection at the treatment site, have a severe blood clotting disorder, or have open wounds in the treatment area.

Why Choose Spectrum Therapeutics for Shockwave Therapy in Wayne NJ?

Shockwave therapy is only as effective as the clinician delivering it. At Spectrum Therapeutics, Dr. Rob Letizia personally performs every shockwave treatment and integrates it into a comprehensive one-on-one physical therapy program. This means the shockwave is targeted precisely to the right tissue based on a thorough clinical examination, and the results are supported by an individualized exercise program designed to maximize and maintain your improvement. You are not getting shockwave therapy from an aide or technician. You are getting it from a Doctor of Physical Therapy with over 25 years of clinical experience and 500+ shockwave treatments delivered, who treats you one-on-one, every visit.

Spectrum Therapeutics is located at 601 Hamburg Turnpike, Suite 103, Wayne, NJ 07470 — minutes from Pompton Lakes, Hawthorne, Little Falls, Lincoln Park, Fairfield, Verona, and the surrounding Passaic and Bergen County communities. Direct access in NJ — no physician referral required. Same-week appointments available.

Frequently Asked Questions About Shockwave Therapy

How quickly does shockwave therapy work?

Some patients notice improvement after the first session, but most experience significant changes after 2 to 3 sessions. The full benefit continues to develop for 6 to 12 weeks after the final treatment as tissue healing progresses. Patience is important because the treatment triggers biological processes that take time to complete.

Can shockwave therapy replace surgery?

In many cases, yes. Research shows that shockwave therapy can eliminate the need for surgery in patients with chronic plantar fasciitis, calcific tendinitis, and certain tendinopathies. It should be considered before surgical intervention for these conditions, especially since it carries minimal risk compared to surgery. Dr. Rob Letizia can help you determine whether shockwave therapy is a viable alternative to surgery for your specific condition.

Is shockwave therapy the same as ultrasound therapy?

No. Shockwave therapy and therapeutic ultrasound are completely different treatments. Therapeutic ultrasound delivers low-intensity continuous sound waves that produce gentle heat in tissue. Shockwave therapy delivers high-energy acoustic pressure waves that create a mechanical stimulus for tissue healing. Shockwave therapy is significantly more powerful and produces more robust clinical results than therapeutic ultrasound for chronic conditions.

Can I exercise after shockwave therapy?

Light activity and the exercises prescribed by your physical therapist are generally fine after shockwave therapy. However, high-impact activities and intense exercise involving the treated area should be avoided for 24 to 48 hours after each session. Dr. Rob Letizia provides specific activity guidelines based on your condition and treatment response.

Who should not get shockwave therapy?

Shockwave therapy is not appropriate for patients who are pregnant, have a pacemaker or other implanted electronic device, have blood clotting disorders or are on uncontrolled anticoagulant therapy, have active infections or tumors in the treatment area, or have open wounds over the treatment site. See the full Contraindications section above for the complete list.

How much does shockwave therapy cost at Spectrum Therapeutics?

Shockwave therapy is offered at a competitive per-session cash rate. The total cost depends on how many sessions your condition requires — typically 3 to 5. Dr. Rob Letizia discusses all costs during your initial evaluation so there are no surprises. HSA and FSA accounts typically reimburse shockwave therapy when it is performed by a licensed physical therapist with a documented condition.

Does shockwave therapy work for arthritis?

Shockwave therapy can help reduce pain associated with osteoarthritis, particularly in the knee and hip. While it does not reverse the structural changes of arthritis, it can reduce pain, improve function, and decrease reliance on pain medication. It is most effective when combined with a comprehensive exercise-based physical therapy program. The evidence for shockwave in OA is more modest than for tendinopathy, but the treatment is low-risk and worth considering for patients who have not benefited from standard care.

What is the difference between focused and radial shockwave?

Focused (high-energy) shockwave concentrates acoustic energy at a specific tissue depth, making it ideal for deep tendon attachments and bony interfaces. Radial (lower-energy) shockwave spreads energy across a wider, more superficial area, making it well suited to muscle trigger points and broader soft-tissue regions. Modern devices like the StemWave system used at Spectrum allow the clinician to switch between modes within a single session based on the treatment goal.

Will I need to pause my other physical therapy during shockwave?

No. Shockwave therapy is designed to be integrated with — not a replacement for — manual therapy and exercise-based rehabilitation. At Spectrum Therapeutics, your shockwave session is bundled into a comprehensive one-on-one PT visit that includes hands-on manual therapy and progressive loading exercises. The combined approach produces measurably better outcomes than shockwave used in isolation.

Can shockwave therapy be used after a cortisone injection?

Wait at least 6 weeks after a cortisone injection in the same area before beginning shockwave therapy. Cortisone temporarily weakens the tendon, and combining the two too soon increases the risk of tendon rupture. After the 6-week waiting period, shockwave can be used safely and is often particularly effective in patients whose cortisone injection produced only short-term relief.

Is shockwave therapy FDA approved?

Specific shockwave devices are FDA-registered for specific indications — chronic plantar fasciitis (since 2000), chronic lateral epicondylitis / tennis elbow (since 2003), and several others. The StemWave system used at Spectrum Therapeutics is FDA-registered. Use of FDA-registered ESWT for off-label musculoskeletal indications (most chronic tendinopathies) is widely accepted in clinical practice and supported by published research.

What's the success rate at Spectrum Therapeutics specifically?

Dr. Rob Letizia has delivered over 500 shockwave treatments at Spectrum Therapeutics in Wayne, NJ. Outcomes consistent with the published literature: most patients with chronic plantar fasciitis, calcific shoulder tendinitis, Achilles tendinopathy, tennis elbow, and patellar tendinopathy report 60-80% pain reduction by the end of treatment, with continued improvement over the following 6-12 weeks. Outcomes are best when shockwave is integrated with a structured exercise program and the patient completes the full recommended course of sessions.

Can I get shockwave therapy without a referral in NJ?

Yes. New Jersey's direct-access law allows patients to begin physical therapy — including shockwave therapy — without a physician referral. This means you can call Spectrum Therapeutics directly to schedule an evaluation and begin treatment the same week. A referral is only needed if your insurance specifically requires one for reimbursement; since shockwave therapy is generally not covered by insurance, this is rarely an issue.

Ready to find out if shockwave therapy can help your chronic pain? Call Dr. Rob Letizia at (973) 689-7123 or visit spectrumtherapynj.com to schedule your evaluation at Spectrum Therapeutics in Wayne, NJ. No fluff. Just results.

This article is for informational purposes only and does not constitute medical advice. Please consult with a qualified healthcare provider for diagnosis and treatment of any medical condition.