Shockwave Therapy
We are offering Shockwave Therapy Treatments at our main Victoria Physiotherapy Clinic located at 100B-3200 Shelbourne Street, Victoria, B.C., V8P 5G8. The clinic is conveniently located near the Hillside Mall at the corner of North Dairy and Shelbourne Street.
To book an appointment for Shockwave Therapy please call our clinic today at 250-598-9828.
What Conditions Can Be Treated?
Shockwave Therapy can be used to treat a wide variety of musculoskeletal conditions, in particular, those involving areas where major connective tissue attaches to bone. Common sites that can be successfully treated are:
- Foot – Plantar Fasciitis, heel spurs & Achilles tendonitis
- Knee – Patellar tendonitis, jumper's knee & shin pain
- Elbow – tennis or golfer’s elbow
- Shoulder – rotator cuff tendonitis & calcification
- Hip – trochanteric bursitis
- Muscles – various trigger points throughout the body and muscle tension
- Bones-Stress fractures, non union's(delayed bone healing)
- Nerves-Morton's Neuroma
What are the Advantages?
Shockwave therapy is a recent development that is used successfully by healthcare providers that specialize in musculoskeletal disorders. As compared to other treatment methods, the advantages are:
- Quickly reduces pain
- No medication is needed
- Avoids surgery and anasthesia
- No side effects
- No risk of allergies
- Accelerates healing
- Effective for chronic conditions
How does shockwave work?
Shockwaves accelerate the healing process by activating the body’s self-healing powers, particularly in cases where the body has been unable to do it on its own. It stimulates metabolism and enhances blood circulation which enables damaged tissue to regenerate and eventually heal. The treatment relieves pain by producing an analgesic effect on the treatment area. Healing occurs over several treatments by initiating an inflammatory response and ultimately vascularization to the area. The high energy acoustic waves that are transmitted through the surface of the skin are spread radially (spherically) into the body and the body responds with increased metabolic activity around the area of the pain. This stimulates and accelerates the healing process and is especially useful for those suffering from chronic heel, shoulder, knee, achilles, elbow and back pain.
Your therapist will apply shockwaves through a specially designed hand piece that produces strong energy pulses for short periods of time. The shockwave energy pulses are applied directly to the affected tissue areas in controlled procedure.
Shockwaves have a mechanical effect on the tissue. Pressure in the front of the shockwave is transmitted into the tissue, creating micro-cavitation bubbles that expand and burst into a resultant force. (see chart A)
This force penetrates tissue and stimulates cells in the body which are responsible for bone (osteoblast) and connective tissue (fibroblast) healing.
Research has also shown that Shockwave also breaks down calcium deposits.
What is the success rate?
After only 2-3 sessions, over 80% of patients report a significant reduction in pain.
- 90% improvement for plantar fasciitis (Journal of Orthopedic Research, 2005)
- 91% improvement for calcific tendonitis (Journal of American Medical Association, 2003)
- 77% improvement for tennis elbow (Journal of Orthopedics, 2005)
How Long Does Treatment Last?
The therapy session takes about 10-15 minutes depending on the disorder that is treated. In general, 3-5 sessions are necessary at weekly intervals.
Ask your doctor or therapist if your condition can be treated by Shockwave Therapy and book your treatment sessions today at Shelbourne Physiotherapy in Victoria BC!
Research Articles
The following articles confirm the scientific validity of Shockwave Therapy;
Radial extracorporeal pressure pulse therapy for the primary long bicipital tenosynovitis a prospective randomized controlled study.
Liu S, Zhai L, Shi Z, Jing R, Zhao B, Xing G.
Source
Orthopaedic Department, Medical College Affiliated Hospital of Chinese People's Armed Police Force, Tianjin, China.
Abstract
Long bicipital tenosynovitis is regarded as one of the common causes of shoulder pain and dysfunction. The traditional therapeutic approach includes a variety of conservative treatments, but these treatments are not substantiated, owing to the lack of proven clinical efficacy. Radial extracorporeal shock wave therapy (rESWT) uses a pneumatically generated and radially propagating low-energy pressure pulse and has been clinically shown to be a new alternative form of treating refractory soft tissue inflammation. While treating patients suffering from long bicipital tenosynovitis, a randomized, controlled trial was conducted to analyze the effects of radial shock wave therapy on pain and function. Seventy-nine adults with long bicipital tenosynovitis were randomized to receive either active (1500 pulses, 8 Hz, 3 bars) or sham treatment through four sessions that were held once a week. All of these adults were assessed before treatment and at time intervals of 1, 3 and 12 months since the completion of the treatment. The outcomes were measured through the visual analogue scale (VAS) and L'Insalata shoulder questionnaire. Mean VAS in the rESWT group showed significant and sustained reduction from 5.67 ± 1.32 at baseline to 2.58 ± 1.49 at one month, 1.83 ± 1.25 at three months and 1.43 ± 0.94 at 12 months from baseline, whereas the sham group's mean VAS was 6.04 ± 0.97 before treatment and stabilized at 5.57 ± 0.84 at 12 months. Similar trends were found for the function scores. Mean scores were increased after rESWT from 60.57 ± 6.91 at baseline to 79.85 ± 6.59 at 1 month and 83.44 ± 5.21 at 12 months from baseline. Both pain and function scores showed significant differences between the two groups (p < 0.001). The rESWT group consisted of "invalid conservative treatment subgroup" and "none conservative treatment subgroup." Both groups showed good recovery and prognosis. Therefore, we recommend rESWT in treating primary long bicipital tenosynovitis.
Extracorporeal shockwave therapy in musculoskeletal disorders.
Wang CJ.
Source
Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan. w281211@adm.cgmh.com.tw
Abstract
The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave therapy (ESWT) in musculoskeletal disorders has been around for more than a decade and is primarily used in the treatment of sports related over-use tendinopathies such as proximal plantar fasciitis of the heel, lateral epicondylitis of the elbow, calcific or non-calcific tendonitis of the shoulder and patellar tendinopathy etc. The success rate ranged from 65% to 91%, and the complications were low and negligible. ESWT is also utilized in the treatment of non-union of long bone fracture, avascular necrosis of femoral head, chronic diabetic and non-diabetic ulcers and ischemic heart disease. The vast majority of the published papers showed positive and beneficial effects. FDA (USA) first approved ESWT for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis in 2002. ESWT is a novel non-invasive therapeutic modality without surgery or surgical risks, and the clinical application of ESWT steadily increases over the years. This article reviews the current status of ESWT in musculoskeletal disorders.
Extracorporeal shock wave therapy for plantar fasciitis.
Perez M, Weiner R, Gilley JC.
Source
Clintonville Foot and Ankle Group, Inc., 3695 N. High Street, Columbus, OH 43214, USA.
Abstract
Shock wave therapy is quickly becoming a mainstay treatment for chronic recalcitrant plantar fasciitis, and many more applications for this therapy may exist. Many advances have been made in regard to this modality of treatment in just a few decades since it was first investigated in the 1950s. Much research has been conducted, revealing the physics and physiologic effect of shock wave therapy. Devices are now approved that produce shock waves for medicinal purposes by one of the three primary methods of shock wave generation. Studies and research are actively being reported and published that demonstrate shock wave therapy success rates comparable to those found in surgical intervention but without the risks inherent in surgery. In conclusion, ESWT has proved to be a viable treatment option for the intervention of chronic recalcitrant plantar fasciitis.
Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study.
Kudo P, Dainty K, Clarfield M, Coughlin L, Lavoie P, Lebrun C.
Source
Fowler Kennedy Sport Medicine Clinic, 3M Centre University of Western Ontario, London, Ontario N6A 3K7, Canada.
Abstract
Despite numerous publications and clinical trials, the results of treatment of recalcitrant chronic plantar fasciitis with extracorporeal shockwave therapy (ESWT) still remain equivocal as to whether or not this treatment provides relief from the pain associated with this condition. The objective of this study was to determine whether extracorporeal shock wave therapy can safely and effectively relieve the pain associated with chronic plantar fasciitis compared to placebo treatment, as demonstrated by pain with walking in the morning. This was set in a multicenter, randomized, placebo-controlled, double-blind, confirmatory clinical study undertaken in four outpatient orthopedic clinics. The patients, 114 adult subjects with chronic plantar fasciitis, recalcitrant to conservative therapies for at least 6 months, were randomized to two groups. Treatment consisted of approximately 3,800 total shock waves (+/-10) reaching an approximated total energy delivery of 1,300 mJ/mm(2) (ED+) in a single session versus placebo treatment. This study demonstrated a statistically significant difference between treatment groups in the change from baseline to 3 months in the primary efficacy outcome of pain during the first few minutes of walking measured by a visual analog scale. There was also a statistically significant difference between treatments in the number of participants whose changes in Visual Analog Scale scores met the study definition of success at both 6 weeks and 3 months posttreatment; and between treatment groups in the change from baseline to 3 months posttreatment in the Roles and Maudsley Score. The results of this study confirm that ESWT administered with the Dornier Epos Ultra is a safe and effective treatment for recalcitrant plantar fasciitis.
Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study.
Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L Jr, Weil L Sr, Russlies M, Stienstra J, Scurran B, Fedder K, Diehl P, Lohrer H, Henne M, Gollwitzer H.
Source
Department of Orthopedic and Traumatology, Technical University Munich, Klinikum Rechts der Isar, Germany. Gerdesmeyer@aol.com
Abstract
BACKGROUND:
Radial extracorporeal shock wave therapy is an effective treatment for chronic plantar fasciitis that can be administered to outpatients without anesthesia but has not yet been evaluated in controlled trials.
HYPOTHESIS:
There is no difference in effectiveness between radial extracorporeal shock wave therapy and placebo in the treatment of chronic plantar fasciitis.
STUDY DESIGN:
Randomized, controlled trial; Level of evidence, 1.
METHODS:
Three interventions of radial extracorporeal shock wave therapy (0.16 mJ/mm(2); 2000 impulses) compared with placebo were studied in 245 patients with chronic plantar fasciitis. Primary endpoints were changes in visual analog scale composite score from baseline to 12 weeks' follow-up, overall success rates, and success rates of the single visual analog scale scores (heel pain at first steps in the morning, during daily activities, during standardized pressure force). Secondary endpoints were single changes in visual analog scale scores, success rates, Roles and Maudsley score, SF-36, and patients' and investigators' global judgment of effectiveness 12 weeks and 12 months after extracorporeal shock wave therapy.
RESULTS:
Radial extracorporeal shock wave therapy proved significantly superior to placebo with a reduction of the visual analog scale composite score of 72.1% compared with 44.7% (P = .0220), and an overall success rate of 61.0% compared with 42.2% in the placebo group (P = .0020) at 12 weeks. Superiority was even more pronounced at 12 months, and all secondary outcome measures supported radial extracorporeal shock wave therapy to be significantly superior to placebo (P < .025, 1-sided). No relevant side effects were observed.
CONCLUSION:
Radial extracorporeal shock wave therapy significantly improves pain, function, and quality of life compared with placebo in patients with recalcitrant plantar fasciitis.
Clin Rheumatol. 2012 May;31(5):807-12. Epub 2012 Jan 27.
Physical therapy, corticosteroid injection, and extracorporeal shock wave treatment in lateral epicondylitis. Clinical and ultrasonographical comparison.
Source
Physical Medicine and Rehabilitation Clinic, Ankara Training and Research Hospital, Ankara, Turkey.
Abstract
The aim of this study was to compare--clinically and ultrasonographically--the therapeutic effects of physical therapy modalities (hot pack, ultrasound therapy, and friction massage), local corticosteroid injection, and extracorporeal shock wave treatment (ESWT) in lateral epicondylitis (LE). Fifty-nine elbows of 59 patients with LE were randomized into three treatment groups receiving either physical therapy, a single corticosteroid injection, or ESWT. Visual analogue scale (VAS) was used to assess pain intensity, Jamar hydraulic dynamometer for grip strength, finger dynamometer for pinch strength (before treatment, on the first, third, and sixth months of treatment). All subjects were also evaluated with ultrasonography before and 6 months after treatment. In all groups, VAS scores of the patients were found to decrease significantly on the first, third, and sixth months of treatment. With respect to grip strength evaluations, the increase after treatment was significant only on the first month in group II; on the first and third months in group I; and on the first, third, and sixth months of treatment in group III. Pinch strength and ultrasonographical findings did not change during follow-up in any group. We imply that physical therapy modalities, corticosteroid injection, and ESWT have favorable effects on pain and grip strength in the early period of LE treatment. The increase in grip strength lasts longer with ESWT. On the other hand, ultrasonographic findings do not change in the first six months of these treatment methods.
Shockwave Therapy for Calcium Deposits in Shoulder
Reference:Adnan Saithna, BMedSci(Hons), MBChB, MRCSEd, et al.
Is Extracorporeal Shockwave Therapy for Calcifying Tendinitis of the Rotator Cuff Associated with a Significant Improvement in the Constant-Murley Score? A Systematic Review.
In Current Orthopaedic Practice. September/October 2009. Vol. 20. No. 5. Pp. 566-571.
What's the best way to treat calcifying tendinitis of the shoulder that doesn't respond to physical therapy, medications, or steroid injections? The authors of this systematic review report that the use of extracorporeal shockwave therapy (ESWT) has proven successful, though we still don't know if it is the best treatment approach. That remains to be determined in future studies.
What is calcifying or calcific tendinitis? It's a degenerative condition affecting the four tendons surrounding the shoulder called the rotator cuff. These include the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. All four muscles can be affected, but usually it's just one of the four. And the tendons are listed here in declining order of frequency (i.e., supraspinatus is affected most often and subscapularis least often).
Calcium crystals called calcium pyrophosphate are deposited in the tendons. No one knows where these crystals come from exactly. But once the tendons start to degenerate, the crystals are released into the soft tissues as the tendon fibrils break down. Research shows that the calcium crystals help the tendon degenerate. The tendons harden and symptoms of impingement can develop. With impingement, there is shoulder pain when the arm is raised overhead or to the side above shoulder level. The stiff tendon doesn't move and glide as it should and it gets pinched between the bony structures of the shoulder. Sometimes the person with this problem can move the arm through the pain all the way overhead. But other people have limited motion that leads to decreased function.
By sorting through five years of data from recently published studies, researchers from the Department of Trauma and Orthopaedic Surgery in England were able to confirm that all studies showed improvement after treating calcifying tendinitis of the rotator cuff with extracorporeal shockwave therapy (ESWT). ESWT is the use of sound waves to create enough energy to disintegrate the calcium deposits. It has been used with good results for other problems like gallstones and kidney stones. Once the calcium crystals have been broken up, it appears that the body absorbs them because X-rays show they disappear.
Most of the studies included patients with Types I and II calcification. There are three types of calcifying tendinitis diagnosed by X-rays. Type I has deposits that have clear outlines. A line can be drawn around the dense deposits to show exactly where they are, their size, and their shape. Type II disease has a clear outline but tends to be spread out more through the tissue and harder to see as a distinct shape. Type III lesions look cloudy without a specific form, shape, or outline.
All studies used a scoring system called the Constant-Murley score to measure results before and after treatment. Having one test used by everyone made it possible to compare the outcomes from one study to the next -- even when the studies weren't all conducted exactly the same way. The authors point out that this advantage was also a disadvantage. With only one measure of results was used, it's impossible to know if other test measures might have shown a different result (better or worse). They suggest that future studies use other scoring systems for a comparison.
But for now, it looks like extracorporeal shockwave therapy is safe and effective for this potentially disabling condition. Significant improvement in motion, pain, strength, and function was consistently reported in all studies included in the review. Improvements were reported using both high-energy and low-energy shockwave therapy but high-energy had the best results. Low-energy therapy was better than no treatment or sham (placebo) groups.
Low-Energy Extracorporeal Shock Wave Therapy as a Treatment for Greater Trochanteric Pain Syndrome
The American Journal of Sports Medicine, Vol. X, No. X
John P. Furia, MD, Jan D. Rompe, MD, and Nicola Maffulli, MD, MS, PhD, FRCS (Orth), FFSEM (UK)From SUN Orthopedics and Sports Medicine, Lewisburg, Pennsylvania, OrthoTrauma Evaluation Center, Mainz, Germany, Centre for Sports and Exercise, Barts and the London School of Medicine and Dentistry, London, United Kingdom
Background: Greater trochanteric pain syndrome is often a manifestation of underlying gluteal tendinopathy. Extracorporeal shock wave therapy is effective in numerous types of tendinopathies.
Hypothesis: Shock wave therapy is an effective treatment for chronic greater trochanteric pain syndrome.
Study Design: Case control study; Level of evidence, 3.
Methods: Thirty-three patients with chronic greater trochanteric pain syndrome received low-energy shock wave therapy (2000 shocks; 4 bars of pressure, equal to 0.18 mJ/mm2; total energy flux density, 360 mJ/mm2). Thirty-three patients with chronic greater trochanteric pain syndrome were not treated with shock wave therapy but received additional forms of nonoperative therapy (control). All shock wave therapy procedures were performed without anesthesia. Evaluation was by change in visual analog score, Harris hip score, and Roles and Maudsley score.
Results: Mean pretreatment visual analog scores for the control and shock wave therapy groups were 8.5 and 8.5, respectively. One, 3, and 12 months after treatment, the mean visual analog score for the control and shock wave therapy groups were 7.6 and 5.1 (P < .001), 7 and 3.7 (P < .001), and 6.3 and 2.7 (P < .001), respectively. One, 3, and 12 months after treatment, mean Harris hip scores for the control and shock wave therapy groups were 54.4 and 69.8 (P < .001), 56.9 and 74.8 (P < .001), and 57.6 and 79.9 (P < .001), respectively. At final follow-up, the number of excellent, good, fair, and poor results for the shock wave therapy and control groups were 10 and 0 (P < .001), 16 and 12 (P < .001), 4 and 13 (P < .001), and 3 and 8 (P < .001), respectively. Chi-square analysis showed the percentage of patients with excellent (1) or good (2) Roles and Maudsley scores (ie, successful results) 12 months after treatment was statistically greater in the shock wave therapy than in the control group (P < .001).
Conclusion: Shock wave therapy is an effective treatment for greater trochanteric pain syndrome.
Keywords: extracorporeal shock wave therapy; hip; subgluteus bursa; bursitis
Evidence to Support Shock Wave Therapy for Plantar Fasciitis
Plantar Fascitis is a painful condition affecting the bottom of the foot. It is a common cause of heel pain and is sometimes called a heel spur. Plantar fasciitis is the correct term to use when there is active inflammation. Acute plantar fasciitis is defined as inflammation of the origin of the plantar fascia and fascial structures around the area. Plantar fasciitis is usually just on one side. In about 30 per cent of all cases, both feet are affected.
Treatment is usually with conservative (nonoperative) care. This could include stretching, wearing a splint at night, the use of antiinflammatory medications, and/or a special arch support to help reduce the pressure on the fascia.
Shock wave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for plantar fasciitis. It's possible that the shock waves disrupt the plantar fascial tissue enough to start a healing response. The resulting release of local growth factors and stem cells causes an increase in blood flow to the area. Recent studies indicate that this form of treatment can help ease pain, while improving range of motion and function.
There are different types of shock wave therapy. In this study, researchers from Taiwan conduct a systematic review and meta-analysis comparing the effectiveness of two major types of shock wave therapy. The most common type is called focused shock wave therapy (FSW). A newer, alternative form called radial shock wave therapy (RSW) was also evaluated.
Focused shock wave (FSW) therapy is just as it sounds: the energy wave is directed at a specific area. FSW concentrates the wave field whereas radial shock wave (RSW) disperses the energy over a wider range. With RSW, it is not necessary to find the painful spots before applying the energy wave.
A particular area of interest in this study was to see the value in using different intensity levels, which represent energy flow through the tissue. Turning the intensity up may provide more pain relief but could also temporarily increase pain, local swelling, and tenderness. Studies have not been done to determine the most optimal intensity to use when treating plantar fasciitis with shock wave therapy.
Focus shock wave therapy can be delivered in three intensities: low, medium, and high. Patients receiving FSW were divided into three groups based on the intensity of wave delivery. Patients receiving RSW made up the fourth group. Results were measured based on pain reduction and overall success of the treatment. The goal was to see if one type of shock therapy was superior to the others in treating plantar fasciitis.
What did they find? Well, first of all, any type of shock wave therapy yielded better results than a "sham" or placebo (pretend) treatment. The best results were gained using radial shock wave (RSW) therapy. Focused shock wave (FSW) gave the best results when used at the highest energy density tolerated by the patient in the medium intensity range.
For those who use this modality to treat plantar fasciitis, the authors say don't go out and purchase a radial shock wave machine if you already have a focused shock wave device. Anyone just considering purchasing this equipment is advised to select radial shock wave therapy. It costs less and gives better results with fewer potential side effects.
Reference:
Ke-Vin Chang, MD, et al. Comparative Effectiveness of Focused Shock Wave Therapy of Different Intensity Levels and Radial Shock Wave Therapy for Treating Plantar Fasciitis: A Systematic Review and Network Meta-Analysis. In The American Journal of Sports Medicine. July 2012. Vol. 93. No. 7. Pp. 1259-1268.
Extracorporeal shock wave therapy without local anesthesia for chronic lateral epicondylitis
J Bone Joint Surg AM, 2005 Jun:87(6):1297-304
Pettrone FA, McCall BR.
Source
Commonwealth Orthopaedics, 1635 North George Mason Drive, Suite 310, Arlington, VA 22205, USA.
Abstract
BACKGROUND:
The use of extracorporeal shock wave therapy for the treatment of lateral epicondylitis is controversial. The purpose of this study was to evaluate the use of extracorporeal shock wave therapy without local anesthesia to treat chronic lateral epicondylitis.
METHODS:
One hundred and fourteen patients with a minimum six-month history of lateral epicondylitis that was unresponsive to conventional therapy were randomized into double-blind active treatment and placebo groups. The protocol consisted of three weekly treatments of either low-dose shock wave therapy without anesthetic or a sham treatment. Patients had a physical examination, including provocation testing and dynamometry, at one, four, eight, and twelve weeks and at six and twelve months after treatment. Radiographs, laboratory studies, and electrocardiograms were also evaluated prior to participation and at twelve weeks. A visual analog scale was used to evaluate pain, and an upper extremity functional scale was used to assess function. Crossover to active treatment was initiated for nonresponsive patients who had received the placebo and met the inclusion criteria after twelve weeks.
RESULTS:
A total of 108 of the 114 randomized patients completed all treatments and the twelve weeks of follow-up required by the protocol. Sixty-one patients completed one year of follow-up, whereas thirty-four patients crossed over to receive active treatment. A significant difference (p = 0.001) in pain reduction was observed at twelve weeks in the intent-to-treat cohort, with an improvement in the pain score of at least 50% seen in 61% (thirty-four) of the fifty-six patients in the active treatment group who were treated according to protocol compared with 29% (seventeen) of the fifty-eight subjects in the placebo group. This improvement persisted in those followed to one year. Functional activity scores, activity-specific evaluation, and the overall impression of the disease state all showed significant improvement as well (p < 0.05). Crossover patients also showed significant improvement after twelve weeks of active treatment, with 56% (nineteen of thirty-four) achieving an improvement in the pain score of at least 50% (p < 0.0001).
CONCLUSIONS:
These results demonstrate that low-dose shock wave therapy without anesthetic is a safe and effective treatment for chronic lateral epicondylitis.
Repetitive low-energy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis
Rompe JD, Meurer A, Nafe B, Hofmann A, Gerdesmeyer L.
Background:
It remains unclear whether application of local anesthesia (LA) interferes with clinical efficacy of extracorporeal shock wave therapy (ESWT) for chronic plantar fasciitis.
Aims: To evaluate the effect of local anesthesia on the clinical outcome after repetitive low-energy ESWT for chronic plantar fasciitis.
Methods:
Eighty-six patients with chronic plantar fasciitis were randomly assigned to receive either low-energy ESWT without LA, given weekly for three weeks (Group I, n=45; 3 x 2000 pulses, total energy flux density per shock 0.09 mJ/mm2) or identical ESWT with LA (Group II, n=41). Primary outcome measure was: Reduction of pain from baseline to month 3 post-treatment in a pain numeric rating scale [0-10 points] during first steps in the morning, evaluated by an independent blinded observer. Calculations were based on intention-to-treat.
Results:
No difference was found between the groups at baseline. At 3 months, the average pain score was 2.2+/-2.0 points for patients of Group I, and 4.1+/-1.5 points for patients of Group II. The mean between-group difference was 1.9 points (95% CI: [1.1-2.7 points]; P<.001). Significantly more patients of Group I achieved 50% reduction of pain compared to Group II (67% vs 29%, P<.001).
Conclusions: ESWT as applied should be done without LA in patients suffering from chronic heel pain. LA applied prior treatment reduced the efficiency of low-energy ESWT.
Arch Phys Med Rehabil. 2013 Mar 13. pii: S0003-9993(13)00205-0. doi: 10.1016/j.apmr.2013.01.030. [Epub ahead of print]
Clinical improvement and resorption of calcifications in calcific tendinitis of the shoulder after shock wave therapy at 6 months follow-up. A systematic review and meta-analysis.
Ioppolo F, Tattoli M, Di Sante L, Venditto T, Tognolo L, Delicata M, Rizzo RS, Di Tanna G, Valter S.
Source: Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy. Electronic address: francescoioppolo@yahoo.it.
Abstract
OBJECTIVE: To evaluate the effect of the Shock wave therapy (SWT) on functional improvements and reduction of pain, and what is rate of disappearance of calcifications after therapy at 6 month follow up.
DATA SOURCES: Articles were searched from the COCHRANE LIBRARY, MEDLINE, EMBASE, CINAHL and OVID DATABASE.
STUDY SELECTION:We included randomized controlled trials from 1992 to 2011 and their quality was assessed using the PEDro scale.
DATA EXTRACTION: Studies were evaluated by two independent reviewers for their methodological quality. If disagreement arose the plan was that it would be settled by a third reviewer. Then data were extracted and cross-checked for accuracy. The reviewers were not blinded to the authors of the articles.
DATA SYNTHESIS: In studies of Hearnden, Hsu, Cacchio and Cosentino the resorption of calcifications was evaluate using meta-analysis because in them there were two groups of treatment, while the studies of Peters and Gerdesmeyer were analyzed descriptively because they considered three groups of treatment. Fixed and random effects models were used to meta-analyze total and partial resorption ratios and to assess heterogeneity the I2 statistics were calculated.
CONCLUSIONS: We found a clinical improvement with a pooled Total Resorption Ratio of 27.19 (95% CI: 7.20-102.67) and a pooled Partial Resorption Ratio of 16.22 (95% CI: 3.33-79.01). SWT increases shoulder function, reduces pain, and it is effective in dissolving calcifications. These results were maintained over the following 6 months.
Am J Phys Med Rehabil. 2013 Apr 2.
Effectiveness of Extracorporeal Shock Wave Therapy in Chronic Plantar Fasciitis: A Meta-analysis.
Source: Dizon JN, Gonzalez-Suarez C, Zamora MT, Gambito ED.
From the Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines.
Abstract
The objective of this study was to evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) in treating chronic plantar fasciitis. An online database search was conducted for studies using ESWT in managing chronic plantar fasciitis. Eleven high-quality randomized controlled trials were included in the meta-analysis and showed that ESWT was more effective in reducing morning pain (weighted mean difference, -0.77 [95% confidence interval {CI}, -1.30 to -0.25]; odds ratio, 0.65 [95% CI, 0.42-1.00]). Moderate-intensity ESWT was more effective in decreasing overall and activity pain (weighted mean difference, -6.6 [95% CI, -6.74 to -6.46], and weighted mean difference, 0.47 (95% CI, 0.30-0.74). Both moderate- and high-intensity ESWT were more effective in improving functional outcome, with odds ratios of 0.51 (95% CI, 0.30-0.84) and 0.47 (95% CI, 0.29-0.75). The adverse effects that were seen more in ESWT were pain on the calcaneal area and calcaneal erythema. This study concludes that moderate- and high-intensity ESWT were effective in the treatment of chronic plantar fasciitis.
