SHOCK WAVE

Shock Wave

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This is the application of the well-known and tested method of extracorporeal lithotripsy in the field of physical therapy and rehabilitation. So far, the statistical results of this method suggest that treatment by percussive waves provides improved blood supply to the area of pain. Probably, it’s the only method that works as a monotherapy (i.e. Using only shock waves – ESWT) and yet gives such results in diseases of the musculoskeletal system, as described below. Its existence in a modern sanitarium is necessary for the benefits they can provide to the patient are manifold. It should be noted that, although it is prescribed by physicians, it’s not applied by any other physiotherapy center.


Extracorporeal Shock Wave Therapy (ESWT)

The shock waves have revolutionized the fields of urology and orthopedics. They allow the processes to take place within the human organism without spilling a single drop of blood. After their first use in the treatment of urinary calculi and bladder at the beginning of 1980, the shock waves soon gained world recognition. Soon, the use of pressure waves became an effective treatment method in the field of urology. Today, a total of 70% of all patients that have been treated  with the ESWT method have been cured of kidney and urinary calculi problems. In addition, the investigations were directed toward other indications in the field of oncology, surgery, gastroenterology and Orthopedics. Because of the promising results, the studies focused more on Orthopedics.

During a research program on the side effects of shock waves, a Bulgarian/German research team discovered the healing effect of shock waves in the treatment of fractures. Also noted that, after the extracorporeal treatment with shock waves, many patients were relieved by the pain in the area, which was submitted to the treatment. This finding prompted the use of shock waves in order to deal with the pain, especially the pain in soft tissues near the bone.

In 2000, Dr. Bauermeister added to the findings the trigger points of pain also known as muscle-peritoneal pain.

Definition and diagnosis of trigger points of pain

The trigger points of pain are also called “myelogeloseis”. Caused by disturbances in the energy balance of muscle cells. The identification of the precise trigger point of pain is of crucial importance for the success of the treatment. The trigger points of pain are permanently deleted and inflated areas of muscle fibers located within the muscle. During the diagnosis, it is important to distinguish between the remote and the structural trigger points of pain.

Pathological / Anatomical effects of trigger points of pain

The trigger points of pain are responsible for pain and tension. In most cases, the symptoms are listed in a completely different part of the body, away from the area around the firing point, so it is essential to have an accurate diagnosis. DR Wolfgang Bauermeister describes the following steps for diagnosing the trigger points of pain.

1.A Medical background is formed, through a questionnaire relating to the pain. Further evaluation if the symptoms are typical of a muscle-peritonic pain syndrome.

2. Investigation of the firing of pain points counting the ROM (range of motion) of the joints and spine.

3. Locate trigger points of pain in the muscle tissue by applying pressure.

4. Identifying symptoms.

 

The trigger points of pain can weaken the muscles and increase the propensity for injury. The contraction of the muscle caused by trigger points create mechanical overloading of the tendons and the intervertebral disc, which is the primary cause of many orthopedic conditions.

 

Principles of operation

General effects of the (RSWT) (Radial Shockwave Therapy)

First effect after a few minutes/hours of treatment

  • The usage of extracorporeal shock waves:

 

  • It stimulates the skin fibers of peripheral nerves that trigger defense mechanisms of pain in the posterior Horn of the spinal cord (Gate control theory of pain).

 

  • It modifies the interior environment of the cell, so as to attract substances that block the pain stimulus.

 

  • It stimulates the release of endorphins, which reduce the local sensitivity to pain.

 

Secondary effects after a few days/months/years of treatment:

 

  • The shock waves affect the function of the cell membrane. As a result the pain sensors do not produce more pain signals.
  • Chronic inflammation turns into acute inflammation (which is detected and treated by the human organism).
  • Enables the automatic healing mechanisms of the organization.

All the aforementioned mechanisms have been studied clinically.

Indications

Thorn calcaneus.

Plantar Fasciitis.

Elbow tennis elbow (epicondylitis of the elbow).

Pain in the shoulders (asbastopoios tendonitis).

Tendonitis of the Achilles tendon.

Tibial edge syndrome.

Summit of patella syndrome.

Iliotibial Band Syndrome

 

Contraindications

 

Blood coagulation disorders.

Intake of medical formulations that affect blood clotting.

Acute inflammation in the area of applied treatment.

Tumors in the region that the treatment is applied

Pregnancy.

Gas tissue (lungs) in the area of implementation of treatment.

 

 

Contraindications

Blood coagulation disorders.

Intake of medical formulations that affect blood clotting.

Acute inflammation in the area of applied treatment.

Tumors in the region that the treatment is applied

Pregnancy.

Gas tissue (lungs) in the area of implementation of treatment.

 

Side Effects

 

Until today, when treated with ESWT (SWiSS DolorClast) the following side effects have been observed: irritation, petechia, hematoma, edema, pain. Side effects disappear relatively quickly (within 1-2 weeks). Skin lesions have also been observed in patients with a background of relatively long-term use of cortisone. With the treatment of Trigger Points of pain (with shock waves), it is likely to experience mild bruising or petechia  depending on the pressure. The change in Biomechanics may cause the temporary appearance of symptoms elsewhere in the body.

Treatment

In patients with extreme sensitivity to pain, treatment can begin at operating pressure of 1.5 – 2 bar. The analgesic effect starts after approximately 250 pulses. As treatment progresses, the intensity of pressure (bar) and the operating frequency (ΗZ) can then be raised at recommended operating parameters.