First European DolorClast Advisory Board (EDAB) Chateau de Bonmont

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What can I say, it takes a lot for me to take a Friday off work and travel to Geneva, to visit like minded Professionals from around Europe consisting of 14 clinicians like myself, scientists, Professors all treating patients at very high levels Sport (mostly National) and the general public at large. Some working in very large teaching facilities, having resources available to develop high level RCT’s.

My trip started at Heathrow, bit of a trip but heard that Swiss Air was worth it, well apart from changing my seat so far so good. All wrapped up as in pic, heard cold out here in Geneva.

So I arrived at Geneva airport only to find my pals Professor Christoph Schmitz and Johnathan Wride was sharing the same transport to the wonderful Chateau de Bonmont. Didn't have too much time on arrival as a little late for the start of evening in fact missed the opening session from Paolo Zanetti, we all introduced ourselves and JC (please see pic, seriously outsizing me and looking like a Gucci model) our chairman Per Andersen took us through what to expect on Saturday and we promptly headed for cocktails and dinner.

 JC seriously outsizing me.

JC seriously outsizing me.

Early start on the Saturday, no gym so a 30 minute work in my very large, very beautiful room before a quick breakfast and on with case studies from all which was 5 minutes, offically and then the floor had to comment this went on till lunch.

In my presentation I referred to the previous night being slightly overdressed, the only man in TUX and now calling myself a dinosaur as I was the only clinicain using what is considered the ‘old’ frequencies!

My presentation was very factual, used my August blog for my examples on semi professional footballers (males) with chronic knee pain. Needless to say outstanding results from RSWT using the DolorClast, and more over Professor Christoph said that I am correct with my choice of frequencies as incord with current RCT’s but some are finding other frequencies more benefical, which we spoke more about this over coffee.

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Following lunch we had a great Brainstorming 1.5 hours. I was on table innovation and in very good company with Johnny and Per having good discussions, recording appropiate treatment protocols, energy and grouping conditions together to assist EMS to get a collective to use around the world in terms of setting standards and solutions.

If I dont mind saying, I think the UK (with Per) did very well, may be Germany had the edge but were was close not thats what it was about but it was competeive!

Christoph when through recent scientific literature and questions from the floor which really revealed differences from varying countries. Christoph is always very good value, and can prove everything he quotes with scientific evidence to support.

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Next was my very good friend Aude, who was pushing everyone to use online tools and gave a good scenario for all and yours truly gave his penny worth regarding social as I did so much when I was there.

 As you can see, this was my clip from my IG

As you can see, this was my clip from my IG

JC finally went through the conclusion, what we all should be thinking about and getting together a group of Professionals to help develop with Swiss DolorClast Method.

We had a wonderful evening out, starting with wine tasting, which I abstained as getting over my chest infections and the most wonderful meal later. So all in all this is what has been instigated, the very first of its kind. A huge thanks goes to those at EMS for all the hard work, i.e JC, MC, Aude and our new arrival Yael.

Its just the beginning, watch this space for development to the ‘Building the Future of the DolorClast Method’ and to that end very glad to be part thereof.

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Sunday was really exhausted, rested went for a walk around the grounds and my delightful chaffuer look me back to Geneva airport and finally got back to Heathrow at 8pm. Till next year, looking forward to help develop (EDAB) and put EMS on the map even more than it currently is.

In summary, great weekend, met some very interesting clinicians who I’de like to get more involved with in terms of there research and studies. Super venue, felt really appreciated that made the effort to get to and simply be part of, ‘First European DolorClast Advisory Board (EDAB)’

Bonne Voyage Chateau de Bonmont, Cheserex, Switzerland

October's Shocking Stories

So we are nearly a wrap for October working in reverse order, here’s what I posted this month and a few snippets from ESWT world.

1.Calficic Tendinopathy, study using EMS and Stortz equipment 3,6,12 and 24 months reviews.

https://www.researchgate.net/profile/Johnny_Padulo/publication/328354086_Extracorporeal_shock_wave_therapy_in_the_treatment_of_calcific_tendinopathy_of_the_shoulder_the_ASSERT_database/links/5bc831aba6fdcc03c78efb60/Extracorporeal-shock-wave-therapy-in-the-treatment-of-calcific-tendinopathy-of-the-shoulder-the-ASSERT-database.pdf

Not surprising to all that RSWT did not do so well in this study both short and long term.

Not a randonised controlled group, varying practioners but i believe most of of the opinion for Calcific Tendinopathy then FSWT may well be the answer.

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2. October 17 Good general review of knee tendinopathies and soft tissue disorders and well reviewed. Nice plug for RSWT and FSWT

https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2204-6

Please my patient video, theres an abundance of knee patients that have done so well with RSWT.

3. A very interesting small study that I shared and added more information from a colleague Professor Christoph Smidtz is definatinely worth a look at. Whilst most of the studies we see are realted to chronic recalcitrant cases the acutes do interest me- so say why wait? The simple answer is that we have guidelines here!

https://www.linkedin.com/pulse/extracorporeal-shock-wave-therapy-acute-injury-care-review-morrissey-1e/

4. Then on 13th October my daughter and I got up at 4am to get Belfast to teach for the Swiss DolorClast Academy. We had a blast, great delegates with great sense of humour and wanting good studies and background to support ESWT. April my daughter was great help and took some great pics, one of us two,

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5. October kicked off with a nice summary and update in the management of foot and ankle disorders, usual added bonus from yours truly.

https://www.linkedin.com/pulse/achilles-tendon-athletes-paul-morrissey/

Please dont forget there’s plenty of practioner material on my site, have a look it may be of interest https://shockwave-therapy.co.uk/shockwave-practitioners

Shockwave Training In Belfast

A great weekend was afforded to me to share the good work of SwissDolorclastAcademy.com and sponsor Algeos.com

The slight delay to the day was captured on Facebook Live.

The morning started with an academic look at Shockwave Therapy, discusing briefly how I got into ESWT in 2003/4 and moving on promptly to look at the Swiss DolorClast Method which is based around technology, clinical proof, and education.

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I spoke principally about Radial therapy, but also briefly discussed the focused device that’s getting traction in the UK.

We reviewed EBM as it’s defined in the NHS, the approved conditions Shockwave can help with, and spoke about PEDro and the DolorClasts significance in terms of accepted RCT’s. An important note to this group being that of the accepted studies approximately 80% were performed using the Dolorclast, which speaks for itself.

Moving on to peer reviews, the the appropriate conditions, depth of treatments and the various MSK indications, the short and long term effects of Shockwave on the tissue before looking at what, in my opinion, really works to create success. Everything from patient selection to evidence of outcomes.

Finally, before lunch we looked at 3 conditions: Lateral epicondylitis; GTPS; and Plantarfasciopathy with the appropriate RCTs and the energies used.

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Most find the level of energies used, too high to deliver to patients, so some time was spend discussing the essential role power plays to create angiogenesis. It’s important to educate the patient before hand, and remind them they have been in so much pain for a long period of time with the condition, refocusing that tolerance to the treatment, and with the right techniques from the practitioner, it’s usually possible to deliver the recquired energy and get a successful outcome.

Take a look at the lunchtime Facebook live we recorded.

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The afternoon was all about learning to use this great kit for upper and lower limb pathologies and all the delegates had chance to be both the practitioner and patient during the practice sessions.

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We wrapped up the day discusing the Swiss Dolorclast Academy and the opportunities from the outstanding worldwide education program.

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Finally, back on a plane at 7am this morning and back to the family.

This was a great group of enthusiastic practitioners, and it was an honor to be able to share my experience with them.

I’m looking forward to the next event.

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Sepember Shockwave Acitivities

So in reverse order for a change, rather late there was an interesting article on PRP for elbow pathologies, https://link.springer.com/article/10.1007/s12178-018-9520-1 in my humble opinion lateral epicondylitis may be helpful, as the author agrees, but other conditions listed simply do not.

“The response to PRP seems to be favorable when compared to steroid injection for pain management and for patient-reported outcomes in lateral epicondylitis. PRP injection does not seem to have the potential complications associated with a steroid injection such as skin atrophy, discoloration, and secondary tendon tears. Only a few manuscripts comparing the results of PRP treatment with either extracorporeal shockwave (ESW), dry needling, or even surgical treatments in lateral epicondylitis exist. The use of PRP in other elbow pathologies such as golfer’s elbow, ulnar collateral ligament injury, and distal biceps and triceps pathology is examined in few studies, with unclear recommendations.”

“Regarding elbow pathologies, PRP injections in tennis elbow seems to be the best-studied intervention. A major limitation in these studies is the significant heterogeneity in the methods used for preparing PRP, for example employing leukocyte-rich, leukocyte-poor preparations, PRP with or without activation, which makes the results of the studies difficult to compare. Results of this review show that more studies on larger cohorts, with comparable formulations, and with longer follow-up are required to give optimal suggestions concerning the use of PRP in elbow pathologies.”

Bring on ESWT!

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A rather descriptive and visual ( even cautioned on social medial ) wound management and SW! Still medicine unaware to the benefits to patients, a must read if involved in wound care.

https://www.linkedin.com/pulse/shockwave-therapy-selected-soft-tissue-diseases-review-paul-morrissey/

Nice article on comparing doses for calcificic tendonitis of the cuff, focused devise seemingly having more of a place for this condition.

https://www.linkedin.com/in/paul-morrissey-80972b50/detail/recent-activity/

Did you see my video to help with tennis elbow using the Flex Bar, please excuse video being in portrait as this complies with IGTV.

https://vimeo.com/287746367

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Finally and not ‘ Strictly ‘ September but really looking forward to teaching in Belfast this weekend, anyone new to EWST should come along.

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Summers gone but Shockwave is Blazing

OMG wheres the sun gone, I must admit whilst difficult to work in clinically I loved the warmer weather.

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So what been happening in the ESWT world, well in clinic I have had a number of young males from the world of football, some semi Pro's others good club level age 23-35 which chronic knee pain this month. All with Left knee, all post operative, having exhausted Physio and PRP injections. Delighted to say that all bar one are doing great, having 3 treatments pain free and now loading and 'exploding' as it were. The 'remainer' has a history of 3 years with severe P/T and 2 years since surgery, however theres a change in symptoms almost like a sub acute. Confident with a little more treatment he will do well, heres a link to some of the exercises given - apologises as the model somewhat senior! 

https://www.instagram.com/p/BkXFBbMBIDr/?utm_source=ig_web_copy_link&igshid=1j0l11ry1xas7

https://www.instagram.com/p/Bi89FOnBa6Q/?utm_source=ig_web_copy_link&igshid=1w4umc97o6zc9

https://www.instagram.com/p/BjeUfTthkaV/?utm_source=ig_web_copy_link&igshid=15h8bbbrdbbdq

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We have 2 rcts on non traumatic Osteonecosis of the Femoral Head and ESWT was found to be helpful in the early stages, links accordingly,

 https://www.linkedin.com/pulse/efficacy-extracorporeal-shock-wave-therapy-knee-other-paul-morrissey/ https://www.linkedin.com/pulse/clinical-radiological-outcomes-extracorporeal-shock-wave-morrissey/

Further, I had a part replaced on my red power hand piece which made me think about the hand pieces that I have used since 2003, the benefits to all particulary patients and also the revenue generated therefrom and huge thanks the the EMS Team, Aude, Marie-Christine and JC. Here's the link to the Video- grab a coffee first

Finally a good end to the month, my colleague and main EMS educator Mr Jonathan Wride did some great work with a UK athlete,  Marilyn Okoro @mokoro4 so what this space and love the title 'Radial Shockwave Rocks' 

https://www.linkedin.com/pulse/radial-shockwave-rocks-paul-morrissey/

So thats it, its a wrap

 

 

 

My Journey of the Handpiece ( for delivery of Shockwave Therapy )

Last week I received a replacement handpiece from EMS https://www.ems-dolorclast.com/en like most products they need to be regular servicing and indeed a replacement part periodically, shame are bodies are not so easily maintained!

To that end it gave me the idea about the history of the handpiece. This essentially started with the Radial devise and indeed the Power handpiece, which I have just had replaced and It should be mentioned and indeed recorded that these devises was used to get the current NICE guidelines  https://www.evidence.nhs.uk/search?q=shockwave+therapy way back  (2003 ) The Power hand piece is a devise where you need serious energy, for example Calcific Supraspinatus this can produce up to .55mj/mm2 in terms of energy output.

Some new comers to the world of shockwave may not be aware of this, and often other manufactures quote these references but have not got a scrap of evidence with there devises and essentailly 'piggy backing' on EMS's good work over the years. 

This is also a direct result of us getting shockwave paid by the insurance companies which a good number of clinicains have benefited therefrom! Myself included I might add.

I am a user of the EMS product purely on the basis of #evidence I am an Ambassador for the product and get remuneration if I give training days for the https://www.swissdolorclastacademy.com

I decided to record this video for a number of reasons namely 

1. History, fact

2. Development from the Radial to the EVO blue , please see my additional video https://youtu.be/jg2V8Lercug

3. Discuss the Nice Guidelines as mentioned above

4.The only Radial Shock Wave device on the market with FDA approval for plantar fasciopathy

5. Appreciation to the hard work done by EMS and thank accordingly for the benefit of over 2000 patients from my clinic alone.

6. My understanding of Focused Shockwave is for deeper lesions such as early AVN, non union fractures and urology ,  but I did give an explanation to a patient that had who had a chronic de quervans, 2 years and where I need to use more energy and the patient may not have tolerated well the radial devise, I had a superb response and recorded here if you wish to see https://vimeo.com/278133049

Heres the video for those interested relating to MY Journey

Sizzling July's Shockwaves

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My word what a period its been in the UK, sizzling comes to mind and forsure the world is in change, rather than gobal warming. Seemingly EMS gets everywhere, even at my annual party at my Cheyne Walk practice drinking my BCAA's to keep going -no alcohol as had to look after everyone!

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Some very interesting things happened this month not all on LinkedIn, here's the hot list,

I had the most wonderful clinical result for a 2 year old dupuytren's with Dr Mary Onianwa using my Focused devise, it would have been difficult to delivery the energy required using my usual favoured evo blue. #shockwaveworks

Meta analysis always works well, check out my linkedin post on ESWT and osteonecrosis of the femoral head

https://www.linkedin.com/pulse/meta-analysis-potential-role-extracorporeal-shockwave-paul-morrissey/

A repost of a favoured, by popular request I might add as some dont have access to all social platforms

https://www.linkedin.com/feed/update/urn:li:activity:6417080268905156608/

Further, as this posted created so much interest I had a go a creating a video to same, script was done on the basis of the above and im pleased with the outcome save the AI's version of tendinopathy ( apologises in advance ).

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Finally a rather well received post on GPTS with my usual critique, https://www.linkedin.com/pulse/long-term-outcome-low-energy-extracorporeal-shockwave-paul-morrissey/

My views on ESWT and back pain are really quiet clear, and have been for some time. Here's my last one of the month I did today https://www.linkedin.com/pulse/effect-shock-wave-therapy-postpartum-low-back-pain-paul-morrissey/

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Cavitation is King

It's great to see, as the month's progress, the audience for the blog grow. December when I first started this blog, seems like only yesterday, yet here we are, over half way through 2018, and it been great to hear the positive feedback. So welcome. I hope you continue to get a lot from this.

Today I was very pleased to interview another patient, this time with De Quervains tenosynovitis with a 2 year history pending surgery following the birth of child. See Dr Mary Onianwa testimonial to the remarkable help shockwave has afforded and my brief summary of upper limb conditions where shockwave can be effective.


I was asked to repost a Linkedin article about Shockwave that was well received:

9 Things you didn't know about ESWT Shockwave therapy

There have been a few questions from the post, so watch this space for a video follow up. 


There has been a lot of interesting talk recently about cavitation. I don't necessarily agree with the position some educators are giving the public and healthcare professionals, so I thought I would give my point of view here:

Cavitation: Important to successful Shockwave treatment 


Finally, I have agreed to go to Belfast, Northern Ireland to present for the Swiss DolorClast Academy with Algeos

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May's Shockwave Stories

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I'm delighted to advise that the video of all the presentations (incuding mine) made at the third http://www.britishshockwaveassociation.com conference in late March is now available to buy. Apologies for the delay in posting due to technical issues.

You will be able to listen to my thoughts on what, in my professional opinion, works and indeed some areas that fail unnecessaryily so. The upper limbs seemingly respond better to ESWT - the particular condition that comes to mind is Lateral Epicondylitis, as you will see in the slide above confirming Yang et al '17 study.

According to the study and my experiences it is important to ensure that: 

1. That the energy is delivered to the patient at an average of 3.1 bar [Yang]. The patient that was brought in for me to treat at the BSWA had previously undertaken a course of treatment of RSWT. The patient had an average of 1.5 bar delivered X3 treatments. I believe the energy or lack of was the reason the patient responded poorly to treatment and didn't get the outcome both the practitioner and patient desired. This is not an untypical case. 

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You will see that I managed to deliver an average of 3 bar to the patient in the video who was clearly not comfortable with the pain but tolerated it. We managed to work through despite being in front of a big audience. I'm now looking forward to hearing how he gets on with further treatments at this level of energy and that he has a successful outcome now.

Link to presentation and treatment.https://vimeo.com/273241291

 

Link to presentation, please email me and happy to send.

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2. Not all shockwave devices deliver the same energy as this study demonstrates.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625004/

For example, some handpieces have been proven to lose a substantial amount of energy into the soft tisses, while using ultrasound gel can also affect energy absorption. I really like the Evo Blue as it does not lose energy irrespective of bar pressure. I loved this great progression of a handpiece from EMS and have produced this video which you may find of interest. https://youtu.be/jg2V8Lercug

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3. Lastly, it is important to note that ESWT simply cannot fix every patient. Here's another slide of mine from my presentation. I remember 10 years plus ago, it was fashionable to talk about success outcome rates in percentage terms - PF, MAT etc were always in the high eighties whereas UL was about 70%. Fortunately we've moved on from using percentages as a way of measuring successful outcomes. Now there are recorded research findings that would follow successful treatments - i.e) measuring at three, six and 12 months post treatment. 

Finally, I've decided to attach a recent study using EMS Swiss dolorClast which proved enormously popular on my social media channels. Radial shockwave treatment promotes human mesenchymal stem cell self-renewal and enhances cartilage healing.

https://stemcellres.biomedcentral.com/articles/10.1186/s13287-018-0805-5

That's all for this month guys. Happy continued great outcomes for your patients using ESWT.