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.

April's Review

Paul and Reah

April appeared to be rather quiet but on review, we covered a number of topics, posts, RCTs, and of course, my presentation at the British Shockwave Association weekend.

I'll share that video as soon as it's available (hoping my 'man flu' wasn't too evident), and thanks to those that enquired... the car is all back to normal following the broken window during my talk!

The talk went very well and I think I had more questions and follow up from delegates in this event than any other. It was a great, engaged audience. A lot of the enquiries were about energy requirements to get successful outcomes.  To that end here's a link to a video I posted on our Facebook.com/OsteopathicClinic page answering the questions in more detail. 

 
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April Recap

So let's summarise the April posts and comments in case you missed anything:

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The medical view of Shockwave treatment

I had the pleasure of sitting down with medical practitioner and Shockwave patient, Dr Peter Campbell recently to talk about his experience as a patient and a professional.

Peter had treatment 6 years ago for a persistent Achilles problem, 2 years later for tennis elbow. He talked candidly about the treatment and the outcomes.

A must watch for anyone in practice.


Shockwave training

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I had the pleasure of providing in-house training at a local clinic, My Physio Croydon last month.
It was a great session and I'd just like to wish Chirag and his really enthusiastic team all the very best.

 

If you're introducing Shockwave to your practice, or looking to further develop your team, we have a program suited to you. Just drop me an email and we'll take it from there. 


Swiss Dolorclast Course

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I understand a great course was held in London under the care of Chris Downton with Mr Manog Sood and Mr Jonny Wride last month. It's great to see so many people becoming certified.

Check out the next course in Birmingham this month (schedule).

This is another must for anyone serious about bringing Shockwave to their patients.

Academic March

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What a busy March, with posts starting with upper extremities and stroke patients, O/A 1st CMC, a super study on human mesenchymal cells and finally my presentation at the British Shockwave Association


Best Study so far...

I think this is the study of the year so far. Rviewed by record breaking numbers and appreciable  comments from colleagues.

In the present study, we found that radial shockwaves significantly promoted the proliferation and self-renewal of MSCs in vitro and safely accelerated the cartilage repair process in vivo, indicating favorable clinical outcomes.

Also a great plug for the outstanding work currently being research and clearly that for the devise i.e EMS Swiss Dolorclast, keeping Radial Shockwave a the forefront where it clearly belongs.

The link to the study is below 

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


British Shockwave Association Presentation

I was delighted to be asked to present more on the practical aspects of Shockwave and what works in practice.

To be terribly honest I was so unwell, I had a nasty Chest Infection, missed all the lectures before me, getting out of my hotel bed just 30 minutes before my talk.

The talk was well received and people appreciated the fact that I made it. Professor Nicola Maffulli gave a very nice intro and also appreciated the part of talk informing what, in my opinion, does not work.

There will also be a video available of the conference, form the organisers, if any of you wish to purchase  

Those wishing to get a copy of my presentation can email me. I'm happy to share as long as it's not reproduced, which I'm sure you can appreciate.

Whilst being open and honest with colleagues I recently found a few individuals copying my website, using my photos and content, claiming this as there own material. It's very frustrating and clearly plagiarism which I though was a thing of the past.

The presentation was a varied topic but I really looked at the conditions that failed and why, Chronic Lateral Epicondylitis was a favourite, comparing the evidence in Yang's 2017 study for a condition that should respond well, to the outcomes people see when it's not 'done right'.

The organisers brought in a patient who had a course of treatment with another devise that failed miserably. Whilst the video recording is not positioned well, I think the approach is self explanatory. At least 3bar 15mm head is required locally (Yand et al 3.1 ) 10 hz and 2000 impulses. An additional 1000 impulses using a 36mm head to the extensor group distally. In this case from the musculartendinous junction towards the radial head.


As mentioned, a busy month with Shockwave. Let's look to the future and hope to continue with supplying great studies and continued conversations with you all.

Finally, it made my day at the presentation to hear a fellow colleague travelled from the USA to see me at the BSWA, thanking me most sincerely for the information we share here and on the social channels. He downloads, goes through content and it helps in clinical work with ESWT. Comments like that make it worth while. Appreciated that John, thank you.

Eventful February

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Another month down. As the weather slowly improves, we're seeing a few patients who've been in hibernation over the winter start to come out as they think about their health in the year ahead.

Here's a quick recap of what's been happening this month.

PS: Remember, you can follow me on LinkedIn to see these as they happen...


RCT Review

Interestingly not so much from the RCT's to end this month, well certainly not at this stage.


Persistent Plantar Fasciopathy

 EMS EVO BLUE

Had a really interest case where clear signs of a tear of the Plantar Fascia duration 18 months resulting from sporting activities. The patient had visited a local consultant who uses RSWT but the problem being that the devise is a desk top version and I really have concerns with the amount of energy that can be delivered in order for angiogenesis to occur. There may also be loss of energy being delivered and consequntial poor cavitation!

This patient presented to me as he had a course of treatment but very poor outcome and if Im being terribly honest, have seen a few from Laptop shockwave devices.

Im very pleased to say that I have helped this man get to 80%, his 5th shockwave treatment was delivered after this video and I will be following up in 4 weeks time. Interesting point was that he was incredibly tender on the medial tubercle of the calcaneus as you would expect, but also that in the fat pad. Both not unusual but not to that degree , I treated accordingly following Yangs study on the elbow where considerations looked a failed treatments, really giving the patient as much as they could tollerate was followed. Those that have read my posts from the past will no my thoughts on energy and this is also very clear in my book.

Yangs study: Yang et al., Am J Phys Med Rehabil 2017;96:93-100.

Just a tip with recalcitrant PF, always check the achilles you may need to apply 1000 shots 8HZ . 2-3 bar should help if necessary.


BSWA UK Conference

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Finally, it's 4 weeks to go to the 3rd Shockwave UK conference which takes place in London on 24th March. Yours truly will be speaking amongst some very learned experts in the field of Shockwave Therapy.

You can register here

Progressive February

Well February most certainly been busy with a few good posts and confirmation of the 3rd Shockwave UK Conference organised by Professor Nicola Maffulli with a good cast of speakers, guest speaker Professor Ludger Gerdesmeyer who really launched ESWT with his study on Plantar Fasciopathy https://www.ncbi.nlm.nih.gov/pubmed/18832341?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

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The day is really looking interesting with Imaging with Dr Otto Chan, as mentioned we have Ludger Gerdesmeyer on the science and really couldn't have anyone better on this with two FDA approvals on his books.

There's also auditing and setting up a shockwave service, Jonathan Wrides EMS UK  principle educator is talking about realities in clinical practice, I'm looking forward in discussing the conditions that we know work and there's also a chance for everyone to join in and experience ESWT from a practical perspective with Jonathan and myself. 

We also have Dr Adam Read discussing data collection and Finally there's a speaker on Urology.

Those that are interested Professor Muffulli is presenting the inauguration of the  British ShockWave Association

Prior to the founding of BSWA, there was no shockwave association in the UK. The primary aim of this newly formed association is to bridge the gap between device companies, clinicians and patients, to facilitate an exchange of knowledge and ideas between all of us. We will adhere to national and international guidelines, whilst maintaining a pragmatic, non-exclusive approach in all specialties in which SWT has been proven to be effective.

Our ethos is that it is essential that all healthcare personnel administering SWT are trained to the highest standards, and are aware of all the relevant research and up to date to provide effective SWT.

BSWA will facilitate future collaborative research in SWT to ensure a bright, long future.

Please save this date, it will be full of academics and practical solutions.

Two post that caught my eye earlier this month,

Nice to see this in one of our main journals confirming best clinical results in terms of energy is low to mid and the endorsement of FSWT on Calcific Tendinopathies, not sure of the name given to RSWT though.

https://www.linkedin.com/pulse/role-extracorporeal-shockwave-treatment-disorders-paul-morrissey/?trackingId=YL8Xpw80AUfcfV9zOoxxSA%3D%3D

Finally, another good post confirming FSWT for another Hip pathology. Like the post last year with early AVN Focused seems to be helpful

https://www.linkedin.com/pulse/high-energy-extracorporeal-shock-wave-therapy-femoral-paul-morrissey/

Finally please take time to look at this testimonial from young Simon who had 6 years plus of knee pain and now finally out of pain and now is looking to get back into his of Football thanks to Radial Shockwave.