Eventful February

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...

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RCT Review

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

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Persistent Plantar Fasciopathy

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.

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BSWA UK Conference

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

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.

Busy January

Where has the month of January gone! Lots going on.

Here's a quick recap of the updates I posted this month.

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

New and Accurate Predictive Model for the Efficacy of Extracorporeal Shock Wave Therapy in Managing Patients With Chronic Plantar Fasciitis

To identify factors for the outcome of a minimum clinically successful therapy and to establish a predictive model of extracorporeal shock wave therapy (ESWT) in managing patients with chronic plantar fasciitis.

 http://dx.doi.org/10.1016/j.apmr.2017.05.016

This study establishes a new and accurate predictive model for the efficacy of ESWT in managing patients with chronic plantar fasciitis. The use of these parameters, in the form of a predictive model for ESWT efficacy, has the potential to improve decision-making in the application of ESWT.

Effect of Extracorporeal Shockwave Therapy Versus Intra-articular Injections of Hyaluronic Acid for the Treatment of Knee Osteoarthritis

Study has limitations for sure, placebo, sample size and indeed energy selection. However, ESWT and intra-articular HA therapy are effective in alleviating pain and improving physical functions in patients with knee OA. Statistically, no significant differences in curative effects were observed between the two treatments. Therefore, ESWT can be considered another option that is as effective as intra-articular HA injections for treating knee OA.

 https://doi.org/10.5535/arm.2017.41.5.828 

https://www.ncbi.nlm.nih.gov/pubmed/23953895 ( Zhao's study Dec 13 )

Analgesic Effect of ESWT Combined with Fascial Manipulation Theory for Adhesive Capsulitis of the Shoulder: A Retrospective Study

Understand this study but honestly prefer ESWT as a stand alone treatment. Fascial work has on its own some really good RCTs in this study the ESWT followed fascial theory local and distally. Notable pain and slight functional improvement was achieved through this ESWT-FM.

I tend to use ESWT in late stage and get good results thereto, excellent with Diabetic patients

https://doi.org/10.1155/2018/3450940

Comparative Effectiveness of Radial Extracorporeal Shockwave Therapy and Ultrasound-Guided Local Corticosteroid Injection Treatment for Plantar Fascii

This was floating around last week on Twitter, worth a share for sure and not surprise from the JAPMA.

http://www.japmaonline.org/doi/abs/10.7547/14-114

Conclusions: Both rESWT and corticosteroid injection therapy are effective modalities for treatment of chronic plantar fasciitis. However, rESWT seems to be superior to corticosteroid injection therapy due to its longer duration of action.

Comparison of single-dose radial extracorporeal shock wave and local corticosteroid injection for treatment of carpal tunnel syndrome

Good news for mild-moderate severe CTS, for RSWT users, similar to results from London Olympics. See EMS for this info.

https://doi.org/10.1186/s12891-018-1948-3

Recent studies have reported that radial extracorporeal shock wave therapy (rESWT) reduces pain and improves function in patients with mild to moderately severe carpal tunnel syndrome (CTS) compared to a placebo. However, most of those studies used multi-session rESWT combined with wrist support and evaluation of efficacy was limited to a maximum of 14 weeks.

There was significantly greater improvement in symptom severity scores, functional scores and Boston questionnaire scores at weeks 12 to 24 in the rESWT group compared to the LCsI group. When compared to the baseline, there was significant reduction of VAS and functional score in the rESWT group at weeks 12 and 24. The LCsI group had no statistically significant differences in VAS reduction and functional score of the same period.

Conclusions

Treatment of CTS using single-dose rESWT has a carry-over effect lasting up to 24 weeks suggesting that single-dose rESWT is appropriate for treatment of mild to moderate CTS and provides longer-lasting benefits than LCsI.

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What to watch out for...

There's some really intersting news on a new development for Shockwave in the UK happening in March. Stay tuned and I'll update you as soon as I can.

I'm also seeing more and more social reports and comments on Shockwave which can only be a good thing around the world. It's great that more people are starting to spread the word.

Lastly, a great testimonial from Triston James, European Jiu Jitsu Gold Medalist, about his success after treatment.
It's great to see the perspective of patients already in tune with their bodies, like sports professionals.

Happy New Year, 2018's first Blog

I hope that you all had some quality time out with the family and now recharged. Im not sure that if your like me after time out its difficult and harder to get going following the New Years break, but it takes decisions, start strong and plan for a better year.

With respect to Shockwave the end of the year presented with some nice papers on the upper and lowerlimbs, my new website www.shockwave-therapy.co.uk was launched and indeed this blog. By the way appreciate those kind works on the efforts and looking forward to sharing continued studies and posts with you all.

Also one very exciting postive move is that been asked to get involved Knee studies using Focused and Radial. Not cleared yet but think O/A and P/T chronic tendinopathies, without question will let you know how I get on.

One area that gave me much pleasure in receiving was the latest info from EMS regarding PEDro which is a free database of over 29,000 randomized trials, systematic reviews and clinical practice guidelines provided by the George Institute for Global Health in Sydney.

Hers the link http://shockwave-therapy.co.uk/peer-reviews/  

 30/45 of the randomized controlled trials (RCTs)2 on rESWT listed in the PEDro database3, 4 were performed with the Swiss DolorClast®
> In 80% of these studies, the Swiss DolorClast® resulted in better clinical outcome than the control group
> In the remaining 20% of these studies either not enough energy was applied5 or patients with indications not approved for the Swiss DolorClast® were included

So if your a clinican and looking to get into shockwave therapy then this should speak volumes.

Heres to a great year, Happy Shockwaving just like the Pro Body Builder below who really enjoys Shockwave ( as if,)  just likes the results !

9 Things you didn’t know about ESWT Shockwave Therapy

IT’S NON INVASIVE
Shockwave Therapy can be used to treat longstanding pain and discomfort. We use an EMS Swiss DolorClast shockwave machine. A hand-held device is moved over a conductive gel on the skin to send waves of energy to painful areas in the body. These mechanical pressure pulses – known as shockwaves - work by reinjuring tendons and tissues, which in turn stimulates blood flow helping problem areas to heal (neoangiogenesis).

IT’S RISK FREE
Shockwave Therapy requires no surgery which means there’s no chance of infection and there’s very littlerisk of tendon rupture, which may occasionally occur with steroid injections. There’s no need to take medication. It’s a wonderful technique to consider if all your other treatment options have failed.
The Shockwave Solution

IT’S NOT JUST FOR TENDON INJURIES
Yes Shockwave Therapy can be used to treat pain in areas such as the achilles tendon, but evidence shows it can help other conditions from Peyronie’s Disease (bent penis syndrome) to refractory plantar fasciitis (Policeman's Heel) and even help reduce the appearance of cellulite! It’s also great for chronic shoulder pain (calcific tendonitis of the shoulder), and hip bursitis inflammation around the outside of the hip joints, which can cause people discomfort on one side when they lie down or try to do certain exercises.

IT’S NOT TIME CONSUMING
A course of 3 sessions is generally needed but the sessions only last 15 minutes and after treatment you can go about your daily business. Exercises may be given at the end but it is inadvisable to participate in sport until your practitioner has given you the all clear.

THERE’S MORE THAN ONE OPTION:

FOCUSED SHOCKWAVE: This is generally used to treat targeted deep-rooted painful conditions and is particularly useful for joint related problems. The device uses piezoceramic crystals to generate a pressure wave through the tissue into the target area at a depth of 8cm. This creates cavitation bubbles which collapse, creating a secondary shockwave. This approach is less painful than the radial option.

RADIAL SHOCKWAVE: This is ideal for 90% of the problems we see in clinic. For example, soft tissue/ tendons which are more superficial. In fact some studies have shown this treatment can help with osteoarthritis and bone healing such as delayed non-union fractures. This process works in the same way as the Focused approach except the Radial shockwave does not penetrate as deep and therefore its use is considered for more superficial conditions. 

IT’S USED BY ATHLETES
Some of the best sports teams in the world including The AC Milan football club and its scientific research centre, the Milan Lab, have researched and used Shockwave Therapy as a way of keeping their athletes in peak condition.

IT’S APPROVED FOR USE IN THE UK
NICE (the National Institute for Health and Care Excellence) has reviewed Extracorporeal Shockwave Therapy (ESTW) and approved its use in the treatment of six conditions. The machine we use is on a number of databases around the world such as PEDro. 80% of randomised controlled studies featured on PEDro, have been undertaken using the Swiss DolorClast machine. 

IT’S NOT AS EXPENSIVE AS YOU MIGHT THINK
A full consultation will be given. If you are deemed suitable for a course of Shockwave Therapy, then the cost of three sessions including the consultation is £600. If you are not considered suitable for the treatment, then the consultation fee is £65. Would you put a price on becoming pain free? 

INSTANT ACCESS FROM AN EXPERT ON YOUR DOORSTEP

This treatment should only be performed by an expert practitioner with an understanding of the underlying adverse biomechanics of the body to ensure the results are the best they can be. Step in Paul Morrissey. Author of ‘The Shockwave Solution – The Non-Surgical Answer to Becoming Pain Free’. Paul has treated patients using Shockwave Therapy for the past 14 years. He’s also an ambassador and qualified trainer for EMS. And the best part is there’s no waiting list. Book an appointment today.

December's Early Blog

Shockwave enthusiasts may find some of the posts of interest. I recently spent time with the Guru of Shockwave, Professor Christoph Schmitz at Therapy Expo, assisting with In- house training, tutorials on Proximal Hamstring Tendinopathy and Tennis Elbow.

This week I was discussing a study published in the BMA Journal on failed A/C decompression shoulder impingement surgery and appropiate recommendations. This is a great opportunity for clinicians to push ESWT whether bias of Focused or Radial.

Here's a link to my post on Linkedin.

Here's another link to a post in favour of ESWT.

Another study of significance.

The message is clear, use Shockwave on your patients for shoulder impingements!

Shockwave at Therapy Expo

Well what another busy week, apologies for patients on my Thursday list as had to shoot up to the NEC to spend time with Professor Christoph Schmitz, clearly the most influential academic in Shockwave - MD Full Professor and Head, Extracorporeal Shock Wave Research Unit, Department of Neuroanatomy Ludwig-Maximilians-University of Munich, Germany. 

Christoph's talk was ‘Extracorporeal Shockwave Therapy on the musculoskeletal system in sports medicine and evidence based medicine’. This was well received and I personally got to spend  time with Christoph and managed to bend his ear on a few of his studies.

I have to say its one of the first exhibitions that I have been where other manufacturers of Shockwave machines were present and most certainly raised my eyebrows to some unusual experiences. One practitioner mistakenly believed that he could deliver shockwaves through clothing, whereas in fact castor oil is the necessary medium to allow the transmission of energy into the soft tissues. If the 'learned' practitioners are advocating this as standard practice then it's a worry because the general public will believe the same.

A further worry is that physiotherapists and sports physicians, the people buying these machines are being hoodwinked by price . 

There are other cheaper machines with very little evidence to support what they do but they don't produce consistent energy into the soft tissues.

For what we all charge professionally, we should all be using machines that have evidence to support their product and studies in abundance. The Swiss DolorClast has unrivalled evidence from around the world and one only needs to look at Pedro.org to confirm this.

For those who are following me on LinkedIn, there have been two interesting posts this week; one on subacromial impigement and another on Osteo Arthritis of the knee. Watch this space for more info and hopefully Christoph will shoot me details on his treatment for a 3D hamstring injury for a star he has worked in one of the main international football leagues. The results were amazing and he returned to competitive sport 31 days later. That's all I can say at this stage! 

Training in Camberley

I had a really great day yesterday (14th November) training the team at Camberley Chiropractics.

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Having recently expanded their services to include Shockwave, I was asked to deliver our QuickStart training to get them up to speed and familiar with the device, the latest research and delivery best practices. The day included a general introduction to Shockwave, a scientific overview of the technology, background information on who's using shockwave, the latest research, a in-depth look at the Swiss Dolorclast method and practical use as well as some things to look out for in further developments.

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They're a really keen team under Dr James Everett, and adding ESWT to their very modern clinic which has a strong interest in sports medicine is going to be a great benefit for their patients and their business.

As ever, the EMS device was purchased based on the wealth of evidence and the machines use in many of the clinical trials. This, along with the great support of the Swiss DolorClast Academy  (which all members will be invited to join), make it the perfect choice.

Anyone close to Camberley should check out this clinic for insertional tendinopathies, osteoarthritis and sporting injuries. They have the most up-to-date and internationally recognised radial shockwave equipment. 

If you've added or are considering adding shockwave to your practice, feel free to reach out to me at paul@osteopathclinic.co.uk with any questions or to find out more about the support and training we provide. 

New Video on Proximal Hamstring Tendinopathy (often called High Hamstring or Hamstring Syndrome)

Well again another busy week and fitting in another video was really challenging. I have to thank Rhea, my Pilates Teacher/ Ironman extraordinaire, my wife in the background and the ever supportive Artur who provides us with such good photos.

So what's so particular about this proximal hamstring video. Well the hamstring itself can be the cause of problems with the lower back, hip and indeed the knee. For this particular condition we see a number of athletes from the running world in particular and when not responding to treatment or even misdiagnosed, then Shockwave can be a valid solution. I've treated a number of these conditions with very successful results.

For the academics out there, check out our other Shockwave Practitioner videos and this very good paper to support this condition http://journals.sagepub.com/doi/abs/10.1177/0363546510379324.

For those of you who have or think you may have this condition, i.e pain in the lower buttock, worsened on sitting also whilst running during acceleration / deceleration phase, check out the Hamstring Tendinopathy page here. This may be your saving grace (as in Cacchio's study).

Have a good week everyone.

New Shockwave Video on Tennis Elbow

My word what week it has been, what with the launch of this new site! Thank you all for the nice comments; it's really appreciated. Incredibly 80 more copies of my book, The Shockwave Solution, have been downloaded which is amazing! Furthermore we shot another practitioner video on Tennis Elbow last Friday with Steve Avery Six times Professional Body Builder who has many other accolades and recently won the British title. 

I'm very proud of what Steve has achieved in his field of excellence, I have looked after Steve in excess of 25 years and treated a number of his injuries during this period. Steve is only too aware of the benefits of Shockwave despite his picture for the camera.

Watch this space for more Shocking news.