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.

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.

Principal Paul applying Shockwave to his knee

Never let it be said we’d recommend things we weren't willing to do ourselves…

Earlier this week Paul broadcast a Facebook Live session as he Shockwaved his knee. For those technically minded: lateral femoral condyle and soft tissues superiority and inferiority work 😉

If you’ve ever wondered about the procedure, this is a great watch.