Radial Shock Wave Therapy for Pain Relief and Healing
By Mohsen Kazemi RN DC FCCSS(C) FCCRS(C)
By Mohsen Kazemi RN DC FCCSS(C) FCCRS(C)
Solid results shown in chronic tendinopathies, and for delayed or non-union fractures.
A few years ago, I heard about shock wave therapy that was producing amazing results in chronic conditions such as plantar fasciitis, and Achilles and patellar tendinosis. Further investigation revealed a number of very good quality scientific papers, which confirmed the effectiveness of this therapy in an average of three sessions. Following is a brief literature review:
Ogden et al.(1) defines shock wave as, “A transient pressure disturbance that propagates rapidly in three-dimensional space.” Initially, shock wave was used to break down stones within renal, biliary and salivary gland tracts.(2,3,4) Over the past 15 years, this procedure has been used for musculoskeletal conditions such as calcific tendinosis of the shoulder,(4,5) tendinopathies,(6,7), and acute and non-union fractures.(8-11)
Wang et al.(4), in their prospective clinical study with two-year follow-up, incorporated 37 patients (39 shoulders) with calcific shoulder tendonitis, who were treated with shock wave therapy (1000 impulses at 14 kV), and observed for 24 to 36 months. They recruited six patients (six shoulders) into the control group that was treated with dummy electrodes, with average follow-up of six months. They reported that, in the study group, 60.6% were complaint-free, 30.3% were significantly better, 3.0% were slightly better, and 6.1% were unchanged. Comparing pre- and post-shock wave therapy shoulder radiographs in the study group, they found total dissolution of calcium deposits in 57.6%, partial in 15.1%, and unchanged in 27.3%. The control group patients showed 16.7% fragmentation and 83.3% unchanged deposits. They reported no recurrence of calcium deposits in the study group during the two-year follow-up.
Wang and Chen(6), in their case series study, included 43 patients with lateral epicondylosis in the study group, and six patients in the control group. The study group patients received 1000 impulses of shock wave therapy at 14 kV to the affected elbow. The control group patients were treated by a sham procedure. They used a 100-point scoring system to evaluate strength, pain, function, and elbow range of motion. Wang and Chen reported that 61.4% of the elbows in the study group were complaint-free, 29.5% were significantly better, 6.8% were slightly better and 2.3% were unchanged. However, the results were unchanged in all six patients in the control group.
Rompe et al.(7) recruited 45 running athletes who had suffered from intractable plantar heel pain for more than 12 months. They assigned half to the treatment group that received three applications of 2100 impulses of low-energy shock waves, and another half received sham treatment. Blinded observers conducted follow-up examinations at six months and at one year. At the six-month follow-up, 60% of patients in the treatment group reported at least a 50% reduction of pain, versus 27% of the patients in the sham group. After one year, 72% of patients in the treatment group, versus 35% of the patients in the sham group, reported the same.
Wang et al.(10) investigated the effect of shock wave therapy in the treatment of 72 patients with 72 non-unions of long bone fractures (41 femurs, 19 tibias, 7 humeri, 3 ulnas, one radius and one metatarsal). They used 6000 impulses at 28 kV for femur and tibia, 3000 impulses at 28 kV for the humerus, 2000 impulses at 24 kV for the radius and ulna, and 1000 impulses at 20 kV for the metatarsal. All patients were treated under general or spinal anesthesia. Patients were evaluated clinically, by plain radiographs and tomography. There was 40% bony union at the three-month follow-up, 60.9% at six months, and 80% at 12 months.
Wang et al.(11) surgically induced bilateral tibial fractures in 10 dogs. Each fracture was then stabilized by plates and screws. They eliminated two dogs from the study due to post-surgical deep wound infection. Each right tibia was treated with 2000 impulses of 14 kV, and the left tibias were used as the control. Upon evaluation of callus formations utilizing serial radiographic examinations at 1, 4, 8, and 12 weeks, and histological examination at 12 weeks, the authors found statistically significant callus formation in the treated group only at 12 weeks. They concluded that the effect of shock wave therapy on bone healing might be time-dependent at three months.
There is obviously good evidence for the effectiveness of shock wave therapy in chronic tendinopathies, and for delayed or non-union fractures.
In October 2003, I joined 900 scientists at the prestigious 7th IOC World Congress on Sports Sciences in Athens, Greece, where I presented my research, “Sydney Olympic 2000 Taekwondo Athlete Profile.” At the accompanying trade show, a Swiss company was showcasing a radial shock wave therapy system, which provided the opportunity to experience this therapy and ask questions. Radial shock wave therapy units are smaller, more portable and more affordable than the electromagnetic and piezoelectric types, since the shock waves are produced by an air compressor. For the past two years, a radial shock wave therapy unit has been in use in my practice, and the results have been remarkable. In addition, radial shock wave therapy does not require local anesthetic prior to application.
The literature suggests total resolution of symptoms in the majority of patients with three sessions of five to ten minutes. Marked pain relief may be observed in most patients just eight to ten days after the first treatment.
Since they treat neuromusculoskeletal injuries, chiropractors are well-placed for use of this modality.•
Ogden JA, Toth-Kischkat A, Schultheiss R. Principles of shock wave therapy. Clin Ortho and Related Research 2001; 387:8-17.
Chaussy C. Brendel W, Schmidt E. Extracorporeally induced destruction of kidney stones by shock waves. Lancet 2 1980;1265-1268.
Streem SB. Contemporary clinical practice of shock wave lithotripsy. J Urol 1997; 157:1197-1203.
Wang CJ, Yang KD, Wang FS, Chen HH, Wang JW. Shock wave therapy for calcific tendonitis of the shoulder. Am J Sports Med 2003; 31:425-430.
Perlick l, Luring C, Bathis H, Perlick C, Kraft C, Diedrich O. Efficacy of extracorporal shock-wave treatment for calcific tendonitis of the shoulder: experimental and clinical results. J Ortho Science 2003; 8:777-783.
Wang CJ, Chen HS. Shock wave therapy for patients with lateral epicondylitis of the elbow. Am J Sports Med 2002; 30:422-430.
Rompe JD, Decking J, Schoellner C, Nafe B. Shock wave application for chronic plantar fasciitis in running athletes. Am J Sports Med 2003; 31:268-275.
Rompe JD, Rosendahl T, Schollner C, Theis C. High-energy extracorporeal shock wave treatment of nonunions. Clin Ortho and Related Research 2001; 387:102-111.
Schaden W, Fischer A, Sailler A. Extracorporeal shock wave therapy of nonunion or delayed osseous union. Clin Ortho and Related Research 2001; 387:90-94.
Wang CJ, Chen HS, Chen CE, Yang KD. Treatment of nonunions of long bone fractures with shock waves. Clin Ortho and Related Research 2001; 387:95-101.
Wang CJ, Huang HY, Chen HH, Chen CE, Pai CH, Yang KD. Effect of shock wave therapy on acute fractures of the tibia. Clin Ortho and Related Research 2001; 387:112-118.