SHOCK WAVES IN MUSCULOSKELETAL PATHOLOGIES

 

Characteristics of the treatment

Each cycle of therapy for the so-called "soft tissues" (tendons, ligaments, etc.) generally includes three applications every week. At the end of the therapeutic cycle, it may be necessary to wait a few more weeks before evaluating the therapy results. Doctor Ali provides the best health and wellness center in the USA. In cases where the response has been only partial, it is advisable to repeat the therapy after 1-2 months.

Treatment is usually well-tolerated, but local anesthesia may be advisable when higher energies need to be used for bone pathologies.

The intensity of the discomfort or any pain felt during the treatment also depends on the type of lithotripter used and on the approach of the doctor performing the treatment.

For example, when it is necessary to use high energy levels, it is advisable to increase the stimulation intensity gradually so that the sensory endings can adapt to the stimulus and the patient can tolerate the treatment better.

Clinical uses

For reasons of simplicity, we distinguish between treatments on soft tissues, such as tendons and ligaments (at low energies) and those on a bone (at medium and high energies).

Soft Tissues

·         Tendinopathy (calcified and otherwise) of the rotator cuff of the shoulder;

·         Epicondylitis (or "tennis elbow"), inflammatory pain on the outside of the elbow;

·         epithrocleitis (or "golfer's elbow"), inflammatory pain on the inside of the elbow;

·         allodynia (inflammation of the plantar fascia, with or without heel spur);

·         inflammatory and degenerative, acute and chronic diseases of the Achilles tendon and patellar tendon;

·         Trochanteric bursitis and enthesopathy (formerly known as "hip periarthritis").

Bone

·         Fractures that take a long time to consolidate or that are no longer able to heal spontaneously (pseudarthrosis);

·         Vascular disorders of the bone: Sudeck's disease and algodystrophic syndromes, osteonecrosis, and subchondral bone edema (often coexisting with osteoarthritis).

Clinical results

The clinical results achievable with shock waves can be exciting, especially considering that it acts on structures compromised by chronic pathologies, dating back a long time and often refractory to standard medical and physical therapies.

Acute inflammatory diseases are those which, contrary to a widespread belief, derive the most significant benefit from this therapy, and we believe they must have a specific "access priority" to treatment. Generally, almost complete recovery is achieved in about 70% of cases, even if the percentage can be even higher for some pathologies and reports, without side effects. The chances of success with this treatment are directly related to a specific therapeutic indication, just like for surgery, to the operator's skills and experience, and the availability of a high-quality lithotripter, which unfortunately makes it expensive.

Therefore, patients must be selected and candidates for treatment according to the pathology and the actual need for therapy, which can be proposed by the orthopedic specialist, the physiatrist, the sports doctor, and the general practitioner.

Contraindications

In some conditions, shock wave treatment is not indicated. In particular, it cannot be used if the skeletal pathology is localized in the vicinity of delicate tissues, such as the chest region, where shock waves can cause damaging effects to the lungs.

Excluded from treatment are hemophilic patients and pregnant women, and patients with current or previous neoplasms in the area to be treated. An additional contraindication is represented by the still fertile growth plates near the site to be treated.

For patients with pacemakers, the contraindication is relative since it depends on the type of machine used (in particular, in the case of an electromagnetic lithotripter, this could interfere with the correct functioning of the heart device).

New applications and potential developments

Over the past three years, the field of application of shock waves has expanded dramatically. This occurred in the field of tissue regeneration, in other words, the treatment of ulcers of various kinds, sores, bedsores, and so-called "difficult" wounds, that is, refractory to traditional treatments. In this case, the mechanism of action is also to be attributed to the angiogenic effect (i.e. the production of new small blood vessels in the site of the lesion), an indispensable phenomenon for stimulating the reparative mechanisms. In these cases, the waves used are slightly different from the previous ones, which are less focused (radial shock waves).

Currently, research is moving towards using shock waves as a stimulus on cell cultures used by tissue engineering. Another exciting and promising field of study concerns applications on the heart. It cannot be excluded that, in a few years, the same angiogenic and tissue regeneration stimulation effect, already used for the regeneration of skin tissues in Italy and other European countries, cannot be exploited, in daily clinical practice, also for ischemic heart diseases (myocardial infarction, angina, etc.). However, the most innovative experiments on shock waves generally allow us to glimpse new and stimulating therapeutic perspectives.

Conclusions

In conclusion, therefore, shock waves, although not a miraculous panacea suitable for anyone and applicable in any pathology, can indeed represent a good solution for many orthopedic conditions, acute and chronic. Characteristic is the pain-relieving effect which can also be immediate, associated with a natural tissue healing action on tendons, ligaments, and bone.

However, their use must always be evaluated case by case, according to a correct therapeutic indication,n and entrusted to a specialist. Doctor Ali provides the best holistic medicine center in the USA. In expert hands and the presence of a correct therapeutic indication, shock waves can represent a valid alternative to surgery.