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Shockwave therapy - application procedure

Mgr. Ondrej ProuzaPhysiotherapist & BTL medical consultant

Shockwave therapy/ Ondrej Prouza 2

Shockwave therapy – therapeutic steps

Clinical examination, localize the painful spots by palpation, eventually consult with X-ray, ultrasound or MRI scans

Set the therapy parametresApply conductive gel over the treatment areaApply the shockwaves


Application techniques

Swivelling/semi-static technique

Painting/dynamic technique


Application procedure

Around the most painful spot - analgetic affect, patients adaptation. About 500 pulses

Most painful, key point - usually not more than 1 500 pulses

Other soft tissues in the area- associated muscle chains, other regional impairments


Shockwave Therapy- therapeutic protocol video

( .avi)


Final clinical assesment 2 months from the end of the therapy

Recheck 12 months after last therapy

Instruct patient to do stretching and post-isometrical relaxation between sessions /i.e. elbow tendinopathies/

Apply in relaxed position, supine optimally

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Application procedure


Implications for therapy

Switch the frequency to prevent receptors accomodationRefrain from sport activities between sessions- body part, acute healing phaseHigher frequency better toleratedMaximum therapeutic effect is 8 weeks delayedBurst mode for sensitive patientsNO use of anesthesia or analgetics Possible application of cold pack after therapy


SHOCKWAVE – THERAPY VARIABLES

Intensity of the pulse /Bars/ 2- 3.5 Bar Frequency of the pulses 5-15 Hz, recommended to change during the therapyPulses per session 1500- 6000 depending on the size of the areaFrequency of the sessions- every 7 daysNumber of treatments 3-6


DYNAMIC MYOFASCIAL CONCEPT

Combination of techniques of Prague´s school of manual TherapyTravell and Simon´s Treatment of Myofascial Pain Aim is to cure not only local pain but also transferred and referred painESWT is dynamically applicated to the locality of radial epicondyle, trigger points in extensors in the direction of irradiating pain,combination with technique stretch and spray Static aplication on radial epicondyle is used in the second phase if relive of pain is not achieved

Dynamic Myofascial Treatment /Nedelka J, Nedelka T.,2010/


Shoulder pain treatment

Most frequent diagnoses for shockwaves:

Impingement syBiceps tendon calcificationChronic subdeltoid burse inflammationFrozen shoulderLocal muscle hypertonus- Trigger pointsPeriarthritis humeroscapularis


„Efficacy of ESWT in calcifying shoulder tendonitis was proved in 70% patients “ Cosentino R et al., Ann Rheum Dis, 2003

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Shoulder pain treatment


Required generator pressure 3 bars

Minimum 1500 pulses for session

Recommended parameters: 3 bars, 2500 pulses, frequency 10-15 Hz

Focused applicator

Include dynamic application to trapezius p.s.

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Application procedure – shoulder pain


Plantar pain treatment

Heel spurPlantar fasciitisToe flexors hypertonusTrps in soleDistant disorder irradiation

No strict clinical division between these, but has to be considered in therapy


Heel Spur- clinical results

Heel spurEfficacy in 61% of heel spur patients /Hammer et al, Foot Ankle Int, 2003/

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Before SW therapy

After 4 SWT sessions

Shockwave therapy/ Ondrej Prouza 16 16

Plantar fasciitis – application procedure

Therapeutic pressure 2– 2,5 bars and more depending on patients tolerabilityHigher frequency recommended 10-15 HzAround 3000 shocks per sessionStart with semistatic application around the most sensitive spotInclude dynamic apllication on medial aspect of the sole


Achilles tendon pain

Typical indications for SWTLocal overuse of the tendonPost traumatic healing impairmentLocal trigger points – m. soleusGeneral disorder- back or postural disorder …key role in crossed muscular chains

Might be imporant aspect in decision to treat distant areas too


Achilles tendonitis - application procedure

Therapeutic pressure 2,5 – 3,5 bars

Frequency rates recommended: 10-15 Hz

2000-4000 shocks per session

4-6 sessions


Epicondilitis

Lateral elbow tendinopathies – golf and tennis elbow

Evidence of effectivity was found in majority of recent studies

Use in restricted conditions necessary – inacute phase

Good results in longterm follow-up Rompe et al., British Medical Journal, 2007


Application procedure – epicondylitis

Therapeutic pressure 2 bars, higher energy prefered only according to patients tolerance1500 – 2500 pulses per session3-5 sessionsFrequency: 10 (15) HzSoft pressure with the appllicator!

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LOW BACK PAIN

Disc hernia or protrusion is contraindication !Direct application to spinous process is contraindicatedPressure not exceeding 2 barsOnly to PV muscles


SHOCKWAVE THERAPY IN ACUTE MUSCLE STRAIN

ESWT in acute conditions = „Advanced“ users application

Important to follow-up regimen precautions, contraindicatíons and recommended procedure

Detailed therapeutic encyclopaedia:

Extended therapy descriptions step by step Detailed contraindications and regimen

restrictions for each diagnose


SHOCKWAVE THERAPY IN ACUTE MUSCLE STRAIN II.


SHOCKWAVE THERAPY IN ACUTE MUSCLE STRAIN III.

Stage 1: 1-4 days from the injury respect to the acute trauma, therapy

is concentrated on the surrounding structures

Muscle spasm, pain Stage 2: 5th - 28th day after injury Application both above the injured

area as well as the surrounding structures.

Healing support and acceleration


OTHER INDICATIONS…


THANK YOU FOR YOUR ATTENTION..

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