SHOCKWAVE THERAPY Cheltenham, Walsall and Moseley

Firstly… is the shock electric?

No, the “shock” is NOT an electric shock. It is a PERCUSSIVE / SOUND WAVE shock,   generated by a metal projectile shooting up and down a special handpiece, the shock being transferred to the body tissues via an applicator head. The shock can be made electro-magnetically  or pneumatically   ( using a specialised compressor unit ). The machine used in Oakwell is the latter.

Press on the below link to see the same shockwave machine being used used. Graphics explain the working mechanism as well as treatment conditions being listed.

https://www.youtube.com/watch?v=uDfngyEBjnw

 

Why use shockwave therapy ?

Shockwave therapy is an increasingly popular means of treating many types of musculoskeletal injuries – especially tendon problems. The evidence behind shockwave as a treatment modality is very positive and steadily increasing. The UK government agency NICE ( National Institute of Clinical Excellence ) who decide whether treatments / drugs are effective – have said that it is effective for many types of tendon / muscle strain. Conditions listed below. NICE will not recommend any drug   or therapy is unless a lot of well carried out trials and research show that is effective in the large majority of the population.

Shockwave is particularly good for chronic problems that have not responded to other procedures e.g physiotherapy, acupuncture, steroid injections AND is useful for those people wanting to avoid injections and or surgery. Unlike injections or the use of ice and anti-inflammatories, where rest is essential ( typically 2 days to 2 weeks ), training / exercise can often continue the following day. This is why shockwave is increasingly used as a preventative modality especially by those really pushing themselves e.g marathon runners, Triatheletes, professional sports people.

Other advantages are that it is non-invasive so no risk of infection and there is also no risk of tendon rupture which can rarely happen with recurrent steroid injections.

Shockwave is being used in many hospital physiotherapy departments and also Orthopaedic hospitals : Birmingham Orthopaedic Hospital uses Storz Medical equipment. Storz have just made a contract to supply over 100BMI Hospitals with their Shockwave units. They also provide  machines to over 10 Premier Football physiotherapy departments. A Storz Masterpuls 50 ( MP50 ) is used in all treatments.

 

 

Conditions well suited to Shockwave therapy

 

Shoulder tendonitis  *** / calcified tendinopathy *** / capsular strain 

Peri articular shoulder pain ( trigger points )

Lateral epicondylitis ( tennis elbow ) ***

Medial epicondylitis ( golfer’s elbow ) ***

Cervical syndrome ( upper back pain / trigger points )

Thoracic dorsalgia ( mid back pain / trigger points )

Trigger point lumbago ( lower back pain )

Gluteal / Trochanteric ( hip ) pain syndrome / tendonitis ***

Quadriceps / hamstring / adductor trigger points

Quadricep / patella tendonitis ***

Calf muscle shortening / repetitive or chronic cramp problem

Tibial stress syndrome 

Achilles tendonitis***

Plantar fasciitis***

Metatarsalgia

*** denotes NICE recommended

 

How does Shockwave therapy work?

To put it simply, it turns a tendon or muscle injury from a chronic situation into an an acute situation i.e allowing / promoting the healing process. It does this in several ways. The shocks cause:

1/ some re-vasculisation to the affected area ( increases blood flow ).

2/ stimulation of cells to produce more Substance P ( a pain and growth mediator ) which reduces pain. 

3/ interference with the “inflammation cascade” to reduce chemicals that cause pain.

4/ interference ( and consequent reduction ) with the pain signals that travel along nerves from the affected area to the brain. This is known as the “Pain Gate” Theory. An easy way to describe this is to remember the last time you caught a finger in a door or stubbed your toe: the initial pain is often very high but when the affected body part is rubbed or squeezed, the pain subsides significantly and quickly. Behold… the Pain Gate Theory in action.

There is no guarantee that the problem will not return if underlying causative factors are not corrected. This is why it works so well with an osteopath who will be looking out for these biomechanical problems.  

 

What can I expect during a treatment?

A treatment will consist of 2000 – 3000 shocks. With shallow tendon problems e.g to the elbow and knee, the percussive shocks are 12 -15 times a second. Deeper hip treatments will be at 8-10 times a second. A small amount of gel will be applied to the area being treated, this causes the shocks to be more effective / penetrate more deeply.

The problem will be approached in an Osteopathic manner – that is to say that the biomechanics of adjacent joints will be examined to try and work out why the problem started in the first place – though frequently it is down to simple overuse / repetitive use.

Some soft tissue work ( functional massage ) and / or acupuncture may be done in the muscle of the offending tendon plus mobilisation of adjacent joints. Tendon problems usually occur because the muscle was too tight as well as being overused. This approach tries to ensure that the problem will not reoccur in the future.

 

Does it hurt?

Some levels of minor discomfort are common – if it is too sore the power level is simply turned down. Research has shown that shockwave works best if the treatment levels are taken up to what can be tolerated. This seems to provoke a better healing response.

Some mild bruising / swelling  / tenderness / redness is common which generally settles down with 36-48 hours. Cold packing or paracetamol is advised for this. Taking ibuprofen or any other type of anti-inflammatory medication will interfere in the provoked healing process.

 

How many treatments will I need?

Acute and recently chronic problems ( 1 – 12 months ) usually react well to 3 treatments. Very chronic conditions / problems ( 2-3 years plus ) often need 5 -6 treatments.

 

When can I expect any pain reduction?

This varies from patient to patient and with the severity of the symptoms. For the lucky ones some pain reduction may occur after the first treatment. Most improvements are noticed after the second and third treatments. Research has shown that optimum recovery time is between 6-12 weeks after a group of 3-4 treatments.

NICE has provided research evidence showing that 75-80% of patients ( with tendinopathies ) report significant improvements / recovery even 18 months after shockwave therapy, in contrast to only 20% of those who have had steroid injections. This is why the therapy is being offered more regularly at Orthopaedic hospitals before surgery – the last resort – is contemplated /offered.

 

Some effort is also needed from yourself!

For certain tendinopathies ( especially the achilles ) a fuller recovery / faster return to functionality depends of the person carrying out regular stretching exercises for a few months. The stretches are very specific and are called ECCENTRIC – simply put, the muscle being contracted WHILST being stretched. This will all be explained very clearly. The stretching consists of three sets of !5. It takes 5-7 minutes ( per leg ) and should be done twice a day.

 

Can Shockwave therapy be used alongside osteopathy?

Absolutely. A full osteopathic assessment will be made in all consultations. Any obvious spinal / joint adjustments needed will be offered / advised during the consult. Postural and exercise advice will also be given.

If anyone having an osteopathic consultation or treatment is thought to be suitable for Shockwave therapy, it will be offered. This would incur a additional cost of £20 per treatment.

 

What is the success rate for Shockwave therapy?

Documented international research show an overall improvement rate of 77% of chronic ( tendon ) conditions that have not responded to other types of treatment. It is important to highlight that this means that here is a 23% chance of no or only slight improvement. Maximum benefit has been shown to occur 8-12 weeks after the first treatment so sometimes patience is needed to let the body tissues do their work.

A review 12 weeks after the final treatment is recommended – this is following the guidelines used by many UK Orthopaedic Surgeons. If symptoms persist at this stage, alternative treatment / surgery would be discussed.

 

Contraindications

1/ If pregnant

2/ Any blood clotting disorders ( including thrombosis )

3/ Oral anti-coagulants being taken

4/ Steroid injection in the previous 6 weeks

5/ If a pacemaker being used

6/ Tumours local to affected area

7/ Infection / skin abrasion at the treatment site

8/ If under 18yrs old ( except for Osgood-Schlatter disease

9/ Treatment over any air filled areas such as the lungs or guts also not 

possible.     

 

British Shockwave Association

I am a member of the BSWA. Their ethos is:

“It is essential that all healthcare personnel administering SWT are trained to the highest standards, and are aware of all the up to date and relevant research to provide effective SWT.”

BSWA aims to facilitate future collaborative research to ensure SWT enjoys a bright and long future.

http://www.britishshockwaveassociation.com

 

Storz Medical

They are a German company ( now based in Switzerland ) and have been making medical equipment since 1946. All products are designed and made to very strict standards in their Swiss factory. They have been making shockwave products since 1987.

http://www.storzmedical.com

 

Venn Healthcare

This UK based company provide a lot of the shockwave expertise in this country today. They provide equipment, training courses, advice and general information for all things to do with shockwave. I should point out that I provide RADIAL Extracorporeal ShockWave Therapy – RESWT or RSW Other conditions need to be treated with FOCUSSED shockwave therapy – FSWT.

You can check the Venn Healthcare website at the below link to see more information about what different problems can be treated with the different types of therapy.

http://www.vennhealthcare.com

 

Cost of treatments

Consultation ( includes treatment  )  45 minutes   £80

Follow up treatments  ( 30 mins )                             £60

Block booking of consultation and 2 treatments   £180   ( saves £20 )

Block booking of 4 treatments                                   £216   ( saves £24 )

Trial SW treatment during osteopathy                    £60

 

Please note, above costings are for one area / problem being treated. A second area adds £15 / Three areas adds £25 ( per treatment ) NICE recommends a minimum of three treatments. All hospital orthopaedic and physiotherapy units follow this procedure.

 

There is a price variation between clinics – plus occasional promotional offers. Please contact me for further details.

 

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