Explaining Extracorporeal Shockwave Therapy (ESWT)

Transcription

1 Explaining Extracorporeal Shockwave Therapy (ESWT) Historical use of shockwaves in medicine. The intuition of a housewife who encouraged her husband to investigate the use of shockwaves for biomedical application eventuated into the development of the kidney stone lithotripter, the world s first minimally invasive surgery. This introduced extracorporeal shock waves (ESW) into medicine and to date remains the gold standard for the eradication of kidney stones. Characteristics of a shock wave ESW are acoustic pressure pulses that transmit energy from a generator source, presented as a single positive peak pressure pulse with a rapid peak rise time of up to 100MPa, followed by a pressure decrease within nanoseconds (Figure 1). Figure 1. Physical properties of medical shockwaves. A radial pulse or wave does not have this characteristic and therefore is NOT a shockwave device. Methods of generating a shock wave (Figure 2). There are only 3 ways to generate a medical shock wave. Shockwave therapy in medicine evolved from Urology, the two most popular devices to date for kidney stone lithotripsy are the spark gap or electrohydraulic, and electromagnetic type devices. Radial waves (Dolorclast) are not shock wave devices, they are radial pulse. They have never been used in kidney stone lithotripsy.

2 Where is shockwave therapy used today? Shockwave therapy is used widely in sports and orthopaedic medicine, but have continued to expand into cardiology, complex pain syndromes, vascular application, anti-microbial and neurological syndromes (Amelio & Manganotti, 2010; Angehrn, 2008; Cacchio, et al, 2009; Chanderau et al., 2011; Craig et al., 2012; Craig & Miller, 2010; Craig & Walker, 2012; D Agostino, et al., 2011; Furia, 2006; Furia, 2008; Gerdesmeyer et al., 2005; Moretti et al 2008; Moretti et al, 2009; Notarnicola et al., 2010; Ogden et al., 2004; Romeo et al., 2011; Schaden et al., 2007; Taki et al., 2007; Tinazzi, 2010; Trompetto et al., 2009; Yardi, et al., 2010; Vasyuk, et al, 2010; Wang, 2007; Weil et al, 2002; Zelle, 2010). *Only more recent and relevant material cited. There are over 1000 publications on shockwave therapy in multiple journals since , making shockwave therapy possibly one of the most researched medical intervention ever. The types of devices use in these disciplines are the electro-hydraulic and electro-magnetic devices. The piezo-electric and radial type (Dolorclast) devices are not used in cardiology, neurology, complex pain syndromes and vascular applications. The Essen-Mayo clinic in Germany, the world s premier cardiology centre uses the electro-hydraulic CardioSpec device. ESWT in New Zealand In 2000 Bruce Twaddle (Orthopaedic Surgeon) and I were the first to assess all these technologies over an 18 month period. We decided on the electrohydraulic device because it provided the best outcomes, period!! Today we are the most experienced providers of shockwave therapy in New Zealand and continue to conduct cutting edge research in medical shockwave therapy with institutions and researchers in internationally. We had the vision in 2000 that shock wave therapy would prove to be highly effective, and 12 years on shockwave therapy is gaining popularity and expanding across medical disciplines (unlike most technologies that quickly become redundant). Our motivation has always been the enhancement of human science and wellbeing through developing and investigating safe, effective and drug free rehabilitation.

3 Twelve years on (2012), those who were skeptical of shock wave therapy even those who were opponents to this treatment modality, now realize that this is actually the best and safest treatment option for many chronic sporting injuries and syndromes, and some have decided to provide this therapy. However; they are not using the same technology as us. Some provider are using radial-wave devices and calling it shockwave therapy. This is because the radial wave devices are a cheaper alternative. To set the record straight, we have both the electro-hydraulic and radial-wave devices. This is simply because we are truly the shockwave centre of excellence in New Zealand and felt that we needed to have the completed range of shockwave devices in order to provide unbiased and appropriate therapy. Our case series using shockwave therapy for chronic musculoskeletal injuries have exceeded over 1500 cases with a success rate of over 85%. We have no doubts as to the effectiveness of this treatment for sports and occupation injuries. Most of us who are the pioneers of this treatment have now moved onto other areas of ground breaking research such as in; neurology, vascular disease, complex pain syndromes and developmental research. Our Research We were the first in the world to use shock wave therapy to reverse nerve insensitivity in a diabetic foot (Craig et al, 2012), and are pioneers in the use of shock waves in non-cancer pain syndromes of the extremity (Craig & Walker, 2012). We continue to develop and expand frontiers in rehabilitative medicine using shock waves and have been successful in utilizing shockwaves for muscle dystonia and spasticity in Cerebral Palsy (CP) and Charcot-Marie-Tooth (CMT) Disease patients, once again leading and pioneering use of shock wave therapy. We are presently in the process of presenting a hypothesis with European investigators on the reversal of Type 1 diabetes mellitus and are developing a treatment protocol to reverse this disorder, and reduce or eliminate insulin dependence using shockwaves (Craig, D Agostino, Poratt & Walker, Pending Publication). Finally for any treatment to be effective, the correct philosophy and technology must be selected and operated by an experienced and caring professional. We wish you health & wellbeing always.

4 Images of Electro-hydraulic Shockwave Devices: Images of Radial Pulse / Wave Devices:

5 Reference Amelio, E. & Manganotti, P. (2010). EFFECT OF SHOCK WAVE STIMULATION ON HYPERTONIC PLANTAR FLEXOR MUSCLE IN PATIENTS WITH CEREBRAL PALSY: A PLACEBO-CONTROLLED STUDY. Journal of Rehabilitative Medicine 42(4) Angehrn, F., Kuhn, C., Sonnabend, O. & Voss, A. (2008). Impact of extracorporeal shock waves on the human skin with cellulite: A case study of an unique instance. Clinical Interventions in Ageing, 3(1) Cacchio, A., Giordano, L., Colafarina, O., Rompe, J. D., Tavernese, E., Ioppolo, F., Flamini, S., Spacca, G. & Santilli, V. (2009). Extracorporeal Shock-Wave Therapy Compared with Surgery for Hypertonic Long-Bone Nonunions. The Journal of Bone and Joint Surgery, Chandreanu, C. D., Spinu, A. & Andone, I. (2011). Extracorporeal Shock Wave Therapy A new wave (also) in Physiatry? Practica Medicala, 1(21), Craig, K., D Agostino, C., Poratt, D., Lewis, G. & Hing, W. (2012). Original Exploratory Case Study: Utilization of ESWT to Restore Peripheral Vibrosensory Perception in a non- Sensitive Type I Diabetic Foot. Paper Presented at the 15 th International Society for Medical Shockwave Treatment Congress, Cartagena, Columbia. Craig, K. & Miller, A. (2011). Extracorporeal shockwave therapy (ESWT) an option for chronic tendinopathy management: a clinical perspective. New Zealand Pain Society Publication, Summer Issue, Craig, K. & Walker, M. (2012). Medical Shockwaves for the treatment of peripheral neuropathic pain in a Type II diabetic: a case report. New Zealand Pain Society Publication, Winter Issue, D Agostino, C. Romeo, P., Amelio, E. & Sansone, V. (2011). Effectiveness Of ESWT In The Treatment Of Kienbock s Disease. Ultrasound in Medicine and Biology, 37(9), Furia, J. P. (2006). High-Energy Extracorporeal Shock Wave Therapy as a Treatment for Insertional Achilles tendinopathy. The American Journal of Sports Medicine 34(5) Furia, J. P. (2008). Jigh Energy Extracorporeal Shock Wave Therapy as a Treatment for Chronic Non-insertional Achilles Tendinopathy. The American Journal of Sports Medicine 36(3)

6 Gerdesmeyer L, Eiff C, Horn C, et al. (2005). ANTIBACTERIAL EFFECTS OF EXTRACORPOREAL SHOCK WAVES. Ultrasound in Med. & Biol. 2005; Vol. 31(1), Moretti, B., Notarnicola, A., Maggio, G., Moretti, L., Pascone, M., Tafuri, S & Patella, V. (2009). The management of neuropathic ulcers of the foot in diabetes by shock wave therapy. BMC Musculoskeletal Disorders 10 (54). Retrieved May 20, 2009 from Moretti, B., Notarnicola, A., Maggio, G., Moretti, L., Pascone, M., Tafuri, S & Patella, V. (2009). A volleyball player with bilateral knee osteochondritis dissecans treated with extracorporeal shock wave therapy. Musculoskeletal Surgery 93(1) Notarnicola, A., Moretti, L., Tafuri, S., Panella, A., Filipponi, M., Casalino, A., Panella, M. & Moretti, B. (2010). Shockwave therapy in the management of complex regional pain syndrome in medial femoral condyle of the knee. Ultrasound in Medicine & Biology, 36 (6) Ogden, J. A., Alvarez, R. G., Levitt, R. L., Johnson, J. E. & Marlow, M. E. (2004). Electrohydraulic High-Energy Shock-Wave Treatment for Chronic Plantar Fasciitis. Journal of Bone and Joint Surgery 86-A (10) Romeo, P. D Agostino, C. M., Lazzerini, A., Sasone, V. C. (2011). Extracorporeal Shockwave Therapy inpillar Pain after Carpal Tunnel Release: A Preliminary Study. Ultrasound in Medicien and Biology, 37(10), Saginni, R., Figus, A., Troccola, A., Cocco, V., Saggini, A. & Scuderi, N. (2008). EXTRACORPOREAL SHOCK WAVE THERAPY FOR MANAGEMENT OF CHRONIC ULCERS IN THE LOWER EXTREMITIES. Ultrasound in Medicine & Biology, 34(8), Schaden, W., Thiele, R., Kölpl, C., Pusch, M., Nissan, A., Attinger, C. E., Maniscalo-Theberge, M. E., Peoples, G. E., Elster, E. A. & Stojadinovic, A. (2007). Shock Wave Therapy for Acute and Chronic Soft Tissue Wounds: A Feasibility Study, 143 (1) Taki, M., Iwata, O., Shiono, M., Kimura, M. & Takagishi, K. (2007). Extracorporeal Shock Wave Therapy for Resistant Stress Fracture in Athletes. The American Journal of Sports Medicine, 35 (7) Tizanni, E., Amelio, E., Marangoni, E., Guerra, C., Puccetti, A., Codella, O. M., Simeoni, S., Cavalieri, E., Montagnana, M., Adani, R., Corrocher, R. & Lunardi, C. (2010). Effects of shock wave therapy in the skin of patients with progressive systemic sclerosis: a pilot study. Rheumatology International, 12. Retrieved January 28, 2010 from df

7 Trompetto, C., Avanzino, L., Bove, M., Marinelli, L., Molfetta, L., Trentini, R. & Abbruzzese, G. (2009). External shock waves therapy in dystonia: preliminary results. European Journal of Neurology, 16 (4) Vasyuk, Y. A., Hadzegova, A. B., Shkolnik, E. L., Kopeleva, M. V., Krikunova, O. V., Iouchtchouk, E. N., Aronova, E. M. & Ivanova, S. V. (2010). Initial Clinical Experience With Extracorporeal Shock Wave Therapy in Treatment of Ischemic Heart Failure. Original Research. Retrieved September 9, 2010 from Wang, C. J., Ko, J. Y., Chan, Y. S., Weng, L. H., Hsu, S. L. (2007). Extracorporeal Shockwave for Chronic Patellar Tendinopathy. The American Journal of Sports Medicine, 35(6) Wang, C. J., Kuo, Y. R., Wu, R. W., Liu, R. T., Hsu, C. S., Wang, F. S. & Yang, K. D. (2008). Extracorporeal Shockwave Treatment for Chronic Diabetic Foot Ulcers. Journal of Surgical Research, 152 (1), Weil, L. S. Jr., Roukis, T. S., Weil, L. S. Sr., & Borelli A. H. (2002). Extracorporeal Shock Wave Therapy for the Treatment of Chronic Plantar Fasciitis: Indications, Protocol, Intermediate Results, and a Comparisonof Results to Fasciotomy. Journal of Foot and Ankle Surgery 41(3) Yardi, Y., Appel, B., Jacob, G., Massarwi, O. & Gruenwald, I. (2010). Can low-intensity Extracorporeal Shockwave Therapy Improve Erectile Function? A 6-Month Follow-up Pilot Study in Patients with Organic Erectile Dysfunction. European Urology, 58: Zelle, B. A., Gollwitzer, H., Zlowodski, M. & Buhren, V. (2010). Extracorporeal Shock Wave Therapy: Current Evidence. Journal of Orthopaedic Trauma 24(3)S