International, English Follow us on: Products About us News Events Contact NewsAnalgesic Effects of FSWT in Common Orthopedic Diagnoses SHORT-TERM ANALGESIC EFFECTS OF FOCUSED SHOCKWAVE THERAPY IN COMMON ORTHOPEDIC DIAGNOSES August 10th, 2021 Neckař P*, Kadrmasová Z, Klementová R, Centrum sportovní ortopedie a medicína, U Radnice 736/4, 41501 Teplice, Czech republic. Background: Common orthopedic diagnoses are considered to be the cause of pain for a great number of patients. Current options for pain management include medication, injection or surgery. Recently, Focused Shockwave Therapy (FSWT) has gained popularity due to its clinical efficacy and non-invasive application. Objective: The aim of this study was to evaluate the short-term efficacy of FSWT in pain management of patients diagnosed with epicondylitis, rotator cuff syndrome, plantar fasciitis, patellar tendinopathy and Achilles tendinosis. Methods: Patients underwent 3,5 ± 0,4 treatment sessions on average, depending on their state of health. All patients were treated with a FSWT device BTL-6000 FSWT and their perception of pain was evaluated prior to the beginning of treatment (baseline) and after the last treatment using the Visual Analogue Scale (VAS). Results: A significant (p<0.01) difference was found between VAS baseline and VAS after the last treatment in all diagnoses. The most significant pain reduction according to the VAS score was found in the group of patients with Achilles’ tendinosis (60.9%), followed by the patellar tendinopathy (57.8%) group. Conclusion: FSWT was found to be an effective modality in immediate pain reduction in patients with epicondylitis, rotator cuff syndrome, plantar fasciitis, patellar tendinopathy and Achilles’ tendinosis. FSWT uses the technology of extracorporeal shockwave which was introduced in 1980, when high-energy extracorporeal shockwaves served as a means of treating kidney stones. Gradually, the principle of regenerative effects was discovered and shockwave therapy was introduced in the field of orthopedics. Since then, ESWT has become the preferred choice in the treatment of many orthopedic disorders including plantar fasciitis of the heel, epicondylitis of the elbow, or tendinitis of the shoulder. This therapy has also proven to be useful in the treatment of nonunion of long bone fractures. Prospective studies using ESWT on patellar and Achilles’ tendinopathies indicate good results as well. Rare studies done by Asian authors also show positive results in the treatment of avascular necrosis of the femoral head. A shockwave is defined as an acoustic wave that produces a short (microsecond duration) three-dimensional pressure pulse. There are two modalities for shockwave therapy: focused (convergence) and radial (divergence). In FSWT, the source of energy is either electrohydraulic, electromagnetic, or piezoelectric and shockwaves are concentrated into small focal areas at selected depths in the body tissues to ensure the optimal therapeutic effect. On the other hand, in Radial Shock Wave Therapy (RSWT), the focal point is not centered on the target zone, as in the case of FSWT. Instead, shockwave is generated through the acceleration of a projectile inside the handpiece of the treatment device and thus the focal point is on the tip of the applicator. The pressure wave then penetrates the body radially and can not be focused in the deeper layers, the area of treatment is more superficial. Therapeutic effects are considered to be dependent on the energy delivered to a focal area (the energy flux density), the focal zone size, and on tissue penetration. Although the subject is still under study, it is known that ESWT stimulates the local biological response and is able to relieve pain, as well as positively regulate inflammation. Moreover, shockwaves improve tissue regeneration and healing by neoangiogenesis and stem cells activities. ESWT can be presented as an alternative to chirurgic therapy in some chronic tendinopathies and healing disorders. Its advantages are safety and non-invasivity. In the time of the Covid pandemic, the use of ESWT is coming to the fore even more. RESULTS A total of 149 patients received up to 6 treatments (3,5 ± 0,4 on average), depending on their diagnosis and state of health. Results will be presented for each diagnosis separately. A significant (p<0,01) difference was found between VAS baseline and VAS after the last treatment in all diagnoses. Epicondylitis For the patients diagnosed with epicondylitis, the VAS baseline results were 6.6 ± 1.3. From the baseline, VAS decreased to 4.5 ± 1.8. The difference of 2.1 ± 1.7 represents 31.9% reduction in pain. For 30 patients, data including the final intensity of 29.5 ± 7.1 were available. Rotator cuff syndrome In patients with rotator cuff syndrome, the perception of pain reduced from 6.4 ± 1.3 to 3.8 ± 1.6. The decrease corresponds with 41.5% (2.7 ± 1.6). The final intensity data of 38.0 ± 5.7 were obtained for 36 patients. Plantar fasciitis The VAS baseline for the group of patients with plantar fasciitis was 6.7 ± 1.7 and after the last therapy, the obtained VAS results were 3.7 ± 1.7. The difference between both VAS values is 44.8% (3.0 ± 1.8). For 39 patients of this group, there were available data about the final intensity of 34.6 ± 6.4. Patellar tendinopathy In the patellar tendinopathy group, VAS baseline results were 7.3 ± 1.0. A difference of 57.8% (4.2 ± 2.0) was found between VAS baseline and VAS after the last treatment. From baseline, VAS was reduced to 3.1 ± 1.5. The final intensity data were taken for 3 patients (38.7 ± 10.1). Tendinosis of Achilles tendon In patients diagnosed with Achilles’ tendinosis, the pain evaluation decreased from 5.8 ± 1.8 to 2.3 ± 1.6. The difference between VAS results represents 60.9% (3.5 ± 1.7) reduction in pain perception. For 10 patients, the final intensity data of 35.9 ± 6.7 were included. CONCLUSION FSWT is an effective modality in the treatment of patients diagnosed with epicondylitis, rotator cuff syndrome, plantar fasciitis, patellar tendinopathy and Achilles’ tendinosis based on its analgesic properties. The results of the present study proving short-term effects on pain reduction are encouraging but other studies with larger samples or comparisons with other conservative interventions should be implemented, to better understand the effects of FSWT and to unify optimal treatment parameters. For these reasons, continued research in this area is therefore of great importance. Read the entire study here: Analgesic Effects of FSWT in Common Orthopedic Diagnoses. Please be aware that some of the information / intended uses / configurations / accessories mentioned here are not available in your country. For more information contact your local distributor. ABOUT US Founded in 1993, BTL has grown to become one of the world’s major manufacturers of medical equipment. BTL's major segments include physical therapy, cardiology and medical aesthetics. Learn more Follow us on: PRODUCTS Physiotherapy Cardiology & Spirometry Aesthetic medicine Respirators #BTLcares MENU About company Careers Send us your CV Worldwide offices News Contact form Request user manual OUR WEBSITES www.btlaesthetics.com www.shockwavetherapy.eu www.tr-therapy.com www.high-intensity-laser.com www.super-inductive-system.com © 2021, BTL. 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