A) The short term outcome of extracorporeal shockwave therapy for the treatment of various soft tissue injuries seen in private practice: a descriptive study.

Introduction

  • The purpose of this piece is to evaluate the effect of the PowerShocker LGT -2500A Extracorporeal Shock Wave Therapy (ECSWT) on various soft tissue injuries. The use of ECSWT is becoming widely used within the sporting community and more so in the Physiotherapy Community.

Shockwaves are defined as “acoustic waves with high energy, high amplitude wave and non-periodicity.” They are similar to the type of wave left after a sonic boom or lightning strike left in the atmosphere. There use has been documented since the early 1980s where ECSWT was used to treat Kidney Stones 1. Currently, it is used private practice to treat various soft tissue injuries.

Some of the medical effects of ECSWT are Neovascularization of Damaged tissue, causing micro-rupturing of Capillaries which stimulates growth indicators. This leads to the formation of new blood vessels 2. The physiological effects of ECSWT are well known.

Aim

  • The aim of the 3 month trial was to determine the short-term effect of ECSWT on pain perception using the visual analogue scale (VAS) and function in patients who presented with soft tissue injuries to the Sports Science Physiotherapy Centre.

Objectives

  1. To determine the short-term effect of ECSWT on Pain perception of patients who presented with various injuries at the Sports Science Physiotherapy Centre over a period of 3 months, utilising the Visual Analogue Scale
  2. To determine the short-term effect of ECSWT on function in patients who presented with various injuries at the Sports Science Physiotherapy Centre over a period of 3 months, utilising various private practice Functional Outcomes measures.

Methods

21 Patients gave their consent to use their information in the 3 month trial period. A Visual Analogue Score (VAS) was used to determine the effect of ECSWT on pain perception. Various functional outcome measures were used to measure functinality. These tests included : Knee-to-wall, Single-leg calf raise, Thomas test, Running distance and shoulder external rotation strength which are used in private practice. All tests were graded 1-4. Injuries of participants ranged from: Achilles tendinopathy, Plantar Fasciitis, Tibialis Posterior Tendinopathy, ITB Syndrome, Patellar Tendinopathy, Hamstring Tendinosis, Biceps Tendinopathy, Medial Tibial Stress Syndrome, Adductor Tendinopathy, Calcific Tendinitis of the Rotator Cuff tendon, Lateral Epicondylitis and Chronic Anterior Knee pain.

Methodology

Patients presented to the Sports Science Physiotherapy Centre (SSPC) with various injuries. They were assessed by a physiotherapist and diagnosed with an injury, after which they were treated and then referred for ECSWT. Only one Physiotherapist administered the ECSWT to the 21 participants. Patients had the procedure explained to them and had an opportunity to ask questions and enquire about more information prior to treatment. Immediately post-treatment, Functional testing was done. Pain perception was done at the commencement of ECSWT (first session) and then at 2 week intervals. Patients were treated according to standard ECSWT protocol for individual injuries devised at SSPC. Treatment prescriptions were indicated for 2,3 weeks or 5 weeks.

Results

At initial treatment, average pain perception was 5,3/10. Pain perception at week 3 averaged 3/10 and at week 5, average was 2/10. Functional scores, according to grading, at initial treatment was 2.3 out of a possible 4 grades. At week 3, functional scores averaged 3.1 out of 4 possible grades. At week 5, functional scores averaged 4 out of a possible 4 grades. Two subjects dropped out of the trial. 21 participants began ECSWT and 19 completed the trial, average treatment time was 3.4 weeks, with the shortest treatment time of 2 weeks and longest being 6 weeks.

Summary

In summary, Participants improved on average 1 point per week on the Visual Analogue Scale for pain perception. The funtionality improved by 1 grade every 2 weeks as measured by  the various functional tests. From the above information. From the trial, ECSWT can be seen to have a reduced the VAS scores and increased the Functional Test Grades.

References

  • 1. Eisenberger F, Fuchs G, Miller K, Bub P, Rassweiler J.Extracorporeal shock wave lithotripsy (ESWL) and endourology: an ideal combination for the treatment of kidney stones. World Journal of Urology,1985;3(1);41-47.
  • 2. van Leeuwen MT, Zwerver J, van der Akker-Scheek I. Extracorporeal shock wave therapy for patellar tendinopathy: a review of the literature. Br J of Sports Med, 2009; 43:163-168.

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