Shockwave Therapy & Cold Laser for Rapid Musculoskeletal Pain Relief

Symptoms of golfer’s elbow include:

• Pain on the inner side of the forearm (the wrist and elbow)
• Weakness in wrists
• Stiffness of the wrists
• Tenderness in the inner elbow

Activities that can cause pain with golfer’s elbow include:

• Overload by repeated forceful wrist and finger movements that leads to microtrauma to the muscles and tendon
• Weightlifting
• Javelin throwing/Jet skiing /windsurfing
• Swing a golf club or racket
• Squeeze or pitch a ball
• Shake hands
• Turn a doorknob
• Pick up something with your palm down
• Flex your wrist toward your forearm

Evaluation can be done by palpation, nerve and muscle tests, Real Time Ultrasound and Handheld Dynamometer. All standard care at EastWest Physiotherapy.

Symptoms

Include pain and weakness in the outer forearm with movements like

• Lifting an object /racquet
• Writing or holding a cup
• Turning the wrist while opening the car door or opening a jar
• Pain or stiffness when you stretch your hand

Causes

Tendons become irritated when there is a sudden increase in load, by doing something outside the tendon capacity. Major cause is the overuse of the forearm, be it in a sport or one’s profession. Micro tears occur in the tendon which lead to inflammation and pain.

Activities such as:

• Sports such as tennis, badminton, squash or throwing discus
• Using paint brush while painting the walls, carpentry activities
• Typing and writing
• Wear and tear due to age

Evaluation can be done by palpation, nerve and muscle tests, Real Time Ultrasound and Handheld Dynamometer. All standard care at EastWest physio.

The shoulder is the fourth most common site of musculoskeletal pain reported by patients to general practitioners and physiotherapists. Rotator cuff, impingement syndrome, and rotator cuff tendinosis are terms used synonymously with shoulder pain.

There are many possible causes of pain in the shoulder. The following list outlines some of the common presentations to physio. When you are assessed at EastWest physio we need to diagnose why you are in pain.

• Tendonitis (including calcific tendonitis)
• Bursitis
• Arthritis
• Instability/dislocation
• Impingement
• Tendon tears
• Neuropathy
• Referred pain from neck or thoracic spine
• Medical Red flags (tumor etc.)

Your therapist will examine your shoulder and determine if shockwave is appropriate for your condition. If diagnosis is unclear, we may require some further medical investigation or scans. Shockwave is usually an adjunct to a strengthening and mobility program which will be prescribed depending on your diagnosis and time frame.

In examining the current research on shockwave therapy for the shoulder the results conclude conflicting evidence. Some good studies have reported beneficial effects in cases of calcareous tendinopathy. We recommend the use of Shockwave as an adjunct to regular physiotherapy, particularly in chronic conditions. (See Research for articles on Shockwave effectiveness)

Chronic pain arising from joints and muscles in the spine

Chronic muscle pain syndrome is one of the main causes of musculoskeletal pathologies requiring treatment. Many terms have been used in the past to describe painful muscular syndromes affecting the Spinal skeletal muscles Terms such as:

• Muscle hardening,
• Myalgia
• Muscular rheumatism
• Fibrositis
• Myofascial Pain
• Trigger Points

Pain of this nature, if it persists over six months or more, often becomes therapy resistant and frequently results in chronic generalized pain. We will term this as Myofascial pain syndrome. Myofascial pain syndrome (MPS) is defined as a series of sensory, motor, and autonomic symptoms caused by a stiffness of the muscle, caused by hyperirritable nodules in musculoskeletal fibres, known as myofascial trigger points (MTP), and fascial constrictions. There is good evidence suggesting Shockwave is a good treatment for persistent muscular pain conditions (See Research Page: Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia)

Shockwave has an effect on the joints in the spine (Facet Joints). The application of Shockwave directly over the dysfunctional joint has been shown to be more effective than injections. (See Research page : Mechano-transduction effect of shockwaves in the treatment of lumbar facet joint pain: Comparative effectiveness evaluation)

At EastWest Physiotherapy, you will be examined to diagnose if your back pain is likely to improve with shockwave. Adjunct therapies may include exercise prescription, manual therapy, acupuncture etc.

Gluteus Medius / Minimus Tendinopathy

Tendinopathy of the Gluteus Medius and Gluteus minimus tendons is now recognized as a primary local source of lateral hip pain. The condition mostly occurs in mid-life both in athletes and in subjects who do not regularly exercise. Females are afflicted more than males. Symptoms occur after common weight bearing tasks such as walking, climbing stairs, sleeping on side, and sitting in low chairs. The combination of excessive compression and high tensile loads within tendons are thought to be most damaging. Diagnosis is based on gait assessment, muscle strength and compression tests. Management of this condition commonly involves corticosteroid injection, exercise, or shock wave therapy, with surgery reserved for recalcitrant cases. The current evidence base suggests Shockwaves as an excellent adjunct to an exercise /tissue loading program. (1) It is important to understand why(diagnosis) you may have lateral hip pain as some common home remedies such as foam rolling may be aggravating.

(1)Shock wave therapy is an effective treatment for greater trochanteric pain syndrome.  1. Furia JP, Rompe JD, Maffulli N. Low-Energy Extracorporeal Shock Wave Therapy as a Treatment for Greater Trochanteric Pain Syndrome. The American Journal of Sports Medicine. 2009;37(9

Trochanteric Pain syndrome/Bursitis Tendinopathy

Greater trochanteric pain syndrome (GTPS) refers to a clinical condition with pain and tenderness at or around greater trochanter, which can radiate to the lateral aspect of the hip or thigh. Classically, GTPS has been attributed to the trochanteric bursitis, but more recent studies suggest that this condition involves degeneration, and/or tearing of the gluteal tendons. Magnetic resonance imaging (MRI) is useful to demonstrate the pathology in and around greater trochanter or gluteal tendon as well as exclude other causes of lateral hip pain . Management of this cindition is dependant on diagnosis of the severity of the tissue degeneration . Typically Bursiitis has been managed with steroid injections and rest. A more progressive (and evidence based approach)  is to stimulate tissue repair with Shiockwaves and and implement an  appropriate tissue loading program. Standard care at EastWest Physio.

(1)Shock wave therapy is an effective treatment for greater trochanteric pain syndrome.  1. Furia JP, Rompe JD, Maffulli N. Low-Energy Extracorporeal Shock Wave Therapy as a Treatment for Greater Trochanteric Pain Syndrome. The American Journal of Sports Medicine. 2009

Patients/athletes who complain of deep buttock pain, pain when sitting, or deep, posterior, upper thigh pain may be suffering from high (proximal) hamstring tendon injury.

Chronic high hamstring tendinopathy is becoming increasing recognized as a causative factor in both sitting and activity-related posterior hip pain. Unlike an acute tear, the pain usually comes on gradually and may be aggravated by repetitive activities, such as running or biking, and worsened by prolonged sitting.

Hamstring tendon pain can become chronic when a damaged tendon fails to heal properly. It usually begins with one or more of the following conditions:

• A previous tear of the tendon (an acute injury) that failed to properly heal.
• Chronic tendinitis, an inflammatory tendon condition that can lead to non-inflammatory, degenerative changes to the structure or composition of the tendon (called tendinosis or chronic tendinopathy).

Hamstring tendinopathy can potentially cause significant pain and long-term disability. This pain and disability may be avoided by recognizing symptoms, seeking an accurate diagnosis and getting prompt treatment.

Shockwave therapy is a safe and effective treatment for patients with chronic proximal hamstring tendinopathy .As with all tendinopathy cases an appropriate loading program is highly recommended and will be prescribed in conjunction with shockwave therapy.

1. Cacchio A, Rompe JD, Furia JP, Susi P, Santilli V, De Paulis F. Shockwave Therapy for the Treatment of Chronic Proximal Hamstring Tendinopathy in Professional Athletes. The American Journal of Sports Medicine. 2011

The Achilles tendon – where Achilles’ tendon disorders occur – is the band of tissue that runs down the back of the lower leg, connecting the calf muscle to the heel bone. Also called the heel cord.

Causes of Achilles Tendon Disorders

Achilles tendonitis and tendonosis are usually caused by a sudden increase of a repetitive activity involving the Achilles tendon. Common examples are running and jumping activities.Such activity puts too much stress on the tendon too quickly, leading to micro-injury of the tendon fibers. Due to  ongoing load stress on the tendon, the body is unable to repair the injured tissue. The structure of the tendon is then altered, resulting in continued pain.

The gold standard for tendon treatment is a loading program specific to the phase of healing your tendon is in. Clinical trials have shown a combination of shockwave and exercise is significantly more effective in pain and function .(1)

1. Rompe JD, Furia J, Maffulli N. Eccentric Loading versus Eccentric Loading plus Shock-Wave Treatment for Midportion Achilles Tendinopathy: A Randomized Controlled Trial. The American Journal of Sports Medicine. 2009;37(3)

The plantar fascia is a piece of strong and thick tissue that runs along the bottom of the foot. It connects the heel bone to the toes, creating the foot’s main arch. Syndromes of pain in the plantar fascia have been called plantar fasciitis; however, because there is usually no inflammation, plantar fasciosis is more correct.  Plantar fasciosis may involve acute or chronic stretching, tearing, and degeneration of the fascia at its attachment site.

Plantar fasciosis can be caused by:

•     playing sports that put stress on the foot, like running and hiking.
•     pronated / flat-footed or high arches
•     being overweight (high BMI)
•     pregnancy
•     spending a lot of time on your feet
•     wearing shoes with poor arch support or stiff soles
•     mortons foot

The main symptom of plantar fasciitis/fasciosis is pain under the heel, which can be dull or sharp. The medial arch may ache or burn and your heel may be slightly swollen.

The pain is often worse:

•    in the morning, as you take your first steps
•    after prolonged standing or sitting
•    after intense activity

Treatment should include a combination of the following :

•    specific loading and mobility exercises
•   strapping
•   cold laser/acupuncture
•    shoes with good support and cushioning
•   moderate reduction in activity
•    custom orthotics

If these measures don’t work and you have had the pain for over three months Shockwave therapy is highly recommended and clinical trials have shown it to be very effective.(1)

1. Theodore GH, Buch M, Amendola A, Bachmann C, Fleming LL, Zingas C. Extracorporeal Shock Wave Therapy for the Treatment of Plantar Fasciitis. Foot & Ankle International. 2004.

Chronic muscle pain  is one of the main causes of musculoskeletal pathologies requiring treatment. Many terms have been used to describe painful muscular syndromes affecting the Spinal skeletal muscles Terms such as:

• Muscle hardening,
• Myalgia
• Muscular rheumatism
• Fibrositis
• Myofascial Pain
• Trigger Points

Pain of this nature, if it persists over six months or more, often becomes therapy resistant and frequently results in chronic generalized pain. We will term this as Myofascial pain syndrome. Myofascial pain syndrome (MPS) is defined as a series of sensory, motor, and autonomic symptoms caused by a stiffness of the muscle, caused by hyperirritable nodules in musculoskeletal fibres, known as myofascial trigger points (MTP), and fascial constrictions.

There is good evidence suggesting Shockwave is a good treatment for persistent muscular pain conditions (See Research Page: Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia)

At EastWest physio, you will be examined to diagnose if your  pain is likely to improve with shockwave. Adjunct therapies may include exercise prescription, manual therapy, acupuncture etc.

A Trigger Point  is a hyperirritable spot, a palpable nodule in the taut bands of the skeletal muscles’ fascia. Direct compression or muscle contraction can elicit jump sign, local tenderness, local twitch response and referred pain which usually responds with a pain pattern distant from the spot. It is sometimes difficult to determine if pain is coming from compressed nerves at the spinal level (commonly diagnsed) or local muscular issues . Often refered pain patterns are from trigger points. At EastWest Physio you will be examined to ascertain the likely cause of your pain.

If the pain is from muscle then Shockwave willl likely be a very effective treatment. Other treatments used as an adjunct may include Myofascial release, acupuncture  and exercise. There is good evidence suggesting Shockwave is a good treatment for persistent muscular pain conditions. See Research Page: Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia.

Arthritis is a broad and complex topic with many types, subtypes, and variations. It is defined as an acute or chronic joint inflammation that often co-exists with pain and structural damage. Arthritis describes a set of symptoms that includes pain, stiffness, and joint deformities subsequent to an inflammatory process. Physiotherapy and Arthritis care typically involves some hands on treatment (manual therapy and mobilisation) and low impact exercises. The use of shockwave is relativly new in this sphere but there is evidence of Shockwaves having positive outcomes with knee osteo arthritis.

This study provides results that suggest that using ESWT for treatment
of knee OA has a beneficial effect on pain relief and physical function for up to 12 months.

Efficacy and Safety of Extracorporeal Shockwave Therapy for Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis
Ying-Chun Wang, MD, Hsuan-Ti Huang, MD, Peng-Ju Huang, MD,Zi-Miao Liu, PhD, and Chia-Lung Shih, PhD