ΕλληνικάMethod Swiss Dolorclast
Principles Of Shockwave Generation
Shockwaves are mechanical pressure pulses that propagate in a medium, e.g. a gas or liquid. (Over-) pressure can build up at their wavefront within very short rise times. This is followed by an underpressure phase with tensile stresses. The shockwaves used in medical technology to date are short pressure pulses generated in water.
There are various methods of generating shockwaves.
The course of a shockwave generated by the EMS Swiss DolorClast is shown below by way of an example.
Shockwaves can be made visible by what are known as Schlieren photographs. Shown below using a shockwave generated by the Swiss DolorClast.
Theories On The Working Mechanism Of Eswt
Why does the application of shock waves lead to a long-term, pain-alleviating effect on chronic pain?
It may be supposed that shock waves:
- change the chemical environment in such a manner that pain-inhibiting substances are produced
- destroy the cell membranes wiping out the transmission potential of the pain receptor where pain signals are generated
- stimulate the pain receptor causing it to emit a high frequency of nerve impulses. The retrocession of these pain impulses which are entirely dependent on external stimulation is thus inhibited (the so-called "Gate Control Theory").
- cause the release of endorphins which in turn leads to a reduction in (local) sensitivity to pain
All these theories are at present undergoing clinical investigation. Up till now neither experimental nor clinical studies have contributed to supporting the truth of these hy¬potheses. Potentially it could be the symbiosis of several mechanisms which lead to a long-term, pain-alleviating effect.
The results obtained so far are however convincing: the success ratio was 70% (taking into consideration the ratings - far better, satisfying, good and very good results) whereby the rate of success was defined as functional im¬provement and / or pain-alleviation.
Effects Of Eswt On Tissue
- Metabolism is increased at the application site
- Irritating calcium deposits in and around tendons are resorbed
- Inflammatory activity and its consequences are reduced
- Tenderness is reduced
- Mechanical loading is increased
A measure of the effect of shockwaves on tissue is what is known as the energy flow density. This means the amount of energy that flows through a defined area (mJ/mm²).The ability of cells to regenerate after shockwave treatment, known as the cell repair potential, decreases as the energy flow density increases.
If the energy is set too high, the cell nucleus is destroyed. In Osteotherapy, in order to achieve an osteoneogenetic effect, the shockwaves have to be strong enough to destroy bone structures. In pain therapy on the other hand the destruction of tissue is an undesired side-effect.
The energy flow density should be differenciated according to the given application:
Indications Of Eswt
- Rotator cuff tendinopathy with and without calcification (shoulder pain)
- Lateral and medial Epicondylopathy
- Plantar fasciitis
- Shin splints
- Patella tendinopathy
- Achilles tendinopathy
- Pseudo-arthrosis
- Iliotibial band friction syndrom
- Treatment of delayed bone fracture healing
- Pain caused by myogeloses (trigger points)
The Range of Indications
The range of indications for the Swiss DolorClast covers the whole spectrum of pain therapy. Besides muscular pain caused by myogeloses (trigger points), the following indications are also part of the treatment spectrum:
Other indications
The list of potential applications for ESWT with the Swiss DolorClast is being continu¬ously extended and demonstrated by clinical studies. The following indications have currently been clinically investigated:
- Plastic induration of the penis (PIP)
- Adductor muscle insertion
- Dupuytren's contracture
Example: Treatment Of Tennis Elbow
- The treatment area is located by palpation.
- After being located, the skin over the treatment area is marked.
- Any local anaesthesia required is administered subcutaneously. The injection site should not lie in the immediate treatment area.
- The contact is improved by using EMS Swiss DolorClast contact gel.
- The tip of the applicator is passed over the treatment area, using either single or continuous pulse mode and applying light pressure.
Recent Announcements
Friday, 30 Jul 2010
2ND Congress European College of Sport & Exercise Physicians 12TH Annual Scientific Conference in SEM QMUL CSEM
Recent Articles
Acute Lateral Ankle Sprains In Track & Field Athletes: A Proposal Of An Expanded Classification
We present a longitudinal observational study on classification of acute lateral ankle ligament injuries in track & field athletes, based on objective criteria. These very common and sometimes troublesome sports injuries are treated functionally but there is a lack in international literature in predicting the time needed for full recovery.
Ten year follow-up study comparing conservative versus operative treatment of anterior cruciate ligament ruptures. A matched-pair analysis of high level athletes
Objective: To compare long term outcome of highly active patients with anterior cruciate ligament ruptures treated operatively versus non-operatively.
Design: We reviewed high level athletes with an anterior cruciate ligament rupture on either MRI or arthroscopic evaluation more than 10 years previously, who were treated conservatively. They were pair-matched with patients who had had an anterior cruciate ligament reconstruction with bone-patella-tendon-bone, with respect to age, gender and Tegner activity score before injury.Participants: In total 50 patients were pair-matched.
Results: We found no statistical difference between the patients treated conservatively or operatively with respect to osteoarthritis or meniscal lesions of the knee, as well as activity level, objective and subjective functional outcome. The patients who were treated operatively had a significantly better stability of the knee at examination.
Conclusion: We conclude that the instability repair using
a bone-patella-tendon-bone anterior cruciate ligament reconstruction is a good knee stabilising operation. Both treatment options however show similar patient outcome at 10 year follow up.
ACL injuries. Diagnosis, treatment and rehabilitation
The ability to recognize the ACL deficient knee is lacking, even among orthopaedic surgeons. The history of an acute ACL tear is remarkably constant, because the injury is often non contact, and patients usually report a twist on the flexed knee, turning to the same side as the injured knee, although hyperextension or direct injury is the cause in some sports. Patients often remember a loud pop, but, because there are no nociceptors in the ACL, pain is not an immediate feature in the isolated lesion. Players may attempt to continue to play, but they usually stop because the knee feels insecure. Pain ensues in association with a hemarthrosis: 70% of acute hemarthroses of the knee are associated with a tear of the ACL. The diagnosis must be confirmed before treatment is offered.
