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Extracorporeal Shock Wave Therapy

Discussion in 'General Issues and Discussion Forum' started by Dieter Fellner, Oct 20, 2004.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: A North American confirmatory study.

    J Orthop Res. 2005 Nov 18;24(2):115-123
     
  2. eddavisdpm

    eddavisdpm Active Member

    Last edited by a moderator: Jan 27, 2006
  3. DrPod

    DrPod Active Member

    Which is realy easy to dismiss as it was uncontrolled. JAPMA also did a nose dive in credibility over this article by not printing a disclaimer such as one of the authors having a "proprietary and commercial interests" in ESWT !!! Another article in that edition of JAPMA on a different commercial product did disclose the authors commercial interests in a disclaimer.

    I am with something Craig said earlier in the thread about the lengths that supporters of ESWT will go to when it comes to discrediting studies that do not support ESWT, yet are not prepared to put the studies that do support it under the same methodological scrutiny.

    I have no vested interest either way (I do not own a machine or have shares in a company), so like to think I am not blinded by this interest and my reading of the literature has me unconvinced either way as to its effectiveness.
     
  4. eddavisdpm

    eddavisdpm Active Member

    ESWT Article

    Only Dr. Norris has a "proprietary" interest. It is very common for manufacturers to fund studies. Dr. Werber, was the primary researcher in the study as far as I know. I will look at the Journal again to see what disclosures Dr. Norris provides but I have noted him to be an individual with impeccable ethics. The primary fault would rest with JAPMA for failing to provide full disclousre but would not use that as a major factor to discredit Dr. Werber's work nor the JAPMA itself. JAPMA has few studies of this sample size and most of the papers presented in JAPMA, have smaller sample sizes or are case reports. JAPMA typcially contains few if any double blinded peer reviewed studies. I would certainly consider this to be one of the better articles in JAPMA. United Shockwave is not a manufacturer but a distributor and in all likelihood did not have the funds to commit to a double blinded peer reviewed study as a large manufacturer or drug company could accomplish.The experimental design did not have obvious flaws such as in the Buchbinder study which a sublcinical does of shock wave energy was applied and about 50% of the patients in the study did not meet the basic criteria for the diagnosis of chronic plantar fasciitis. Refer to the comments of Dr. Jan Rompe of the University of Mainz on websites such as www.heelspurs.com. Additionally, the study supports the vast body of experiential evidence already in place.

    Experience based medicine is an important and accepted part of the healing art and we are at the point where the successful experience with ESWT in the US, Canada and Europe is considerable. Certainly, we would not ask for a double blinded peer reviewed study for aspirin (there is none that I know of) due to the vast body of experience with the effects of that drug. We also would not ask that to be performed on foot orthotics. Would you stop utilizing foot orthotics becasue no study that meets such criteria exists?

    Ultimately, studies based on the VAS score which is subjective are not as accurate as tissue level studies. Refer to the www.ismst.com website for Rompe's studies which demonstrate decresase in plantar fascial thickness 20 weeks after application of ESWT to a population. I would hope that more such studies are performed and could accept the paucity of such studies as an argument against ESWT. The numerous studies on www.ismst.com demonstrate when looked at collectively, that when ESWT is applied to tissue at adequate levels, there is a beneficial tissue effect. That is an effect not just limited to the plantar fascia. Much of the literature on the www.ismst.com site has progressed well beyond the plantar fascia to utilzation in various tendinopathies, enthesopathies and even non-unions.

    Understandably, much of the literature on the www.ismst.com site does not meet the criterion of the double blinded peer reviewed study which is what is often being asked for. That may be a valid criticism. Nonetheless, considering the mass of literature demonstrating a tissue effect coupled with the mass of experiential evidence is quite compelling.
    Regards,
    Ed Davis, DPM
     
  5. eddavisdpm

    eddavisdpm Active Member

    ESWT/JAPMA/Dr. Norris

    I loooked at the article in JAPMA again this morning and note that Dr. Norris is clearly listed on the bottom of the first page as being associated with United Shockwave Therapy. JAPMA is not culpable of hiding that affiliation.
    Ed Davis, DPM so, considering the fair disclosure and relative research quality of the paper and I could not conisder its publishing to be a "new low" for JAPMA.
    Ed Davis DPM
     
  6. NewsBot

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    Articles:
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    Second Application of Low-energy Shock Waves Has a Cumulative Effect on Free Nerve Endings.
    Clin Orthop Relat Res. 2006 Feb;443:315-319
     
  7. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Long-term Results of Extracorporeal Shockwave Treatment for Plantar Fasciitis
    The American Journal of Sports Medicine 34:592-596 (2006)
     
  8. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study.
    J Orthop Res. 2006 Feb;24(2):115-23
     
  9. Don ESWT

    Don ESWT Active Member

    So, what I have been saying since 1998 is now valid and that ESWT works for most patients. ESWT is the last line before surgery and all avenue's should be exhausted before ESWT
    1. Anti inflams
    2. Measure feet compare with footwear
    3. X-Ray and Ultrasound
    4. Orthotics
    5.Footwear
    6.ESWT
    7.Surgery

    No to cortisone injections
    Good evening to all

    Don Scott
    Wollongong
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Extracorporeal shock wave therapy in the treatment of chronic tendinopathies.
    J Am Acad Orthop Surg. 2006 Apr;14(4):195-204
     
  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    High-Energy Extracorporeal Shock Wave Therapy as a Treatment for Insertional Achilles Tendinopathy
    The American Journal of Sports Medicine 34:733-740 (2006)
     
  12. Admin2

    Admin2 Administrator Staff Member

    Extracorporeal Shockwave Therapy Versus Placebo for the Treatment of Chronic Proximal Plantar Fasciitis: Results of a Randomized, Placebo-Controlled, Double-Blinded, Multicenter Intervention Trial.
    J Foot Ankle Surg. 2006 July - August;45(4):196-210
     
    Last edited by a moderator: Jan 25, 2008
  13. NewsBot

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    Articles:
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    Ewst

    Extracorporeal shock wave therapy for tendinopathies.
    Expert Rev Med Devices. 2006 Jul;3(4):463-470
     
  14. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Extracorporeal shockwaves induce the expression of ATF3 and GAP-43 in rat dorsal root ganglion neurons.
    Auton Neurosci. 2006 Jul 30;128(1-2):96-100
    Murata R, Ohtori S, Ochiai N, Takahashi N, Saisu T, Moriya H, Takahashi K, Wada Y
     
  15. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Location modalities for focused extracorporeal shock wave application in the treatment of chronic plantar fasciitis.
    Foot Ankle Int. 2006 Nov;27(11):943-7
    Dorotka R, Sabeti M, Jimenez-Boj E, Goll A, Schubert S, Trieb K
     
  16. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Comparison of different energy densities of extracorporeal shock wave therapy (ESWT) for the management of chronic heel pain.
    Chow IH, Cheing GL.
    Clin Rehabil. 2007 Feb;21(2):131-41
     
  17. NewsBot

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    Articles:
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    Extracorporeal shock wave treatment for chronic plantar fasciitis (heel pain).
    Issues Emerg Health Technol. 2007 Jan;(96 (part 1)):1-4
    Ho C
     
  18. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Thinner Plantar Fascia Predicts Decreased Pain After Extracorporeal Shock Wave Therapy.
    Clin Orthop Relat Res. 2007 Mar 8;
    Liang HW, Wang TG, Chen WS, Hou SM
     
  19. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device.
    Gollwitzer H, Diehl P, von Korff A, Rahlfs VW, Gerdesmeyer L.
    J Foot Ankle Surg. 2007 Sep-Oct;46(5):348-57.
     
  20. NewsBot

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    Articles:
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    High-Energy Extracorporeal Shock Wave Therapy as a Treatment for Chronic Noninsertional Achilles Tendinopathy
    John P. Furia,
    American Journal of Sports Medicine 2007, doi:10.1177/0363546507309674)
     
  21. NewsBot

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    Articles:
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    The Electrophysiological and Functional Effect of Shock Wave on Peripheral Nerves.
    Wu YH, Lun JJ, Chen WS, Chong FC.
    Conf Proc IEEE Eng Med Biol Soc. 2007;1:2369-2372.
     
  22. admin

    admin Administrator Staff Member

  23. NewsBot

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    Articles:
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    Preliminary Experience of a Single Session of Low-energy Extracorporeal Shock Wave Treatment for Chronic Plantar Fasciitis.
    Höfling I, Joukainen A, Venesmaa P, Kröger H.
    Foot Ankle Int. 2008 Feb;29(2):150-4.
     
  24. DaVinci

    DaVinci Well-Known Member

    Control group? duh? :pigs: :deadhorse:
     
  25. NewsBot

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    Articles:
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    Extracorporeal shockwave application to the distal femur of rabbits diminishes the number of neurons immunoreactive for substance P in dorsal root ganglia L5.
    Hausdorf J, Lemmens MA, Kaplan S, Marangoz C, Milz S, Odaci E, Korr H, Schmitz C, Maier M.
    Brain Res. 2008 Mar 25 [Epub ahead of print]
     
  26. NewsBot

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    Articles:
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    Extracorporeal shock-wave therapy (ESWT) with a new-generation pneumatic device in the treatment of heel pain. A double blind randomised controlled trial.
    Marks W, Jackiewicz A, Witkowski Z, Kot J, Deja W, Lasek J.
    Acta Orthop Belg. 2008 Feb;74(1):98-101.
     
  27. drsarbes

    drsarbes Well-Known Member

    Hi Don:
    ESWT does work (most of the times) as well as cryo or orthotics or surgical procedures.
    The question is, if we are performing all these different therapies for the same diagnosis, why doesn't ONE of them work ALL THE TIME?

    I think numerous previous discussions here on the underlying etiologies for heel pain should be taken seriously. Whether spurs, periostitis, fasciitis, fascioses, neuritis, tarsal tunnel, mechanical irritation, bursitis, etc......... is causing the heel pain, one size fits all treatment doesn't make it in the real world.

    Patients expect results. If they don't get it they will go somewhere else.

    I think the key to treating heel pain successfully is first and foremost a proper diagnosis. I always view outcome studies on heel pain treatments with a grain of salt mainly because we really aren't sure what the patients in the study ACTUALLY had - do we?

    Isn't it logical to assume that if the failure rate of ESWT for chronic fasciitis is 22% then perhaps those 22% had something other than fasciitis causing their symptoms?

    Steve
     
  28. drsarbes

    drsarbes Well-Known Member

    Hi Don:
    ESWT does work (most of the times) as well as cryo or orthotics or surgical procedures.
    The question is, if we are performing all these different therapies for the same diagnosis, why doesn't ONE of them work ALL THE TIME?

    I think numerous previous discussions here on the underlying etiologies for heel pain should be taken seriously. Whether spurs, periostitis, fasciitis, fascioses, neuritis, tarsal tunnel, mechanical irritation, bursitis, etc......... is causing the heel pain, one size fits all treatment doesn't make it in the real world.


    I think the key to treating heel pain successfully is first and foremost a proper diagnosis. I always view outcome studies on heel pain treatments with a grain of salt mainly because we really aren't sure what the patients in the study ACTUALLY had - do we?

    Isn't it logical to assume that if the failure rate of ESWT for chronic fasciitis is 22% then perhaps those 22% had something other than fasciitis causing their symptoms?

    Steve
     
  29. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Selective loss of unmyelinated nerve fibers after extracorporeal shockwave application to the musculoskeletal system.
    Hausdorf J, Lemmens MA, Heck KD, Grolms N, Korr H, Kertschanska S, Steinbusch HW, Schmitz C, Maier M.
    Neuroscience. 2008 Apr 7. [Epub ahead of print]
     
  30. Secret Squirrel

    Secret Squirrel Active Member

    Is that a good thing? Get rid of the chronic pain by denervation? What about the pathological process that is still going on?
     
  31. Dieter Fellner

    Dieter Fellner Well-Known Member

    Emerging Concepts In Shockwave Therapy

    - By Lowell Weil, Jr., DPM, MBA

    http://www.podiatrytoday.com/article/8785
     
  32. NewsBot

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    Articles:
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    Last edited by a moderator: Sep 22, 2016
  33. NewsBot

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    Articles:
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    The Use of Low-Energy Radial Shockwave in the Treatment of Entrapment Neuropathy of the Medial Calcaneal Nerve: A Pilot Study
    Stephen L. Barrett
    Foot & Ankle Specialist, Vol. 1, No. 4, 231-242 (2008)
     
  34. DaVinci

    DaVinci Well-Known Member

    Interesting observations...

    BUT,
    We have no idea if that is any better than a placebo; they did not use any controls.
     
  35. NewsBot

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    Articles:
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    Comparison of two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. A randomized controlled study.
    Tornese D, Mattei E, Lucchesi G, Bandi M, Ricci G, Melegati G.
    Clin Rehabil. 2008 Sep;22(9):780-7.
     
  36. NewsBot

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    Articles:
    1
    Radial Extracorporeal Shock Wave Therapy Is Safe and Effective in the Treatment of Chronic Recalcitrant Plantar Fasciitis: Results of a Confirmatory Randomized Placebo-Controlled Multicenter Study
    Ludger Gerdesmeyer, Carol Frey, Johannes Vester, Markus Maier, Lowell Weil Jr, Lowell Weil Sr, Martin Russlies, John Stienstra, Barry Scurran, Keith Fedder, Peter Diehl, Heinz Lohrer, Mark Henne, Hans Gollwitzer
    American Journal of Sports Medicine (First published on October 1, 2008)
     
  37. NewsBot

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    Articles:
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    Extracorporeal Shockwave Therapy for the Treatment of Achilles Tendinopathies
    A Prospective Study

    Robert Fridman, Jarrett D. Cain, Lowell Weil, Jr., and Lowell Weil
    Journal of the American Podiatric Medical Association; Volume 98 Number 6 466-468 2008
     
  38. DaVinci

    DaVinci Well-Known Member

    How can they make that claim in the absence of a control group? How do we know that the natural history of the condition did not change during the study?

    I wonder how those who support EWST would react to the small sample size and lack of a control group if the study had the opposite result?
     
  39. Don ESWT

    Don ESWT Active Member

    Here we go again!
    We live in the real world where we have to make a living and don't have the time or money to do studies. We can only give you data arising from patients we treat.
    Not all work can be done under uni study grants etc. Yes I own a machine and I have been told I have a vested interest in the outcome of any study which is beneficial and makes me money.
    This all got out of hand back in 2001 and it still has not been resolved by the same mob who did a study on elbow treatments, where they are still compiling the data. (look up Monash uni Rachel Buchbinder)

    Where is there conclusive data that double blinded tests are accurate. Because after a time the people who were part of the sham group will demand a real treatment for their compliant, negating the control of the study.

    The moment a patient leaves your paractice after any treatment what is the time factor when he/she trips on a crack in the sidewalk and undoes the work carried out to repair them.

    DO A CONTROL STUDY ON THAT
     
  40. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Comparison of two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. A randomized controlled study.
    Tornese D, Mattei E, Lucchesi G, Bandi M, Ricci G, Melegati G.
    Clin Rehabil. 2008 Sep;22(9):780-7.
     
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