Shockwave Therapy for Trigger Points

[Hacksquat]

I stumbled across a page for a local naprapathy clinic where I live. They claim they have had great success with treating trigger points with some sort of shockwave device. Anyone heard of this?

Still I don't know how this would be applicable to intrapelvic trigger points.

http://www.canadianchiropractor.ca/cont ... w/998/131/

[webslave]

Radial shock-wave therapy (RSWT) is used for tendonitis and calcific tendonitis, eg PMID 16649891.

There are no studies on RSWT and triggerpoints.

In addition, there are studies linking shock-wave treatments to changes in nerve fibres, eg PMID 18579315. Not sure if ESW is the same as RSWT, but it gives me pause.

[Hacksquat]

http://www.renalandurologynews.com/Shoc ... le/116118/

Don't know where to get hold of the complete study. It's good though that there is some research in this area!

[webslave]

Well, that study is about ESWT, not the RSWT you referenced in your initial post. Apparently, the two types of treatment are not the same:

RSWT is not the same as ESWT (Extra-corporeal shock wave therapy) because the treatment works in a different way.

Unlike Extra-Corporeal Shock Wave Therapy (ESWT) which can pass the energy wave through undamaged tissues like skin and muscles, Radial Shock Wave Therapy (RSWT) uses a pneumatic generator to physically deliver the shock wave to the skin, (which may cause some bruising), and from there it passes into the body. It is perhaps most analogous to a tiny pneumatic jackhammer striking the skin to create the shock wave.

Because the force of the energy of unfocused RSWT is applied directly to the skin, the energy waves begin to dissipate as soon as it hits the skin. This makes it impossible to focus the depth of RSWT shock waves, making it much more difficult to ensure the shock waves are being delivered at the proper strength and to the proper depth of tissue inflammation and damage. This limits RSWT's applications and effectiveness to superficial structures.

From this site

I would regard ESWT with caution (see my post above).

Here's the ESW study:

BJU Int. 2008 Sep;102(8):976-80. Epub 2008 May 28
Extracorporeal shock-wave therapy for treating chronic pelvic pain syndrome: a feasibility study and the first clinical results.
Zimmermann R, Cumpanas A, Hoeltl L, Janetschek G, Stenzl A, Miclea F.
Department of Urology, Elisabethinen Hospital, Linz, Austria. [email protected]

OBJECTIVE: To investigate the feasibility and clinical outcome of extracorporeal shock-wave therapy (ESWT) for patients suffering from chronic pelvic pain syndrome (CPPS).

PATIENTS AND METHODS: The study included 34 patients who had had chronic prostatitis / chronic pelvic pain syndrome for >or=3 months, who were investigated in two subsequent studies. ESWT was administered using a perineal approach with two different standard ESWT devices with and without an ultrasonographic positioning system. The follow-up was at 1, 4 and 12 weeks after ESWT, to evaluate the effects on pain, quality of life and voiding. Imaging studies and changes in prostate-specific antigen (PSA) were used to investigate the safety and side-effects of ESWT.

RESULTS: All patients completed the treatments and follow-up; there were statistically significant improvements in pain and quality of life after ESWT. Voiding conditions were temporarily improved but with no statistical significance. Perineal ESWT was easy and safe to administer with no anaesthesia on an outpatient basis. Side-effects could be excluded clinically, by imaging studies and by changes in PSA level.

CONCLUSION: Perineal ESWT must be considered as a promising new therapy for CPPS, in particular as it is easy to apply and causes no side-effects.

PMID: 18510660 [PubMed - indexed for MEDLINE]

Note that there do seem to be side effects (see my previous post).

[pelvicpainspecialist]

Here is the paper you alluded to, webslave. Notice that it is based on an animal model, and that there are no effects on myelinated fibres.

Furthermore, if on analyses the details of the studies, the proposed mechanism and effects are enhanced due to the small size of a rabbit femur relative to the shockwave (compared to a human). Futhermore, "ESW were applied as 11500 pulses with efd0.9 Mj/mm 2 at a frequency of 1 Hz over 25 min. The EFD was measured with a laser hydrophone before ESW application."

Thus, in summary the shockwave was not moved (held in one position for 25min) (which is incorrect in a human model). The protocol is an extreme version of what actually takes place during therapy (the dose, settings and technique are all extreme and not consistent with human treatment protocols).

http://issuu.com/drkandrew/docs/selecti ... ers_after_

[pelvicpainspecialist]

Still I don't know how this would be applicable to intrapelvic trigger points.

Shockwaves are able to penetrate tissue at a depth of the operators choosing (depending on settings of frequency and energy level).

Much like shockwaves are able to penetrate a great depth to target renal calculi (kidney stones) during lithotripsy.

[pelvicpainspecialist]

There are no studies on RSWT and triggerpoints.

Reference:

Diagnosis and therapy of myofascial trigger point syndrome through stimulation of sensitized nociceptors using focused electrohydraulic shockwaves
Journal of musculoskeletal pain [1058-2452] Simons yr:2006 vol:14 iss:1 pg:58 -59

[webslave]

There are no studies on RSWT and triggerpoints.

Reference:

Diagnosis and therapy of myofascial trigger point syndrome through stimulation of sensitized nociceptors using focused electrohydraulic shockwaves
Journal of musculoskeletal pain [1058-2452] Simons yr:2006 vol:14 iss:1 pg:58 -59

Not indexed in Medline, I'm afraid.

[pelvicpainspecialist]

"You cannot get the right answers if you fail to ask the right questions"

The 'theory' that the anatomical and physiological aspects of this condition are only related to 'trigger points' is a gross oversimplification and thus flawed.

We do however, treat any related 'trigger points' using the 'standard' (established) therapies outlined by Travell and Simons (as previously noted, our protocol is comprehensive). Practically any therapist can do this effectively, it is relatively straightforward (go to your local physiotherapist). It is also not nearly enough to solve this condition.

[webslave]

Published studies talk, bullshit walks.

[pelvicpainspecialist]

Published studies talk, bullshit walks.

Again, http://issuu.com/drkandrew/docs/prostat ... ockwave-tx

[webslave]

We are already aware of that study, see viewtopic.php?p=41771#p41771

In addition, that study involves ESWT administered by urologists. The outcomes are interesting.

But I'd be cautious myself. The study does seem to labor under the misapprehension that the prostate is the organ to be targeted, but of course shock waves, which certainly do affect muscle fibres too, would suffuse the whole pelvic floor.

My biggest problem with shock waves is that they actually damage muscle fibres, eg
http://pubmed.ncbi.nlm.nih.gov/18579315
http://pubmed.ncbi.nlm.nih.gov/8356784

Too invasive, too heroic, perhaps?

[European]

Webslave, I completely agree with you. I had one session of ESWT in 2011 and it aggravated my pain for several months. despite of the fact, that ESWT is largely accepted as a safe tool for CPPS, I would not recommend it to everybody. I am afraid that it irreversibly damaged some muscle fibers in my case.

[User-CPPS]

We have to differentiate:

Is low energy focused shock wave therapy also not recommended?
The doctor said it would not cause bad side effects, because it is low energy and focussed, which is good for pain management.

I had a therapy once 10 years ago, which did not really help me.
Hopefully it did not hurt my muscle fibers.
This thread scares me a little now.

https://www.google.com/search?q=low+ene ... gy+focused