The Zurriola Clinic of San Sebastian-Donostia has implemented to its portfolio of services the acquisition of the Duolith® T-Top Ultra focal shock wave device, high energy and latest generation technology, in the medical approach through physical therapy against pain.
This therapy allows a non-invasive treatment of regenerative medicine on the ultrasound-guided focus of the pathology. This process is generated by the focal shock wave in the injured area through an electromagnetic effect via biological and mechanical mechanisms. Extracorporeal shock wave therapy has become an innovative method for the treatment of musculoskeletal pain.
After many years of experience, scientific evidence has demonstrated the improvement of certain pathological changes in tendons, ligaments, capsules, muscles and bones, being able to eliminate their pain in a specific way with this treatment.
Extracorporeal shock wave therapy, carried out by qualified and experienced therapists such as our specialist in Physical Medicine and Rehabilitation, Dr. Agustin Gutierrez Ruiz, makes it a treatment method largely free of risks and side effects to treat pain in the musculoskeletal system. With this objective in mind, the ISMST (International Society for Medical Shockwave Treatment) accredits professionals in their aptitude in the use of this technology.
Thanks to its application with ultrasound guidance, it gives greater effectiveness and value to the focal application of the treatment, our medical specialist has several years of experience in its treatment.
What are shock waves?
Shock waves are high energy audible sound waves. Shock waves have been used in medicine since 1980 to dissolve kidney stones.
In pain therapy, shock wave energy is transferred to the pain areas of the human body. There it can develop its healing effects.
How does the shock wave work?
Through a process called mechano-transduction, the mechanical stimulus of shock waves generates a biological response. The nucleus of the cells is activated and the production of proteins responsible for tissue regeneration processes is initiated, i.e. the production of so-called “growth factors” is stimulated.
Shock waves activate angiogenesis, new blood vessels are formed. They increase collagen production, from growth factors such as TGF-beta1 and IGF-I. Tissue regeneration is also mediated by the release of nitric oxide and the growth factor VEGF. Studies show the presence of the PCNA antigen, which indicates cell proliferation.
Other very recent work has been able to prove an influence of shock waves on stem cell differentiation and migration. This biological response prevents the production of fibrosis in the treated tissues.
In short, extracorporeal shock waves are intended to accelerate the healing of damaged tissues.
What problems are most commonly treated?
Elbow:
- Epicondylitis (tennis elbow): Tendinopathy on the lateral aspect of the elbow generates a painful state of tendon irritation of the extensor muscles that influence stabilization of the wrist when performing grips.
- Epitrochleitis (golfer’s elbow): Presence of pressure pain on the medial aspect of the elbow with intensification of pain when the wrist and finger flexor muscles are activated.
Knee-leg:
- Patellar tendonitis (jumper’s knee): Inflammation of the patellar tendon, causing pain at the lower end of the kneecap. The pain usually affects only one side. Patellar tendonitis often occurs in runners.
Ankle-foot:
- Achilles tendinopathy: is a syndrome of Achilles tendon pain, sometimes with the presence of calcification. Achilles pain or achillodynia usually becomes chronic and leads to functional limitation.
- Plantar fasciitis: Heel spur is a calcification on the bottom of the foot. The presence of pain and inflammation of the plantar fascia on the sole of the foot, called plantar fasciitis, usually incapacitates the heel during walking.
Shoulder:
- Calcifying tendinopathies: calcium deposits are frequently found in tendons and tendon insertions. The supraspinatus tendon is the most frequently affected.
Hip:
- Trochanteritis: insertional tendinopathies in the trochanter are a frequent cause of pain during walking and during night rest support.
How does shock wave therapy work?
The physician will conduct an interview to obtain a detailed medical history with the patient and will locate the area of pain to be treated by ultrasound. The correct diagnosis and indication of the treatment is the key to the success of the therapy.
A gel is applied to the skin in the area to be treated to apply shock waves to your body without loss of energy. Intensities, frequencies and impulses are applied according to the pathology to be treated and the patient’s tolerance.
How often is the treatment necessary and how long does it last?
The treatment lasts between 15 and 30 minutes, depending on the clinical picture. On average, between 3 and 6 sessions are required depending on the pathology and the patient to be treated, with the lesion being monitored at each consultation.
How successful is the treatment with focal Shock Waves?
After the correct indication and application of the treatment, many patients report that they feel no pain or much less pain after only one or two sessions. The improvement in pain restores functionality and quality of life to the patient.
What are the differences between Focal Shock Wave treatment and Radial Shock Wave treatment?
The effectiveness of any treatment depends on being able to apply it in the appropriate region, in this case, it depends on being able to focus the energy of the treatment in the injured region. The focal shock wave allows us to go deeper, avoiding the dispersion of the energy in the adjacent body tissues, which gives the treatment greater safety and the possibility of treating the lesions in a more effective way than radial shock waves.
To achieve this objective it is necessary a correct medical diagnosis and a correct ultrasound localization of the area to be treated, thus positioning the focus of action in a precise way without the energy applied being dispersed in areas that are not the object of treatment.
This complexity, added to the cost of this technology, has led to a greater proliferation of radial shock wave treatments compared to focal shock wave treatments in rehabilitation clinics, despite the greater efficacy of focal shock waves at the cellular level by directing the waves to a single point of action.