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Shockwave Therapy

What can it be used for ?

Extracorporeal shockwave therapy is used to treat a variety of tendon disorders (Calcific tendinitis of the shoulder, tennis elbow, golfers elbow, trochanteric bursitis, jumpers knee, shin splints, achilles tendinopathy, plantar fasciitis).

Where can you get this treatment ?
Mr Sturdee has been using shockwave therapy since April 2009 at the Spire Elland Hospital . It is recognised by the major insurance companies and is a recognised treatment by NICE (National Institute for Clinical Excellence). Although in the past it has been funded by the local PCT’s for NHS patients at the moment there is no routine funding for this treatment on the NHS.

How does it work ?
It works by increasing local blood flow that stimulates cell regeneration in the tendon and repair. It also has an anti inflammatory effect locally. Extracorporeal shockwaves were first used to break up kidney stones and has been scaled down for use in tendons. There are number of papers in the medical literature that show its efficacy. It is a useful non operative treatment that can be performed as an out patient and typically three treatment sessions are required that take about ten minutes. Low energy shockwaves are produced by the machine and the hand piece distributes these to the local tissues through the skin via a medium, usually gel. Patients typically do not require any painkillers or anaesthetic. The machine used is called EMS Swiss Dolorclast .

Mr Sturdee has mainly used shockwave therapy for achilles tendiopathy and plantar fasciitis. All patients are audited and in none of the cases treated has it made the patients symptoms worse.

As of March 2014 Mr Sturdee has treated 45 patients who have had plantar fasciitis with a 65% success rate, and 30 patients with achilles tendinopathy with a 74% success rate. 1 patient with tibialis posterior tendinopathy has been treated with a 100% success rate.

If the achilles tendinopathy patients are separated into non insertional and insertional the results are however different. 24 patients with non insertional achilles tendinoapthy have been treated with a 75% success rate. 6 patients with insertional tendinopathy have been treated with a 33% success rate. These results are similar to published data, and for achilles tendinopathy shockwave works well for non insertional achilles tendinaopathy but is not very successful for insertional but may be worth trying to avoid surgery as no patients have been made worse by the treatment.

Ongoing research
Elland Hospital and Mr Sturdee are a recognised centre for the ASSERT study (Assessment of Effectiveness of ESWT for Soft Tissue Injuries). All patients will be invited to be part of the ASSERT study which is looking at the results of shockwave treatment in multiple centres. ASSERT is an online database which monitors the effectiveness of ESWT in a systematic and consistent way.

The study was launched in March 2011 by Professor Nicola Maffulli. In 2014 the preliminary results of ASSERT 1 were published and found improvement in patients receiving ESWT for calcific tendinopathy of the shoulder; tennis elbow; trochanteric bursitis; patellar tendinopathy; Achilles tendinopathy; plantar fasciitis. However, significant differences were identified for patients receiving ESWT for: tennis elbow, Achilles tendinopathy and plantar fasciitis in both the short term and long term follow-up.

From June 2014 ASSERT 2 superseded ASSERT and Mr Sturdee has started to recruit patients into ASSERT 2.

The ASSERT studies involve information about the severity of the condition being collated and function and pain scores will be performed up to three months by the treating clinician. After this time ASSERT researchers will contact patients by email or telephone to get long term results.

Shockwave Case Example

Elland man back on his feet following innovative shock wave treatment
Fifty-five year old JR suffered with tightening and pain in his right foot for several years. While at first the discomfort came on in waves, it soon became a continual unbearable pain and he sought help from his GP.

He was told he had plantar fasciitis, a condition which is caused when part of the plantar fascia – the band of fibrous tissue that supports the arch of the foot and is crucial in the function of the foot – becomes inflamed and thickened and is very painful. Repetitive impact activities such as running can trigger it, but anyone who stands a lot during the day can get the condition especially if they have poorly supporting shoes.

As a car sales supervisor, JR had to be up on his feet walking customers around the showroom. He explains: “It was really difficult at work because I had to restrict my walking which resulted in me not being able to do as much as I wanted to do. My social life was also affected and I had to give up all sport and limit going out.”

JR did a lot of stretching and massage every morning which helped to get him up and about and he was referred to a podiatrist who recommended the use of shoe inserts to cushion the foot during the day, and a special supportive sock to sleep in at night. JR said: “It all helped ease some of the pain – the sock was particularly good – but I was still suffering, and dependent on a walking stick to get about.”

JR went back to his GP who referred him to Mr Simon Sturdee, consultant orthopaedic surgeon at Spire Elland Hospital and Calderdale and Huddersfield NHS Trust.

Mr Sturdee explained that there was a surgical solution to the problem which would involve releasing the plantar facia but the results of surgery are not great so it has to be a last resort for treatment. [need details from Mr Sturdee].

He also told JR about an innovative treatment called extracorporeal shockwave therapy – known as eSWT – which had just been introduced at Spire Elland Hospital. The therapy was so new that JR was the first patient to be treated with eSWT at the hospital.

Mr Sturdee explains: “The therapy involves applying shockwaves to the diseased tendon tissue. A projectile is accelerated by compressed air in the probe and this hits the applicator which is placed on the skin. A gel transmits the impulses into the tissue where a radial shockwave is produced and spreads into the tissue which in most cases is a diseased tendon. It is successful in about 70% of cases and JR was an ideal patient. With no-known side effects it was definitely more preferable to undergoing surgery.”
JR says: “I really didn’t want to have to have surgery which would put me out of action for so long and was pleased to hear that a non-surgical option was available. However, I was a bit apprehensive about having the shockwave therapy was so new.

“Having said that, I had been relying on a walking stick for the last six months, and the muscles in my right foot were so damaged they resembled spaghetti junction. I had to do something and was happy to follow Mr Sturdee’s advice.”

Within three weeks Joseph had the three eSWT treatments. Each treatment is done in the clinic and takes no more than five minutes. He explained: “It felt like a small hammer drill going into my foot and my foot ached at first but very soon I could feel the benefit. It was very good.”
“I can now walk without the stick and feel so much better. I even went out for a run for the first time, although I am taking things very steady. I’m not sure I’ll ever play cricket or box again but am happy that I can lead a more active life again.”