Extracorporeal Shockwave Therapy (ESWT)Section-Electrotherapy-2nd Year Physical Therapy Students SVU скачать в хорошем качестве

Extracorporeal Shockwave Therapy (ESWT)Section-Electrotherapy-2nd Year Physical Therapy Students SVU

-The strong mechanism of action of Shockwave Therapy is through Neovascularization. -Lithotripsy is a procedure that uses high-energy focused shockwaves to break up or fragment stones in the kidney and the ureter (Kidney Stones are composed of Calcium oxalates 60-70%, Calcium phosphates 10-20%, Uric acid, Cystine, and Cholesterol). -When we speak regarding the Radial Medium Intensity Shockwave or Focused Medium Intensity Shockwave (which are commercially available) and their effect to fragment bone spurs or osteophytes ( Spurs or osteophytes are bony extensions that have osteoblasts, osteocytes, bone matrix, calcium, and collagen fibers. so, spurs are different from stones), this will not be a scientific claim as to destroy bone, we will need massive energy. -Radial (soft) Shockwave Vs Focused (Hard) Shockwave. -Shockwave Therapy may be an important part of the Physical Therapy session rather than to be the whole treatment program. -In Dermatology, Shockwave can be used for hypertrophic scars because scar tissue is very rich in collagen and as Ultrasonic these waves are highly absorbed by collagen-rich tissues like bones, tendons, and fascia. -In Cardiology, Research regarding Neoangiogenesis in rats with induced myocardial infarction provides a promising results in treatment of acute myocardial infarction. -In Neurology, there is a strong evidence that both radial and focused Shockwaves reduce post stroke spasticity and improve function with radial parameters ( 2000 shocks per session, 2 bar intensity, 1_8 HZ frequency with 6_8 sessions). -In Gynecology, there is a promising results for Medium intensity Shockwaves on reduction of size and stiffness of Uterine Fibroids in rats, that may be a positive step in research phases towards human application. -Classification of Shockwave Intensity: *Low Energy Shockwave is below 0.08 mj/mm2. *Medium Energy Shockwave is between 0.08 - 0.28 mj/mm2. *Hih Energy Shockwave is above 0.28 mj/mm2 and in some references is above 0.6 mj/mm2. -Intensity of Radial Shockwave: *Less than 1.5 bar for activation of tissue healing except for facilitation of Non_unioned fractures. *Between 1.5 - 2 bars for pain, chronic inflammation, muscle spasm, trigger points and edema reduction. *Above 2.5 bars for elimination or reabsorption of calcifications. -Calcific deposits are not similar to bone spurs or osteophytes. -Shockwave eliminates the calcific deposits in tendons and muscles however, Shockwave improves plantar fasciitis with or without calcaneal spur but it reduces its chronic inflammation rather than fragmentation or disappearance of the spur. -Calcaneal spurs may be inferior spurs that may increase planter fasciitis or posterior spurs that may increase Achilles tendonitis. whatever the site of the spurs, Mechanical correction for flat feet or weight reduction should be considered. -Shockwaves haven't bactericidal effect because there were no changes in activation of resting macrophages type 1( M1 are proinflammatory type for phagocytosis ) but there was a transformation of macrophages type 1 to macrophages type 2 ( M2 inhibit inflammation and increase protein production as collagen so, Shockwaves have anti_inflammatory properties). -Shockwave can be applied with caution on the paraspinal muscles NOT on the spinous process itself. -The Physical Therapist may stretch the targeted tissue during the Shockwave session to assist in more breakdown of adhesions and to increase tissue extensibility. -Shockwave Therapy stimulator head should be held perpendicular on the target tissue to enhance its absorption and reduce its reflection. Shockwaves penetration depends on frequency and intensity as: *Radial 1 bar can penetrate 1 cm. *Radial 2 bars can penetrate 2.2 cm. *Radial 3 bars can penetrate 3.9 cm. -Acetaminophen (Paracetamol) may be taken after the Shockwave Therapy session if there is considerable pain as it is analgesic, antipyretic, but NOT anti_inflammatory ( as the process of acute inflammation after Shockwaves is required). _Research-Based Indications of ESWT (Moderate Evidence): 1- Shoulder, Elbow, Achilles, and Patellar chronic tendinopathies. 2- Chronic plantar fasciitis and Calcaneal Spurs. 3- Calcific tendonitis of the rotator cuff in the shoulder. 4- Chronic foot ulcers, either diabetic or nondiabetic. 5- Osteoarthritis of the knees. 6- Nonunion and delayed-union bone fracture. 7- Avascular Necrosis of the femoral head. _Contraindications for ESWT: 1- Bleeding conditions. 2- Pacemakers. 3- Medications that prolong blood clotting. 4- Over major blood vessels and nerves, and Joint replacements. 5- Pregnancy: over uterus—disrupts fetal development. 6- Acute injuries—increase the inflammatory process. 7- Active bone growth at the epiphysis—alters normal growth.. 8- Over gas-filled tissues such as lungs and intestine—severe tissue damage. *Some side effects can occur after treatment, including transient pain, and local soft tissue swelling.