
Tratamiento de la fascitis plantar crónica recalcitrante con terapia combinada
Las tendinopatías son un tema importante en la práctica de los deportes profesionales. Este tipo de patología debe ser tratada rápidamente para no comprometer el rendimiento físico de los atletas. A veces estas tendinopatías persisten a lo largo del tiempo a pesar de los esfuerzos de tratamiento realizados por los equipos de atención. Luego se vuelven crónicas y pueden poner en peligro la carrera del deportista que no tiene más remedio que vivir con la patología y luego, eventualmente, causar otros problemas funcionales.
El testimonio de Jamies George sobre el tratamiento de su fascitis plantar crónica
Antes de ser tratado con la terapia combinada, Jamie George sufría de una fascitis plantar crónica que le afectaba a diario, tanto en su vida profesional como en su vida cotidiana.
"He sufrido con dolor de talón durante aproximadamente 2 años - principalmente causado por el constante entrenamiento y el juego en una superficie firme con sarracenos. Cuando llegué a la clínica, se realizó una consulta inicial con Rhys - quien confirmó el diagnóstico de fascitis plantar en una ecografía. Sugirió que la tratáramos con terapia de ondas de choque (que ya he tenido antes), pero también sugirió el uso de láser antes de ella.
Junto con un riguroso programa de estiramiento y fortalecimiento, ideado por nuestro equipo de fuerza y acondicionamiento en Saracens, tuve 4 sesiones de tratamiento con láser y ondas de choque - cada una separada por una semana.
Al final de la 4ª semana, experimenté una mejora del 60% en el dolor, particularmente después del entrenamiento y a primera hora de la mañana. Continué con el entrenamiento de fuerza por otro mes y estimaría una recuperación del 95% ahora, con sólo una leve molestia después de un juego en un campo artificial.
Esto solía causar tanto dolor que cojeaba. Recomendaría ampliamente el tratamiento con láser DolorClast® y ondas de choque radiales para cualquier lesión particularmente obstinada, y sé dónde ir si mi dolor vuelve a aparecer.
How Rhys Carter treated the pathology thanks to the combination therapy
Jamie George attended Rhys Carter's clinic reporting right heel pain for over 2 years. On objective examination, there was point tenderness over the insertion of the plantar tendon and there was evident tendinopathic changes in the plantar tendon on diagnostic ultrasound, in keeping with plantar fasciitis.
Once the diagnosis was given to Jamie, it was explained that this injury can take up to 3 months to recover. Rhys Carter explained that this would be a combination of the new GDT protocol (explained to him as Laser and Shock Wave combination therapy) and a progressive strengthening program to be done in conjunction with his strength and conditioning coaches at his club.
To carry out the treatment according to the GDT protocol, Rhys Carter used the new DolorClast® Radial Shock Waves and the new DolorClast® High Power Laser in combination. He used the DolorClast® High Power Laser on the analgesic setting of 3 minutes, 60KHz, 75% modulation and a manual setting. Afterwards, he was able to use 2.8 Bar of pressure, 10Hz and 2000 impulses on the DolorClast® Radial Shock Waves. It is interesting to note that Jamie was able to tolerate just 2.0 Bar of pressure without a Laser treatment before the Shock Wave therapy.
Regarding exercise, Rhys Carter worked closely with the Saracens strength and conditioning coaches and devised a series of ‘short foot’ intrinsic foot strengthening exercises, eccentric soleus strengthening and calf stretching. He also recommended gentle rolling of the arch of the foot with a tennis ball.
After 10 years of using Shock Wave therapy, I would thoroughly recommend the additional use of the DolorClast® High Power Laser as an analgesic. - Rhys Carter, physiotherapist
The combination of the Laser and Radial Shock Wave therapies gave exceptionally good results. Jamie reported a continuous improvement in symptoms and once he started to feel no pain after training/matches and no pain in the morning when bare foot walking after 8 weeks, they stopped treating him as the initial problem had resolved. Having used the DolorClast® High Power Laser in analgesic mode, Rhys Carter can confirm that the tolerance level of higher pressured Radial Shock Wave therapy is greatly increased, which has generated faster results.
We thank Rhys Carter for conducting this case study highlighting the potential of combination therapy with the new DolorClast® products, which also allowed the rugby player Jamie George to return to the field with a full confidence.
Why is the combination therapy effective in the treatment of plantar fasciitis?
DolorClast® High Power Laser
When designing the DolorClast® High Power Laser, the wavelength of 905 nm was specially chosen because it inhibits the nociceptors1.
Nociceptors are sensory neurons located at the nerve ending, that respond to potentially damaging stimuli by sending pain signals to the spinal cord and the brain. If they are inhibited, they will not send a signal and the patient won’t therefore feel pain anymore.
This powerful analgesic effect is already evident 5 minutes after the end of the treatment and lasts for up to 72 hours after the treatment.
1MEZAWA, S. et. Al, Archives of oral biology, 1988, vol. 33,9.
DolorClast® Radial Shock Waves
Shock wave therapy allows the expression of growth factors (PCNA, eNOS VEGF)1, making allowing for the formation of new blood vessels (angiogenesis) in tissues with blood supplies. This increased blood circulation fosters a faster healing of the treated tissues1.
Moreover, shock wave therapy activates mesenchymal stem cells2, which increases the formation of new cells for the regeneration of the injured tissues.
1HOFMAN et al., J Trauma / CONTALDO ET AL., Microvasc Res 2012, 84:24:-33 / KIRSCH ET AL., J Surg Res 2016; 201:440-445
2WANG CJ, ISMST Newsletter 2006, Vol 1, Issue 1