Can I use cryotherapy to ease the pain (if any)?
No clinical study has been conducted on the combination shock waves and cryotherapy. However, Dr. Marc Rozenblat (Centre Coralis, Ozoir La Ferrière, France) reported at the 2008 ATRAD congress (Berlin, Germany) the combination of shock wave therapy using the Swiss DolorClast method and neurocryostimulation was successful in approximately 7000 cases.
Do you have clinical proof for your device?
Yes, being clinically proven is one of the pillars of the Swiss DolorClast method. Many randomized controlled trials (RCTs) demonstrating efficacy and safety of the Swiss DolorClast method on different indications have been published in the international peer-review literature. So far, 26 RCTs have been published on the Swiss DolorClast method, 15 of which have been listed in the PEDro database (search for “radial shock wave” at www.pedro.org.au)
Can we carry out the treatment in 1 session instead of 3 by applying 6,000 shocks? (as with focused devices)
This has not been tested in a clinical study. With regard to focused shock waves, no study listed in the PEDro database has tested the hypothesis that the application of 6,000 shocks in a single session is as effective as (or more effective than) the application of 2,000 shocks in three sessions.
Can we use shock waves only on athletes?
ESWT has been developed to be conducted on athletes and non-athletes. The vast majority of RCTs on the Swiss DolorClast method were performed on non-athlete patients.
Does castor oil offer better transmission than standard contact gel for ESWT treatments?
Yes, castor oil is better than standard contact gel according to Maier et al., 199910, “Castor oil decreases pain during extracorporeal shock wave application”. However, it is recommended to use the standard contact gel provided with the device.
10) Maier M, Staupendahl D, Duerr HR, Refior HJ.: Castor oil decreases pain during extracorporeal shock wave application. Arch Orthop Trauma Surg 1999;119(7-8):423-427
What are the mechanisms of action of shock waves?
The therapeutic effects of shock waves on the musculoskeletal system (pain relief and healing) are based on a multitude of molecular and cellular mechanisms. Without going into detail, the main short-term effects are depletion of presynaptic substance P in C nerve fibers (resulting in pain relief) and improved blood circulation in the treated area (which is the basis for healing). The main long-term effects are blockade of neurogenic inflammation and improved tendon gliding ability (resulting in pain relief) as well as activation of mesenchymal stem cells and new bone formation (both essentially involved in healing).
What are the contraindications?
Treatment over air-filled tissue (lung, gut), treatment of preruptured tendons, treatment of pregnant women, treatment of patients under the age of 18 (except for the treatment of Osgood-Schlatter disease), treatment of patients with blood-clotting disorders (including local thrombosis), treatment of patients treated with oral anticoagulants, treatment of tissue with local tumours or local bacterial and/or viral infections, treatment of patients treated with local cortisone injections (within the six-week period following the last local cortisone injection).
Improvement in a week? This can only be pain relief but not healing...
It is absolutely correct that reduction of pain within a few days does not mean that healing has taken place in such a short time. On the other hand, sustained and statistically significant pain relief even two years after treatment of chronic plantar fasciopathy with the Swiss DolorClast method11 is a strong indicator of healing. The final proof of healing would require taking biopsies which is not possible for ethical reasons.
11) Ibrahim MI, Donatelli RA, Hellman M, Hussein AZ, Furia JP, Schmitz C. Long-term results of radial extracorporeal shock wave treatment for chronic plantar fasciopathy: A prospective, randomized, placebo-controlled trial with two years follow-up. J Orthop Res Epub ahead of print on Aug 27, 2016.
Can I treat fresh injuries and other acute pathologies? Will they heal faster?
In general, this is possible. However, the following points must be considered: (i) The Swiss DolorClast method is not yet approved for the treatment of fresh injuries; related clinical research is ongoing. (ii) With regard to tendon pathology, it is critical to note that there are no acute tendinopathies, only newly diagnosed ones. Safety and efficacy of the Swiss DolorClast method for treating newly diagnosed tendinopathies was demonstrated in the international peer-review literature for plantar fasciopathy (Rompe et al., 201012), primary long bicipital tenosynovitis (Liu et al., 201213) and lateral or medial epicondylitis (Lee et al., 201214)
12) Rompe JD, Cacchio A, Weil L Jr, Furia JP, Haist J, Reiners V, Schmitz C, Maffulli N. Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy. J Bone Joint Surg Am 2010;92:2514-2522.
13) Liu S, Zhai L, Shi Z, Jing R, Zhao B, Xing G. Radial extracorporeal pressure pulse therapy for the primary long bicipital tenosynovitis a prospective randomized controlled study. Ultrasound Med Biol 2012;38:727-735.
14) Lee SS, Kang S, Park NK, Lee CW, Song HS, Sohn MK, Cho KH, Kim JH. Effectiveness of initial extracorporeal shock wave therapy on the newly diagnosed lateral or medial epicondylitis. Ann Rehabil Med;36:681-687.
If there is pain or swelling in the target area, do you treat?
These conditions usually require great care and very gentle treatment. In particular, the handpiece of the Swiss DolorClast should not be pressed against the patient’s skin. Furthermore, the therapist should be aware that even the lowest settings of the Swiss DolorClast may be too much and cause excessive pain during treatment. In these cases the treatment should be stopped. Good patient compliance is usually achieved when explaining to the patient that it is worth a try and that the treatment can be stopped at any time if it is too painful.