Trattamento della fascite plantare cronica recalcitrante con terapia combinata
Le tendinopatie sono un argomento importante nella pratica dello sport professionistico. Questo tipo di patologia deve essere trattata rapidamente per non compromettere le prestazioni fisiche degli atleti. A volte queste tendinopatie persistono nel tempo nonostante gli sforzi di cura compiuti dalle squadre di assistenza. Diventano poi croniche e possono mettere a rischio la carriera dell'atleta che non ha altra scelta se non quella di convivere con la patologia per poi causare altri problemi funzionali.
La testimonianza di Jamies George sul trattamento della sua fascite plantare cronica
Prima di essere trattato con la terapia combinata, Jamie George soffriva di una fasciitis plantare cronica che lo colpiva quotidianamente, sia nella vita professionale che in quella quotidiana.
"Ho sofferto di dolore al tallone per circa 2 anni, causato principalmente dall'allenamento costante e dal gioco su una superficie solida con i saraceni. Quando sono arrivato in clinica, un primo consulto ha avuto luogo con Rhys - che ha confermato la diagnosi di fascite plantare con un'ecografia. Ci ha suggerito di trattarla con la terapia con onde d'urto (che ho già avuto in precedenza), ma prima ha anche suggerito l'uso del laser.
Oltre a un rigoroso programma di stretching e rafforzamento, ideato dal nostro team di forza e condizionamento di Saraceni, ho fatto 4 sedute di trattamento con Laser e Shock Wave - ognuna separata da una settimana.
Alla fine della quarta settimana, ho avuto un miglioramento del 60% del dolore, in particolare dopo l'allenamento e per prima cosa al mattino. Ho continuato l'allenamento di forza per un altro mese e stimerei un recupero del 95% ora, con solo un lieve disagio dopo una partita su un campo artificiale.
Questo mi provocava così tanto dolore che zoppicavo. Consiglio vivamente il trattamento DolorClast® Laser e Radial Shock Waves per qualsiasi lesione particolarmente ostinata, e so dove andare se il mio dolore dovesse mai tornare.
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
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