Shock Waves In Top Sports - Shockwave Therapy

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Shock Waves In Top Sports - Shockwave Therapy

Shock Waves In Top SportsSPORT & MEDICINE TODAYShock Waves In Top SportsIn 1996, for the first time, a shock wave device (MINILITH SL1, STORZ MEDICAL AG, Switzerland) wasused by the German Olympic Team during the Olympics in Atlanta. At the Soccer World Championship1998 in France, three of the participating teams including winner France and Italy made use of ESWTmachines to keep the athlets on their top performance level on time.IntroductionShock waves for medical useExtracorporeal shock waves are frequently used as themethod of choice for kidney and ureteral stonefragmentation. The indication range has beenextended to nearly all types of body concrements. Ontop of stone fragmentation shock waves arediscovered to possess a therapeutic effect in a numberof specific sports injuries such as tennis elbow,calcified shoulder and, in general, close to bone tissuepain. In the orthopaedic field, first investigationalapplications were published by Haupt 1 et. al. in 1987,Graff 2 in 1989 and Ekkernkamp 3 et al. in 1991.Valchanov and Michailov 4 first applied ESWT inhumans in 1991. While treating non union fractures,an analgesic effect was observed accidentally. Later,several groups used shock waves of different energylevels in orthopaedics, traumatology and5, 6, 7rheumatology.Today, extracorporeal shock wave therapy ESWT, isnot only frequently used in the above mentioned„standard“ indications but also in several specificindications of sports traumatology in top athletes.1 Haupt, G./Haupt, A./Chvapil, M.: Shock waves enhance fracturehealing; Surgical Biology Research Meeting, University of Arizona, 19872 Graff, J.: Die Wirkung hochenergetischer Stosswellen auf Knochenund Weichteilgewebe; Habilitationsschrift, Ruhr Universität Bochum,19893 Ekkernkamp, A./Haupt, G./Knopf, H. J./Püllenberg, P./Muhr/Senge,Th.:Effects of extracorporeal shock waves on standarsized fractures inshees; Journal of Urology, 145:257 A, 19914 Valchanov, V./Michailov, P.: High energy shock waves in thetreatment of delayed and non union fractures; InternationalOrthopaedics, 15:181, 19915 Dahmen, G. P./Meiss, L./Nam, V. C./Skruodies, B.: ExtrakorporaleStosswellentherapie (ESWT) im knochennahen Weichteilbereich derSchulter; Extracta Orthopaedica, 11:25, 1992, pp. 25 - 276 Schleberger, R./Senge, Th.: Non-invasive treatment of long bonepseudarthrosis by shock waves; Arch. Orthop. Trauma Surg. 111 (4),1992, pp. 224 - 2277 Loew, M./Jurgowski, W.: Extrakorporale Stosswellen-Lithotripsie beider Tendinosis calcarea; Zeischrift für Orthopädie, 131, 1993,pp. 470 - 473Shock waves in medicine are usually focused highpressure acoustical waves of very short duration (pulselength < 1 Mikrosecond). The focal pressure reachesvery high values of several 10 up to 100 Megapascal(100 – 1000 bar). The shock waves are generatedoutside the human body in water and transmittedwidely spread over a large skin transmission area ontothe target region where the acoustic energy isconcentrated to a focal area of 2 – 8 mm diameter.Modern ESWT devices make use of coupling cushionsinstead of an open water bath to couple the shockwaves into the body without significant losses.Targeting of the treatment region is done either by anisocentrically attached co-axial ultraound transduceror by a flouroscopic localisation device.Treatment of the affected tissue region is done by asequence of 1000 – 4000 shock wave pulses firedwith a repetition frequency of 1 – 4 pulses persecond. The whole treatment lasts 15 – 30 minutesand is usually performed without or with very littlelocal anaesthetic drugs.The most advanced shock wave generator devicefeatures a cylindrical coil arrangement with aparabolic reflector. The precision of shock wavedelivery and control is unmatched and itsimultaneously provides the appropriate space on thecentral axis for implementation of either co-axial(inline) ultrasound or X-ray localisation.1


Shock Waves In Top SportsMedical aspectsConclusionTop athletes need to be fit on time and do not like toundergo time consuming conservative therapiesunless absolutely required. ESWT offers a simple, fastand effective therapeutic procedure which allows forcontinuation of sports activities usually the followingday after treatment. ESWT is a non-invasive therapywithout significant side effects.Extracorporeal shock wave treatment has proven anew and promising treatment modality in a numberof specific sports injuries. It cures non-invasivelywithout significant side effects and speeds up therecovery time of the athletes allowing training thefollowing day. The field of indications is just openedand potential future applications will be evaluated.The following indications were treated:• Patella tendon syndrome• Plantar and dorsal heel spur• Golfers and tennis elbow• Supraspinatus tendon syndrome• Tendinosis calcarea• Stress fractures• Tibia pain• Osteochondrosis and othersThe earlier the betterGenerally, the results are good to very good (60-80%), varying slightly with indication, meaning beingcompletely cured without any pain left or featuring asignificant reduction of pain. Of specific importanceof ESWT in top sports is the fact, that the percentageof completely painfless patients (very good result)increases from 40% in case of chronic pain persistentover more than 6 month to 62% in patients withpersisting pain shorter than 6 month. This fact clearlyfavours an nondelayed treatment by shock waveswhereas usually for reimbursement reasons only,6 month of unsuccessful conservative treatment isrequired before ESWT.STORZ MEDICAL AG ∙ UNTERSEESTR. 47 ∙ CH-8280 KREUZLINGEN ∙ TELEFON: +41/71/677 45 45 ∙ TELEFAX: +41/71/677 45 05E-MAIL: INFO@STORZMEDICAL.COM ∙ INTERNET: WWW.STORZMEDICAL.COM2

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