Extracorporeal Shock Wave Lithotripsy Research Articles

Clinical Efficacy and Safety of Low-Energy Extracorporeal Shock Wave Therapy for Various Conditions of Deep Dermal and Subdermal Fibrosis.

Extracorporeal shock wave therapy (ESWT) enhances extracellular matrix remodeling and tissue regeneration by promoting growth factor release, regulating blood and lymphatic flows, and reducing fat and fibrotic tissues. Focused shock wave therapy (F-SWT), radial shock wave therapy (R-SWT), and combined F-SWT and R-SWT have been used to deliver different patterns of shock energy depending on the characteristics of the target lesions. We investigated the efficacy and safety of ESWT in patients with dermal and subdermal fibrosis. Fifty-two patients treated with F-SWT and/or R-SWT for dermal and subdermal fibrosis caused due to various reasons were retrospectively analyzed by reviewing their medical records, clinical images, and ultrasound study images. The mean number of pulses administered for F-SWT on the cheek, temple, and chin were 2600.0 ± 1040.8 shocks/session and for R-SWT were 5080.0 ± 2234.6 pulses/session, and the number of treatment sessions were 8.0 ± 4.4. In patients who were treated with ESWT on the abdomen, the mean number of pulses for F-SWT were 2600.0 ± 2408.3 shocks/session and for R-SWT were 8400.0 ± 894.4 pulses/session, and the number of treatment sessions were 3.2 ± 1.6. Most patients were satisfied with the results. Pain during ESWT was well tolerated and post-ESWT edema was more common in R-SWT than in F-SWT. Our data demonstrated that ESWT effectively and safely improved the clinical appearance and functional movement of patients with dermal and subdermal fibrosis caused due to various reasons.

Extracorporeal Shockwave Therapy Is Associated With Similar Functional Outcomes for Male and Female Runners With Patellar or Quadriceps Tendinopathy: A Pilot Investigation

PurposeThe purpose of this study is to characterize functional outcomes in runners with patellar tendinopathy (PT) and quadriceps tendinopathy (QT) following extracorporeal shockwave therapy (ESWT) and explore differences in response by tendinopathy (PT or QT) and by sex (female or male). MethodThis is a retrospective cohort study of runners with PT or QT treated with ESWT (radial or combined) at a single sports medicine clinic during a 5-year period. Individuals were included if they had a primary diagnosis of PT or QT, self-identified as a runner, and had complete baseline and final functional outcome questionnaires for ESWT with treatment duration defined by response based on best practices. Functional outcome at baseline and following treatment were assessed using the Victorian Institute of Sport – Patellar Tendon (VISA-P) questionnaires. Treatment success was defined as meeting minimal clinically important difference (MCID) of ≥13 points. ResultsOf the 19 runners included, 26% identified as female and 74% as male; all runners identified as cisgendered. There were 12 runners with PT (17% female, 83% male) and 7 with QT (43% female, 57% male). Median follow-up was 3.0 months (range: 1.0-23.0, IQR: 3.0, 6.0). Of all runners, 67% with PT and 71% with QT achieved MCID with no significant difference between tendinopathy groups (p= 0.90). There was also no difference in the percentage that achieved MCID between sexes, with 80% females and 64% males meeting MCID (p=0.72). ConclusionsSimilar functional outcomes were observed in female and male runners with QT or PT following radial and combined ESWT, with the majority achieving MCID. This study suggests that ESWT, in combination with physical therapy, may be an effective treatment for runners with PT or QT and that ESWT could be considered for PT or QT refractory to physical therapy. Level of EvidenceLevel IV, retrospective case series.

Clinical utility of extracorporeal shock wave therapy in restoring hand function of patients with nerve injury and hypertrophic scars due to burns: A prospective, randomized, double-blinded study.

Joint contractures and nerve injuries are common after hand burns. Extracorporeal shock wave therapy (ESWT) is effective not only for the regeneration of various tissues, including scar tissues, but also for reducing pain and pruritus in patients with burns. Researchers have attempted to explore the effects of ESWT on hand dysfunction caused by nerve injury following burns. We evaluated the effects of ESWT (compared to sham stimulation) on hands with nerve injury and hypertrophic scars and thereby on hand function. The current study was a double-blind randomized controlled trial involving 120 patients. The ESWT parameters were as follows: energy flux density, 0.05-0.30mJ/mm2; frequency, 4Hz; 1000 to 3000 impulses per treatment; and 12 treatments, one/week for 12 weeks. Outcome measures were as follows: 10-point visual analog scale for pain, Jebsen-Taylor hand function test, grip strength, Purdue Pegboard test, ultrasound measurement of scar thickness, and skin characteristics before and immediately after 12 weeks of treatment. No significant inter-group difference was noted after the initial evaluation (P>0.05). More significant improvements were found in the ESWT group than in the sham group in terms of the VAS score (P=0.004), extension ROMs of hand joints (P=0.02), the JTT scores (writing, small, and light) (P<0.001, P<0.001, and P=0.002), and skin characteristics (melanin, skin distensibility, and biologic skin elasticity) (P=0.004, P<0.001, and P<0.001). Other measured outcomes did not differ between the two groups after the treatment. We identified the clinically beneficial effects of ESWT in promoting hand function, improving scarring, and alleviating scarring-related pain, thereby highlighting its advantages in improving hand function that has been impaired due to nerve injury and hypertrophic scars after burns.

Prognostic factors of extracorporeal shockwave therapy in the treatment of nonunion in long bones: a retrospective study.

Nonunion of long bone fractures is a significant complication following surgical fixation, with an incidence ranging from 5% to 10%. Surgical intervention is the standard treatment for nonunions, but it may come with potential complications. Nonoperative approaches, such as Extracorporeal Shockwave Therapy (ESWT), have been advocated as alternatives. The retrospective study, conducted between January 2004 and January 2018, 91 patients who underwent ESWT for tibia or femur nonunions were included. Nonunion was defined based on radiographic criteria and clinical symptoms. The nonunion morphology was categorized as hypertrophic, oligotrophic, or atrophic. ESWT was administered using the OssaTron device in a single treatment session. Bony union was defined as the presence of bridging callus over fracture site with more than three-fourths of the circumference in both planes within the 12-month postoperative period. The study included 91 patients, with an overall union rate of 62.6%. Higher healing rate was observed in trophic nonunion(69.9%) than atrophic nonunion(33.3%). Multivariate analysis identified the number of surgeries, maximum fracture gap, and atrophic nonunion as independent factors influencing the risk of fracture nonunion after ESWT. ROC curves were generated for these factors, providing more than one surgical interventions, and fracture gap greater than 3.94mm as negative predictors of ESWT for long bone nonunions. The study's primary findings suggest that ESWT is effective in achieving bony union for nonunions in long bones(62.6%). Despite the overall positive results, the study highlights that atrophic nonunions, larger fracture gaps more than 3.94mm, and multiple surgeries are associated with poorer outcomes.

MODELING OSTEOCYTE UNDER SHOCK-WAVE THERAPEUTIC LOADING

Dental implants have substantial significance in modern dentistry, but their osseointegration stage remains the most crucial and time-consuming step for compensating for a lost tooth. One promising approach to improve osseointegration rates is the use of extracorporeal shock wave therapy, which has shown efficacy in treating fractures, bone defects, and bone tissue regeneration in surgical and arthroplasty procedures. To comprehend the potential of shock wave therapy in accelerating implant osseointegration, it is crucial to investigate the influence of mechanical loading on ossification processes of varying scales objectively. This study aims to study numerically the effects of low-energy shock wave therapy at different intensities on the mechanical response of a single osteocyte, the principal bone cell that corresponds to microscale of bone tissue. The investigation employs the method of movable cellular automata for modeling. The computer simulation results and analysis based on mechanobiological principles indicate that low-intensity shock wave loading creates conditions for intramembranous ossification, whereas high-intensity shock wave exposure creates conditions for endochondral ossification.

A review of Peyronie's disease insurance coverage.

Peyronie's disease (PD) is a fibroproliferative disorder that causes an abnormal curve of the penis resulting in pain, discomfort, and erectile dysfunction with management options including correctional surgery, penile external/internal devices, shock wave therapy (SWT), intralesional Verapamil (IV), and collagenase Clostridium histolyticum injections. To investigate the insurance coverage of these treatment options. The authors performed a cross-sectional analysis of the top US insurance policies for coverage of PD. Companies were chosen based on their market share and enrollment. Their policies were identified through a Web-based search and telephone interviews, and the companies' medical necessity criteria were defined. The online policies were then re-examined for interval change 3 years later. There are significant discrepancies for in coverage for the different modalities of Peyronie's treatment. Of the 100 companies examined, only 54% of companies had a policy that directly addressed the treatment coverage for PD. The most covered treatment was CCH injections with 37 companies providing unanimous coverage (n = 37, 100%). Within this category, all companies required a palpable plaque as a requirement. Additionally, external/internal devices were unanimous covered by 18 companies (n = 18, 100%). Surgical treatment was covered by eight companies with six companies denying coverage (n = 8 vs. n = 6, 57.1% vs. 42.9%). IV was covered by two companies. The least covered treatment option was SWT which was universally denied by 19 companies (n = 19, 100%). Insurance coverage of PD should be aligned with current medical literature to better increase access to care. This study is limited by the updated policies of insurance companies and future applicability. Additionally, this study assumes that a written policy will provide coverage and may overestimate the actual extent of coverage. Finally, this study only addressed some of the common treatment options of PD and did not expand on all possible treatment options. Differing rates for modalities of treatment may present a barrier for patients to receive individualized and adequate treatment for PD.

Ultrasound-guided percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a systematic review with meta-analysis of randomized controlled trials.

Ultrasound-guided lavage (UGL) is a minimally invasive percutaneous treatment for rotator cuff calcific tendinopathy (RCCT). It involves the use of a syringe containing saline and/or anesthetic solution injected directly into the calcification allowing aspiration of the fragmented calcific material. The aim of this systematic review is to investigate if UGL is effective in improving pain, function, quality of life, range of motion (ROM), and in promoting complete resorption of calcifications in patients with RCCT. Only randomized controlled trials considering people diagnosed with RCCT, at any stage and at any time of the onset of symptoms treated with UGL, were included. Embase, CENTRAL, CINHAL, PEDro and MEDLINE were explored up until May 2024. Two independent authors selected randomized controlled trials by title and abstract; afterwards, the full text was thoroughly evaluated. The risk of bias (ROB) was assessed using the Cochrane risk of bias 2 (ROB2) tool and the certainty of evidence was evaluated through the GRADE approach. Seven studies (709 subjects) were included. Overall, three studies were judged as low risk of bias. Pooled results showed non-significant differences between UGL and extracorporeal shock-wave therapy (ESWT) at 12 weeks (SMD=-0.52, 95% CI -1.57, 0.54, P=0.34, I2=93%) and at 26 weeks (MD=-1.20, 95% CI -2.66, 0.27, P=0.11, I2=82%), while a significant difference favoring UGL (SMD=-0.52, 95% CI -0.85, -0.19, P=0.002, I2=38%) resulted at 52 weeks. In regard to function, pooled results showed non-significant difference between UGL and ESWT at 6 weeks (MD=3.34, 95% CI -11.45, 18.12, P=0.66, I2=79%) and at 52 weeks (SMD=0.10, 95% CI -0.40, 0.60, P=0.69, I2=30%). Considering the rate of resorption of calcifications between UGL combined with subacromial corticosteroid injection (SCI) versus injection alone, pooled results showed significant difference favoring UGL at <52 weeks (RR=1.63 95% CI 1.34, 1.98, P<0.00001, I2=0%). Certainty of evidence ranged from low to very low. UGL seems to be a reasonable and safe treatment for RCCT, however compared to other non/mini-invasive approaches, UGL showed doubtful results in controlling pain and increasing function and rate of calcifications resorption. These results should be interpreted with caution because certainty of evidence ranged from low to very low.

202 - Erectile dysfunction treatment by platelet-rich plasma and extracorporeal shock wave therapy

202 - Erectile dysfunction treatment by platelet-rich plasma and extracorporeal shock wave therapy

Letter to the Editor regarding "Comparison of High-intensity Laser Therapy with Extracorporeal Shock Wave Therapy in the Treatment of Patients with Plantar Fasciitis: A Double-blind Randomized Clinical Trial".

Letter to the Editor regarding "Comparison of High-intensity Laser Therapy with Extracorporeal Shock Wave Therapy in the Treatment of Patients with Plantar Fasciitis: A Double-blind Randomized Clinical Trial".

Randomized trial of low intensity shockwave therapy for erectile dysfunction utilizing grayscale ultrasound for analysis of erectile tissue homogeneity/inhomogeneity.

Electrohydraulic shockwave devices have been Food and Drug Administration-cleared for improved blood flow and connective tissue activation and have been used to treat erectile dysfunction (ED). In this study, the main focus was to evaluate improvement in erectile tissue quality after low intensity shockwave therapy (LiSWT). A single-blind, sham-controlled, randomized, prospective study, was performed in men with ED naïve to shockwave or radial ballistic pressure wave therapy. Participants were randomized 1:2 to simulated (sham) or active LiSWT treatment. After simulated treatments, participants in the Sham Arm were converted to active LiSWT, while participants initially in the Active Treatment Arm received no further treatment. Assessments were performed at baseline and two follow-up visits. Subjective parameters of erectile function (EF) were assessed by total and EF domain scores of the International Index of Erectile Function (IIEF) and sexual encounter profile (SEP). Objective parameters of penile erection were measurements of hypoechoic areas in images obtained by grayscale ultrasound (GUS) with high resolution 15.4 MHz probe and cavernosal artery peak systolic velocity (PSV) and end diastolic velocity (EDV) by color duplex Doppler ultrasound (DUS). Outcome measures for erectile and urinary function were also obtained. Simulated LiSWT did not significantly change any assessment parameter. Sham Arm participants who converted to active LiSWT had significantly increased mean IIEF total (P=0.02) and IIEF-EF scores that approached statistical significance (P=0.06), relative to baseline. Similarly, at the end of the study, Active Treatment Arm participants had significantly increased mean IIEF total (P=0.02) and IIEF-EF scores that approached statistical significance (P=0.07), relative to baseline. Additionally, at the end of the study, SEP3 success rates (erection lasting long enough for successful intercourse) approached statistical significance when Sham Arm participants were converted to active LiSWT (P=0.08) and reached statistical significance in the Active Treatment Arm (P=0.049). GUS assessments by visual grading were significantly correlated to IIEF-EF score (P=0.002) and were significantly increased relative to baseline in the Active Treatment Arm at follow-up Assessment 1 (P=0.03) and Assessment 2 (P=0.04). The greatest reduction in hypoechoic area after LiSWT occurred in the proximal penile shaft. EDV was also significantly reduced in the Active Treatment Arm at follow-up Assessment 1 (P=0.04) and Assessment 2 (P=0.04). LiSWT also resulted in improved prostate symptom scores, approaching significance in the Active Treatment Arm (P=0.055) with no changes in prostate-specific antigen. Treatment-related adverse events were limited and transient. In this prospective trial, LiSWT was safe and efficacious for erectile symptoms using GUS imaging as a novel, non-invasive method to assess improvements in corporal veno-occlusive function. Improved veno-occlusion and reduced hypoechoic area demonstrated by GUS imaging suggest that LiSWT decreases connective tissue content in penile erectile tissue. Lower urinary tract symptoms also improved with LiSWT. NCT06600893 on clinicaltrials.gov.

The dose effectiveness of extracorporeal shockwave on plantar flexor spasticity of ankle in stroke patients: a randomized controlled trial

BackgroundExtracorporeal shockwave therapy (ESWT) has been proven beneficial for post-stroke spasticity (PSS) of ankle plantar flexor muscles. This study aims to investigate the dose-response effectiveness of focused-ESWT and the duration of its effect on the treatment of ankle PSS in stroke patients.MethodsIn this double-blinded randomized controlled trial, stroke patients diagnosed with PSS in the ankle plantar flexor muscles were randomly assigned to two groups. The experimental group received double-dose ESWT (4000 pulses per session) targeting spastic calf muscles, while the control group received half the dose (2000 pulses per session). Both groups underwent four sessions over two weeks. The outcomes, including modified Ashworth Scale (MAS), modified Tardieu Scale (MTS), passive range of motion (PROM) of the ankle, Timed Up and Go (TUG) Test, Barthel index and strain elastography were evaluated at baseline, 1st, 4th, 12th, and 24th week after ESWT.ResultsWithin-group analysis revealed significant improvements in MAS, PROM, TUG Test, and Barthel index for the double-dose ESWT group and improvements in Barthel index for the control group. Between-group analysis revealed greater improvements in TUG Test, Barthel Index and strain elastography for the double-dose ESWT group. Generalized estimating equations analysis indicated that the double-dose ESWT group achieved superior outcomes in the TUG Test, Barthel Index, and strain elastography across various time points and groups.ConclusionsDouble-dose ESWT showed better functional improvement and elastography compared to the control group. ESWT demonstrated dose-response effectiveness for PSS of ankle-equinus.Trial registrationNCT05878223.

Is low-intensity shockwave therapy for erectile dysfunction a durable treatment option?-long-term outcomes of a randomized sham-controlled trial.

Low-intensity shockwave therapy (LiSWT) is an emerging non-invasive and restorative therapy for erectile dysfunction (ED) with demonstrated efficacy and few adverse events. Although LiSWT has been shown to improve erectile function amongst men with ED, few studies have examined its long-term durability. We present the long-term results of a randomized controlled trial (RCT) assessing erectile function after LiSWT. A total of 30 patients with baseline ED seen at the University of Virginia were randomized to LiSWT or sham treatment. Patients in the sham group crossed over at 1 month and were unblinded. After initial trial completion, patients enrolled in the long-term outcome study were considered one combined cohort. Patients were treated twice weekly for 3 consecutive weeks with a Storz® Duolith™ device delivering 3,000 shockwaves at 0.1 mJ/mm2 to the distal penis, the base of the penis, and the crura. Primary outcomes were changes in Sexual Health Inventory for Men (SHIM) and Erection Hardness Score (EHS) from baseline (3 months pre-treatment) up to 36 months post-treatment. Changes in SHIM and EHS scores were evaluated using linear mixed effects models. Patient satisfaction was assessed with the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) index. The mean baseline SHIM score was 10.8±0.94. At 12-, 24-, and 36-month assessment following treatment, the mean SHIM scores were 15.6±1.27 (P<0.001), 15.0±1.14 (P<0.001), and 12.2±1.43 (P=0.31). The mean baseline EHS score was 1.87±0.17. At 12-, 24-, and 36-month assessment following treatment, the mean EHSs were 2.70±0.24 (P<0.001), 2.66±0.21 (P<0.001), and 2.29±0.26 (P=0.10). The median [interquartile range (IQR)] EDITS score was 48.9 (22.7, 74.4), indicating moderate satisfaction with LiSWT. There were no adverse events recorded. Our analysis demonstrates sustained long-term improvement in erectile function after LiSWT for a heterogeneous cohort. While limited by population size, the results suggest durable improvement in erectile function for the first 2 years with a peak treatment effect at 1 year. Treatment effect appears to decline between 2 and 3 years. ClinicalTrials.gov, NCT04434352.

Physiotherapy compared to shockwave therapy for treatment of proximal hamstring tendinopathy, a pilot randomised trial

Physiotherapy compared to shockwave therapy for treatment of proximal hamstring tendinopathy, a pilot randomised trial

The effects of extracorporeal shock wave therapy on cutaneous radiation injury in a mouse model.

Although radiation-induced skin injuries are a concern in patients receiving radiation therapy, there are few effective treatments. The aim of this study was to evaluate the protective effects of extracorporeal shock wave therapy (ESWT) on irradiated fibroblasts and mouse skin. In the in vitro study of human dermal fibroblasts, the experimental group was subjected to ESWT following irradiation (20 Gy). The control groups were only irradiated or only subjected to ESWT. At 24 or 48 h post-ESWT, cell viability, cell migration, and mRNA and protein expression were measured. In the in vivo study, the experimental group (7 mice) was treated with ESWT following irradiation (45 Gy). The control group (7 mice) was only irradiated. At 8 weeks post-irradiation, dorsal skin was harvested for histopathologic examination and protein isolation. In dermal fibroblasts, treatment with ESWT increased viability of irradiated cells compared with irradiated-only and untreated cells (p = 0.005). ESWT increased cell migration 24 h post-irradiation (p = 0.002), and decreased TGF-β1 protein expression 48 h post-irradiation (p = 0.024). In mice, ESWT decreased the level of radiation-related skin injury (p = 0.006). Treatment of irradiated skin with ESWT decreased TGF-β1 (p = 0.009) and phospho-Smad3 (p = 0.009) protein expression, as well as decreasing myofibroblasts (p = 0.047) and increasing vessel density (p < 0.001). Our study demonstrated that ESWT alleviated radiation-induced fibrosis by downregulating TGF-β1 expression. It suggests the potential of ESWT for the treatment of radiation-induced fibrosis.

Benefits of Extracorporeal Shock Wave Therapy to Reduce Spasticity in Cerebral Palsy and Stroke Patients

Background: Spasticity, a common issue in cerebral palsy and stroke patients, significantly impairs mobility and quality of life. Non-invasive treatments like Extracorporeal Shock Wave Therapy (ESWT) have been explored for spasticity reduction.Objective: To evaluate the effectiveness of ESWT in reducing spasticity in cerebral palsy (CP) and stroke patients using the Modified Ashworth Scale (MAS).Methods: A randomized controlled trial (RCT) was conducted on 28 spastic CP and stroke patients. Participants were divided into Group A (n = 14, ESWT combined with conventional physiotherapy) and Group B (n = 14, conventional physiotherapy only). ESWT was administered at 5 Hz frequency, 0.10 mJ/mm² energy flux density, and 1500 impulses per session for 30 minutes, 5 days a week, for 6 months. Spasticity was assessed using MAS pre- and post-intervention. Data were analyzed using IBM SPSS version 25.Results: The ESWT group showed a significant reduction in MAS scores from 3.21 ± 0.25 to 1.77 ± 0.37 (p &lt; 0.001), compared to the control group (3.10 ± 0.44 to 2.36 ± 0.60; p &lt; 0.001).Conclusion: ESWT significantly reduced spasticity in CP and stroke patients, demonstrating its potential as an adjunctive therapy.

Effects of Postural Corrective Exercise Combined with Extracorporeal Shockwave Therapy on Muscle Activity, Neck Function and Pain in Adults with Forward Head Posture

Effects of Postural Corrective Exercise Combined with Extracorporeal Shockwave Therapy on Muscle Activity, Neck Function and Pain in Adults with Forward Head Posture

Comparative Effectiveness of Radial Extracorporeal Shock Wave Therapy on Single and Multipul Trigger Points in Patients with Biceps Tendinopathy

Comparative Effectiveness of Radial Extracorporeal Shock Wave Therapy on Single and Multipul Trigger Points in Patients with Biceps Tendinopathy

SPECTRUM OF BACTERIAL CULTURE AND ANTIBIOGRAM IN PCNL PUNCTURE URINE SAMPLE

Percutaneous nephrolithotripsy (PCNL) is the standard treatment for high-volume renal stones, stones resistant to extracorporeal shockwave lithotripsy (ESWL), and multiple and inferior calyx renal stones. Objective: The study's main objective is to find bacterial culture and antibiogram spectrum in PCNL puncture urine samples. Methods: This retrospective observational study was conducted at CMH, Lahore, from April 2024 to July 2024. Data were collected from 185 patients. Urine samples were collected directly from the renal pelvis through the PCNL puncture site during the surgical procedure. This method ensures that the samples accurately represent the microbial environment of the kidney. Results: Data were collected from 185 patients according to the study's criteria. The gender distribution comprised 110 males (59.5%) and 75 females (40.5%). The age of the patients ranged from 25 to 70 years, with a mean age of 48.23±3.54 years. Among the positive cultures, Escherichia coli was the most prevalent species, found in 46.2% of cases, followed by Klebsiella pneumoniae (23.1%), Pseudomonas aeruginosa (15.4%), Enterococcus faecalis (7.7%), and Proteus mirabilis (3.8%). Additionally, 3.8% of the samples included other bacteria, including mixed infections. Conclusion: It is concluded that the bacterial spectrum in PCNL urine samples is diverse, with significant antibiotic resistance patterns observed among isolated pathogens.

Post-mechanotherapy differences in postural control in patients with Achilles tendinopathy - A randomized controlled trial

BackgroundNeuromuscular deficits affecting functional ability can occur in patients with Achilles tendinopathy during difficult balance activities. This study aimed to assess postural control in patients with Achilles tendinopathy after shockwave and sonotherapy, using advanced analytical methods, including rambling-trembling signal decomposition and sample entropy. Research questionWhat are the differences in postural control between patients with Achilles tendinopathy after shockwave therapy, ultrasound therapy, and placebo ultrasound? MethodsThirty-nine patients were included in the study, and randomly assigned to 3 groups, i.e., shockwave therapy, ultrasound therapy and placebo ultrasound. Postural sway was assessed during quiet standing with eyes open and closed, with two force platforms, one for the affected and the other for the non-affected limb, at baseline and at weeks 1 and 6 after treatment. Rambling-trembling trajectories and sample entropy were calculated for the antero-posterior and medio-lateral directions. ResultsThe parameters of trembling trajectory in both directions were significantly smaller for the affected compared to non-affected limb. The ultrasound group had significantly larger rambling-trembling trajectories in the antero-posterior and medio-lateral sway directions than the shockwave therapy group. Also, all patients had more difficulty controlling their postural sway while standing with eyes closed compared to eyes open. Sample entropy was not significantly affected by the therapy type, timepoint and limb condition. SignificanceAs opposed to sample entropy, rambling-trembling decomposition can complement or replace traditional linear measures of COP time series in functional assessment of the Achilles tendon.

Effect of extracorporeal shockwave on gait parameters in patients with plantar fascitis: a randomized controlled trial

BackgroundPlantar fasciitis (PF) is the most common cause of heel pain affecting both young active patients and older sedentary individuals. It most often arises as a result of degenerative changes in the proximal plantar fascia.AimThe purpose of this study was to investigate the effect of extracorporeal shockwave on gait parameters in patients with plantar fasciitis.DesignA randomized controlled clinical trial.SettingThe outpatient physiotherapy clinic of the teaching hospital Shibin El Kom.MethodsParticipants were randomly divided into two equal groups. Group (A) (study group): received extracorporeal shockwave therapy one session per week and traditional treatment (ultrasound, stretching exercises, and strengthening exercises) three sessions per week for 4 weeks. Group (B)(the control group): received traditional treatment (ultrasound, stretching exercises, and strengthening exercises) 3 sessions per week for 4 weeks. The pre- and post-treatment development of the patients was evaluated by visual analog scale (VAS) to measure pain, foot function index (FFI) to measure foot function, and Kinovea software to analyze gait parameters (stride length, stride time, walking speed, and cadence).ResultsBoth groups showed improvement in all study variables, but the study group showed more improvement. There was a statistically significant decrease in VAS (p = 0.001), a significant decrease in FFI (p = 0.001), a significant increase in stride length (p = 0.001), a significant decrease in stride time (p = 0.001), a significant increase in walking speed (p = 0.001), and a significant increase in cadence (p = 0.01) post-treatment compared to group (B).ConclusionExtracorporeal shockwave treatment is regarded as a useful treatment for improving gait parameters in patients with plantar fasciitis.Clinical rehabilitation impactExtracorporeal shockwave therapy improved gait parameters in patients with plantar fasciitis as it increases stride length, walking speed, cadence, and decreases stride time. So, it is recommended to be included in the rehabilitation program for patients with plantar fasciitis and gait disabilities.