FEATURE TECHNOLOGY HELPING HAND 4 reasons why you should integrate shockwave therapy into your practice DR. ROBERT GORDON AND IRENE KIROPLIS O ver the last 20 years, shockwave therapy (SWT) has evolved at an incredible pace. Originally developed to treat kidney stones, SWT is a non-invasive alternative to surgery, and has been used to treat people of all ages, and multiple conditions. Shockwave therapy has set a high standard of care. Numerous dou-ble-blind randomized studies have supported its use and it has been scien-tifically shown to create neovasculariza-tion and neurogenesis in the effected tissue. These studies have been reviewed and supported by the FDA. Shockwave therapy has also been shown to be very cost effective: covered by most insur-ance companies as part of chiropractic care. By incorporating shockwave ther-apy into their practices, chiropractors have been able to practise longer and have decreased wear and tear on their bodies. SCIENCE OF THE TECHNOLOGY Shockwave devices, like computers, have transformed from large (200 kg) machines to portable, lightweight de-vices with the computer and controls being housed in the hand-piece. Shock-wave devices were originally designed to penetrate a small target in the tissue with high energy, dissipated over a short period of time. These devices were tra-ditionally spark gap generated and electromagnetic. The focused devices are now more commonly used in ortho-pedics for the treatment of shoulder calcification, stress fractures, and bony non-unions. The most common device used now is a radial shockwave device – a lower energy pressure wave dissipated over a longer period of time. It is primarily used to treat musculoskeletal disorders and tendinopathies. This radial device works by propelling a small metal pro-jectile through a chamber using high air pressure. The projectile then collides with the head of the hand-piece creating the sound wave. Gel is used to propa-gate the wave through the skin to the desired tissue. There, the sound waves activate the body’s natural healing pro-cesses and stimulate tissue repair. Chiropractors often perform treat-ment on many areas of the body using different modalities, and shockwave treatment now accounts for many of those indications. One company also offers a hand piece that combines vibra-tion and shockwave to treat myofascial disorders. Some devices have the ability to do cupping, needleless acupuncture, and spine treatments Shockwave ther-apy allows chiropractors to broaden their scope of practice, enhancing treat-ment of the patient. A study recently published in the Jour-nal of Bone and Joint Surgery described how shockwave could be used to treat plantar fasciitis, Achilles tendinopathy, stress fractures, non-unions, jumper’s knee, hamstring tendinopathy, rotator cuff tendinopathy, and calcific tendin-opathies. Other indications include fascial release, pain reduction, acupunc-ture points, trigger point therapy, tennis elbow, shin splints, Osgood-Schlatter, Morton’s neuroma, hallux rigidus, and chronic pelvic pain syndrome. Shockwave therapy is non-invasive and does not use needles or probes. It has replaced numerous other methods of treatment. Local anesthetic is not re-quired as the treatment is not painful and usually only takes about four minutes. Shockwave therapy works by reduc-ing pain, increasing blood circulation and metabolism. It also stimulates bone growth and creates neovascularization. A study published in Clinical Ortho-paedics and Related Research (2001) www.canadianchiropractor.ca INDICATIONS DR. ROBERT GORDON is an orthopaedic surgeon specializing in knee surgery. He is on staff at the University Health Network at the University of Toronto and at William Osler Health Centre. He is the past president of the International Society for Medical Shockwave Treatment. Gordon helped introduce shockwave therapy to Canada and has lectured at numerous institutions and conferences. He has published papers on shockwave therapy and has been treating patients for almost 20 years with shockwave. IRENE KIROPLIS COMPLETED her Bachelor of Science in Kinesiology at The Pennsylvania State University in 2018. Irene also played for the Rugby team and NCAA Division 1 Nittany Lions women’s ice hockey team. Currently Irene is a research assistant with Dr. Robert Gordon and Dr. Jas Chahal at the University Health network in Toronto. 26 Canadian Chiropractor February 2019
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