showed that SWT created a biologic response in the Achilles tendon tissue that increased Bone Morphogenetic Proteins (BMP), nitric oxide synthase (NOS), vascular endothelial growth factor (VEGF), and proliferating cell nuclear antigen (PCNA). This lead to improved blood flow to the effected area and resulted in tissue regeneration. Shockwave therapy has also shown to have analgesic effects by affecting sub-stance “P.” The contraindications for shock-wave therapy include: existing cancer, those with pacemakers, and preg-nancy. Patients are also asked to re-frain from taking anti-inflammatory medications as it will block the path-way shockwave uses to promote tissue healing. However, patients who require blood thinners do not have to stop their medication because it improves the effectiveness of the treatment. In a recent Current Concepts Review, Dr. Moya demonstrated the pathway where shockwave therapy works. There are phases to the mechanism of healing: First is the physical phase, where sound waves increase permeability of the ef-fected tissue, and cell signaling pathways are activated. Second is the physico-chemical phase, where shockwave stim-ulates the release of biomolecule aden-osine triphosphate (ATP) to activate cell signal pathways. In the third (chemical) phase, shockwaves change the functions of ion channels in the cell membrane and the calcium mobilization in cells. Following this phase, the biological 28 Canadian Chiropractor February 2019 ROBUST RESEARCH phase modulates angiogenesis [von Willebrand factor [vWF], vascular en-dothelial growth factor [VEGF], en-dothelial nitric oxide synthase [eNOS], and proliferating cell nuclear antigen [PCNA]), anti-inflammatory effects. The combination of these four phases results in the great healing potential of shockwaves. The effectiveness of shockwaves with respect to numerous conditions has been published in a number of studies. For example, shockwave therapy can be effective in improving function and decreasing pain by 91 per cent for cal-cific rotator cuff tendinopaties. Dr. Gerdesmeyer reported that those who underwent shockwave therapy saw an 86 per cent calcium reabsorption in one year. Shockwave therapy, when used in combination with eccentric loading exercises, is 76 per cent more successful for treating patellar tendinopathy. Eccentric loading in combination with shockwave therapy is important because it increases muscle mass without putting excess pressure on the joints and ligaments. Hans Gollwitzer ( Journal of Bone and Joint Surgey , 2015) showed an 84 per cent success rate for the treatment of plantar fasciitis. There have been over 108 studies and seven randomized dou-ble-blind controlled trials all showing that SWT is significantly better than placebo for the treatment of plantar fasciitis. There is also a study from the American Orthopaedic Foot & Ankle Society (2012), on the use of shockwave therapy for plantar fasciitis that showed SWT reduced the thickness of the plantar fascia to a more normal compo-sition. Impressively, in a study done by Dr. Cacchio ( American Journal of Sports Medicine , 2010), he showed that in pro-fessional soccer players in the English Premier League who had chronic prox-imal hamstring tendinopathy, 17 of the 20 patients (85 per cent) in the shock-wave therapy group saw at least a 50 per cent reduction in pain after three months and were able to return to play 8.5 times faster than the placebo. Other studies have shown the effec-tiveness of shockwave therapy in the treatment of tennis elbow, Morton’s neuroma, frozen shoulder, and shin splints. Most studies used radial shockwave devices that treat the patient three times over a two-week span. With success rates ranging from 76 to 91 per cent improvement, it is still very important to understand that the regenerative healing process that occurs from shock-wave therapy takes three months. The treatment of trigger points only requires a one-time treatment and can be done as often as the practitioner feels necessary. (As opposed to treating tendinopathies, which require three treatments.) ECONOMICS View this story on our website for a list of references: Canadianchiropractor.ca www.canadianchiropractor.ca Photo: Shockwave Canada In Canada there are two companies that are both Health Canada and FDA ap-proved. These machines are very af-fordable and cost as low as $220 a month (lease to own). Shockwave therapy gives a high return on invest-ment, resulting in greater profits for your clinic. Moreover, treating patients successfully at a higher rate than your colleagues who do not have SWT in their practice differentiates you from the competition. Machines are portable, lightweight and can be easily transported if neces-sary. This is especially convenient for chiropractors that make house calls or have multiple clinics. Simply put, by making your patients better, your busi-ness will flourish and your patients will significantly improve in their function and quality of life.
Chiropractic + Naturopathic Doctor February 2019: Page 28
