Queston for Dr. RompfPosted by Dr. Z on 2/22/04 at 08:03 (145009)
If you are looking at a study that shows good results with low energy using a three treatment procotol that delivers lets say 1000mj/mm2 ( total energy flux density per treatment) can you determine that the results would be similiar if you deliver that same amount of energy in just one treatment.
Re: Question for anyone that knows the answerDr. Z on 2/22/04 at 21:36 (145048)
Re: Question for anyone that knows the answerEd Davis, DPM on 2/22/04 at 21:54 (145059)
I beleive that the 'magic number' being used is now 1300 mj/ sq. mm (for PF) so the implication is that total energy delivered may have greater meaning as to HOW the nergy is delivered.
Re: Question for anyone that knows the answerDr. Z on 2/22/04 at 22:29 (145063)
I am not sure what you mean. Could you please repeat this again. Are you saying that three low energy treatments at 1300mj/mm2 is equal to one high energy eswt that delivers one treatment at 1300 mj/mm2.
The reason I am asking this is I want to take low energy treatment protocol for other parts of the body ie elbows and apply this to a one high energy treatment protoocl. There are few if no high energy treatment protocols in the literature.
Re: Question for anyone that knows the answerEd Davis, DPM on 2/23/04 at 23:11 (145148)
I would use those figures for the plantar fascia. I see your dilemna for other body parts. I think that some of that will be left to your clinical judgement -- size and strength of the tendon/ligament, etc. The other thing to do is to read some of the protocols used by the European researchers in their papers on http://www.ismst.com
Re: Queston for Dr. RompfJan R. on 2/24/04 at 03:48 (145163)
You could do me great favor if you spellt my name in a correct way.
I have no clear answer to your problem. But I am convinced there is a biological limitation to the energy flux density that can be applied.
From >0.2 mJ/mm² per shock you must be aware of - reversible? - damage to tendinous tissue.
So, instead of applying 3x 2000 shocks of 0.09 mJ/mm² in weekly intervals (= 540 mJ/mm²), I would not apply 500 impulses of 1.08 mJ/mm² once, or 1000 impulses of 0.54 mJ/mm².
You risk detrimental effects (rupture, inflammation) at an already damaged tendon.
The effects of extracorporeal shock waves on the rat Achilles tendon: is there a critical dose for tissue injury?
Arch Orthop Trauma Surg 2004, in press
Introduction: Extracorporeal shock waves (ESW) have been extensively studied in the field of orthopedics. Experimental and focused, well-designed clinical studies have suggested the clinical utilisation of ESW in several pathologies including delayed bone union, tennis elbow, and plantar fasciitis. However, the unwanted detrimental effects of ESW on various tissues have been questioned by some authors. In this experimental study, the effects of ESW were investigated at different intensity applications on the Achilles tendons of rat.
Materials and methods: A total of 32 adult Wistar albino rats was divided into four groups. The first three groups received 1000 impulses of 0.15 mJ/mm2, 1500 impulses of 0.15 mJ/mm2, and 2000 impulses of 0.20 mJ/mm2, respectively. The last group was kept as the control group. Subsequently, Achilles tendons were harvested for histological studies from all rats at the 3rd week after a single application of ESW.
Results: There were no histological abnormalities observed in the Achilles tendons of the first two groups compared with the control group. No alteration in the histological configuration was observed, and consequently the pathologist who had been blinded could not differentiate these rats from the control group by light microscopy. However, in the high intensity group (2000 impulses of 0.20 mJ/mm2), grade II and III disorganisation of collagen fibers was noticed in 7 out of 8 rats, which was not detected in any of the rats from the first two groups (p<0.05). Consequently, the pathologist could distinguish the majority of the rats (7 out of 8) of this group from the remaining ones. Meanwhile, grade I lymphocyte infiltration was observed in some sections of the rats receiving the highest ESW dose.
Conclusion: This study confirms that ESW application at high intensity is associated with detrimental tissue effects. Additionally, it was suggested that the extent of tissue injury caused by ESW is dose-related.
Re: Queston for Dr. RompeDr. Z on 2/24/04 at 10:18 (145174)
Sorry about that. I know another Dr. Rompf who is an insurance medical director. I had just been talking to him
Thanks for your comments. So as long as I keep the mj/mm2 below 0.20mj/mm2 I can still place the amount 1300mj/mm2 in one treatment session instead of three treatment sessions. Is my thinking correct?