It should not come as a surprise that if one gets good result with shockwave therapy, one can get better results if the same treatment is combined with Class 4 cold laser. Generating shock waves by accelerating a bullet which hits the applicator, transforming its kinetic energy into radially expanding shockwaves has been shown to be effective in conditions such as plantar faciitis and lateral epicondylosis. Using shockwave therapy has also been studied in treatment of Greater Trochanter Pain Syndrome, Chronic Plantar Fasciitis, Chronic Medial Tibial Stress Syndrome and Achilles Tendinopathy. Low lever laser therapy (LLLT) is theorized to accelerate the repair of connective tissue and effect fibroblast function. It can also improve healing and reduce pain. A systematic review published in 2009 by Kromer et al found 2 studies that investigated the clinical efficacy of LLLT in the treatment of impingement syndrome. They concluded that there is conflicting evidence and no specific recommendation can be offered. However, Michener et al.’s systematic review on the effectiveness of rehabilitation on patients with shoulder impingement syndrome came to a much different conclusion (Research Review Services).
But do we have to follow research blindly? So if there is no study for shockwave combined with class 4 laser for chronic knee pain we should not try it?
Well in this report that is exactly what we did….
A middle age women injured her left knee by getting caught in the GO Train in Toronto. She attended what we call traditional physiotherapy. There has been some studies showing efficacy of TENS for knee pain. Many practitioners have also had good results with ultrasound therapy for knee injuries. Exercises for knee pain and injures have been well studied. But in this case none of the above helped our patient. In fact according to our patient these treatments made her worse. I walked in to this patient who was one of our old patients limping around our medical clinic. I told her about our new Shockwave and Apollo Laser courtesy of Vitality Depot. Quick physical exam showed lack of ROM in flexion. No swelling was observed. No instability was noted. Pain was reported during pivot shift test. Meniscus tear is suspected but this patient is being sent to a specialist and will probably undergo advance imaging.
Regardless we administered both shockwave (120 mJ, 2000 pulses) and Apollo Class IV laser (350 Jules). Total treatment time was about 5-6 minutes. Patient was able to sleep for the first time in many months pain free. Her knee pain had made her lose sleep night after night.
Now that she is in less pain therapeutic exercises can be administered. This was a great case and I was happy to see such good results in one session.
This small case is the reason behind this website. As practitioners we can always use our common sense, look outside of the box and try new things. In fact this is how case studies are born which can lead to randomised double blind studies in future. I encourage all the readers to add their experimental findings on this website.
Also Read
| Case Study: Shockwave Therapy on Finger Arthritis | Juvenile Scoliosis |
| Elbow Bursitis | Heberden’s Nodes |