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Wednesday, May 21, 2008

Extracorporeal Shockwave Therapy for Plantar Fasciitis

Gary;
Thank you very much. Yr answer was very helpful.
My ache is a bit high nowadays I don't know why, although there is no physical activity increase in my daily life. The problem is still with my left foot.
To tell you the truth, I am doing the stretching exercises a bit lazily.
What I heard is that there is a very new healing process called as ESWT Extracorporeal Shockwave Therapy. But I am not sure if this really helps. If you have an idea abt this new technology, I will be very glad to know more about this.
http://en.wikipedia.org/wiki/Plantar_fasciitis
Thanks & Best regards,

Turgut
__________________________________
Gary Moller comments:

"Conclusion We found no evidence to support a beneficial effect on pain, function, and quality of life of ultrasound-guided ESWT over placebo in patients with ultrasound-proven plantar fasciitis 6 and 12 weeks following treatment." Source: Ultrasound-Guided Extracorporeal Shock Wave Therapy for Plantar Fasciitis JAMA 2002

I am naturally sceptical of extremely expensive machines that are promoted as easy sources of revenues for health practices. This is cost-plus medicine that is unsustainable.

While this machine works to some degree, I would contend that it is no better than a good
deep tissue massage by an experienced therapist. The only difference is that it is dead easy for the therapist who has only to set the machine up, set the timer and away it goes. A good massage is hard work and takes time to do properly.

When a therapist starts work in a clinic for the first time he or she will be instructed that there is a 10 or 15 minute limit of contact time per patient after the first appointment (Total appointment time is usually 20 minutes). The only solution for this kind of limited production-line format of medicine is to resort to machines that are set up, turned on and left, allowing the therapist to flit from one patient to the next. And to do so without wearing out his or her hands! This is not good medicine.

Machines such as the shock wave ones are like most drugs: They do not deal with the underlying causes of ailments like plantar fasciitis such as overweight, muscle weakness, poor posture, poor footwear and poor sporting technique. These must all be addressed for there to be lasting relief and these take time. Sadly, we will see the proliferation of machines like these in modern times.

I am reminded of the proliferation of bone density testing machines in clinics around the country: First, invent the technology; then beat up the disease in the media (osteoporosis) and then sell the poor patient the terribly harmful drugs to counter the disease, thus causing even more disease - a very tidy business package indeed!

Too much medicine is little more than a cynical money-go-round between health professionals, emptying their patients' bank accounts as they go and doing little to improve health.


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6 comments:

Satya said...

Gary,
I am quite surprised with the kind of criticism by Gary. i came cross many published literature which claim that ESWT helps in regeneration of bone tissue.

http://www.shockwavetherapyindia.com/
http://www.eswtusa.com/

Below are some research papers.

Treatment of osteonecrosis of the hip: comparison of extracorporeal shockwave with shockwave and alendronate
Ching-Jen Wang • Feng-Sheng Wang • Kuender D. Yang • Chung-Cheng Huang •
Mel Shiuann-Sheng Lee • Yi-Sheng Chan • Jun-Wen Wang • Jih-Yang Ko

Extracorporeal shockwave therapy shows regeneration in hip necrosis
C.-J. Wang1, F.-S. Wang2, J.-Y. Ko1, H.-Y. Huang3, C.-J. Chen4, Y.-C. Sun2 and Y.-J. Yang2

Extracorporeal Shockwave Treatment of Osteonecrosis of the Femoral Head in Systemic Lupus Erythematosis
Po-Chun Lin, MD,* Ching-Jen Wang, MD,* Kuender D. Yang, MD, PhD,y Feng-Sheng Wang, PhD,z Jih-Yang Ko, MD,* and Chung-Cheng Huang, MD

Treatment for Osteonecrosis of the Femoral Head: Comparison of Extracorporeal Shock Waves with Core Decompression and Bone-Grafting
Ching-Jen Wang, Feng-Sheng Wang, Chung-Cheng Huang, Kuender D. Yang, Lin-Hsiu Weng and Hsuan-Ying Huang


Extracorporeal Shock Wave Therapy for treating musculoskeletal conditions.
WCB Evidence Based Practice Group Dr. Craig W. Martin, Senior Medical Advisor

Osteonecrosis of the humeral head after Extracorporeal shock-wave lithotripsy
H. B. Durst, G. Blatter, M. S. Kuster
From Kantonsspital, St Gallen, Switzerland

regards,
Rao

Wayne said...

doctors have no problems spending $100,000 on some high tech gear thats of negligible use, a compuer engineer I know commented to me, he's seen surgeries full of expensive gear that may hardly be used and they are running an old computer that barely works at all. medical professionals can be very good at putting all their eggs in one basket.

Gary Moller said...

Thanks for your comment Satya.
I have not said that it does not work as a therapy. But I would argue that the jury is still out and I would argue that this therapy is probably no better than what can be achieved by an experienced hands-on therapist. From my reading of the research literature, of which there is plenty, the results are mixed. It would seem other factors such as weight, diet, posture, sporting biomechanics are as big a factors as anything else. In sport the solution to chronic injuries is to review technique by a good technical coach.

After all, the plantar fasciitis is the result of some kind of injurious mechanism and one must identify and deal with the cause. To treat the end result without dealing with the cause is poor medicine - in my opinion.

Again, thanks for commenting.

Satya said...

Gary,
Thank you for the clarification. Recently I can accross a website about a china Herb called 'Osteoking'.
http://www.osteoking.com/

Do you think this is helpful in treating Avascular Necrosis(AVN). Does it have any side effects.

Thank you,
Rao

Gary Moller said...

Satya
I do not know anything about this form of Chinese medicine. But I would not discount its benefits for a moment. I am increasingly of the view that therapies that have developed over thousands of years should not be discounted. Instead, they should be respected and studied carefully. I have an open and positive mind about these traditional medicines.

With regards to avascular necrosis of bone, I am not an expert on this either. However; I am very interested in some of the common causes such as drugs like Warfarin and the biphosphenates like Fosamax. If the osteonecrosis is the result of drugs like these then any kind of therapy would be of limited value. Obviously, one should avoid these drugs at all costs. I am not aware of anything that can treat osteonecrosis.

Anything that can reverse or halt osteonecrosis would be exciting to know about. Let me know if you discover anything!

Joe Brownlee said...

Acute osteonecrosis needs treatment with hyperbaric oxygen.The symptomatic response can be dramatic but you need to have the diagnosis within days of onset.