for therapeutic and in Ballet Dancers Shin Splints
500 Unit/Units per Month Efficacy of Radial Extracorporeal Shock Wave Therapy in Ballet
Packaging & Delivery
aluminium carry case and carton for Efficacy of Radial Extracorporeal Shock Wave Therapy in Ballet Dancers Shin Splints
Efficacy of Radial Extracorporeal Shock Wave Therapy in Ballet Dancers Shin Splints
Mini Shockwave therapy system Model : BS-SWT2X
SmartWave Shock Wave Therapy Equipment
Shock Wave Therapy Equipment, Radial Pulse Therapy (RSWT), ESWT extracorporeal shockwave therapy, also called Acoustic Wave Therapy Equipment, mainly for physical therapy treatment, sports injury and rehabitation treatment. A Non-Invasive Alternative to Orthopedic Surgery for tendon, musculoskeletal, soft tissue issues, non-union fractures to promote revascularization healing.
BS-SWT2X SMARTWAVE uses the latest electric-magnetic technology, without air-compressor, so comes with longer lifecycle, at the same time it can provide higher energy and frequency for better treatment result. From technical view, BS-SWT2X can reach energy from 10mJ (0.25Bar) to 190mJ (5Bar), adjustable at stepping 10mJ(0.25Bar). Frequency ranges from 1Hz to 22Hz adjustable.
From the view of transmitter, BS-SWT2X Smartwave has 5 different alloy made transmitters targeting to different depth and treatment disease.It includes 6mm, 15mm, 15mm unfocused, 25mm, 36mm,which covers most applications for physical treatments as well as aesthetics treatments.
Shin Splints: Efficacy of Radial Extracorporeal Shock Wave Therapy in Ballet Dancers. A Series Of Cases Tutté ML, 1, 2, 3 PhD; Galin G1, 2 PT 1 (Department of Rehabilitation, Central de Servicios Médicos, Banco de Seguros del Estado, Montevideo, Uruguay) 2 (Department of Rehabilitation, Ondas de Choque Uruguay, Montevideo, Uruguay) 3 (Department of Rehabilitation, Blue Cross & Blue Shield, Montevideo, Uruguay) Abstract: Shin splints — also known as medial tibial stress syndrome, anterior compartment and posteromedial compartment syndrome — have been widely studied in athletes, mostly in runners, but not in dancers. This paper presents the results of treatment with radial extracorporeal shockwave therapy (rESWT) in 4 ballet dancers with shin splint diagnosis. Four patients were treated with two different rESWT devices after the failure of different therapeutic modalities. They received 6 weekly sessions applied along the tibial shaft (3,000p, 2.5b, 7Hz), and a stretching program. The Visual Analogue Scale (VAS) was used for pain quantification during ballet training and a rating score to determine maximum painless jumping tolerance. Mean decrease in pain VAS score was 4,8 points. Impairment of exercise tolerance was reduced from 3 to 1 points. Patients were able to continue with their normal training and performance schedules. Three were asymptomatic after 6 months; one experienced some discomfort during high-intensity rehearsals, but was still able to perform. rESWT was shown to be an effective, non-invasive treatment alternative for these patients, achieving functional improvement and pain relief, allowing them to comply with their performance schedules. Large-scale prospective trials are still required to elucidate the effectiveness of rESWT in these patients. Keywords: dancers, medial tibial stress syndrome, shin splints, shock wave therapy.
Mechanism of Action
Shockwave is an acoustic wave which carries high energy to painful spots and myoskeletal tissues with subacute, subchronic and chronic conditions. The energy promotes regeneration and reparative processes of the bones, tendons and other soft tissues.
Shockwaves are characterized by jump change in pressure, high amplitude and non-periodicity.
The kinetic energy of the projectile, created by compressed air, is transferred to the transmitter at the end of the applicator and further into the tissue.
Acoustic waves with high energy peak used in Shockwave therapy interact with tissue causing overall medical effects of accelerated tissue repair and cell growth, analgesia and mobility restoration. All the processes mentioned in this section are typically employed simultaneously and are used to treat chronic, sub-acute and acute (advanced users only) conditions.
New Blood Vessel Formation
Nutrient blood flow is necessary to start and maintain the repair processes of damaged tissue. The application of acoustic waves creates capillary microruptures in tendon and bone.
Reversal of Chronic Inflammation
Mast cells are one of the key components of the inflammatory process. Their activity may be increased by using pervasive acoustic waves.
Stimulation of Collagen Production
The production of a sufficient amount of collagen is a necessary precondition for the repair processes of the damaged myoskeletal and ligamentous structures. Shockwave therapy accelerates procollagen synthesis.
Dissolution of Calcified Fibroblasts
Calcium build-up is most often the result of micro-tears or other trauma to a tendon. Acoustic waves break up the existing calcifications.
Dispersion of Pain Mediator “Substance P”
Substance P is a neurotransmitter that mediates pain information through the C-fibers. This neuropeptide is generally associated with intense, persistent and chronic pain.
Release of Trigger Points
Trigger points are the principal cause of pain in the back, neck, shoulder and limbs. Delivered acoustic energy unblocks the calcium pump and thus reverses the metabolic crisis in the myofilaments and releases the trigger points.
Which affections do we treat?
Shoulder: calcification (that can be seen by x-ray)
Hip: calcification at the trochanter, tendinitis at the trochanter or tuber ischiadicum
Knee: tendinitis at the tuberositas tibiae or patella
Foot: fasciitis plantaris, Achilles tendinitis
Bone: non-union, delayed fracture healing.
How is the treatment done?
The ESWT is performed for outpatients without anesthesia. Usually three sessions are needed one week apart. Each session takes 30 minutes. Before the first treatment an appointment is necessary to check the indications and chances to treat the painful condition with ESWT. The health insurance company will be asked to cover the costs (there is no obligatory insurance for ESWT).
Advantage and Specification of SmartWave:
Long lifespan acoustic wave applicator, over 3 million shots before maintenance needed
5 PCS Ti-alloy made applicator, can fully transfer energy to patients, double efficiency than 1st generation
Can continuously work over 10000 shots without break, so as to provide excellent treatment result
More than 38 pre-set treatment protocols, and support user defined protocols
Energy from 10mJ to 190mJ, adjustable per 10mJ as stepping (equal to 0.25Bar to 5Bar)
Frequency from1Hz to 22Hz, adjustable per 1Hz as stepping
Shockwave works as a direct myofascial release method and is used to engage the myofascial tissue "restrictive barrier" (tension). Direct release is achieved with shockwave as it can mechanically influence muscles. The physiological intrinsic oscillations of 15 to 30 Hz have been described by Nazarov & Gorozhani (1988) as important for muscular relaxation, blood circulation and lymphatic drainage. Travell & Simons (1983) and Shah et al. (2008) said these oscillations could led to breaking of Actin-Myosin-Links, whilst Mense & Simons (2001b) said shockwave could lead to the destruction of damaged fibers. All of which should reduce myofascial tension.
Application: Physical: - Sports Injury/- Rehabilitation ( also diabetes )/- Pain relief (Chronic)/- Body injury
BENEFITS OF SHOCKWAVE THERAPY:
clinical studies – success rate above 75%
shockwave therapy has a great input/output rate
non-invasive solution for chronic pain in the shoulder, back, heel, and elbow
shockwave therapy is a new technology with effects which have been medically proven
no anesthesia, no drugs
main areas of use: orthopedics, rehabilitation, sports medicine
Myositis ossificans (MO) is a fairly common evolution in sports activity and can be due to direct trauma or to repeated micro-injuries. The traditional therapeutic approach relies on a variety of treatments, such as physical therapy but evidence of their proven clinical efficacy is lacking. The latest therapeutic option is surgical removal but this is a demolitive procedure and is frequently associated with a significant loss of functional integrity. There are few articles in literature about the treatment of post-traumatic MO, and none on extracorporeal shock wave therapy (ESWT). We illustrate a case series of 24 sportsmen treated with three sessions of electro-hydraulic shockwave therapy and an associated rehabilitation program. Only a partial reduction of the ossification was observed in the X-ray images but all the patients showed signs of functional improvement immediately after therapy. Two months after the therapy, a normal range of motion and no signs of weakness were observed. Three months after treatment, 87.5% of patients resumed regular sports activities.
II. Material And Methods Four ballet dancers with shin splint diagnosis were treated with 2 different devices of rESWT after the fail of different therapeutic modalities. Three of them were men (20, 22 and 23 years old), and 1 woman (15 years old). Two of them were treated with an EMS Swiss Dolorclast®Classic, and 2 of them with LONGEST PowerShocker LGT-2500S. Case 1. Twenty-year-old male with a 2-year history of pain, exacerbated in the past 4 months concurrently with an increase in physical activity level. Describes bilateral pain along the entire tibial shaft, predominantly along the 2/3 distal posteromedial aspect of the lower leg. Radiography showed multiple radiolucid areas of cortical bone in tibial diaphysis, with a marked left side predominance in the anterior section. (Fig. 1a. 1b.). MRI showed periosteal oedema only. (Grade1, Fredericson classification for tibial stress fractures) . Case 2. Twenty-two-year-old male with a 1-year history of pain, describes focal pain along left anterolateral tibial shaft, predominantly proximal, during weight-bearing activity with knee flexion (plié) and with jumps. String-of-beads pattern is perceived along the tibial shaft upon palpation. Case 3. Twenty-three-year-old male, recounts similar symptoms as in Case 2. Case 4. Fifteen-year-old female student of the National Ballet School, with a 6-month history of bilateral pain along the tibial shaft that prevent her from finishing ballet classes. Pronated right foot. They received 6 weekly sessions, with 3000p, 2,5b, 7 Hz per session protocol, applied along the tibial shaft (pain zone), combined with a program of stretching exercises and counseling on correct jumping technique. 2 patients had bilateral pain, totaling 6 observations. The Visual Analogue Scale (VAS) was used for the quantification of pain during ballet training, concretely during jumping. Another rating score, proposed by Schulze , was used to determine maximum painless tolerance when jumping, where: 0 = no pain when jumping; 1 = slight pain; 2 = severe pain when jumping; 3 = jumping impossible. III. Results Mean decrease in pain with VAS score was 4,8 points at 2 months from baseline. (4,7 with EMS device and 5 with LONGEST device). Impairment of exercise tolerance was reduced from 3 to 1 points. Patients were able to continue with their normal training and performance schedules. Three of them were asymptomatic after 6 months; one experienced some discomfort during high-intensity rehearsals, but was still able to perform. IV. Discussion The studied cases show that the rESWT therapy is a potentially effective method for treatment of shin splints in dancers, achieving functional improvement and pain relief. This treatment, applied properly, could prevent serious complications like the tibial stress fracture. It must not be forgotten that an important part of the treatment is to evaluate a dancer's jumping technique and provide systematic training to develop the skill and avoid hard surfaces. Stretching exercise for Achilles tendon when it is tight are also required. As said before, there are very few studies of shin splints in ballet dancers, and even less about the treatment with radial ESWT in this kind of patients. We found only one article referred to shin splints in ballet dancers ; the hypothesis of the study was that dancers with a history of recurring shin splints, manifested as pain along the tibia, do not place their heels on the floor as often as ballet dancers without such a history. The usual technique of classical ballet jumping begins with a knee bend with the heels on the floor, the weight is then transferred from the heels to the ball of the foot while the knees and hips begin to extend. The final pushoff is given by the toes. At the peak of the jump, the knees are extended and the ankles are strongly plantar flexed. In the first stage of landing, the toes and then the ball of the foot contact the floor and continue to a more complete landing by placing the heel on the floor. They complete the jump in a knee bend like the initial position. The next jump can then be initiated from this position. Some dancers land from one jump and push off for the next separately by a brief instant where the heel pops off the floor, and the author found that this situation had a significant relationship (p.<0.05) with a history of shin splints. Although this study had a very small N (16 dancers) and used simple and now outdated equipment, it was among the first investigations into the etiology of shin splints in ballet dancers. A search conducted in PubMed using the keywords "shin splints" OR "Medial tibial stress syndrome" AND "shock wave therapy" yielded only two studies. One of them, by Rompe et al, , was a cohort study of 47 subjects with chronic recalcitrant MTSS that underwent a standardized home training program and received repetitive low-energy rESWT (2000 shocks; 2.5 bars of pressure), and a control group of 47 subjects who only received the same training program. They found that at 15 months from baseline, 40 of 47 subjects in the treatment group had been able to return to their preferred sport at their preinjury level, as had 22 of the 47 control subjects, so the conclusion was that rESWT as applied was an effective treatment for MTSS. The other one study, by Moen et al , was a prospective controlled trial of 42 athletes with MTSS, performed with focused ESWT. One group was treated with a graded running programme, while patients in the other group were treated with the same graded running programme and focused ESWT (five sessions in 9 weeks).The study showed that MTSS patients may benefit from ESWT in addition to a graded running programme. Although there is abundant literature about "shin splints" AND "running", a similar search "dancers" didn't yield any results. For this reason, we believe that the cases described in this paper, though just a few, may constitute an interesting contribution, even if large, controlled studies are still required. V. Conclusion Both rESWT devices were shown to be an effective, non-invasive treatment alternative for these patients, achieving functional improvement and pain relief and allowing them to comply with their performance schedules. Large-scale prospective trials are still required to elucidate the effectiveness of ESWT for shin splints in ballet dancers