411 - Comparative study of using ultrasound to target focused, defocused and radial shockwave therapy for low back pain

Thursday, May 26, 2022

5:00 PM – 6:30 PM CT

Presenting Author(s)

LK

Lev Kalika, MD

MD
New York Dynamic Neuromuscular Rehabilitation & Physical Therapy https://nydnrehab.com/
New York, New York, United States
RB

Rostyslav Bubnov, MD, PhD

medical doctor, ultrasound
dr.rbubnov@gmail.com
Kyiv, Kyyiv, Ukraine

Objectives: Extracorporeal shock wave therapy (ESWT) can alleviate myofascial pain, can be used in the protocols of management various types of pain and spasticity, neuromusculoskeletal pathologies. The efficacy of performance ESWT under ultrasound (US) guidance have not been studied yet.
The aim of the study was to compare the effectiveness of US guidance and releveance of ESWT regimes for treatment various neuromusculoskeletal pathologies, muscle pain and dysfunction.

Design: We included 26 patients, 10 females, 23-43 years, who clinically diagnosed chronic low back pain. All patients underwent general exam, including MRI, precise physical tests and functional ultrasound. We did ESWT using Storz Medical DUOLITH® SD1 Ultra and Orthogold 100, SoftWave TRT, LLC. Then patients were randomly assigned to: group 1 of patients who received targeted US-guided ESWT using focused, defocused and radial shockwave; and group 2, who received shockwave therapy without effective US assistance (sham). We did focused, defocused and radial shockwave (F-ESWT, D-ESWT and R-ESWT accordingly) where appropriate to treat muscles, fascia and tendons. VAS 0-10 scores were measured in all patients before and after intervention.

Results: In all patients cases with positive subjective response at areas of pain after ESWT. Pain relief in blind ESWT group was: VAS improved from 7.4 to 5,4. immediately after, signs of inactivation trigger points, motion recovery were not recognized. In US-guided ESWT group VAS improved from 7.5 to 4.3 immediately after. The best clinical effects were detected: for F-ESWT to treat tendinopathies US guidance was most effective for back muscles (multifidus, quadratus lumborum miuslces, etc.); R-ESWT was used for relaxation of large muscles of legs decreasing neuropathic component of pain: and D-ESWT - for sciatic nerve, thoracolumbar pain on the abdominal and chest walls.

Conclusions: ESWT is effective to decrease chronic low back pain. US guidance increase effectiveness of ESWT for ameliorating myofascial and neuropathic pain.