By Charlotte Cowie, MBBS, DipSportMed, DM-SMed, FFSEM(UK) - Clincal Director at St.George's Park
Extracorporeal Shock Wave (ECSW) Lithotrypsy has been an established minimally invasive treatment for renal stones for some time now, but its application in the treatment of refractory plantar fasciitis, Achilles tendinopathy, ‘tennis elbow’ and calcific tendonitis of the shoulder is more recent and less well known. However, having heard promising anecdotal reports of its effectiveness from colleagues, we have invested in a radial shockwave machine here at St. George’s Park and, in line with NICE guidelines, are offering the treatment for cases that have been resistant to physiotherapy and conventional injection therapy. As the treatment is non-invasive and has less risk attached to it than a local injection, it was an obvious choice for a clinic specializing in sports and musculo-skeletal problems.
Whilst there are a number of papers which suggest that ECSW is an effective treatment either in comparison with sham treatment or other standard treatments for these conditions, (1,2,3,4), many of them are relatively small. The documents associated with Swiss Dolorclast, the company that has pioneered radial shockwave treatment, which we use here at Perform, claim an overall 77% success rate in patients with chronically symptomatic patients refractory to other treatment. However, this is complicated by the high rate of progress even with placebo in some of these RCTs, probably reflecting the fact that these conditions all have the potential to be self-limiting.
The evidence is sufficient for NICE to accept treatment with ECSW as a possible therapeutic modality on the NHS for cases refractory to more conventional treatment and most private medical insurance companies will fund this treatment.(5) In addition, NICE is satisfied that ECSW treatment has been conclusively demonstrated to be a safe procedure (2,6)
However it is important that we, as doctors, continue to collect objective data as to its effectiveness. Here at Perform at St. George’s Park, we have joined the multi-centre ASSERT trial, which aims to collate information on the use of ECSW for tendinopathy and associated conditions with a view to establishing a data-set that is consistent and allows more powerful statistical analysis. Thus, over time, we very much hope to be able to deliver more information to back up the very good anecdotal results we have discovered so far. Our protocols are in line with those recommended by the ASSERT group, based at Queen Mary University London.
If you would like to know more about the treatment, or have patients who may benefit either from more conventional management of this group of conditions or who have exhausted these options, I would be happy to discuss the treatment and its applications in more detail, either by phone, letter or email. Patients can book up for a consultation, simply by calling our reception line.