Lower Back
Pain }

Pathology

Lower back pain without sciatica, stenosis or severe spinal deformation (henceforth referred to as idiopathic lower back pain, ILBP) is common and affects people of all ages. It is second only to the common cold as the most common affliction of mankind and is among the leading complaints bringing patients to physicians’ offices.

Its reported point prevalence is as high as 33%, its one-year prevalence as high as 73% and its lifetime prevalence exceeds 70% in most industrialized countries, with an annual incidence of 15-20% in the United States. In physically active adults not seeking medical attention, the annual incidence of clinically significant ILBP with functional impairment is approximately 10-15%. An alarming increase in the prevalence of chronic ILBP has been observed in industrialized countries over the last years, affecting both men and women and across all ages and racial and ethnic groups.

The social and economic impact of ILBP is substantial. It is the most frequent cause of disability for people under age 45. Acute ILBP (lasting three to six weeks) usually resolves in several weeks, although recurrences are common and low-grade symptoms are often present years after an initial episode.

Risk factors for the development of disabling chronic or persistent ILBP (variously defined as lasting more than three months or more than six months) include pre-existing psychological distress, disputed compensation issues, other types of chronic pain and job dissatisfaction. Diagnosis is based on clinical features. Diagnostic imaging should be considered to rule out other causes of lower back pain (particularly in chronic cases) or to establish the diagnosis of ILBP when in doubt.

The goals of management for patients with ILBP are to:
(i) decrease the pain,
(ii) restore mobility,
(iii) hasten recovery so the patient can resume normal daily activities as soon as possible,
(iv) prevent development of a chronic recurrent condition, and
(v) restore and preserve physical and financial independence and comfort.

However, management for patients with ILBP is challenged by the following problems:
(i) most back pain has no recognizable cause;
(ii) an underlying systemic disease is rare;
(iii) most episodes of back pain are unpreventable, and, most importantly,
(iv) few if any treatments have been proven effective for ILBP.

Among those treatments are limited bed rest, exercise, nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (Tylenol), muscle relaxants and opioids (if acetaminophen or NSAIDs do not relieve the pain), chirotherapy, physiotherapy and, ultimately, surgery (in cases of cauda equina syndrome, infections, tumors and fractures compressing the spinal cord, mechanical instability of the back, and, perhaps, intractable pain with a positive straight-leg-raising test and no response to conservative therapy).

However, the analgesic effects of many treatments for non-specific low back pain are small and do not differ in populations with acute or chronic symptoms. Radial shock wave therapy (RSWT) is an alternative to conservative treatment and should be applied before considering surgery.

Treatment Procedure

1. PALPATE
Locate the area of pain through palpation and biofeedback.

2. MARK
Mark the area of pain.

3. APPLY GEL
Apply coupling gel to transmit shock waves to the tissue.

4. APPLY SHOCK WAVES
Deliver Radial or Focused Shock Waves to the area of pain while keeping the applicator firmly in place on the skin.

Recommended Settings

Swiss
DolorClast }

  Treatment Myofascial therapy
Number of treatment sessions 3 to 5 3 to 5
Interval between two sessions 1 week 1 week
Air pressure Evo Blue® 2.5 to 4 bar 3 to 4 bar
Air pressure Power+ 2 to 4 bar 2 to 4 bar
Impulses 500 - 1000 impulses per trigger point 2000
Frequency 12Hz 12Hz to 20Hz
Applicator 15mm or 15mm trigger 36mm
Skin pressure Light to moderate Moderate to heavy

 

Clinical Proof

Bauermeister W.
Stosswellentherapie beim idiopathischen Rückenschmerz pseudoradikulären Syndromen. In: Maier m, Gillesberger F: Abstract 2003 zur Muskuloskelettalen Stosswellentherapie: Norderstedt, 2003, 29-34
http://www.abebooks.fr/9783833004230/Abstracts-2003-Muskuloskelettalen-Stosswellentherapie-Gillesberger-3833004231/plp

Risks

Side effects of Radial Shock Wave Therapy (RSWT) using the Swiss DolorClast®

When performed properly, RSWT with the Swiss DolorClast® has only minimal risks.
Typical device-related nonserious adverse events are:

  • Pain and discomfort during and after treatment (anesthesia is not necessary)
  • Reddening of the skin
  • Petechia
  • Swelling and numbness of the skin over the treatment area

These device-related nonserious adverse events usually disappear within 36h after the treatment.

Accordingly the following contraindications of RSWT using the Swiss DolorClast® must be considered:

  • Treatment over air-filled tissue (lung, gut)
  • Treatment of pre-ruptured tendons
  • Treatment of pregnant women
  • Treatment of patients under the age of 18 years (except for Osgood-Schlatter disease and muscular dysfunction in children with spastic movement disorders)
  • Treatment of patients with blood-clotting disorders (including local thrombosis)
  • Treatment of patients treated with oral anticoagulations
  • Treatment of tissue with local tumors or local bacterial and/or viral infections
  • Treatment of patients treated with cortisone

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