CAN’T I GET THE SAME RESULTS WITH FRICTION MASSAGE? Friction massage is used to increase circulation and release areas that are tight; particularly around joints and where there are adhesions within the muscles or tendons. 17 Manually moving tissue in this fashion is actually another form of mechanotransduction. However, the practice is generally not comfortable for patients and can only be applied to superficial structures. Applying these techniques at depth is not tolerated by most patients.
Luckily, ESWT therapies are more comfortable and have the ability to reach much deeper tissues. An added benefit is that these devices also require significantly less work by the practitioner which can help save a clinician’s most valuable equipment, their hands!
SUPPORTIVE EVIDENCE FOR LOWER LEG RUNNING INJURIES
Research shows that radial shockwave treatment is most effective when included as part of comprehensive plans of care that include stretching and exercise. 18 Learn More at pubmed.ncbi.nlm.nih.gov/25940060/
Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values provides best practices to include conservative treatment in the first 4-6 weeks of plantar fasciitis (outlined below). When pain persists beyond 6 weeks, the evidence supports ESWT as the next best course of treatment followed by custom orthotics. 19 This research included feedback from both the clinician and the patient.
Learn More at bjsm.bmj.com/content/55/19/1106
The review revealed the following best practices guidelines for ESWT:
• The core approach (taping, stretching, exercising, and educating) should be used for approximately 4-6 weeks before consideration of adjunctive interventions such as ESWT or orthoses. 19 • ESWT had the best evidence of any adjunctive treatment, including dry needling, if the core approach was unsuccessful at 4-6 weeks. 19 • ESWT had minimal documented adverse events and positive efficacy in the short term, medium term, and long term for the most patient-reported outcomes. 19 • With this in mind many therapists choose to teach patients the ‘Core approach’ but then commence ESWT straight away. Rather than waiting 4- 6 weeks when we have seen that after three weeks, we can achieve up to 89% positive outcomes with ESWT versus placebo and alternative treatment modalities when treating different types of tendinopathies. 4
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