More Shockwave discussions - uses & comparisons

[lehughes]

Interesting note- used it on 2 people who stated that the tension released but there were focal areas of increased pain which seemed to correlate to nerve roots/AcuPoints which did dissipate over the next day or two. I’m wondering if we should treat the deeper nerve issue post ESWT if we are not brave enough to go deep enough to hit the nerve root- which I am a bit afraid of too. Maybe the key is fascial release to facilitate deeper nerve/nerve root work? I do pair with traction and gentle mobs and alpha stim over noticeably active or points associated with where I suspect the issue originates. If that makes sense??

[lehughes]

I actually think it’s the nerve roots we need to target. Fascia is secondary to the nerve irritation. To treat the fascia is to chase the symptom versus the root of the issue.
That’s why treating the L-S junction works in LS disc disease. And it’s why I was trying to get to the region just above the vertebra in the neck - just above where the NR come out.
The reflex loop is broken / exaggerated / inflammed / over-stimulated. To break the cycle, you need to direct therapies at the root (literally and figuratively). Only then can you make headway with the fascia and muscles.
Yes, to traction, mobs, alpha stim and the like… They also address the root of the issue.

Laurie

[lehughes]

Agree 100%!! I do the same. I think the challenge is gauging the depth of the nerve root as you pointed out with the shock wave and being able to direct enough energy there. I guess the other approach in an acute case might be to estimate depth, look for a flare and if none the go deeper until you see a flare then release? I have seen flares followed by relaxation in several cases thus far. But I have also had to play with depth

Theoretically if we inactivate the root then the fascial/muscle tension should release no?

Maybe I need a CE week in Canada to work all this out

C

[lehughes]

I think the Piezo is a bit different than the Radial. With the radial I select BAR which is essentially pressure, which presumably affected depth. Whereas the Piezo you actually attempt to select depth…
However, with any of the shockwaves, you start ‘lighter’ and then build up BAR (or energy flux density) to tolerance.
My goal would be to keep any flare ups to be very short term. Often when I use shockwave on L-S junction in LS disc disease, they feel better right away, no worsening before feeling / looking better. So I have presumed that to be my goal. That being said, I am not surprised if an OA joint is a bit more limpy after a full therapy session… and it tends to feel better as the day goes on. So, I guess I want any flare up to resolve itself by end of day or next day.
I don’t typically think of flare up as my goal for a disc or nerve root case… but indeed it might be - even if just a localized flare, as characterized by increased blood flow. (Yes, local inflammatory reaction is our goal for OA or tendinopathy.) Maybe it’s just in my head that I think “blood flow” versus inflammation that stimulates healing. They are likely one in the same!

Second part - if you calm the nerve root, then the muscle may release. However fascial tightening is a sign of a long standing problem. Fascia is plastic - meaning that if the nerve root has been irritated for a long time, and that has caused muscle tension, which can cause shortening (both of the muscle fibres / sarcomeres, and also of the fascia. Fascia doesn’t release without further work to make it so (stretching, MFR, needling, postural correction, etc.). So, treatment to settle the NR is primary and techniques to address muscle / fascial thickening / shortening is secondary.

This is a great discussion! I’m going to post it on the FourLeg Forum (anonymous of course). I think others would find it useful!

L

[lehughes]

Lol! I think the main point is that our therapy MUST be multi-level. The flare to me is like the twitch at a trigger point- with finger or needle pressure. It indicates an area affected along a dermatome- sometimes helpful in localizing a flare nerve. Seems to me that as you said...our goal is the source or the “root” of the problem but we have to acknowledge and address all of the layers/players affected distally. So far everyone has looked better or worse. A “flare” is an acknowledgement of tenderness not a worsening-sorry poor semantics on the part of my trainer.

C

[lehughes]

Agreed on that main point for sure! There are always layers to the problem that need to be considered!

Laurie

[David Lane]

LEH,

How effective do you feel ESWT is for LS disease? Are there specific Cx you feel it is indicated for?

[lehughes]

DL,

I am using shockwave for each, every, and all L-S cases. I really, really like it for this condition.
Naturally, I'm using it in conjunction with laser, acupuncture, and manual therapy. But I find that the dogs tolerate it well, even seem to enjoy it, and it does seem to provide some relief.
Since surgery isn't 'fail-safe', a lot of owners are happy to periodically have treatments done for this.
So let me rolodex through my brain... I've used it on cases of stenosis and DDD primarily... and others of unknown specific pathology, but pain localized to the L-S.

LEH