Extracorporeal Shockwave Treatment for Low Back Pain A Descriptive Review of the Literature
Main Article Content
Keywords
low back pain, extracorporeal shockwave, literature review, application techniques, orthopedics, regenerative medicine, inflammation
Abstract
Low back pain is a common symptom in patients with chronic musculoskeletal conditions, affecting several individuals. In most cases, low back pain can often prove to be nonspecific or even multifactorial. Current treatment approach is based on surgical and noninvasive interventions, including pharmacological, psychological, physiotherapeutic, or complementary strategies. Extracorporeal shock wave therapy (ESWT) is a type of noninvasive mechanotherapy that has become popular in recent years due to its applicability in the treatment of various musculoskeletal disorders, especially in the lumbar spine of individuals with osteopo-rosis, sacroiliitis, and even spinal cord disorders. The objective of this manuscript is to review the scientific evidence supporting the application of this therapy in the management of low back pain, and give a brief description of the treatment techniques used in clinical settings. The articles included in this descriptive review were selected from databases using the Google Scholar tool, from which a total of 13 applicable studies matching the topic were included. Despite the need for more clinical trials, shock waves have been applied in medical health for many years with satisfactory results. Its application in the treatment of lumbar spine disorders has been shown to be advantageous in the management of pathological progression, such as the natural wear and tear process of musculoskeletal structures. In this sense, shockwave therapy may represent a viable alternative for the treatment of lumbar spine disorders; however, its therapeutic effects and
mechanisms require further elucidation.
References
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2Hoy D, Bain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028-2037. doi:10.1002/art.34347
3. Kamper SJ, Henschke N, Hestbaek L, Dunn KM, Williams CM. Musculoskeletal pain in children and adolescents. Braz J Phys Ther. 2016;20(3):275-284. doi:10.1590/bjpt-rbf.2014.0149
4. Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356–2367. https://doi.org/10.1016/S0140-6736(18)30480-X
5. Hartvigsen J, Christensen K, Frederiksen H. Back pain remains a common symptom in old age. a population-based study of 4486 Danish twins aged 70-102. Eur Spine J. 2003;12(5):528-534. doi:10.1007/s00586-003-0542-y
6. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 [published correction appears in Lancet. 2017 Jan 7;389(10064):e1]. Lancet. 2016;388(10053):1545-1602. doi:10.1016/S0140-6736(16)31678-6
7. Hoy DG, Smith E, Cross M, et al. Reflecting on the global burden of musculoskeletal conditions: lessons learnt from the global burden of disease 2010 study and the next steps forward. Ann Rheum Dis. 2015;74(1):4-7. doi:10.1136/annrheumdis-2014-205393
8. Calvo-Muñoz I, Gómez-Conesa A, Sánchez-Meca J. Prevalence of low back pain in children and adolescents: a meta-analysis. BMC Pediatr. 2013;13:14. Published 2013 Jan 26. doi:10.1186/1471-2431-13-14
9. Louw QA, Morris LD, Grimmer-Somers K. The prevalence of low back pain in Africa: a systematic review. BMC Musculoskelet Disord. 2007;8:105. Published 2007 Nov 1. doi:10.1186/1471-2474-8-105
10. Lemeunier N, Leboeuf-Yde C, Gagey O. The natural course of low back pain: a systematic critical literature review. Chiropr Man Therap. 2012;20(1):33. Published 2012 Oct 17. doi:10.1186/2045-709X-20-3311. Konstantinou K, Dunn KM, Ogollah R, Vogel S, Hay EM; ATLAS study research team. Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. BMC Musculoskelet Disord. 2015;16:332. Published 2015 Nov 4. doi:10.1186/s12891-015-0787-8
12. Stafford MA, Peng P, Hill DA. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Br J Anaesth. 2007;99(4):461-473. doi:10.1093/bja/aem238
13. Verwoerd AJH, Mens J, El Barzouhi A, Peul WC, Koes BW, Verhagen AP. A diagnostic study in patients with sciatica establishing the importance of localization of worsening of pain during coughing, sneezing and straining to assess nerve root compression on MRI. Eur Spine J. 2016;25(5):1389-1392. doi:10.1007/s00586-016-4393-8
14. Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: Evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368–2383. https://doi.org/10.1016/S0140-6736(18)30489-6
15. National Guideline Centre (UK). Low Back Pain and Sciatica in Over 16s: Assessment and Management. London: National Institute for Health and Care Excellence (NICE); November 2016.
16. Mittermayr R, Antonic V, Hartinger J, et al. Extracorporeal shock wave therapy (ESWT) for wound healing: Technology, mechanisms, and clinical efficacy. Wound Repair Regen. 2012;20(4):456–465. https://doi.org/10.1111/j.1524-475X.2012.00796.x
17. Huang C, Holfeld J, Schaden W, Orgill D, Ogawa R. Mechanotherapy: Revisiting physical therapy and recruiting mechanobiology for a new era in medicine. Trends Mol Med. 2013;19(9):555–564. https://doi.org/10.1016/j.molmed.2013.05.005
18. Hausdorf J, Lemmens MA, Kaplan S, et al. Extracorporeal shockwave application to the distal femur of rabbits diminishes the number of neurons immunoreactive for substance P in dorsal root ganglia L5. Brain Res. 2008;1207:96-101. doi:10.1016/j.brainres.2008.02.013
19. Hausdorf J, Lemmens MA, Heck KD, et al. Selective loss of unmyelinated nerve fibers after extracorporeal shockwave application to the musculoskeletal system. Neuroscience. 2008;155(1):138-144. doi:10.1016/j.neuroscience.2008.03.062
20. Orhan Z, Cam K, Alper M, Ozturan K. The effects of extracorporeal shock waves on the rat Achilles tendon: is there a critical dose for tissue injury?. Arch Orthop Trauma Surg. 2004;124(9):631-635. doi:10.1007/s00402-003-0598-5
21. Moya D, Ramón S, Schaden W, Wang CJ, Guiloff L, Cheng JH. The role of extracorporeal shockwave treatment in musculoskeletal disorders. J Bone Jt Surg Am Vol. 2018;100(3):251–263. https://doi.org/10.2106/JBJS.17.00661
22. Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res. 2012;7:11. Published 2012 Mar 20. doi:10.1186/1749-799X-7-11
23. Holsapple JS, Cooper B, Berry SH, et al. Low Intensity Shockwave Treatment Modulates Macrophage Functions Beneficial to Healing Chronic Wounds. Int J Mol Sci. 2021;22(15):7844. Published 2021 Jul 22. doi:10.3390/ijms22157844
24. Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles Ligaments Tendons J. 2012;2(1):33-37. Published 2012 Jun 17.
25. Fiani B, Davati C, Griepp DW, Lee J, Pennington E, Moawad CM. Enhanced Spinal Therapy: Extracorporeal Shock Wave Therapy for the Spine. Cureus. 2020;12(10):e11200. Published 2020 Oct 27. doi:10.7759/cureus.11200
26. Nedelka T, Nedelka J, Schlenker J, Hankins C, Mazanec R. Mechano-transduction effect of shockwaves in the treatment of lumbar facet joint pain: Comparative effectiveness evaluation of shockwave therapy, steroid injections and radiofrequency medial branch neurotomy. Neuroendocrinol Lett. 2014;35(5):393–397.
27. Lee S, Lee D, Park J. Effects of extracorporeal shockwave therapy on patients with chronic low back pain and their dynamic balance ability. J Phys Ther Sci. 2014;26(1):7–10. https://doi.org/10.1589/jpts.26.7
28. Ma J, Yan Y, Wang B, Sun W, Yue D, Wang W. Effectiveness and safety of extracorporeal shock wave treatment for low back pain：a systematic review and meta-analysis of RCTs. International Journal of Osteopathic Medicine. Published online March 2022. doi:10.1016/j.ijosm.2022.03.004
29. Eftekharsadat B, Fasaie N, Golalizadeh D, et al. Comparison of efficacy of corticosteroid injection versus extracorporeal shock wave therapy on inferior trigger points in the quadratus lumborum muscle: A randomized clinical trial. BMC Musculoskelet Disord. 2020;21(1):1–11. https://doi.org/10.1186/s12891-020-03714-3
30. Notarnicola A, Maccagnano G, Gallone MF, et al. Extracorporeal shockwave therapy versus exercise program in patients with low back pain: Short-term results of a randomised controlled trial. J Biol Regul Homeost Agents. 2018;32(2):385–389.
31. Walewicz K, Taradaj J, Rajfur K, et al. The effectiveness of radial extracorporeal shock wave therapy in patients with chronic low back pain: A prospective, randomized, single-blinded pilot study. Clin Interv Aging. 2019;14:1859–1869. https://doi.org/10.2147/CIA.S224001
32. Shi L, Gao F, Sun W, et al. Short-term effects of extracorporeal shock wave therapy on bone mineral density in postmenopausal osteoporotic patients. Osteoporos Int. 2017;28(10):2945-2953. doi:10.1007/s00198-017-4136-7
33. Moon YE, Seok H, Kim SH, Lee SY, Yeo JH. Extracorporeal shock wave therapy for sacroiliac joint pain: A prospective, randomized, sham-controlled short-term trial. J Back Musculoskelet Rehabil. 2017;30(4):779–784. https://doi.org/10.3233/BMR-150405
34. Sheng J, Liu S, Wang Y, Cui R, Zhang X. The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural Plast. 2017;2017:9724371. doi:10.1155/2017/9724371
35. Han H, Lee D, Lee S, Jeon C, Kim T. The effects of extracorporeal shock wave therapy on pain, disability, and depression of chronic low back pain patients. J Phys Ther Sci. 2015;27(2):397-399. doi:10.1589/jpts.27.397
36. Teasell RW, Mehta S, Aubut JL, et al. A systematic review of the therapeutic interventions for heterotopic ossification after spinal cord injury. Spinal Cord. 2010;48(7):512-521. doi:10.1038/sc.2009.175
37. Li Y, Zhu Y, Xie Z, Jiang C, Li F. Long-term radial extracorporeal shock wave therapy for neurogenic heterotopic ossification after spinal cord injury: A case report. J Spinal Cord Med. 2022;45(3):476-480. doi:10.1080/10790268.2020.1760507
38. Jeon HM, Lee WJ, Chung HS, et al. Extracorporeal shock wave therapy to treat neurogenic heterotopic ossification in a patient with spinal cord injury: A case report. J Spinal Cord Med. 2021;44(4):627-630. doi:10.1080/10790268.2019.1632597
39. Taheri P, Khosrawi S, Ramezani M. Extracorporeal Shock Wave Therapy Combined With Oral Medication and Exercise for Chronic Low Back Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2021;102(7):1294-1299. doi:10.1016/j.apmr.2020.12.008
40. Lange T, Deventer N, Gosheger G, et al. Effectiveness of Radial Extracorporeal Shockwave Therapy in Patients with Acute Low Back Pain-Randomized Controlled Trial. J Clin Med. 2021;10(23):5569. Published 2021 Nov 26. doi:10.3390/jcm10235569
41. Fischer AA, Imamura M. New concepts in the diagnosis and management of musculoskeletal pain. In: Lennard TA, organizador. Pain procedures in clinical practice. 2nd ed. Philadelphia, PA: Henley & Belfus; 2000. cap. 23. p. 213–229.
42. Fischer AA. Functional diagnosis of musculoskeletal pain by quantitative and objective methods. In: Rachlin ES, Rachlin IS, editors. Myofascial pain and fibromyalgia. Trigger point management. 2nd ed. St. Louis, MO: Mosby; 2002. chap. 7. p. 145–173.
43. Fischer AA, Dubo H, Young BJ, Imamura M, Cassius DA. Myofascial pain and fibromyalgia. In: O’Young BJ, Young MA, Steins SA, editors. Physical medicine and rehabilitation secrets. 3rd ed. Philadelphia, PA: Mosby; 2007. cap. 74. p. 369–378.
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Dec 5, 2022
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How to Cite
Simplicio, C., Santos, G., Shinzato, G., de Barros, G., Imamura, M., Neto, A., & Lana, J. F. (2022). Extracorporeal Shockwave Treatment for Low Back Pain: A Descriptive Review of the Literature. Biologic Orthopedics Journal, 4(SP1), e96-e105. https://doi.org/10.22374/boj.v4iSP1.46
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Review Articles
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Author Biographies
Claudio Simplicio, Clinica Ortofisio, Araruama – RJ, Brazil
Orthopedics – Sports Medicine – Pain Physician, Clinica Ortofisio, Araruama – RJ, Brazil
Gabriel Santos, Brazilian Institute of Regenerative Medicine, Indaiatuba, Brazil
Medical Laboratory Department, BIRM - Brazilian Institute of Regenerative Medicine, Indaiatuba, Brazil
Gilson Shinzato, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo – SP, Brazil
Physiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo,
São Paulo – SP, Brazil
Guilherme de Barros, Faculdade de Medicina de Botucatu, Botucatu – SP, Brazil
Antalgic Therapy and Palliative Care, Faculdade de Medicina de Botucatu, Botucatu – SP, Brazil
Marta Imamura, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo – SP, Brazil
Physiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo,
São Paulo – SP, Brazil
Antonio Neto, Centro de Reumatologia e Ortopedia Botafogo, Rio de Janeiro – RJ, Brazil
Physiatry, Centro de Reumatologia e Ortopedia Botafogo, Rio de Janeiro – RJ, Brazil
José Fábio Lana, BIRM - Brazilian Insitute of Regeneratvie Medicine, Indaiatuba, Brazil; Medical Specialties School Center, UniMAX - Max Planck University Center, Indaiatuba, Brazil
Orthopedics – Sports Medicine – Pain Physician, BIRM - Brazilian Insitute of Regeneratvie Medicine, Indaiatuba, Brazil
Medical Specialties School Center, UniMAX - Max Planck University Center, Indaiatuba, Brazil