|Name||Tissue||Type of pathologies|
|Acute and chronic muscle aches and pain||Muscle||Pain management|
|Acute and chronic cervical and lumbar pain||Muscle||Idiopathic cervical and low back pain|
|Acute and chronic soft tissue wounds||Skin||Wounds|
|Calcifying tendinitis of the shoulder||Tendons||Tendinopathy|
|Chronic distal biceps tendinopathy||Tendons||Tendinopathy|
|Chronic proximal hamstring tendinopathy||Tendons||Tendinopathy|
|Diseases secondary to trigger points and myofascial Pain||Muscle||Myofascial pain syndrome|
|Greater trochanteric pain syndrome||Tendons||Tendinopathy|
|Insertional Achilles tendinopathy||Tendons||Tendinopathy|
|Medial tibial stress syndrome||Tendons||Tendinopathy|
|Mid-body Achilles tendinopathy||Tendons||Tendinopathy|
|Osgood-Schlatter disease||Bone||Disturbance of musculoskeletal development|
|Patella tip syndrome||Tendons||Tendinopathy|
|Primary and secondary lymphedema||Skin||Lymphedema|
|Primary long bicipital tenosynovitis||Tendons||Tendinitis|
|Proliferative connective tissue disorders||Connective tissue||Fibrosis|
|Spasticity||Central nervous system||Cerebral palsy and stroke|
|Subacromial pain syndrome||Tendons||Tendinopathy|
|Trigger points||Muscle||Myofascial pain syndrome|
Spasticity classically manifests as an upper motor neuron lesion (i.e., of those neurons that connect the brain with the spinal cord). It is characterized by increased resistance of muscles to passive stretching (lengthening), caused by abnormal activity of the muscle spindles. The latter leads to excessive, velocity-dependent muscle contraction and, ultimately, hyperglycemia (i.e., exaggerated deep tendon reflexes).
Spasticity usually occurs as a result of abnormal development or damage of the brain and/or the spinal cord. Cerebral palsy (CP), acquired brain injury including stroke and spinal cord injury are the most common causes of spasticity. Cerebral palsy is characterized by a persistent disorder of posture or movement caused by a non-progressive disorder of the immature brain.
The prevalence of CP is approximately two cases per 1,000 live births, with little variation among Western nations, India and China. Low birthweight, intrauterine infections, multiple gestation and birth complications are among the most important risk factors for CP. Most children with CP suffer from spasticity as the main motor disorder, which is a major challenge for rehabilitation because spasticity can cause pain, prevent or hamper function and may disturb sleep. A particular problem in CP is spasticity of plantar flexor muscles, which can cause toe walking. The latter can result in major functional implications such as disturbances in balance and walking, and interfere with gross motor function development.
The ultimate goal of any therapy program for spasticity in CP must be to achieve the child’s maximum potential in motor skills. Botulinum neurotoxin (BoNT) is an effective and widely used pharmacological treatment for focal muscle overactivity. An alternative is focal, intramuscular injection of phenol and/or alcohol. However, these treatments are not without problems. BoNT is expensive and not available in many countries.
Furthermore, a significant risk of focal, intramuscular injection of alcohol and phenol is persisting pain. Besides this, all these procedures are invasive and, thus, not without risk when applied under difficult hygienic conditions. Orthopedic surgery is considered a last resort in managing spasticity in children with CP. It is not an option for managing spasticity per se but is used to help correct the secondary problems that occur with growth alongside spastic muscles and poor motion control (including joints contractures, muscle shortening and bony deformities).
Recently, extracorporeal shock wave therapy (ESWT) has become an alternative in the treatment of spasticity.
Wang et al., Medicine (Baltimore) 2016 May;95(19):e3649.
A prospective case-control study of radial extracorporeal shock wave therapy for spastic plantar flexor muscles in very young children with cerebral palsyREAD ABSTRACT
Vidal et al., NeuroRehabilitation 2011;29:413-419.
Radial extracorporeal shock wave therapy (rESWT) in the treatment of spasticity in cerebral palsy: a randomized, placebo-controlled clinical trial.READ ABSTRACT
|Number of treatment sessions||3 to 5|
|Interval between two sessions||1 week|
|Air pressure Evo Blue®||2.5 to 4 bar|
|Air pressure Power+||2 to 4 bar|
|Frequency||8Hz to 12Hz|
|Skin pressure||Moderate to heavy|
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