Ready for a shockwave?

Exceed’s Lucy Mason reports on a growing number of practitioners using electrotherapy to treat pain and aid healing.

Osteopaths, chiropodists, sports and massage therapists and podiatrists are increasingly using electrotherapy to treat patients.

The therapy, traditionally used by physiotherapists for over a hundred years to assist pain reduction and the natural healing process, is today being used in new ways – from treating fractures and aiding muscle repairs post-sport to even improving mobility for stroke patients.

New devices are also coming to market which will allow patients to self-treat at home for a wider variety of conditions – freeing up NHS time.

Professor Tim Watson, President of the International Society for Electro Physical Agents in Physical Therapy, is on a mission to make therapists aware of the range of benefits electrotherapy can bring.

With more than 200,000 research papers available on electrostimulation, he says there is a substantial body of evidence to its benefits.

Electrotherapy has been used over the years for pain management (TENS machines), to treat soft tissue injuries (ultrasound) and muscle stimulation to aid post-operative recovery. Research shows that the best results occur when the right electro agent is chosen and the optimum dose parameters are selected.

Professor Watson believes modern electrotherapy practice used at the right time for the patient has a ‘phenomenal capacity to be effective.’

It has real benefit to people with bone fractures.

He says: “We’re seeing impressive results when ultrasound is used on a fracture – in fact it can make up to a 40 per cent difference in a fracture. It can speed up recovery time and mend fractures faster. NICE guidelines support this.

“If a patient has a fracture that’s not healing or is very slow to heal, then ultrasound will stimulate a fracture’s healing response. Studies show a success rate of between 70-95 per cent.

“Often patients will be offered surgery, implants or bone grafts to treat a fracture that’s not healing properly, but these are all invasive treatments. It’s much better for the patient – and the NHS – if these can be treated with a non-invasive therapy.

“Interestingly, some of the research has been out there for 15 years but it’s new to mainstream. Despite NICE saying it works, it’s taking far too long to filter into therapy practice and too many patients are not being offered it.”

It doesn’t just help aid fracture recovery. Electrotherapy can help a huge range of patients including: people with Bell’s palsy, phantom limb pain in amputees, post-operative recovery in knee surgery and sports players with soft tissue injuries.

Stroke patients – often left vulnerable to trips and falls because they can lose feeling in their toes – can benefit from electrostimulation. It can also help incontinence sufferers as electrostimulation stimulates the pelvic floor muscles.

Professor Watson said: “One of the other exciting areas electrostimulation is starting to be used is to help strengthen muscles in patients with chronic respiratory diseases. As a result of their illness, patients often get weaker lower limb muscles which makes it hard for them to exercise.

“Using electrostimulation of the lower limb muscles it is possible to increase their muscle strength and function. This means they are more able to exercise. It can make a huge difference to their ability to be independent and functional and active.”

It can also be used in shockwave treatment to stimulate tissues that are not responding to treatment.

Professor Watson explains: “Shockwave is a relatively new treatment to clinical practice but it is very exciting.

“If a patient has chronic tendon problems it can be difficult to get them to respond to treatment. Mechanical shockwave treatment has been shown to stir up an anti-inflammatory response that is very effective.

“Other treatments such as manual therapy and massage are good too but the really exciting thing about shockwave is that it can be used to take someone’s condition from chronic to a more responsive or acute state. You can then use other tools in the kit such as massage to help the next stage.

“I’d like to see it filter down into mainstream practice.”

The future of electrotherapy is not necessarily contained to a clinical setting – Professor Watson predicts more patients benefitting from a new trend developing for home-based use of electro physical agents.

He says: “People are familiar with TENS machines and they have traditionally been used by patients in a home setting for the past 30 years to deal with pain relief.

“There are a variety of new stimulators now coming to market that people can use at  home and I can see a future where there are more machines that are smaller, usable, dose specific and portable – and they can treat a wider variety of medical conditions.

“The benefit for the patient is that they can treat themselves every day in a relaxed home setting rather than waiting for a weekly NHS appointment. It empowers the patient, is more efficient, cost effective and allows a deliverable treatment at the right dose.”

The professor says that as access to therapy on the NHS becomes increasingly limited, it is going to become more important for patients to self-treat where they can.

He says: “Historically, electrotherapy has been given in a clinical setting. But if a patient can, in addition, treat themselves at home between appointments with the right device at the correct dosage, and save their precious clinical time for the things they can’t do at home it’s a win/win situation.”