Musculoskeletal (MSK) disorders are a prevalent issue for millions of people worldwide, causing pain, discomfort, and reduced quality of life. While there are various treatment options available, managing chronic MSK conditions, such as frozen shoulder and knee osteoarthritis, can prove to be quite challenging.
Fortunately, both radial and focused shockwave therapy have proven to be effective in pain relief and tissue healing in the management of multiple MSK disorders. However, there are limitations to these treatments in acute pain presentations and when dealing with larger areas like the hips or lower back. This is where EMTT can prove to be particularly advantageous.
EMTT (Electromagnetic Transduction Therapy) is a non-invasive treatment that utilizes electromagnetic waves to stimulate the body’s natural healing process. It has been shown to be effective in pain relief and has been found to be superior to conventional therapy in conditions such as chronic low back pain (Krath et al, 2017).
EMTT can be used alone or in combination with other therapies like ESWT (Extracorporeal Shockwave Therapy) to provide a comprehensive treatment plan for patients dealing with chronic MSK pain. This innovative approach to regenerative medicine can help patients regain their active lifestyles without relying on medication or surgery.
In this blog, we will be looking at three clinical scenarios where a combined approach of EMTT + ESWT could be highly beneficial.
1. Management of Frozen Shoulder (Stages 1-3)
Phase 1: EMTT for Stage 1 Frozen Shoulder
During stage 1, the pain may be especially intense at night, making it difficult to sleep on the affected side. The shoulder joint may also become stiff and difficult to move, and activities that require reaching or lifting may become challenging. Without proper treatment, stage 1 of frozen shoulder can progress to more advanced stages and result in long-term loss of function in the affected shoulder.
EMTT uses electromagnetic waves to stimulate the body’s natural healing process, which can help reduce inflammation and promote tissue regeneration. In Stage 1 Frozen Shoulder, EMTT can be used to provide immediate pain relief by reducing inflammation and swelling in the affected area.
Phase 2: Radial or Focused SWT for Stage 2-3 Frozen Shoulder
During stage 2 -3 of frozen shoulder, also known as the “frozen” stage, the pain may begin to subside, but stiffness and limited range of motion persist. This stage can last anywhere from 6-18 months.
ESWT can be an effective treatment option for individuals in stages 2 and 3 of frozen shoulder. Shockwave therapy can help to break down scar tissue, reduce myogenic pain around shoulder and promote blood flow to the affected area, which can help to improve mobility and reduce pain. By targeting the root cause of the frozen shoulder, shockwave therapy can help to accelerate the healing process and reduce the need for more invasive treatments like surgery.
2. Rotator Cuff (RC) Tendinopathy
A randomised controlled trial by Kluter et al, 2018 looked at the effects of combination therapy (ESWT and EMTT) for shoulder pain, due to RC tendinopathy. A total of 86 patients with RC tendinopathy were randomized to undergo three sessions of ESWT in combination with 8 sessions of EMTT or sham-EMTT. The combination of EMTT + ESWT produced significantly greater pain reduction in the visual analogue scale compared to ESWT with sham-EMTT after 24 weeks.
The researchers concluded that combining these two therapies may be a more effective way to treat shoulder pain than using either one alone. Overall, this study provides clinical evidence for benefit of combination therapy for people suffering from rotator cuff tendinopathy.
3. Management of OA of Knee: (Acute and Chronic Stage)
Phase 1: EMTT for Acute Flare-up of Knee Pain
An acute flare-up of osteoarthritis of the knee can cause sudden and intense pain, swelling, and stiffness in the affected joint. During a flare-up, simple activities like walking or climbing stairs can become difficult or even impossible. Managing flare-ups typically involves a combination of pain management, rest, and gentle exercises to improve joint mobility and strength.
In acute pain presentations, EMTT can be highly effective to provide immediate pain relief by reducing inflammation and swelling in the affected area. The therapy can also help improve blood flow to the area, which can speed up the healing process and reduce recovery time.
Phase 2: Focused SWT for Managing Knee Pain due to Bone Marrow Oedema
Bone marrow oedema, or the accumulation of fluid in the bone marrow, is believed to play a significant role in the development of flare-ups in individuals with osteoarthritis of the knee. Research suggests that bone marrow oedema may be caused by microfractures or other types of damage to the bone, which can occur as a result of increased pressure on the joint during weight-bearing activities.
This accumulation of fluid can cause significant pain, swelling, and stiffness in the affected joint, making it difficult to perform even basic activities of daily living. As a result, management of bone marrow oedema is an important component of treating flare-ups in individuals with osteoarthritis of the knee.
Focused shockwave therapy has been shown to be an effective treatment option for individuals with bone marrow oedema-related knee pain. Research has shown that focused shockwave therapy can significantly reduce pain and improve function in individuals with bone marrow oedema-related knee pain. In this study, individuals who received focused shockwave therapy experienced a significant reduction in pain and improvement in knee function compared to the control group (Sanson et al, 2017).
Focused shockwave therapy for knee OA is a safe and well-tolerated treatment option, with few reported side effects.
Conclusion
The combination therapy of ESWT and EMTT can be a highly effective approach in managing difficult MSK disorders, such as frozen shoulder, osteoarthritis of the knee and other pathologies like shin splints, osteitis pubis and OA of the hip.
While ESWT can effectively promote blood flow, EMTT can provide immediate pain relief, reduce inflammation and swelling, and improve the body’s natural healing process. By combining these two therapies, patients can experience faster recovery times, reduced reliance on medication, and improved quality of life. This innovative approach to regenerative medicine provides a non-invasive alternative to traditional treatment options, such as medication or surgery, and can help patients get back to their active lifestyles.
If you are curious to learn more, this 1-day course (LINK) will introduce the concept of combining shockwave therapy with EMTT and present evidence for the superior efficacy of combination therapy in various medical specialties.
The course will feature presentation of case studies, demonstrations, and practical sessions on how to effectively use combination therapy to treat a range of musculoskeletal (MSK) conditions.
Benoy Mathew, MSc, MCSP
Advanced Practice Physio & MSK Sonographer,
Head of MSK Education, Venn Healthcare
References
Krath, A., Klüter, T., Stukenberg, M., Zielhardt, P., Gollwitzer, H., Harrasser, N., Hausdorf, J., Ringeisen, M. and Gerdesmeyer, L., 2017. Electromagnetic transduction therapy in non-specific low back pain: A prospective randomised controlled trial. Journal of orthopaedics, 14(3), pp.410-415.
Klüter, T., Krath, A., Stukenberg, M., Gollwitzer, H., Harrasser, N., Knobloch, K., Maffulli, N., Hausdorf, J. and Gerdesmeyer, L., 2018. Electromagnetic transduction therapy and shockwave therapy in 86 patients with rotator cuff tendinopathy: a prospective randomized controlled trial. Electromagnetic Biology and Medicine, 37(4), pp.175-183.
Sansone, V., Romeo, P. and Lavanga, V., 2017. Extracorporeal shock wave therapy is effective in the treatment of bone marrow edema of the medial compartment of the knee: a comparative study. Medical Principles and Practice, 26(1), pp.23-29.
