This prospective, randomized and single-blinded study to measure the influence of shock wave therapy on patients with low back pain.
In todays world there are many ways of treating and managing lower back pain and sciatic pain. The common medical approach for lower back pain therapy is still mainly pharmacological – which definitely has its place. Physiotherapy, chiropractic and osteopathy all take a more biomechanical look to the treatment of back pain.
International guidelines for the management of lower back pain have been develop and only vary slightly from country. Treatments like spinal manipulation, core stabilisation training, cognitive behavioural therapy and acupuncture all feature. Shock wave therapy on the other hand has not been studied enough for us to know whether it warrants inclusion into guidelines for the treatment of lower back pain.
Shock wave therapy is defined as a series of high energy acoustic wave impulses that produce momentary turbulent pressure changes in the target tissue. Shock wave therapy was initially developed as a non-invasive procedure for breaking up kidney stones. This is made possible by the fact that the shock waves are absorbed by soft tissues to a depth of down to 12 cm.
Radial shock waves (the ones used in the study) are generated by a pneumatic (ballistic) method using a device that produces compressed air, which fires a special bullet inside a short tube. This bullet, after accelerating, hits the head of the device and causes the transformation of kinetic energy into a pressure wave. This wave then propagates into the tissue.
There has been a good deal of interesting research into the benefits and physical effects of shock wave therapy on injured and sick tendon, bone and connective tissue: and its effects on pain. There is however very little high quality research on Shock Wave Therapy’s effects on lower back pain. The researchers in this study were therefore, aiming to assess the influence radial shock wave therapy in the treatment of patients with lower back pain.
A total of 52 patients with LBP were enrolled in the study, this is not a large study group by any means – but it is enough to gather a small but meaningful amount of data – assuming the methods observed in the study are sound.
In order to study a treatment like shock wave therapy and its effects on a complaint like lower back pain you need to be a little bit tricksy. As with all research of this type you need to have a group within the study who think that they are receiving the treatment but who are actually just receiving a placebo. In this case that meant fabricating a cheeky little device that prevented the wave from leaving the device. This meant the lower back pain sufferers could receive a treatment that looked and sounded like the real thing, but wasn’t.
A key limitation of this study was that it was only ‘single blinded’ this meant that the practitioner delivering the treatment knew themselves whether the shock wave therapy for lower back pain was the real thing or not. This allows for the possibility of subtle cues to leak out of the practitioner that impact the patients outcome – it is also entirely possible that they might deliver the treatments slightly differently whether they meant to or not. This fact does not render the data useless as such – it just leaves a small question mark over the accuracy of the lower back pain outcomes.
The study concluded that radial shock wave therapy is effective for patients with lower back pain – particularly in the long-term. The data suggested a significant advantage over a pure placebo effect as the placebo group did not see the same kind of longer term improvements in their pain. The use of this therapy has a significant influence on the reduction of pain and the improvement of the general functional state. The combined with stabilization training appeared particularly effective in the long-term and achieved a stable beneficial effect for patients with lower back pain.
Essentially what this means is that people who received the real radial shock wave treatment for their lower back pain experienced a significant reduction in their pain – and adapted particularly well the rehab exercises which they were better at performing and experienced more benefit from.
No single piece of scientific data will ever tell us everything we need to know about the treatment of lower back pain, and especially not a small and imperfectly designed one like this. But as time goes by if these results can be replicated we will begin to get a clearer picture of whether shock wave therapy should be included in international lower back pain treatment guidelines.
For what it’s worth – my prediction is that further tests will prove successful and ultimately we will learn that shock wave therapy is a valuable treatment for certain lower back pain cases. Lower back pain is often more similar to complaints like tendon pain than you might think – and in those instances there is every reason to be optimistic about the future of shock wave therapy as a treatment for lower back pain. There will however also prove to be many instances where Shockwave Therapy does not bring any relief for back pain sufferers.
As a layperson or even as a healthcare practitioner you may very well ask how it is that delivering high impact acoustic waves to human tissues can trigger long term resolution of a complaint like lower back pain.
There are countless examples in nature of controlled stress being a healthy thing for living tissues and living systems. In the microscopic world bacteria who are fed a tiny amount of poison thrive more than bacteria who live in a completely non-toxic environment.
In human lives we need the stress of exercise and gravity or out bones and soft tissues turn to mush. These are all examples of a natural principle called ‘Hormesis’. Hormeses is a positive and fortifying response to a controlled dose of stress. This is the principle by which shock wave therapy impacts conditions like shoulder pain, back pain, wrist pain, hand pain, ITB band, ankle pain, hip pain and knee pain.