Tendulkar's shock wave treatment

[Danny]

Obviously he's been struggling to overcome this injury, and his surgeon has now suggested 'rest and relaxation' with the view to be fit for the second test against Australia.

I really hope that quote was meant as a generalisation of what treatment he really will be getting.

Am I right in saying that this Tendinopathy which is most probably a Teninosis rather than a Tendonitis requires a well structured rehab program aimed at regenerating and strengthening his tendon?

Tendinosis has a vicious cycle of tendon degeneration and weakening, hopefully 'rest and relaxation' is merely the title of Indias extensive and detailed rehabilitation program for Tendulker.

[hhh]

i assume the shockwave didn't work? Some hardcore science from AJSM says there's not much in it (see below).

Out of interest does an article like this shaft the use of the studied variable, and if there's a positive result from the study, how long does it take before the variable is accepted and used for every case (if it is)? How long does change take and what effect does research have on clinical decision making? Does it depend on the quality of the clinician, ie those that read and those that don't?


Effectiveness of Extracorporeal Shock Wave Therapy in the Treatment of Previously Untreated Lateral Epicondylitis
Bryan Chung J. Preston Wiley, MD*
University of Calgary Sport Medicine Centre, Faculty of Kinesiology, Calgary, Alberta, Canada

* To whom correspondence should be addressed. E-mail: wiley@ucalgary.ca.

Abstract


Background: Extracorporeal shock wave therapy is a relatively new therapy used in the treatment of chronic tendon-related pain. Few randomized controlled trials have been performed on it, and no studies have examined the effectiveness of extracorporeal shock wave therapy as a frontline therapy for tendon-related pain.

Hypothesis: Subjects treated with active extracorporeal shock wave therapy will have higher rates of treatment success than subjects treated with sham extracorporeal shock wave therapy.

Design: Double-blind randomized controlled trial.

Methods: Sixty subjects who had previously untreated lateral epicondylitis for less than 1 year and more than 3 weeks were included in this study. Subjects were randomly allocated to receive 1 session per week for 3 weeks of either sham or active extracorporeal shock wave therapy. Subjects in the active therapy group received 2000 pulses (energy flux density, 0.03-0.17 mJ/mm2). All subjects were provided with a forearm-stretching program. After 8 weeks of therapy, subjects were classified as either treatment successes or treatment failures according to fulfillment of all 3 criteria: (1) at least a 50% reduction in the overall pain visual analog scale score, (2) a maximum allowable overall pain visual analog scale score of 4.0 cm, and (3) no use of pain medication for elbow pain for 2 weeks before the 8 week follow-up. Visual analog scale scores were also collected for pain at rest, during sleep, during activity, at its worst, and at its least, as well as for quality of life (using the EuroQoL questionnaire) and grip strength.

Results: Success rates in the sham and active therapy groups were 31% and 39%, respectively. No significant difference was detected between groups (c21 = 0.3880, P = .533). Mean change in quality of life over 8 weeks was an increase of 1.3 and 3.3 for sham and active therapy groups, respectively, and mean change in grip strength over 8 weeks was an increase of 7.4 kg and 6.8 kg for sham and active therapy groups, respectively.

Conclusions: Despite improvement in pain scores and pain-free maximum grip strength within groups, there does not appear to be a meaningful difference between treating lateral epicondylitis with extracorporeal shock wave therapy combined with forearm-stretching program and treating with forearm-stretching program alone, with respect to resolving pain within an 8-week period of commencing treatment.

Key Words: lateral epicondylitis, randomized controlled trial, extracorporeal shock wave therapy (ESWT)

[Danny]

The Tendulkar injury has been under rated until now. He could miss the series and that would be a huge blow to the struggling Indian top order.




Tendulkar could miss the remainder of the series

Wisden Cricinfo staff

October 10, 2004

As if things weren't bad enough for India after their crushing 217-run defeat at Bangalore, it is now being reported that Sachin Tendulkar might miss the remainder of the series.


Details of the tennis-elbow injury have been far from clear as team officials sought to keep the exact extent of it under wraps. In the build-up to the first Test, Sourav Ganguly told reporters that Tendulkar would be fit while Andrew Leipus, the physiotherapist, said he would not. He was only finally ruled out on the day before before the match started. Leipus has now been ordered by the Indian board not to comment.


Yesterday, Dr Premchand Khincha, an orthopaedic specialist in Bangalore, who examined Tendulkar was quoted in the local Deccan Herald as rating him 50-50 to play in the second Test at Chennai. "He is still feeling the pain while driving the ball and the injury still persists," Kincha explained. "Normally, it takes about six weeks to three months to recover from a tennis elbow, but in the case of a person involved in heavy physical activity, such as Tendulkar, recovery could take longer."

Tendulkar has been out of action for seven weeks, but several Indian journalists who have spoken privately to the specialist have reported that the outlook is far less optimistic.


While there is no doubt that he is on the mend, the process is slow. Initially he was almost incapable of any backlift, and while he can now bat in the nets, he is only able to face three or fours overs before packing in. With the Chennai Test starting on Thursday (October 14) it is almost inconceivable that the improvement in the intervening four days would be enough to enable him to bat for several hours.


Tendulkar himself admitted in an interview with The Sun-Herald that he is struggling and that he also needs to rebuild the muscle in his arm which has wasted because of his inactivity. "If I try to rush into playing early there could be a repeat injury because the muscle is not strong enough to take the pressure of batting," he said. "When there is strength, I can start practising."


On Friday, Tendulkar, who was with the Indian squad at Bangalore, left the Test for a few hours to visit Sai Baba, a popular spiritual guru. He is also believed to be toying with the idea of using a lighter bat to speed his recovery. It seems he is prepared to explore any avenue to get fit, but the reality is that it is simply a matter of time.

© Wisden Cricinfo Ltd

[hhh]

I read the injury is to his bottom hand Danny which makes the injury unusual given the top hand controls grip (requiring the wrist extensors to fire up) and also takes most of the force from the bat. Also read he can only face 15 balls in the nets before breaking for a while

[Monica]

Under-rated medically, Danny, or just downplayed by the Indians?

[Danny]

I really hope it was down playing!

[injuryupdate]

Regarding the paper on shock wave for tennis elbow, the results of this study showed a slight increase in recovery for the ESWT and stretching group compared to the stretching alone group, but they weren't statistically significant.

Jury is still out on ESWT. It makes a lot more sense for conditions where there is calcification in the tendon. This can happen in tennis elbow rarely, but is much more common in supraspinatus and Achilles tendons. This is how ESWT started, being a spin off from lithotripsy for kidney stones.

I like to use ESWT with local anaesthetic in a calcific lesion. With pain relief, you can turn up the machine a lot higher and blast the calcium. I agree that it isn't that impressive for the standard case of tennis elbow.

[Don]

If Tendulkar had ESWT there is at least a 3 month recovery period. If he attempts to bowl or bat all the good work done by ESWT will be wasted.


Studies done in Europe have supported ESWT for the following
Feet- Plantar Fasciitis, Achilles Tendonitis, Retro Calcaneal Bursitis
Knees
Hips
Elbows - Medial and Lateral
Shoulders - Calcifixc tendonitis (L.A. required)
Non Union Fractures (G.A. required)

It does not work for everyone. It is really up to the patient to decide whether to have ESWT or not.

The are about 10 - 12 Dornier EPOS Ultra ESWT machines in Australia
Syndey 2
Melbourne 3
Wollongong 1
Brisbane 1
Perth 1
Adelaide 1
Darwin 1 ??

My machine is located in Sydney

[lquill]

HI

I was wondering if you could please give me phone number and address in Sydney where I could make inquiries about receiving this treatment and the costs involved?

I would be extrememly grateful

Leonie



If Tendulkar had ESWT there is at least a 3 month recovery period. If he attempts to bowl or bat all the good work done by ESWT will be wasted.


Studies done in Europe have supported ESWT for the following
Feet- Plantar Fasciitis, Achilles Tendonitis, Retro Calcaneal Bursitis
Knees
Hips
Elbows - Medial and Lateral
Shoulders - Calcifixc tendonitis (L.A. required)
Non Union Fractures (G.A. required)

It does not work for everyone. It is really up to the patient to decide whether to have ESWT or not.

The are about 10 - 12 Dornier EPOS Ultra ESWT machines in Australia
Syndey 2
Melbourne 3
Wollongong 1
Brisbane 1
Perth 1
Adelaide 1
Darwin 1 ??

My machine is located in Sydney

[Compton Ass Terry]

I can do a good job of Placebo ESWT if you want. I also do a slightly different version called Sham ESWT. They both work just as well as regular ESWT but I undercut everyone's price by 50%. Better still I guarantee about a 60% chance of treatment success. Anyway's gotta go fo, give a reply and I'll hit you back at the first.

[Gibbo]

This placebo type ESWT and sham ESWT sounds promising Terry. You should consider publishing your results as I believe the medical community as a whole is always on the look out for something with proven treatment efficacy that comes with little cost to the consumer. This has the potential to be the next big thing.

[injuryupdate]

ESWT in Sydney is available at 111 Anzac Pde Kensington 2033, ph 96635999, $55 per treatment plus the doctor's fee.

Because it is expensive I think it is best to stick to treating the most indicated injuries with it, which is calcific tendinopathy. Also worth using local anaesthetic to get full value (higher intensity).

[Nicholas]

Interesting information.

[sdredmerah]

I am really interested in shock wave therapy. Would anyone be able to lead me to a video of shock wave therapy.

[Nicholas]

Search the forum "Therapeutic modialities" and you should find one there.