Trigger point infiltration using a medicine (local analgesic injection into painful muscle trigger points)
Pain located in trigger points can be eliminated using a local anaesthetic, whose effect is sometimes strengthened by adding a corticosteroid.
Joint blocks are performed when the pain in the joint has not been eliminated using regular non-invasive treatment methods. A combination of a corticosteroid and an anaesthetic is used.
We use anti-inflammatory medication that relaxes muscle spasms and alleviates pain.
Dry needling, or Western acupuncture, is a technique used to relieve myofascial trigger points using very fine needles. Trigger points are very sensitive points in our muscles, which hurt when pressed and when the muscle in which they are located is activated. First, we palpate the skin to identify the spot of the trigger point responsible for a pain syndrome. Then, we insert a needle through the skin and deactivate active trigger points thus reducing pain. This technique relies upon contemporary knowledge of neuroanatomy and its positive effects have been scientifically proven.
Acoustic pulses are generated outside the body and transformed into shock waves. They are transmitted through a probe and through the skin into deep structures (muscles, sinews and ligaments). This method was introduced around 35 years ago to treat kidney stones and it was later expanded to other fields, such as physiotherapy. It reduces the sensitivity of pain receptors and stimulates tissue regeneration in chronic pain conditions. We can also break up calcifications into smaller particles, which can then be resorbed. It is most frequently used for chronic enthesopathies and tendinopathies with or without calcifications. This method is most frequently used for the following diagnoses:
– Lateral epicondylitis (also known as tennis elbow),
– Medial epicondylitis (also known as golfer’s elbow),
– Sinding-Larsen-Johansson syndrome,
– Plantar fasciitis (jogger’s heel),
– Medial tibial stress syndrome (shin splints),
– Rotator cuff syndrome,
– Calcifying tendinosis,
– Achilles tendon tendinosis,
– Trochanteric bursitis,
– Pseudoarthrosis (nonunion following a bone fracture),
– Carpal tunnel syndrome.
In the case of these conditions, we stimulate blood circulation, which accelerates regeneration and healing. We can use this method for muscle stiffness or knots occurring in chronic pain syndromes in the spinal area, releasing the muscle spasm and relieving pain. ESWT is not applied in the acute stage (inflammation stage) or immediately after an injury. Before beginning the therapy, anti-inflammatory drugs (NSARs) have to be withdrawn. They may be reintroduced four weeks after the ESWT is completed.
The therapy takes 15 to 20 minutes. Five therapies at weekly intervals are usually sufficient. At the Fiziatrija Clinic, we use 10–20 Hz radial waves and 1500–3000 shock waves of up to 4 bars. We use two applicators: first, the R15 applicator for targeted treatment, and then the D20-s D-ACTOR to cover a larger area.
The effectiveness is 70–90%, which is a very good result given that we treat chronic conditions and conditions that are difficult to cure. Patients may experience a transient increase of pain in the first 24–72 hours after the therapy, which then decreases. Since this method initiates the regeneration process, its effect continues for several weeks to up to three months after the application. Some patients experience relief immediately after the therapy, the majority some days later, and sometimes several weeks later. Transient side effects occurring up to 48 hours after the therapy can include pain, bruising of the application spot and, rarely, headache.
Successful treatment first requires an accurate diagnosis given by a specialist physician, i.e. Fiziatrija’s physical medicine and rehabilitation specialist, who uses additional imaging diagnostics (ultrasound, MRI, X-ray). Apart from the ESWT, we also suggest you modify your physical activity and rest patterns. The use of traditional physical therapy, which includes therapeutic exercises and manual techniques, is also advisable.
HIGH-POWERED K-LASER CUBE 4
Laser technology and the use of laser devices in physiotherapy have advanced significantly in recent years. ‘Cold’ low-energy lasers, which have a mainly surface effect (up to 1 cm deep) with their 0.1 W power, have been replaced by new-generation lasers, which are high-powered and penetrate into structures up to 10 cm deep. This means that they have an effect on the insertions of tendons, ligaments and joints. Compared to that of traditional cold lasers, the output power of high-intensity lasers is from 50 to 100 times higher, they have an optimum wavelength with a much lower attenuation when penetrating tissue and a therapeutic effect also in the deep tissues. Because of these properties, the duration of a high-powered laser treatment is much shorter, while its pain-relieving effect is greater and indications for use broader. Its most pronounced effects are its anti-inflammatory, biostimulative (tissue reparation and regeneration) and analgesic action.
Patients of Fiziatrija Clinic may make use of the K-Laser Cube 4, a laser of the newest generation, with a 20 W output power and 660 nm, 800 nm, 905 nm and 970 nm wavelengths. It is used in musculoskeletal pathologies, soft tissue damage, oedema and for laser acupuncture. Indications for high-powered laser treatment are:
Acute pain following injuries and inflammation of tendons and ligaments, soft tissue contusions on the limbs, and sprains,
Partial tears of muscles and tendons (Achilles tendon, shoulder tendons, larger muscles),
Overstraining syndromes (jogger’s heel or plantar fasciitis, epicondylitis, painful insertions of tendons and ligaments on knees, hips and shoulders),
Sprains of the cervical spine and painful neck muscles following a pulled muscle,
Acute lower back pain (lumbago),
Painful trigger points,
Degenerative changes of large and small joints of the fingers,
From 5 to 6 applications of the K-Laser are recommended on the spot concerned every two days. It can also be combined with an ESWT or manual physiotherapeutic techniques.
Diadynamic and interferential currents or TENS therapy produce a pain-relieving and anti-inflammatory effect on the tissues. At the same time, muscle tension is relieved, cell metabolism accelerates and circulation in the tissue increases.
Medical therapeutic massage is a natural form of treatment and a way to maintain health. Manual massage alleviates and eliminates pain. It also has a relaxing effect on the psyche. We use the therapeutic massage technique to relax and stretch muscle fibres and break up the knots caused by tension or stress. Moreover, it has a positive effect on blood circulation because it increases oxygen levels in the tissues thus improving the regeneration of muscles and other structures.