Extracorporeal Shock Wave Therapy Combined With Oral Medication and Exercise for Chronic Low Back Pain: A Randomized Controlled Trial.

OBJECTIVE: To compare extracorporeal shock wave therapy combined with oral medication and an exercise program vs sham treatment with medication and exercise for the treatment of chronic low back pain (CLBP). DESIGN: Randomized controlled trial. SETTING: Outpatient clinic at a university hospital. PARTICIPANTS: Eligibility criteria were age older than 18 years and duration of CLBP exceeding 3 months. Exclusion criteria were concurrent treatment or history of surgery for CLBP, cancer, fractures, infections, and disk degeneration. INTERVENTION: The intervention group received extracorporeal shock wave therapy once a week for 4 weeks along with oral medications and an exercise program. The control group received sham extracorporeal shock wave therapy along with oral medications and an exercise program. MAIN OUTCOME MEASURES: Visual analog scale and Oswestry Disability Index (ODI) were used to assess pain and disability at baseline and after 3 months. RESULTS: The pain score in the intervention group (N=16) was 6.6 at baseline and 3.0 after 1 month (P<.0001) and 1.8 after 3 months (P<.0001). In the control group (N=16), the pain score was 6.8 at baseline, 4.6 after 1 month (P<.0001), and 1.1 after 3 months (P<.0001). ODI scores decreased significantly in both groups compared with baseline values (first month: P<.001, third month: P<.05). The mean ODI score did not differ significantly between the groups (P=.942). CONCLUSION: Extracorporeal shock wave therapy combined with oral medication and exercise was safe and effective in the short-term treatment of chronic low back pain.

Phytotoxicity and antifungal properties of the essential oil from the Juniperus polycarpos var. turcomanica (B. Fedsch.) R.P. Adams leaves.

This study was performed to investigate the constituents, in vitro antifungal activity and phytotoxicity potential of the essential oil from Juniperus polycarpos var. turcomanica leaves. The essential oil was analyzed by GC-FID, and GC/MS, which predominantly contains α-pinene (51.21%), germacrene-B (4.80%), and ∆-cadinene (2.56%). The antifungal activity of the essential oil against some phytopathogenic fungi, including Alternaria alternata, Colletotrichum trichellum, Curvularia fallax, Cytospora sacchari, Fusarium oxysporum, and Macrophomina phaseolina was performed through disk diffusion and agar dilution assays. The essential oil of J. polycarpos var. turcomanica had high antifungal activity against tested phytopathogenic fungi. The most susceptible fungi to the essential oil were C. trichellum in agar dilution and M. phaseolina and C. fallax in disk diffusion methods, whereas, the most resistant fungus to the essential oil was obtained from A. alternata in both assays. Screening methods had an influence on antifungal activity of the essential oil as most of the tested fungi in this study were shown to be more resistant in disc diffusion methods. According to the phytotoxic assay results, the essential oil from J. polycarpos var. turcomanica had high phytotoxicity against three species of weeds, including P. oleracea L., A. retroflexus L., and D. stramonium L. The results of this research suggest that the herbicidal and antifungal activities of the essential oil from J. polycarpos var. turcomanica can be attributed to its major group of constituents, monoterpenes hydrocarbons.

Effect of extracorporeal shock wave therapy on improving burn scar in patients with burnt extremities in Isfahan, Iran.

BACKGROUND: Pathologic scarring is a common problem after burn injury that has functional and esthetic limitations. Conservative and surgical treatments available for these scars are not always satisfactory. Extracorporeal shock wave therapy (ESWT) is a noninvasive modality that has proven positive effects on burn scars and wound healing in few studies. This study was conducted to evaluate the effects of ESWT on improving burn scar in extremities. MATERIALS AND METHODS: This study was a prospective quasi-experimental on burn patients with burn scar in their extremities that underwent ESWT sessions once a week for 6 weeks. For evaluating pain and itching, visual analog scale (VAS) and for scar appearance, Vancouver Scar Scale (VSS) were used. These scales were measured and compared at the beginning of the treatment, at the end of the treatment, and 1 and 3 months after the end of the intervention. RESULTS: In this study, 17 patients were treated with ESWT with a mean age of 37.94 ± 7.25 years that 47.1% of them were male. The mean of VAS score for pain and itching and VSS score were decreased significantly after the treatment and during follow-ups (All P < 0.001). CONCLUSION: ESWT can improve the pain, itching, and appearance of the burn scar in human extremities in burn patients.

Effectiveness of extracorporeal shockwave therapy for chronic Achilles tendinopathy: A randomized clinical trial.

BACKGROUND: In this study, we aimed to evaluate the effectiveness of extracorporeal shockwave treatment (ESWT) on pain and ankle-hindfoot scale of the American Orthopedic Foot and Ankle Society (AOFAS) score of patients with chronic Achilles tendinopathy (AT). MATERIALS AND METHODS: In this double-blind clinical trial, 43 patients with chronic AT were selected and randomly allocated in two groups to receive a basic treatment with ESWT or sham SWT (radial and focused shock waves, four sessions once a week for 4 weeks). AOFAS and pain scores for each patient were recorded at baseline (before intervention), immediately after intervention, and 4 and 16 weeks after intervention using AOFAS and visual analog scale (VAS) scaling method. RESULTS: A total of 43 patients (22 ESWT and 21 sham SWT) were participated in this study. Both groups improved during the treatment and follow-up period. The mean VAS score decreased from 7.55 to 3 in the intervention group and from 7.70 to 4.30 in the sham SWT group. Mean AOFAS and VAS scores were significantly different between ESWT and no ESWT groups at 16 weeks of follow-up (P = 0.013) (P = 0.47). There was no significant difference in terms of AOFAS and VAS scores between both the groups in the other follow-up times. CONCLUSION: Overall, ESWT causes decrease in VAS score and increase in AOFAS score. However, due to the small sample size, the results were not statistically significant. It is recommended to plan more interventional studies with larger sample size in the future.

Effect of Adding Transfer Energy Capacitive and Resistive Therapy to Conventional Therapy for Patients With Myofascial Pain Syndrome in Upper Trapezius: A Randomized Clinical Trial.

Objective: The purpose of this study was to compare the effect of adding transfer energy capacitive and resistive (TECAR) therapy to conventional therapy on patients' symptoms of myofascial pain syndrome (MPS) in the upper trapezius. Methods: Fifty patients with MPS in the upper trapezius were randomized into 2 groups. The intervention group received TECAR therapy (capacitive mode, 2 sessions weekly), and conventional treatment comprised of stretching exercise (9 times a day) and medication (acetaminophen and tizanidine) for 3 weeks, and the comparison group received conventional treatment (same as the intervention group) alone. The patients completed the Numeric Pain Scale, Neck Disability Index, and Shoulder Pain and Disability Index before, after, and 1 month after the treatment. Results: All variables were significantly reduced within both groups by time and treatment separately (P < .001), while a general comparison among the groups showed a significant reduction for all variables in the intervention group compared with the comparison group (P < .05) except for shoulder disability (P = .114). Moreover, the intervention group had better results compared with the comparison group based on the minimal clinically important difference. Conclusion: A combination of TECAR therapy, exercise, and medication substantially reduced symptom severity for patients with MPS in the upper trapezius when compared to only exercise and medication.

The Effect of Shock Wave Therapy on Improving the Symptoms and Function of Patients with Dupuytren's Contracture.

Introduction: We aimed to evaluate the effect of shock wave therapy on the improvement of symptoms and function of patients with Dupuytren's contracture. Materials and Methods: This research is a pre-post intervention study, conducted among patients referred to the physical medicine clinics of Isfahan during 2019-2020. In this study, subjects experienced shock wave therapy for 6 sessions, each in a week, and improvement of symptoms and function were assessed and compared after the period of study and follow-up (before treatment, 6 weeks after treatment, and 14 weeks after treatment). The pain visual analog scale and disabilities of the arm shoulder and hand questionnaire were completed for all patients at the mentioned time, and the finger contraction angle was also measured by a goniometer over these intervals. Results: Twenty patients, 11 (55%) men and 9 (45%) women participated in the study. The mean and standard deviation of their age was 66.6 ± 7.11 years. The trend of pain severity of patients was continuously and significantly decreasing up to 14 weeks, which implies the effectiveness of the intervention (P < 0.05). Moreover, the patients' functional status improved due to the continuation of the intervention, and its trend was decreasing up to 14 weeks (P < 0.05). As for the contraction angle, there was a continuous and significant decreasing trend until week 14, and the intervention was also effective on the contraction angle (P < 0.05). Conclusion: It can be concluded that shock wave therapy can be effective in improving the symptoms and function of patients with Dupuytren's Contracture.

Extracorporeal Shock Wave Therapy Versus Phonophoresis Therapy for Neck Myofascial Pain Syndrome: A Randomized Clinical Trial.

OBJECTIVES: This study aimed to assess the effects of using Extracorporeal Shock Wave Therapy (ECSWT) and phonophoresis therapy on pain and neck disability in patients with neck myofascial pain syndrome (MPS). METHODS: Forty eligible patients were randomly divided into two groups of ECSWT (received three sessions of ECSWT, once a week for three weeks) and phonophoresis (received ultrasound using hydrocortisone gel 1% over the trigger point on trapezius muscle, three times a week for three weeks). Patients in both groups received the same stretching exercise program and drug regimen during the intervention. RESULTS: Pain and NDI scores in both groups were significantly improved at the end of the treatment and four weeks later. At the end of the treatment, the pain score was similar between the groups. Four weeks after the treatment, the pain score in the ECSWT group was significantly lower than in the phonophoresis group (P-value = 0.030). The NDI score was not significantly different between the groups at the end of the treatment. However, four weeks after the treatment, the NDI score was significantly lower in the ECSWT group than in the phonophoresis group (P-value=0.032). The trend of changes in the pain and NDI scores was not significantly different between the groups. CONCLUSIONS: Both phonophoresis and ECSWT groups effectively decreased pain and neck disability in patients with MPS, with the superiority of ECSWT with a more lasting effect for a month after the end of the treatment.

Extracorporeal Shockwave Therapy for Chronic Venous Ulcers: A Randomized Controlled Trial.

Background: Chronic venous ulcers (CVUs), demanding specialized care, are still a major socioeconomic problem facing health care systems worldwide. This study's main goal was evaluating the efficacy of ESWT application as an AT in the treatment of wounds for curing CVUs. Materials and Methods: 50 patients presenting with CVUs were divided into two groups of ESWT and control randomly. Then, ESWT was applied one session per week, during four weeks, along with routine CB. The control group also received sham ESWT together with CB. In this respect, pain score, wound size, patient satisfaction and quality of life (QoL) using the Charing Cross Venous Ulcer Questionnaire (CCVUQ) were consequently assessed at baseline, week four, and week eight and then compared between both groups. Results: The findings showed that patients receiving ESWT along with CB had significantly lower pain and were also feeling more satisfied than the cases undergoing CB alone (P<0.05). The significant efficiency of ESWT in improving the healing process of CVUs was further observed (P<0.05). In addition, QoL, assessed by the CCVUQ, was significantly higher in patients receiving ESWT (P<0.05). Conclusion: These findings established that ESWT was a feasible and safe option to treat patients presenting with CVUs in another word,ESWT seems to be a safe and effective adjunct therapy (AT) compared with CB in patients with CVUs.

CO2-selective poly (ether-block-amide)/polyethylene glycol composite blend membrane for CO2 separation from gas mixtures.

This work focuses on the preparation of composite blend membranes based on poly (ether-block-amide) (Pebax-1657) by incorporating polyethylene glycol (PEG) for gas separation applications. The influence of PEG with different molecular weights (PEG600, PEG1500, and PEG4000) at loading content in the range of 10%wt. to 40%wt. was investigated on the microstructure and gas separation performance of the prepared blend membranes. The fabricated membranes were characterized using SEM, XRD, and water contact angle analyses. Based on the experimental results, the blending of low molecular weight PEG (PEG600) into the Pebax-1657 matrix increased the chain mobility of the membrane, led to a smooth microstructure, and improved the hydrophilicity of the blend membranes, as well as enhanced the gas permeability of N2, O2, CH4, and CO2, but only slightly affected the ideal selectivity of O2/N2, CH4/N2, CO2/N2, and CO2/CH4. In contrast, the incorporation of PEG1500 and PEG4000 meaningfully increased the membrane crystallinity, decreased chain mobility, resulted in a rough microstructure, and reduced the blend membranes' hydrophilicity. For CO2/N2 mixture, the Pebax/40%PEG600 membrane had CO2 permeability of 62.9 Barrer and selectivity of 83.8, while the Pebax/20%PEG600 showed the CO2 permeability of 63.12 Barrer and selectivity of 23.6 for CO2/CH4 separation.

Extracorporeal Shock Wave Therapy for Lateral Epicondylitis, Lonely or in Combination with Topical Corticosteroid; Which Approach is Superior?

BACKGROUND: Lateral epicondylitis (LE) is a common musculoskeletal disorder. Although varieties of modalities have been proposed for its treatment, the outcomes are uncertain, and the responses would diminish early by the time passage. The current study was aimed to assess the efficacy of extracorporeal shock wave therapy (ESWT) merely and in combination with topical corticosteroid for the treatment of LE. MATERIALS AND METHODS: In the current double-blinded randomized clinical trial, 70 patients with the diagnosis of LE were randomly allocated to two intervention groups of ESWT merely (control group) (n=35) or ESWT plus topical corticosteroid (intervention group) (n=35). The ESWT was performed weekly for three weeks. Topical clobetasol was utilized within 30 minutes before ESWT for the intervention group, while Vaseline gel was used in a similar pattern for controls. Pain based on a visual analog scale (VAS), handgrip strength (HGS) and the Patient-Rated Tennis Elbow Evaluation (PRTEE) were assessed for the patients before the intervention, following the intervention cessation, and within two months post-intervention. RESULTS: Statistically significant improvement was found following both interventions in terms of pain, HGS, and function (P-value<0.001 for all), while the comparison of the two interventions, ESWT, merely versus in combination with topical clobetasol, revealed insignificant difference (P-value>0.05). CONCLUSION: The findings of our study are in favor of ESWT use either merely or in combination with topical steroids for the treatment of LE, while the comparison of the two techniques revealed insignificant differences.

The Effect of Extracorporeal Shock Wave Therapy in the Treatment of Patients with Trigger Finger.

INTRODUCTION: Trigger finger disorder is a sudden release or locking of a finger during flexion or extension. Regarding the complications and disadvantages mentioned for the methods used in the treatment of trigger finger disorder, the aim of this study was to investigate the effect of extracorporeal shock wave therapy in the treatment of patients with trigger finger. METHODS: This study was an interventional study recruiting 19 patients with trigger finger disorder. Evaluation of pain severity, severity of triggering, and functional impact of triggering was carried out using the Visual Analogue Scale, Trigger Finger Score suggested by Quinnell, and Quick-Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, respectively, before intervention, immediately after intervention, and in 6 and 18 weeks after intervention. Each patient was treated with extracorporeal shock wave therapy in three sessions with a 1-week interval. Data were analyzed in Statistical Package for the Social Sciences (SPSS) software using ANOVA to monitor changes in pain severity, severity of triggering, and functional impact of triggering during follow-ups. RESULTS: There were statistically significant differences with regard to reduction of the pain severity, severity of triggering, and functional impact of triggering before intervention, immediately after intervention, and in 6 and 18weeks after intervention (P<0.01). However, the effect of extracorporeal shock wave therapy on reducing severity of triggering immediately after intervention did not yield a statistically significant difference compared to before intervention (P>0.01). CONCLUSION: It seems that extracorporeal shock wave therapy leads to a reduction in pain severity, severity of triggering, and functional impact of triggering. These effects persisted until the 18th week after the intervention. It is recommended to use extracorporeal shock wave therapy in terms of a non-invasive intervention with no significant complications for patients with trigger finger.

Physical, mechanical and wound healing properties of chitosan/gelatin blend films containing tannic acid and/or bacterial nanocellulose.

This study aimed to prepare a new composition for wound dressing having desired properties using naturally occurring materials. Chitosan/gelatin (1:2 w/w) films containing various amounts of tannic acid and/or bacterial nanocellulose were prepared. The films were studied by FT-IR spectroscopy, scanning electron microscopy (SEM), XRD experiments and water absorption, gel content, water vapor permeability, mechanical and in in-vivo tests. FT-IR spectra of the samples showed no chemical reaction between the constituents. Moreover, SEM images proved a desirable dispersion of nanocellulose in the matrix. Incorporation of nanocellulose and/or tannic acid into the films was shown to reinforce the films. Also, in-vivo tests on Wistar rats demonstrated that amount of contraction is at least 15% higher for the wounds treated using each of the films compared to those treated without any wound dressing. According to the obtained results, high potential of the tested formulations for application in wound healing was corroborated.

Effect of surfactants at natural and acidic pH on microbial activity and biodegradation of mixture of benzene and o-xylene.

The aim of this work was to explore the effect of lowering pH and application of surfactants (Brij 35, Tween 20 and Saponin) in increasing bioavailability and biodegradability of benzene and o-xylene (BX) as two hydrophobic VOCs in a liquid mixture. All experiments were conducted at neutral and acidic pH to evaluate the effect of population change from bacteria to fungi on the BX biodegradation. The experiments demonstrated that acclimating wastewater inoculum at pH 4 increased the fungal to bacterial ratio. An increase of 11% for benzene and 22% for o-xylene was observed at pH 4 unamended-culture as compared to pH 7. Brij 35 was chosen as the optimum surfactant which was favorable for enhancing the bioavailability of BX at pH 4. Fitting the experimental data to pseudo first-order biodegradation kinetics model showed the BX were biodegraded faster in the presence of optimum surfactant at pH 7 than pH 4.

Giant Enhancement of Magnetostrictive Response in Directionally-Solidified Fe83Ga17Erx Compounds.

We report, for the first time, correlations between crystal structure, microstructure and magnetofunctional response in directionally solidified [110]-textured Fe83Ga17Erx (0 < x < 1.2) alloys. The morphology of the doped samples consists of columnar grains, mainly composed of a matrix phase and precipitates of a secondary phase deposited along the grain boundary region. An enhancement of more than ~275% from ~45 to 170 ppm is observed in the saturation magnetostriction value (λs) of Fe83Ga17Erx alloys with the introduction of small amounts of Er. Moreover, it was noted that the low field derivative of magnetostriction with respect to an applied magnetic field (i.e., dλs/dHapp for Happ up to 1000 Oe) increases by ~230% with Er doping (dλs/dHapp,FeGa= 0.045 ppm/Oe; dλs/dHapp,FeGaEr= 0.15 ppm/Oe). The enhanced magnetostrictive response of the Fe83Ga17Erx alloys is ascribed to an amalgamation of microstructural and electronic factors, namely: (i) improved grain orientation and local strain effects due to deposition of Er in the intergranular region; and (ii) strong local magnetocrystalline anisotropy, due to the highly anisotropic localized nature of the 4f electronic charge distribution of the Er atom. Overall, this work provides guidelines for further improving galfenol-based materials systems for diverse applications in the power and energy sector.

Investigating the Effect of Extracorporeal Shock Wave Therapy on Reducing Chronic Pain in Patients with Pes Anserine Bursitis: A Randomized, Clinical- Controlled Trial.

BACKGROUND: Knee pain, is one of the most common causes of patients' referring to physiatric clinics, and several factors, are involved in its creation. One of these factors is pes anserine bursitis (PAB) for which various treatment methods are used. This study aims to investigate the effect of this method on reducing chronic pain in these patients. MATERIALS AND METHODS: This clinical trial was conducted in 2013- 2014 on patients with PAB referring to academic, physical medicine clinics. The patients with chronic PAB (pain duration more than 3 months), who were refractory to conservative treatments, were randomly divided into two 20-member experimental groups (extracorporeal shock wave therapy [ESWT] and sham ESWT). Pain scores of all patients were measured using the Visual Analog Scale (VAS) and McGill Pain Questionnaire (MPQ) (total and present pain indexes [TPIs and PPIs]) before intervention, immediately after intervention (3rd week), and after 8 weeks. The pain scores were then compared and statistically analyzed. RESULTS: In the ESWT group, the mean patient pain score of the VAS and TPI in MPQ were significantly lower than in the sham ESWT group immediately after intervention (3rd week): P =0.02, P = 0.04 respectively; and 8 weeks after the end of treatment: P =0.01, P = 0.000. Moreover, the PPI in both groups had significantly decreased over time, although in ESWT group this decrement was significantly more than sham ESWT group (P < 0.001). CONCLUSION: The results showed that ESWT could be effective in reducing the pain and treating PAB.

Comparison the Effect of Extra Corporeal Shockwave Therapy with Low Dosage Versus High Dosage in Treatment of the Patients with Lateral Epicondylitis.

BACKGROUND: One of the most common reasons of elbow and forearm pain is lateral epicondylitis diagnosed based on clinical examination. The extracorporeal shock wave therapy is applied for less invasive treatments with different dosages. This study aimed to investigate the effects of high- and low-dose ESW in treating the lateral epicondylitis. MATERIALS AND METHODS: This clinical trial was done in Al Zahra medical center on 40 patients who were selected randomly and divided into two groups. After VAS, the first group was treated by Duolith SD1 shock wave, energy of 0.25 mj/mm2, 1000 shocks; the second was treated by focus with the energy of 0.10 mj/mm2, 1000 shocks per session for 15 minutes with weekly intervals in three sessions. The patients were also treated with drugs (NSAIDs) and the visual analog scale (VAS) was reassessed 1 week after the last session and 12 weeks after finishing the treatment. RESULTS: The mean of pain intensity during study was decreased in the two groups but reduction of pain intensity in the low-dose groups was higher than the high-dose groups (P = 0.001). Changes in other parameters including wrist extension test, middle finger extension test and PG was also similar. CONCLUSION: Extra corporeal shockwave therapy can be effective in treating lateral epicondylitis, but its effects usually appear in after 2 or 3 months and using the low dose of this treating method has more desirable therapeutic effects.

Effects of Taping on Pain and Functional Outcome of Patients with Knee Osteoarthritis: A Pilot Randomized Single-blind Clinical Trial.

BACKGROUND: To determine the effects of knee taping in combination with exercise and medical treatment on functional outcome and pain of patients with knee osteoarthritis (OA). MATERIALS AND METHODS: In a randomized single-blinded clinical trial, 36 patients with knee OA were randomly assigned to two study groups. Both groups received exercise and medical therapy for 6 weeks. In addition, the first group (20 patients) received taping in the first 3 weeks. Pain severity (assessed by visual analog scaling), weekly amount of analgesics consumption, timed get up and go test (TUG), and step tests were recorded at baseline, 3 and 6 weeks after the treatment and were further compared between two study groups. RESULTS: There was no significant difference between two groups in pain severity score (P = 0.228), step test score (P = 0.771), TUG test score (P = 0.821) and weekly amount of analgesics consumption (P = 0.873) at baseline. After 3 weeks, weekly amount of analgesics consumption (P = 0.006), pain severity (P < 0.001) was significantly lower in taping group whereas step test score (P = 0.006) was significantly higher in the taping group. After 6 weeks, patients in taping group had significantly lower pain severity (P = 0.011) and higher step test score (P = 0.042). However, there was no significant difference in TUG test score (P = 0.443) and weekly amount of analgesics consumption (P = 0.270) between two groups. CONCLUSION: Therapeutic knee taping may be an effective method for short-term management of pain and disability in patients with knee OA.

Comparison of Subacromial Ketorolac Injection versus Corticosteroid Injection in the Treatment of Shoulder Impingement Syndrome.

OBJECTIVE: Subacromial impingement syndrome is the most common cause of shoulder pain and restriction in range of motion in the world. The aim of this study was to compare the efficacy of subacromial injection of ketorolac with the injection of corticosteroid for the treatment of subacromial impingement syndrome. METHODS: A total of forty patients were randomly allocated into two groups. Group A received 40 mg of methylprednisolone and Group B received 60 mg of ketorolac as a subacromial injection along with lidocaine. Each patient was evaluated in terms of visual analog scale (VAS) for evaluating pain and Constant's score for function evaluation (pain, activity level, and range of motion with standard goniometry). The patients were re-examined 1 and 3 months after intervention. All the patients educated for simple home exercise. FINDINGS: At 1 and 3 months of follow-up, both treatment arms resulted in an increased range of motion and decreased pain. The difference between the groups was not statistically significant (P > 0.05). In ketorolac group, mean pre- and post-treatment (at 12 weeks) VAS scores were 8.6 (range, 3-9) and 4.5 (range 2-4), respectively. In steroid group, mean pre- and post-treatment (at 12 weeks) VAS scores were 8.3 (range, 3-10) and 3.9 (range, 0-7), respectively. The difference was statistically significant within groups at baseline and 1 (P < 0.001) and 3 (P < 0.001) months after the injection. CONCLUSION: Subacromial injection of ketorolac has an equivalent outcome to subacromial injection of corticosteroid. The use of ketorolac injections can substantially decrease the pain and increase the range of motion of the shoulder and could be a reasonable alternative in case of corticosteroid contraindications.

Effect of Extracorporeal Shock Wave Therapy on Lower Limb Spasticity in Stroke Patients.

BACKGROUND: This study aims to evaluate the effect of extracorporeal shock wave therapy (ESWT) on lower limb spasticity in stroke patients. METHODS: Twenty-eight eligible patients with ankle plantar flexor spasticity were randomly assigned to two groups. ESWT group received 1 session per week for 3 weeks of ESWT along with oral anti-spastic medications and stretching exercises. The control group received only oral anti-spastic medications and stretching exercises similar to ESWT group. At baseline, weeks 1, 3 and 12, spasticity was assessed and compared between the two groups using Modified Ashworth Scale (MAS), clonus score, passive range of motion (ROM) of joint, pain score, 3-m walk duration and lower extremity functional score (LEFS). Three patients were lost during follow-up; 25 patients completed the study and were analyzed. RESULTS: After one session of ESWT treatment, MAS, pain, ROM and LEFS improved significantly compared to baseline. After three weeks of ESWT treatment, MAS, pain and 3-m walk duration improved significantly compared to week 1. At week 12, MAS, pain, ROM, 3-m walk duration and LEFS improved significantly compared to the control group after controlling baseline values. The trend of decrease in pain score and MAS was significantly different between the groups. The trend of increase in ROM and LEFS was significantly different between the groups. CONCLUSION: ESWT significantly improved lower limb spasticity, pain, passive ROM, 3-m walk duration and LEFS immediately and 12 weeks after treatment. So, ESWT in combination with oral anti-spastic medications and stretching exercises could be useful for improvement of spasticity in stroke patients.

Comparative study of shock wave therapy and Laser therapy effect in elimination of symptoms among patients with myofascial pain syndrome in upper trapezius.

BACKGROUND: The aim of this study is to compare the effects of laser therapy and shock wave therapy for symptoms treatment among patients with MPS in the upper trapezius muscle. MATERIALS AND METHODS: In a clinical trial study, 46 patients were selected based on the clinical criteria and physiathrist diagnosis. Subjects were randomized into two groups as follows: Twenty individuals were assigned to exercise-medication-laser therapy group, and 26 to exercise-medication-shock wave therapy group. The pain was assessed based on visual analog scale (VAS), neck disability index (NDI), and SPADI in three stages: Before treatment, subsequently after treatment, and a month after treatment. RESULTS: One man and 19 women, age group of 45.3 ± 7.7 years, were assigned into laser therapy group. Two men and 24 women, average age group of 42.3 ± 10.4 were assigned into shock wave therapy group. A significant difference was found among our study groups before treatment and after starting treatment for VAS, NDI, and SPDI indices, that is, two methods of treatments were effective (P < 0.001). However, among these two treatment methods, laser therapy provided higher effect on VAS and NDI as compared to the radial shock wave method (P < 0.05) in 2 weeks from starting the treatment (consequent to treatment). CONCLUSION: According to this study results, we can conclude that shock wave and laser therapy results on similar effect in long-term for relieve of pain and eliminating symptoms in patients with myofascial but laser provides a faster optimal results.