Official websites use. gov A. The gov website belongs to an official government organization in the United States. Gainswave Treatment near Mount Pleasant SC can help with Osteoarthritis (OA), the most prevalent joint disorder and the leading cause of disability in older populations around the world. It is estimated that by 2030, approximately 25% of adults over the age of 65 will have symptomatic knee osteoarthritis.
The incidence and progression of osteoarthritis are strongly correlated with age due to the cumulative effects of joint overuse, obesity and trauma over time. Older people are especially susceptible to advanced osteoarthritis, which severely affects range of motion, activity of daily living and quality of life. Current conventional treatments for osteoarthritis, such as analgesics, physiotherapy or surgical interventions, have more or less limited efficacy in this population. There is an urgent need for therapies that effectively target the underlying pathophysiology of osteoarthritis in geriatric patients.
Chronic low-grade inflammation and immune system dysfunction are critical to the pathogenesis and progression of osteoarthritis. The increase in proinflammatory cytokines, such as interleukin (IL) -1beta, IL-6 and tumor necrosis factor (TNF) α, stimulate cartilage catabolism and joint deterioration. Activated innate immune cells, such as macrophages, mast cells and neutrophils, infiltrate the synovial membrane of osteoarthritis and further potentiate inflammation. Adaptive immune cells also show aberrant phenotypes, with deficient regulatory T cell (Treg) populations that fail to counteract excessive inflammation.
These immunological changes promote symptoms of osteoarthritis and structural joint damage. Extracorporeal shock wave therapy (ESWT) produces acoustic impulse waves that are concentrated in target tissues and has shown promise in alleviating musculoskeletal conditions. Recent evidence indicates that ESWT can modulate immune responses and inflammation through several proposed mechanisms. Shockwaves can induce localized stress and microtrauma that trigger anti-inflammatory signaling.
ESWT has been found to reduce IL-1beta, IL-6 and TNFα and upregulate treg levels in animal models with osteoarthritis. In human trials, ESWT can reduce pain and improve function associated with the negative regulation of inflammatory mediators in patients with knee and hip osteoarthritis. However, the optimal ESWT protocols, including dosage, timing, and long-term effects, remain uncertain. Currently, there is minimal research on ESWT for OA and associated immunological changes, specifically in the elderly population.
Aging involves an alteration of immune function called immunosenescence, characterized by increased systemic inflammation, reduced T-cell production and deregulation of cytokine profiles. It is not well understood how shock wave therapy affects age-related immune dysfunction in patients with osteoarthritis. Due to limited current scientific questions regarding the immunological consideration of the therapeutic efficacy of shock waves, this study aims to address this gap by investigating the immunomodulatory effects of the different ESWT dosage regimens in geriatric patients with knee osteoarthritis. We hypothesize that a higher intensity ESWT will increase inflammatory cytokines, while a lower intensity will up-regulate anti-inflammatory Tregs.
Based on this hypothesis, we propose that the application of a higher intensity ESWT will lead to an increase in the production of inflammatory cytokines. Conversely, lower intensity ESWT is expected to promote the up-regulation of anti-inflammatory regulatory T cells (Tregs), which are known for their immunosuppressive properties. By specifying the effects of ESWT intensity on the immune response, our goal is to investigate the differential modulation between cytokines and treg and, ultimately, to contribute to a better understanding of the therapeutic potential of ESWT to control inflammatory conditions. The findings will outline the dose-response relationship of shockwave therapy with immunity in older people, guiding optimal protocols for controlling the inflammation underlying osteoarthritis.
Both groups will receive electrostatic therapy once a week for 4 weeks, for a total of 4 treatment sessions. The use of pain relievers will be prohibited within 24 hours prior to each ESWT session. All other treatments for osteoarthritis, including medications, physical therapy, braces, or assistive devices, will remain on stable regimens throughout participation in the study. Any adverse event or deviation from the protocol will be documented.
The main outcome measures will be changes in serum inflammatory cytokines, immune cell subgroups, and treg cells. Peripheral blood samples will be collected at the start of the study, within one week after the last ESWT session, and after one month of follow-up. Serum will be tested for the main pro-inflammatory cytokines, interleukin (IL) -1beta, IL-6 and tumor necrosis factor (TNF) α, using immunosorbent assays linked to enzymes. Whole blood samples will be cultured and stimulated to determine subsets of activated helper T cells and cytotoxic T cells using flow cytometry.
Treg cells will be identified by the expression of FoxP3 and CD25. Cytokines can be measured in serum using a variety of laboratory techniques. We will use the enzyme linked immunosorbent assay (ELISA), which allows the quantitative measurement of specific cytokines in the sample of serum. ELISA involves the use of specific antibodies that can bind to target cytokines. The serum sample is added to a plate that has been coated with specific capture antibodies against the cytokines of interest.
If cytokines are present in the sample, they will bind to the capture antibodies. Subsequently, detection antibodies labeled with enzymes are added, which will bind to the captured cytokines. The plate is then treated with a substrate that produces a color change in the presence of the enzyme, allowing cytokine concentrations to be measured as a function of color intensity. Secondary clinical outcomes include the severity of knee pain based on the visual analog scale (VAS).
And physical function using the osteoarthritis index (WOMAC index) from the universities of Western Ontario and McMaster. The sample size was determined based on the ability to detect a 20% difference in Treg levels between the high and low dose ESWT groups after a month of follow-up. Assuming a standard deviation of 5%, a power of 80% and an alpha of 0.05, 51 participants are needed per group. Taking into account an expected dropout rate of 15%, 120 participants will be recruited, 60 in each treatment group.
Due to the nature of the interventions, participants or treating therapists will not be blinded. However, the researcher responsible for collecting and analyzing the data will not know the assignment of groups. Non-identifiable codes for treatment groups will be used for data entry and processing. Baseline demographic and clinical characteristics will be summarized using descriptive statistics.
The primary outcome data will be evaluated for normality and transformed if necessary. The main analysis will consist of comparing changes in cytokine levels, immune cell subgroups, and Treg levels between baseline levels and Treg levels between treatment groups, using mixed linear models. Post hoc tests will evaluate changes within groups over time points. Differences between groups in terms of secondary clinical outcomes will be analyzed using a covariance analysis adjusted to baseline values.
An analysis based on the intention to treat will be performed to detect missing data. The results will be considered statistically significant from the point of view. Basal characteristics will be similar between the groups (table). The average age of the participants will be around 70 years and around 50% will be female participants.
The average duration of the diagnosis of knee osteoarthritis will be close to 6 years. Most may have serious grade 3 radiographic osteoarthritis. There will be no significant differences in demographic parameters, disease history, medications, or baseline outcome measures between the two treatment groups. Baseline characteristics of two groups Regarding the schedule for outcome evaluations in relation to the intervention period, both groups will receive the ESWT once a week for 4 weeks for a total of 4 treatment sessions. Secondary clinical outcomes include the intensity of knee pain according to the visual analog scale (VAS) and physical function according to the osteoarthritis index (WOMAC index) of the universities of Western Ontario and McMaster.
All blood samples will be taken in the morning. The VAS and WOMAC indices will be analyzed, including the baseline measurement, within one week after the last ESWT session and after one month of follow-up. These results will be collected in the afternoon. Comparison of IL-1beta and IL-6 in groups and between groups There will be a statistically significant difference in the change in IL-1beta levels between baseline levels and 1-month follow-up between the high and low dose ESWT groups (P) Comparison of treg expression within groups and between groups Comparison of clinical outcomes within groups and between groups No serious adverse effects will be reported during the trial. Minor side effects include transient post-treatment pain, muscle pain, and joint stiffness, which will resolve spontaneously within 48 hours.
The frequency of side effects will not vary between the high and low dose groups. It should be noted that we will not detect significant improvements in clinical pain or function with low-dose versus high-dose protocols, although they will only be evaluated in the short term. Both groups will demonstrate symptomatic relief from baseline, consistent with the recognized analgesic effects of shock waves. However, local antinociceptive mechanisms can mitigate systemic immune effects in patient-reported outcomes.
Longer follow-up could reveal the clinical effects of increased inflammation caused by high shock waves intensity in the progression of osteoarthritis. However, our immunological findings support the adoption of conservative intensities in elderly patients to avoid exacerbating age-related immune dysfunction. Henceforth, longer follow-up studies are needed to clarify the effects of ESWT-induced immune changes on osteoarthritis outcomes. Analysis of local joint inflammation and imaging evaluations could further elucidate the mechanisms.
Direct comparisons with pharmacological anti-inflammatory drugs may help to determine relative effectiveness. Tests that stratify intensity based on baseline immune profiles could support personalized ESWT dosing. Translational studies should evaluate the specific signaling pathways that mediate shockwave immunomodulation. Ultimately, more research is needed to evaluate the inflammatory aspects of other age-related diseases, such as sarcopenia, osteoporosis and diabetes, in the eswatic tongue.
It is interesting to note that, in this cohort of elderly people with osteoarthritis, the clinical results of pain and patient functioning will show improvements with both high and low doses compared to baseline. While higher doses exacerbated systemic inflammation, the localized antinociceptive effects of shock waves may continue to provide symptomatic relief regardless of intensity. However, the long-term effects of impaired immunity on the structural progression of the disease are still unknown. While this study will be limited to one month of follow-up, the increase in chronic inflammation induced by high-intensity electrostatic therapy could, in theory, accelerate joint deterioration over time in patients with osteoarthritis.
More research is warranted with prolonged observation. Consent was given to include and publish images of the techniques. Articles from the American Journal of Clinical and Experimental Immunology are provided here, courtesy of E-Century Publishing Corporation, National Library of Medicine, 8600 Rockville Pike Bethesda, MD 20894. There is currently great interest in the use of ESWT and in determining the mechanism of action of this type of treatment, taking into account the good results published in clinical practice (1). Some authors speculate that shock waves alleviate pain in insertional tendinopathy due to hyperhyperpathy.
Stimulation analgesia (1) An initial increase and a subsequent prolonged decrease in substance P However, the release of the treated region could explain the initial pain during and soon after shockwave treatment of tendon insertion and the subsequent lasting relief of pain (1). However, it should be noted that substance P can also cause so-called neurogenic inflammations (1). Therefore, another hypothesis is that, after treatment with extracorporeal shock waves, there is evidence of a decrease in the concentration of this inflammatory mediator in the paratenon (1). More recently, researchers are interested in investigating the mechanism by which physical ESWT (tendon promotion) repair is related to an increase in tenocyte proliferation and the induction of growth factors.
Shockwave therapy uses high-powered sound waves that pass through the skin to the underlying tissue. These high-power sound waves break tight knots or activate points in muscles or dissolve calcifications in the case of kidney stones or Dupuytren's contracture. Shockwave therapy stimulates an inflammatory response that results from microtrauma; in other words, it sets in motion the healing process, since inflammation is necessary for optimal healing. In turn, it reverses chronic conditions, such as tendinopathies, chronic low back or neck pain, or chronic muscle tension.
It's not uncommon to feel a little pain afterward and to have some bruising in the treatment area. After the procedure, it is best to avoid anti-inflammatory medications, such as Advil, since stimulating the inflammation cascade is part of the healing process that triggers eSWT. Aside from that, you can do your normal activities, usually including exercise, if you feel like doing so. You may feel pain, swelling, or minor bruising from shockwaves a couple of hours after receiving treatment. This may make the pain worse at first, but it's a normal part of the healing process.
The pain will usually go away in a day or two. If you start to feel discomfort, you can take pain relievers, but avoid using non-steroidal inflammatory pain relievers such as ibuprofen. These can counteract the treatment, which can undo the effects. Shockwave therapy, also called extracorporeal shockwave therapy (ESWT), is a type of treatment used in orthopedics, physical therapy, sports medicine, urology, and even veterinary medicine.
It's a non-invasive way to restart the healing process. natural. To do this, it causes a short-term (acute) inflammatory response, much like the “normal” process that occurs after an injury. The treatment involves using a device to send shock waves through the skin to influence the affected tissues underneath.
The body responds by increasing blood circulation and metabolism in the affected area. Formation of new blood vessels The nutrients contained in the blood are needed to start and maintain the process of repairing damaged tissue. Sound wave energy creates small injuries (microtrauma) in soft tissue capillaries, bones and tendons (wherever treatment is applied). This stimulates the growth of new vessels. The new blood vessels improve the blood supply and oxygenation of the treated area and promote healing.
Shock waves stimulate tissue repair and reduce pain by activating the body's innate healing mechanisms. After just one treatment session, many patients report significant pain relief. Patients may experience temporary swelling and tenderness at the treatment site, as electroconvulsive therapy causes an inflammatory response, which is the body's healing mechanism. This is a healthy healing response that should not be suppressed with anti-inflammatory medications.
Shockwave therapy is a non-surgical and non-invasive treatment, meaning that there isn't much of a recovery period once it's finished. Because extracorporeal shock wave therapy is not surgical, athletes can undergo treatment while the sports season is still ongoing. Shockwave therapy protocols can be adjusted in a clinical sports medicine setting to promote healing for athletes, depending on the type of injury. Shockwave therapy is particularly effective in treating tendinopathies, which are often slow to heal, as well as tendinosis, a degenerative condition of injured tendons.
The treatment is administered by a doctor using a shockwave device similar to the applicator used in a ultrasound. If the response is quite intense, you should let your therapist know, who may continue treatment with a lower energy level or modify your treatment plan accordingly, to include something more suitable for you. The high success and satisfaction rates of clinical trials and patients may be due to the ability of shockwave therapy to treat a large number of conditions and its classification as a non-invasive treatment. Sports medicine specialists often use extracorporeal shock wave therapy to treat athletes with musculoskeletal diseases.
MECHANISM OF ACTION Shockwave therapy uses an acoustic wave (sound) to carry high energy to painful areas and musculoskeletal tissues with acute and chronic diseases. In the 1960s and 1970s, scientists began researching the possible use of shock waves in human tissue, and by the mid-1980s, shock waves were being used as lithotripsy treatment to eliminate kidney and gallstones. The promising results of this non-invasive treatment option in the treatment of tendonitis justify the indication of shock wave treatment. Causing more trauma to an area that's already sore may seem counterproductive, but the inflammation caused by shockwave therapy triggers the body's natural healing process and forces it to focus on relieving pain.
Keep reading to learn about the benefits of shock wave treatment and how it can be an effective solution for healing. foot injuries.