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NeuroCryoStimulation and Shockwave Therapy

Dr Motto has been using Shockwave Therapy (ESWT) for a number of years due to poor long term outcomes when using cortisone injections for tendon injuries. Recent developments in the field of Shockwave Therapy (and Thermal Shock Therapy) are discussed in this article.

orthoPACE and Piezoewave II
For the last couple of years, we’ve been using the upgraded and highly effective orthoPACE device. Previously, treatment was undertaken with EvoTron, which was particularly uncomfortable for many patients, with conditions such as ‘Tennis Elbow’.

The orthoPACE is outstanding; it utilises a more superficial applicator, which accurately targets the affected area. ESWT with orthoPACE has proven effective after only one treatment, with some patients reporting immediate pain relief after the procedure. The treatment of tennis elbowIt can however take a few weeks for pain relief to begin and if pain relief is not adequate, a second treatment can be considered.

In November 2012, an additional ESWT device was brought to the clinic – the Piezoewave II. This is another focal ESWT device which utilises the piezoelectric method of generating shockwaves (orthoPACE uses an electrohydraulic method). These shockwaves are of generally lower amplitude than those generated by orthoPACE, which means that treatments are more patient friendly. Current thinking suggests at least three treatments are required when using Piezowave II, administered weekly or bi-weekly. Fewer treatments are required with the orthoPACE, typically one or two treatments, three to six weeks apart. However, treatment can be more uncomfortable than the Piezowave II and we usually advise a short period of rest afterwards.

Both orthoPACE and Piezowave II generate focal, high energy pressure waves which can be very effective in treating chronic (calcific) tendon injuries, not only in the shoulder but in areas such as the quadriceps and achilles tendons, and in the plantar fascia. Unfortunately, the use of local anaesthetics before therapy is thought to have a negative effect, so we do not recommend anaesthetic injections prior to treatment. However, pre-cooling or cryotherapy is not thought to be detrimental, and helps in reducing some of the discomfort during treatment.

December 2012 saw the introduction of NeuroCryoStimulation at Sports Injury Diagnosis.

NeuroCryoStimulation, the basic process…
Also known as Hyperbaric Gaseous Cryotherapy, NeuroCryoStimulation (NCS) is the use of CO2 at -78°C under high pressure, which causes the skin temperature to decrease from 32°C to 2°C within 30 seconds. This reaction is known as a thermal shock and activates the cutaneous sensory receptors, generating an immediate distant corrective reflex in the skin and brain, activating the neural system. The process is drug-free and non-invasive.

You can read more on NeuroCryoStimulation at

The NeuroCryoStimulation method attracted Dr Motto’s interest because of the preliminary work undertaken a group of French doctors in Lyon. Early results from the team suggest that the NeuroCryoStimulation method can have a beneficial effect, particularly in patients with
‘less chronic’ (or more acute) tendon injuries. Dr Motto’s experience is that the more chronic the injury, the better the outcome when using ESWT, and, till now, has favoured laser therapy or acupuncture for more acute injuries.

NeuroCryoStimulation provides an effective analgesia prior to ESWT and can also potentially be used on its own as a non-invasive treatment in the management of more acute tendon injuries. This is proving very interesting, as ESWT is not always successful in cases of acute injury.

By employing the NeuroCryoStimulation method, our patients should see better tolerance to treatment in those cases where higher energy ESWT is required, and also in cases where deeper treatments are required (e.g. for muscular injuries).

The Sports Injury Diagnosis clinic still advocates the effectiveness of cortisone and prolotherapy injections, and in most cases will recommend additional physiotherapy and rehabilitation. However, we hope that future research will support the continued use of less invasive medical treatments, such as ESWT and NeuroCryoStimulation, as well as some of the other therapies such as laserneedle and pulsed electromagnetic therapies, also used in our clinic.

Please note: Piezowave II is no longer available as we have found OrthoPACE to be more effective for ESWT (Extracorporeal Shock Wave Therapy).