Shockwave Shocker: Is Peter Malliaras Missing the Mark?

Welcome to the first edition of MSK Momentum!

The world of musculoskeletal health is constantly evolving, and with it comes new research, fresh perspectives, and sometimes a bit of controversy. In this issue, we tackle a topic that has stirred debate across the MSK community: the recent study by Peter Malliaras on shockwave therapy. As always, our goal is to keep you informed, spark thoughtful discussions, and ensure you're equipped with the knowledge to stay ahead in your practice.

Shockwave Shocker: Is Malliaras Missing the Mark?

Peter Malliaras’ recent study on shockwave therapy has sent ripples through the MSK community. His conclusion that shockwave is no better than sham treatments has raised eyebrows, especially given his previous advocacy for ESWT. But is there more to this story than meets the eye?

Device Dilemma

Malliaras’ study used a Chattanooga device, which shares components with Storz machines. Here's the kicker: Rheinhardt's research has shown that the Storz devices can lose significant energy during treatment (please refer to figure 1 - d). This energy loss might explain why Malliaras refers to bar pressure rather than energy output in his study. Remember, not all shockwave machines are the same!

The Overlooked Evidence
While Malliaras’ study is well-designed, it seems to have overlooked some crucial evidence:

Gerdesmeyer et al. (2003)

In a groundbreaking study published in 2003, Gerdesmeyer et al. demonstrated the effectiveness of extracorporeal shock wave therapy (ESWT) for treating chronic calcific tendonitis of the shoulder. 

This double-blind, randomised, placebo-controlled trial involved 144 patients across seven orthopaedic departments in Germany and Austria.

1. Both high-energy and low-energy ESWT significantly improved shoulder function compared to sham treatment after 6 months.

2. High-energy ESWT showed superior results to low-energy ESWT.

3. ESWT reduced self-rated pain and decreased the size of calcific deposits.

4. Benefits were observed at 3, 6, and 12 months post-treatment.

This study provides robust evidence supporting ESWT as an effective non-invasive treatment for chronic calcific tendonitis of the shoulder, challenging previous scepticism and paving the way for its wider adoption in clinical practice.

Zhao et al. (2013)

A comprehensive study by Zhao et al. (2013) investigated the efficacy of extracorporeal shockwave therapy (ESWT) for knee osteoarthritis (OA), offering compelling insights into non-invasive treatment strategies.

Key Outcomes

1. Significant pain reduction at:

   • 1 week post-treatment

   • 4 weeks post-treatment

   • 12 weeks post-treatment

2. Improved knee joint function

3. Reduced perceived OA severity

4. No reported adverse events

The average pain score decreased from 7.56 to 3.83, demonstrating ESWT's potential as a promising non-pharmacological intervention for knee osteoarthritis management. While further research is warranted, this study provides valuable evidence supporting shockwave therapy as an emerging treatment option for OA patients.

These studies provide a compelling counterpoint to Malliaras’ conclusion.

Food for Thought
While we shouldn't dismiss Malliaras’ work entirely, it's important to consider the full picture. Could the choice of device and overlooked evidence be skewing our understanding of shockwave therapy's true potential?

Links to Studies mentioned:

Malliaras: https://pubmed.ncbi.nlm.nih.gov/39704142/

Rheinhardt: https://www.nature.com/articles/s41598-022-21595-5

Gerdesmeyer: https://pubmed.ncbi.nlm.nih.gov/14625334/

Zhao: https://pubmed.ncbi.nlm.nih.gov/23953895/

Final Thoughts

Thanks for sticking around to the end of this issue! Research can get pretty technical, but it’s cool to see how stuff like equipment choices and study designs can really change the game. Malliaras’ study has definitely got people talking, and it’s a great reminder to always dig a little deeper and ask questions about what we’re reading.

If you’ve got thoughts on this or just want to chat about it, drop me a message! I’m here for all the debates, hot takes, or even if you just want share your own experiences.

Keep an eye out for more updates, research, and news about training days. There’s so much exciting stuff happening in MSK, and I’m mega excited to have you along for the ride.

Cya you next time!

Charlie @ MSK Momentum