Dr. Andrew Bruns Chiropractic

Dr. Andrew Bruns Chiropractic www.portlandhealthsupply.com

Objective: To compare the immediate effects of shockwave therapy using two different tips in patients with chronic non-s...
06/04/2026

Objective: To compare the immediate effects of shockwave therapy using two different tips in patients with chronic non-specific low back pain.

Participants: Eighty-one patients with chronic non-specific low back pain aged 18-80 years with pain for ≥3 months and pain intensity ≥3 were randomly recruited for the study.
Intervention: The patients received a single intervention of radial shockwave therapy with 2000 discharges at 100 mJ energy and 5 Hz frequency using concave or convex tips or placebo treatment.

Main measures: The primary outcome was pain intensity immediately post-intervention. The secondary outcomes were pressure pain threshold, temporal summation of pain, and functional performance. Data were collected at baseline and post-intervention.

Results: The post-intervention pain intensity in the concave tip group is an average of two points lower (95% CI = -3.6, - 0.4; p< 0.01) than that in the placebo group. The post-intervention pressure pain threshold for the concave tip group was an average of 62.8 kPa higher (95% CI = 0.4, 125.1; p < 0.05) than for the convex tip group and 76.4 kPa higher (95% CI = 14,138.7; p < 0.01) than in the placebo group.

Conclusion: The concave tip shockwave therapy is effective in reducing pain and local hyperalgesia in patients with chronic non-specific low back pain.

Cláudio Gregório Nuernberg Back et al. Clin Rehabil. 2024 Aug.

“Methods: The study was carried out on a group of 64 subjects (32 males and 32 females), aged between 20 and 39 years. T...
05/28/2026

“Methods: The study was carried out on a group of 64 subjects (32 males and 32 females), aged between 20 and 39 years. The subjects were divided into two groups: 32 subjects who followed a program of functional rehabilitation based on low- and medium-frequency electrotherapy, ultrasound and laser therapy, along with a physical therapy program lasting approximately 3 weeks, and 32 subjects who followed a functional rehabilitation program based on shockwave therapy and specific physical therapy exercises lasting approximately 3 weeks. Results: Following the protocols applied to the two groups, the pain reported by the patients decreased, while the functional parameters of the knee improved, better results being obtained in the group that performed shock wave therapy together with specific physical therapy programs (Cohen Index 5916, p < 0.001).”

“A total of 2000 pulses were delivered per session at a frequency of 10–15 Hz. The intensity was progressively increased from 0.2 to 0.5 BAR depending on patient tolerance. Therapy sessions were conducted twice per week for three weeks, with two days between sessions. Patients were positioned supine, with the affected leg in slight knee flexion and a towel under the popliteal area. Shockwaves were applied to the patellar tendon and the quadriceps insertion.”

“Conclusions: This study indicates that radial shockwave therapy combined with physiotherapy may provide additional benefits for patellofemoral syndrome, including greater pain reduction and improved joint mobility, compared to traditional treatments. However, further research is needed to confirm these findings and their broader clinical applicability.”

Marius Neculăeș et al. J Clin Med. 2024.

“BACKGROUND Myofascial pain syndrome (MPS) is a common cause of chronic low back pain with trigger points in the muscles...
05/26/2026

“BACKGROUND Myofascial pain syndrome (MPS) is a common cause of chronic low back pain with trigger points in the muscles and fascia. This study compared outcomes after radial extracorporeal shock wave therapy (rESWT) plus physical therapy versus infrared therapy plus physical therapy among patients with myofascial low back pain.

MATERIAL AND METHODS Overall, 112 patients were randomly assigned to the experimental group (n=56) or control group (n=56). For 6 weeks, the experimental group received physical therapy combined with rESWT (2000 pulses, 2.0-2.5 bar, twice weekly), whereas the control group received physical therapy combined with infrared therapy (15 minutes per session, twice weekly). Primary outcomes were pain intensity (Numerical Rating Scale [NRS]), functional disability (Oswestry Disability Index [ODI]), and patient-reported improvement (Patient Global Impression of Change [PGIC]).

RESULTS The rESWT group showed greater improvements than the control group in pain (ANRS: 0.68+0.81 vs 0.13+0.66, P

“Objectives: To evaluate the experience with rESWT in the management of nonunion and delayed bone healing.Specifically, ...
03/22/2026

“Objectives: To evaluate the experience with rESWT in the management of nonunion and delayed bone healing.
Specifically, to characterize patients according to demographic and clinical variables; to describe pain evolution using the visual analog scale (VAS); to compare radiological changes using the Montoya scale at one, three, and six months; and to determine patient functionality and satisfaction.

Methods: A descriptive, longitudinal, and prospective study was conducted in 15 patients treated at the Instituto Vivir
Mejor between January 2022 and January 2025. The protocol included rESWT (BTL 5000 SWT Power, 4 bar, 15 Hz,
4,000 impulses, five weekly sessions), nutritional supplementation, and physiotherapy. Variables analyzed included sociodemographic characteristics, pain (VAS), radiological consolidation (Montoya scale), functionality, and satisfaction.

Results: Sixty percent of patients were young adults (19–40 years), with a predominance of males (53.3%). The most
frequent diagnosis was delayed union (80%). Pain decreased significantly, from 33.3% with moderate pain at baseline
to 93.3% pain-free at six months (p < 0.001). Radiologically, 93.3% reached Montoya grade 4 at six months (p < 0.001).
Functionality improved progressively, with 100% of patients no longer requiring assistive devices and 93.3% reporting
being “very satisfied” at six months.
Conclusions: rESWT, combined with nutritional support and physiotherapy, appears to be a safe, effective, and
minimally invasive alternative in superficial nonunions and delayed consolidations. Its benefits include pain reduction,
accelerated bone healing, improved functionality, and high patient satisfaction. Controlled, multicenter studies are
recommended to confirm these findings and standardize clinical protocols.“

Radial Pressure Waves: The Invisible Frontier Between Bone
Healing and Nonunion
Mary S Chávez et al. SVOA Orthopaedics 2025 Oct.

https://sciencevolks.com/orthopaedics/pdf/SVOA-OR-05-018.pdf

Introduction: Greater trochanteric pain syndrome (GTPS) is a debilitating condition characterized by lateral hip pain lo...
03/19/2026

Introduction: Greater trochanteric pain syndrome (GTPS) is a debilitating condition characterized by lateral hip pain located at or around the greater trochanter.

Source of data: We performed a comprehensive search of Pubmed, Medline, Ovid, Google Scholar and Embase databases, from inception of the database to 20th of June 2011, using a variety of keywords. We identified 52 relevant abstracts of articles published in peer-reviewed journals. Fourteen studies reporting the outcomes of patients undergoing conservative and surgical management of GTPS were selected.

Areas of agreement: Significant pain relief and improved outcomes were observed after conservative and surgical management of GTPS. The modified Coleman methodology score averaged 44.7 (range from 14 to 82), evidencing an overall low-to-moderate quality of the studies. Repetitive low-energy radial shock wave therapy and home training approach provide beneficial effect over months, with almost 80% success rate at 15 months.

Management of the greater trochanteric pain syndrome: a systematic review
Angelo Del Buono et al. Br Med Bull. 2012 Jun.

https://pubmed.ncbi.nlm.nih.gov/21893483/

“All three systematic reviews concluded that there is no significant difference between the two treatments regarding sym...
03/06/2026

“All three systematic reviews concluded that there is no significant difference between the two treatments regarding symptom severity and functional status in the short term. Only one SR reported significantly better scores for symptom severity and functional status in the mid and long term (>1 month to >6 months). Two SRs measured electrodiagnostic parameters such as DML, SNAPA, CMAPA, and CMAPL which only changed inconsistently over the two SRs [132], [133],
[136]. Three SRs conducted a subgroup analysis to compare rESWT to fESWT [132], [134], [136].
Two SRs concluded that rESWT is more effective than fESWT in improving the VAS, BCTQS, and BCTQf score in the mid to long term (> 1 month to >6 months) [134], [136]. Kim et al. reported no significant difference between rESWT and fESWT [132].“

https://pmc.ncbi.nlm.nih.gov/articles/PMC12833726/

Radial extracorporeal shock wave therapy alters plantar pressure distribution in chronic plantar fasciitis: a biomechani...
03/06/2026

Radial extracorporeal shock wave therapy alters plantar pressure distribution in chronic plantar fasciitis: a biomechanical analysis

He Shang et al. Front Rehabil Sci. 2026.

Objective: This study aimed to investigate the impact of radial extracorporeal shockwave therapy (rESWT) on plantar pressure distribution in patients with chronic plantar fasciitis
(PF). While prior research has established rESWT’s clinical efficacy in pain relief, its specific biomechanical effects on plantar loading patterns remain less quantified. This study addresses that gap by providing objective pedobarographic evidence of rESWT-induced pressure redistribution.
Methods: A cohort of 42 patients with unilateral chronic PF was enrolled. Plantar pressure parameters-including total foot pressure, forefoot pressure, rearfoot pressure, peak pressure point, mean pressure, and contact area-were assessed using a plantar pressure measurement system before and after a standardized rESWT protocol. Evaluations compared the affected limb with the contralateral unaffected limb.

Results: Following rESWT, significant changes were observed:

on the affected side, forefoot pressure increased (p = 0.001)
and rearfoot pressure decreased (p = 0.001); on the
unaffected side, forefoot pressure also increased (p = 0.002)
and rearfoot pressure decreased (p = 0.003). Total foot
pressure decreased on the affected side (p = 0.032) but
increased on the unaffected side (p = 0.032). Contact area
increased significantly only on the unaffected side (p < 0.001).

No significant alterations were found in peak pressure point location or mean pressure (p > 0.05). Effect size analysis (Cohen’s d > 0.5) confirmed clinically meaningful improvements in forefoot and rearfoot pressure shifts.
Conclusion: rESWT effectively ameliorates abnormal plantar pressure distribution in PF patients, promoting a forward shift in the pressure center and improving gait symmetry. These findings provide a biomechanical rationale for its clinical use.
Future studies should incorporate patient-reported outcomes and longer follow-up to link these biomechanical changes to functional improvement.

https://pubmed.ncbi.nlm.nih.gov/41583729/

“No clear superiority of RSWT or FSWT was observed for pain or functional outcomes, owing to low or very low certainty o...
02/11/2026

“No clear superiority of RSWT or FSWT was observed for pain or functional outcomes, owing to low or very low certainty of evidence. Moderate-quality evidence indicated that RSWT significantly improved wrist extensor strength in patients with tennis elbow compared to FSWT”

Efficacy of radial and focused shockwave therapy for tendinopathy: a systematic review and meta-analysis

Magdalena Stania et al. Sci Rep. 2026.

https://pubmed.ncbi.nlm.nih.gov/41651897/

Methods: In this randomised, double blind, placebo-controlled study, we treated 34 patients with four sessions of RSWT (...
10/10/2025

Methods: In this randomised, double blind, placebo-controlled study, we treated 34 patients with four sessions of RSWT (once weekly) and treated 34 patients with placebo. Participants were assessed at baseline, 1 week after the first session, and 1 week and 4 weeks after the last session. We measured pain using the visual analogue scale for pain, while we assessed muscle tone using the modified Ashworth scale and evaluated spinal excitability using the H-reflex.

Results: After RSWT, muscle tone decreased 1 week after the last session and pain decreased at all the follow-up evaluations, while spinal excitability was unaffected. No significant changes were found after the placebo treatment.

Conclusions: RSWT can reduce pain and muscle tone in MS patients without adverse effects. The lack of RSWT effects on spinal excitability supports the idea that RSWT is likely to act on non-reflex hypertonia, for example reducing muscle fibrosis.

https://pubmed.ncbi.nlm.nih.gov/2525/616/

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