Therapy Protocols

Treatment Recommendations

Radial and ulnar epicondylitis – Acute

Treatment recommendation

Frequency: 5-10 Hz

Power level: 60-90 mJ

Pulses per treatment: 1500-2000

Number of treatments: 1-3

Frequency of treatment: 1-2 per week

Recommended applicator head: 15 mm, after familiarization 6mm

Notes

First treat existing trigger and pain points statically with series up to 600 pulses per point and series , finally work over the area dynamically, preferably in the direction of lymphatic flow.

For treatment point on tendon attachment site : energy level 60 mJ

For treatment point on tendon or muscle : energy level 60 mJ (90mJ)

Tendinitis pf the shoulder/shoulder problems – Acute

Treatment recommendation

Frequency: 5-10 Hz

Power level: 60-120 mJ

Pulses per treatment: 2000

Number of treatments: 1-4

Frequency of treatment: 1-2 per week

Recommended applicator head: 15 mm, after familiarisation 6mm

Notes

Determine problem precisely – which tendon , which attachment point is affected ? First, treat statically with series up to 600 pulses per point and series , finally work over the area dynamically , preferably in the direction of lymphatic flow .

For treatment point on tendon insertion site : energy level 60-90 mJ

For treatment point on tendon or muscle : energy level 120 mJ

Indication

Calcific tendinitis of the shoulder – Acute

Treatment recommendation

Frequency: 5-10 Hz

Power level: 90 mJ

Pulses per treatment: 2000

Number of treatments: 1-4

Frequency of treatment: 1-2 per week

Recommended applicator head: 15 mm, after familiarisation 6mm

Notes

First treat existing trigger and pain points statically with series up to 600 pulses per point and series, then work the entire area over directly using slow dynamic mode.

Status post muscular injury – Acute

Treatment recommendation

Frequency: 5-10 Hz

Power level: 60-90 mJ

Pulses per treatment: 2000

Number of treatments: 3

Frequency of treatment: 1-2 per week

Recommended applicator head: 15 mm, after familiarisation 6mm

Notes

First treat existing trigger and pain points statically with series up to 600 pulses per point and series, then work the entire area over directly using slow dynamic mode.

Indication

Patellar tendinitis – Acute

Determine problem precisely – is the tendon, the upper patellar attachment or the lower areas of the quadriceps muscle affected ?

Treat tendon attachment, existing trigger and pain points statically with series up to 600 pulses per point and series, then work the area over dynamically.

For treatment point on tendon insertion site : energy level 60-120 mJ

For treatment point on tendon or muscle : energy level 120 mJ

Patellar tendinopathy – Acute

Treatment recommendation

Frequency: 5-10 Hz

Power level: 60-90 mJ

Pulses per treatment: 2000

Number of treatments: 1-4

Frequency of treatment: 1-2 per week

Recommended applicator head: 15 mm, after familiarisation 6mm

Notes

Pay careful attention to definite acute signs of inflammation. Upon acute signs of inflammation either suspend the treatment or reduce the dose as appropriate.

Apply treatment that is generally static but from different directions towards the patella tip, approximately 400 pulses per application, finishing on the front.

Achillodynia – Acute

Treatment recommendation

Frequency: 5-10 Hz

Power level: 60-90 mJ

Pulses per treatment: 2000

Number of treatments: 3

Frequency of treatment: 1-2 per week

Recommended applicator head: 15 mm, after familiarisation 6mm

Notes

Differential diagnosis – is the tendon itself or the tendon attachment point on the heel bone affected? Does the tendon move freely or with crepitation or are there detectable nodules in the tendon?

Treat statically on the tendon insertion using energy level 60-90 mJ.

Dynamically on the tendon itself , work statically or semi-statically on nodules. Do not work directly from a dorsal direction but rather from the side at a an angle of 45°. Use energy level 60 mJ or 90 mJ in this case.

Indication

Plantar fasciitis – Acute

Treatment recommendation

Frequency: 5-10 Hz

Power level: 60-90 mJ

Pulses per treatment: 2500

Number of treatments: 3-4

Frequency of treatment: 1-2 per week

Recommended applicator head: 15 mm, after familiarisation 6 mm

Notes

Work with the patient in a prone position with supported or unsupported foot and work the entire aponeurosis dynamically.

Heel spurs – Acute

Treatment recommendation

Frequency: 10 Hz

Power level: 90-120 mJ

Pulses per treatment: 2000

Number of treatments: 6

Frequency of treatment: 1 per week

Recommended applicator head: 15 mm, after familiarisation 6 mm

Notes

Apply directly to the pain point or to incipient or manifest calcification on the heel bone . Work with the patient in a prone position with supported or unsupported foot. Work statically or semi-statically.

Myofascial trigger point therapy e.g. Neck – Acute

Treatment recommendation

Frequency: Burst or 5-10 Hz

Power level: 60 mJ

Pulses per treatment: 1500-2000

Number of treatments: 1-4

Frequency of treatment: 1 per week

Recommended applicator head: 15 mm / 6 mm

Notes

Determine trigger point and myofascial tone and prioritize. First treat existing trigger and pain points statically with series up to 600 pulses per point and series. Begin with the point with the highest priority. Finally, work over the whole area dynamically.

Myofascial trigger point therapy Back Pain – Acute

Treatment recommendation

Frequency: Butst or 5-10 Hz

Power level: 60 mJ

Pulses per treatment: 1500-2000

Number of treatments: 1-4

Frequency of treatment: 1 per week

Recommended applicator head: 15 mm , after familiarisation 6 mm

Notes

Determine trigger point and myofascial tone and prioritize. First treat existing trigger and pain points statically with series up to 600 pulses per point and series. Begin with the point with the highest priority. Finally work over the whole area dynamically.

Trochanteric bursitis – Acute

Treatment recommendation

Frequency: 5-10 Hz

Power level: 60-90 mJ

Shocks per treatment: 2000

Number of treatments: 1-4

Frequency of treatment: 1 per week

Recommended applicator head: 15 mm

Notes

First treat existing trigger and pain points statically with series up to 600 pulses per point and series, then work the entire area over directly using slow dynamic mode. Approach treatment area rather from the side at a 45 degree angle. Do not apply directly from the lateral direction on either the trochanter or iliotibial tract.

Periostitis / shin splints (Condition after overload ) – Acute

Treatment recommendation

Frequency: Burst or 5 Hz

Power level: 60 mJ

Pulses per treatment: 1000

Number of treatments: 3

Frequency of treatment: 1-2 per week

Recommended applicator head: 15 mm

Notes

Careful dynamic treatment over the entire affected tendon insertion site on the anterior tibial spine. Follow the bone geometry and do not treat directly on the tibial spine. If necessary , include the anterior tibial muscle in the treatment.

Dupuytren`s disease – Acute

Treatment recommendation

Frequency: 10 Hz

Power level: 90 mJ

Pulses per treatment 200-300*

Number of treatments: 5

Frequency of treatment: 1-2 per week

Recommended applicator head: 6 mm

Notes

Static directly on the problem site, and in case of tolerance problems, apply the series semi-statically from different directions. Support or fix the joint with two fingers from the left and right sides during the treatment.

* Adhere to the rest periods ( after each 25 pulses ) and observe the reaction of the patient.

Thumb basal joint arthritis / rhizarthritis – Acute

Treatment recommendation

Frequency: 5-10 Hz

Power level: 60-90 mJ

Pulses per treatment: 1500*

Number of treatments: 3

Frequency of treatment: 1-2 per week

Recommended applicator head: 15 mm

Notes

Static directly on the problem site, and in case of tolerance problems, apply the series semi-statically from different directions. Support or fix the joint with two fingers from the left and right sides during the treatment .

* Adhere to the rest periods ( after every 200 pulses ) and observe the reaction of the patient.

Radial and ulnar epicondylitis – Chronic

Treatment recommendation

Frequency: 10-16 Hz

Power level: 120 mJ

Pulses per treatment: 2000-3000

Number of treatments: 4-8

Frequency of treatment: 2 per week

Recommended applicator head: 15 mm, after familiarisation 6mm

Notes

First treat existing trigger and pain points statically with series up to 600 pulses per point and series, finally work over the area dynamically, preferably in the direction of lymphatic flow.

For treatment point on tendon attachment site : energy level 60 mJ.

For treatment point on tendon or muscle : energy level 90mJ.

Tendinitis pf the shoulder/shoulder problems – Chronic

Treatment recommendation

Frequency: 10-16 Hz

Power level: 120 mJ

Pulses per treatment: 3000

Number of treatments: Until 9

Frequency of treatment: 2 per week

Recommended applicator head: 15 mm, after familiarisation 6mm

Notes

Determine problem precisely – which tendon, which attachment point is affected? First treat statically with series up to 600 pulses per point and series, finally work over the area dynamically, preferably in the direction of lymphatic flow.

For treatment point on tendon insertion site : energy level 60-120 mJ

For treatment point on tendon or muscle : energy level 120 mJ

Calcific tendinitis of the shoulder – Chronic

Treatment recommendation

Frequency: 10-16 Hz

Power level: 120 mJ

Pulses per treatment: 2000-2500

Number of treatments: Until 9

Frequency of treatment: 2 per week

Recommended applicator head: 15 mm, after familiarisation 6mm

Notes

First treat existing trigger and pain points statically with series up to 600 pulses per point and series, then work the entire area over directly using slow dynamic mode.

Status post muscular injury – Chronic

Treatment recommendation

Frequency: 10-16 Hz

Power level: 120 mJ

Pulses per treatment: 2000-3000

Number of treatments: 1-6

Frequency of treatment: 2 per week

Recommended applicator head: 15 mm, after familiarisation 6mm

Notes

First treat existing trigger and pain points statically with series up to 600 pulses per point and series, then work the entire area over directly using slow dynamic mode.

Patellar tendinitis – Chronic

Treatment recommendation

Frequency: 10-16 Hz

Power level: 120 mJ

Pulses per treatment: 2000-3000

Number of treatments: 1-6

Frequency of treatment: 2 per week

Recommended applicator head: 15 mm

Notes

Determine problem precisely – is the tendon, the upper patellar attachment or the lower areas of the quadriceps muscle affected? Treat tendon attachment, existing trigger and pain points statically with series up to 600 pulses per point and series, then work the area over dynamically.

For treatment point on tendon insertion site : energy level 90-120 mJ

For treatment point on tendon or muscle : energy level 120 mJ

Patellar tendinopathy – Chronic

Treatment recommendation

Frequency: 10-16 Hz

Power level: 120 mJ

Pulses per treatment: 2000-2500

Number of treatments: until 10

Frequency of treatment: 2 per week

Recommended applicator head: 15 mm, after familiarisation 6mm

Notes

Pay careful attention to definite acute signs of inflammation. Then either suspend the treatment or reduce the dose as appropriate. Generally static but from different directions towards the patella tip. Per application about 400 pulses , finishing on the front

Achillodynia – Chronic

Treatment recommendation

Frequency: 10-16 Hz

Power level: 120 mJ

Pulses per treatment: 2000-3000

Number of treatments: until 1-6

Frequency of treatment: 2 per week

Recommended applicator head: 15 mm, after familiarisation 6mm

Notes

Differential diagnosis – is the tendon itself or the tendon attachment point on the heel bone affected? Does the tendon move freely or with crepitation or are there detectable nodules in the tendon? Statically on the tendon insertion using energy level : 60-90 mJ. Dynamically on the tendon itself , work statically or semi-statically on nodules. Do not work directly from a dorsal direction but rather from the side at a an angle of 45 degree. Use energy level 60 mJ or 90 mJ in this case.

Plantar fasciitis – Chronic

Treatment recommendation

Frequency: 5-10 Hz

Power level: 60-90 mJ

Pulses per treatment: 1500-3000

Number of treatments: 1-7

Frequency of treatment: 2 per week

Recommended applicator head: 15 mm, after familiarisation 6mm

Notes

Work with the patient in a prone position with supported or unsupported foot and work the entire aponeurosis dynamically.

Heel spurs – Chronic

Treatment recommendation

Frequency: 10 Hz

Power level: 90-120 mJ

Pulses per treatment: 2000

Number of treatments: 6

Frequency of treatment: 1-2 per week

Recommended applicator head: 15 mm, after familiarisation 6mm

Notes

Apply directly to the pain point or to incipient or manifest calcification on the heel bone. Work with the patient in a prone position with supported or unsupported foot. Work statically or semi-statically.

Myofascial trigger point therapy e.g. Neck – Chronic

Treatment recommendation

Frequency: Burst or 5-10 Hz

Power level: 60 mJ

Pulses per treatment: 1500-3000

Number of treatments: 6

Frequency of treatment: 1 per week

Recommended applicator head: 15 mm/6 mm

Notes

Determine trigger point and myofascial tone and prioritize. First treat existing trigger and pain points statically with series up to 600 pulses per point and

series. Begin with the point with the highest priority. Finally work over the whole area dynamically.

Myofascial trigger point therapy e.g back pain – Chronic

Treatment recommendation

Frequency: Burst or 5-10 Hz

Power level: 60 mJ

Pulses per treatment: 1500-2000

Number of treatments: 6

Frequency of treatment: 1 per week

Recommended applicator head: 15 mm, after familiarisation 6 mm

Notes

Determine trigger point and myofascial tone and prioritize. First treat existing trigger and pain points statically with series up to 600 pulses per point and series. Begin with the point with the highest priority. Finally work over the whole area dynamically.

Trochanteric bursitis – Chronic

Treatment recommendation

Frequency: Burst or 5-10 Hz

Power level: 120 mJ

Pulses per treatment: 2000

Number of treatments: 6-8

Frequency of treatment: 1 per week

Recommended applicator head: 15 mm

Notes

First treat existing trigger and pain points statically with series up to 600 pulses per point and series , then work the entire area over directly using slow dynamic mode. Approach treatment area rather from the side at an angle 45 degree and do not apply directly from the lateral direction on the trochanter or iliotibial tract.

Periostitis / shin splints ( Condition after overload ) – Chronic

Treatment recommendation

Frequency: Burst or 5-10 Hz

Power level: 60-90 mJ

Pulses per treatment: 2000

Number of treatments: 4-8

Frequency of treatment: 2 per week

Recommended applicator head: 15 mm

Notes

Careful dynamic treatment over the entire affected tendon insertion site on the anterior tibial spine. Follow the bone geometry and do not treat directly on the tibial spine. If necessary, include the anterior tibial muscle in the treatment.

Dupuytren`s disease – Chronic

Treatment recommendation

Frequency: 10 Hz

Power level: 90 mJ

Pulses per treatment: 200-300*

Number of treatments: 3-4

Frequency of treatment: 1-2 per week

Recommended applicator head: 15 mm

Notes

Static directly on the problem site, and in case of tolerance problems, apply the series semi-statically from different directions. Support or fix the joint with two fingers from the left and right sides during the treatment.

* Adhere to the rest periods (after each 25 pulses) and observe the reaction of the patient.

Thumb basal joint arthritis / rhizarthritis – Chronic

Treatment recommendation

Frequency: 5-10 Hz

Power level: 90 mJ

Pulses per treatment: 2000*

Number of treatments: 4-8

Frequency of treatment: 2 per week

Recommended applicator head: 15 mm

Notes

Static directly on the problem site, and in case of tolerance problems, apply the series semi-statically from different directions. Support or fix the joint with two fingers from the left and right sides during the treatment.

* Adhere to the rest periods (after every 200 pulses) and observe the reaction of the patient.