At New Regeneration Orthopedics, we have recently incorporated the use of Extracorporeal Shockwave Therapy into our practice-based data that shows its utility in treating a number of Orthopedic conditions. One of the conditions we see a lot is bone marrow edema, or swelling in the bone. This can be traumatic in nature or associated with osteoarthritis. Either way, it is often extremely painful and important to treat when trying to get our patients back to doing what they love.
A very interesting study out of Europe shows great evidence for using Shock Wave Therapy in patients who have this condition which is notoriously difficult to treat.
Why do bones swell?
When the blood supply in a bone is compromised, the bone can swell and create an extremely painful joint. Often patients will complain of pain with weight-bearing and limitations with activity and exercise. Bone marrow lesions can occur sometimes, without a clear cause, and can actually lead to arthritis if they progress. Other times, the loss of cushion and cartilage in an arthritic joint itself can create the conditions that lead to increased stress on the bone and result in bone marrow edema. Bone marrow edema is a very important condition to monitor because, if it progresses, it can lead to bone death and ultimately a joint that can only be treated with a joint replacement.
What is Extracorporeal Shock Wave Therapy (ESWT)?
Extracorporeal Shock Wave Therapy is an innovative procedure to help reduce acute and chronic pain emanating from certain types of musculoskeletal conditions. Extracorporeal Shock Wave Therapy, commonly referred to as ESWT, is part of an evidence based non-surgical approach in sports medicine. The ESWT device is placed at the target tissue, where it delivers controlled Shock Wave Energy into the inflamed tendons, bones and tissues in order to stimulate angiogenesis (new blood flow), decrease inflammation and help the target tissue remodel. Multiple studies have shown impressive improvements in damaged tendons and bones following ESWT treatments. This technique is used to help these areas heal themselves by stimulating the growth of new blood vessels, and ultimately leading to less pain.
Why use Shockwave Therapy for Bone Marrow Edema?
By using ESWT to send energy into an area of bone marrow edema, the damaged bone can be stimulated to form new blood vessels and growth factors that help the bone heal and ultimately remodel. If the bone is able to effectively remodel, then it will cease to produce the high level of pain and allow the patient to get back to activities without pain.
What does the research show?
In a 2018 study published in the European Journal of Physical and Rehabilitation Medicine, seventy-two patients with bone marrow lesions underwent three rounds of ESWT, three weeks apart. Each of these patients had bone marrow lesions in the knee that were measured via MRI before, and 6 months after, the ESWT. There was a statistically significant improvement in the size of the bone marrow lesions in patients treated with ESWT, which correlated exactly with improvements in these patient’s pain levels.
What is the significance of this research?
ESWT has been proven to be a valuable tool in one of the most difficult orthopedic conditions to treat. Sometimes we combine ESWT with other modalities to give our patient’s the best chance for success. A thorough evaluation with an expert in musculoskeletal conditions should be conducted in order to see if ESWT is an appropriate tool for you.
Are you affected by Bone Marrow Edema? Find out if you’re a candidate for treatment.