Guided DolorClast Therapy

Shockwave Therapy is a non-invasive alternative to surgery, steroidal injections and oral medication. Compressed air accelerates a projectile which strikes a fixed applicator. The kinetic energy is converted into a shock wave delivered to the target tissue through the skin. These shock waves are conveyed radially for broad treatment areas.

Maximize treatment outcomes

The right technologies ​ with the right energies​ to address 90% of all major musculoskeletal disorders​ with success​.

Transform patient experiences

The ally to provide pain-free experience and restore patients’​ confidence in their recovery.

Boost practice success

The partner in care to boost​ your practice productivity, visibility and profitability

Guided Dolorclast Therapy

How to best engage with your patients during a physiotherapy appointment?

assess&engage

Never assume patients know what to expect!

  • Let them know the course of their GDT protocol in details: tell them about session frequency and the treatment sequence.
    This will help them to reduce their possible anxiety and to ensure their compliance with the treatment. 

Set expectations: they play an important role in the outcomes!

  • Openly discuss and set upfront patient expectations; whether they relate to treatment time, pain release, increase of the range of motion, change in the quality of life, etc. 

Recognize your patients as actors of their recovery

  • Take time to explain them their pathology
  • Using simple words how GDT technologies work and how they are going to help them overcome their pain

Determine your patient's pain chronicity

Evaluating your patient's pain chronicity can help you find the most appropriate treatment protocol and is highly recommended by the Guided DolorClast® Therapy. 

Here is how you can determine your patient's chronicity. 

Has your patient been feeling pain for less than one month?

In that case, he's in the acute phase of the pathology. GDT recommends using the DolorClast® High Power Laser by itself. 

Has your patient been feeling pain between 1 and 3 months?

In that case, he is in the sub-acute phase of the pathology. EMS recommends a combination of laser therapy and shock wave therapy.

Has your patient been feeling pain for more than 3 months?

In that case, he is in the chronic phase of the pathology and his condition can only worsen as months pass by. EMS recommends a combination of the DolorClast® High Power Laser and the DolorClast® Radial Shock Waves together with rehabilitation exercises to obtain long-term results. 

Treatment decision tree

EMS has designed a treatment decision tree which will help you decide which protocol best suits your patient's pathology, ensuring not only the most optimal results but will also give your patients a deep understanding of the treatment protocol they are going to receive.

Use DolorClast® Laser for:

  • Superficial or deep MSK indications
  • As 1st choice to address acute inflammation 

What is DolorClast® High Power Laser?

DolorClast® High Power laser’s 905nm wavelength triggers two main types of effects in the targeted area:

Analgesic effect: Kicking in 5min after the end of laser treatment and lasting up to 72h.

Anti-inflammatory effect: Decreasing acute inflammation and leading to a quick absorption of the oedema and a faster healing process of the damaged tissue. 

What are the benefits of laser therapy?

Musculoskeletal injuries are described by patients as highly painful, especially in their acute phase. Unfortunately opioid medication or sedative are still too often prescribed despite the risk of adverse events. To avoid any addictive form of pain management, EMS has developed the DolorClast® High Power Laser to offer a non-invasive, effective yet safe solution to patients suffering from acute phase or those having a low-tolerance threshold of pain.

Shed light to blind pain & regenerate:

No opioids
No sedatives
No pain

How can a laser help in physical therapy?

"905nm - the ideal wavelength for quick pain reduction and lasting healing"

What is the best wavelength for laser therapy?

Wavelengths comprised between 650nm and 1350 nm are known as the “therapeutic window”. Within this frame, wavelengths penetrate deep in the tissues as they are not much absorbed by water, blood and melanin and can therefore trigger biological mechanisms.

Within the therapeutic window, 905nm wavelength has been specifically chosen for the DolorClast® High Power Laser for its ability to be less absorbed by water (and therefore oedema often characteristic of acute inflammation), blood and melanin.

905 nm allows for treatment of deep pathologies

905 nm wavelength allows for a treatment of deep pathologies by a tissue penetration of up to 120mm without a burning of the skin.

905 nm wavelength switches off nociceptors

A nociceptor (from latin “nocere” = “to harm”) is a sensory neuron that responds to damaging or potentially damaging stimuli by sending a threat signals to the spinal cord and the brain. His turn, if the brain perceives the threat as credible, it creates the sensation of pain to direct attention to the body part, so the threat can hopefully be mitigated. 

905nm laser light has the property to switch off these nociceptors after only 3 minutes of irradiation1. Based on this wavelength, the DolorClast® High Power Laser provides a quick and strong antalgic effect, without having to use any pain medication.

1 Mezawa, S et al., 1988

905 nm wavelength supresses acute inflammation

905nm wavelength leads to a reduction of the amount of Prostaglandin E2 (PGE2), which is a key marker of the inflammation. Clinical research2 shows that exposing tissues to such laser light diminishes the acute inflammation thanks to the reduction of PGE2 as fast as 1 hour after the treatment. By mimicking the effect of nonsteroidal anti-inflammatory drugs (NSAIDs), without exposing patients to their side-effects and addiction, 905nm wavelength kicks off  the healing process.  

2 Bjordal, J M et al., 2006

300 Watts Peak power

Pulsed laser delivers bursts of emission. The higher the power peak is, the deeper the laser light can reach tissues. 

 

1.35 Watts average Power

The amount of power 
delivered over time


5 to 80 Kilo Herz frequency

The amount of pulses per second. Changing the frequency changes the overall amount of energy delivered during 1s due to pulses being delivered more (or less) frequently

100 nanoseconds pulse duration

The time measured across a pulse. Changing the pulse duration changes the amount of energy delivered per pulse. A high exposure time of tissue, meaning a high pulse duration, may generate safety issues.  


50% Modulation

The percentage of time the laser is on / off. Changing the % of modulation changes the overall amount of energy delivered due to the laser being on or off. 

Clinical researches1 show that therapeutic effects of laser light on pain reduction and inflammation, characteristic of acute phase of musculoskeletal pathologies, are linked to a specific wavelength: 905 nm.


In order to reach exceptional treatment outcomes on deep MSK disorders, the penetration depth of the 905nm laser light needs to maximized thanks to a high peak power (300W). 


For tissue safety, this amount of energy needs to be delivered to the tissues wisely. A high peak power coupled with short pulse duration guarantee in-depth penetration and tissue safety.

1 Mezawa et al., 1988  / Bjordal et al., 2006

15x more powerful

  • 300 W peak power is 15 times more powerful than conventional low power lasers
  • 905 nm wavelength allows for a treatment of deep pathologies by a tissue penetration of up to 120mm
  • Short pulse duration of 100ns to keep the treated tissues below the thermal threshold and hence avoid risk of burns. 

Guided DolorClast Therapy suggests a combination therapy approach:

Apply DolorClast® Radial Shock Waves or Focused Shock Waves:

  • 5 minutes after the end of DolorClast® High Power Laser treatment for excellent combined clinical outcomes, or
  • 1 hour after the end of DolorClast® High Power Laser treatment for excellent optimal clinical outcomes

What is DolorClast® Radial Shock Waves?

In 1997, EMS patented the first radial shock wave device, the Swiss DolorClast®, based on the ballistic principle.


Compressed air sent to the handpiece accelerates a projectile, which strikes a fixed applicator at high speed (up to 90 km/h). The kinetic energy resulting from this movement is converted into a shock wave transmitted in a radial manner to the targeted tissues.

Shock waves delivery is short in time, usually lasting just a few minutes, thus enabling to be coupled with other therapies within the same session as recommended by the GDT. DolorClast® Shock wave protocol usually includes a total of three to five sessions, planned at a rate of one to two sessions per week with an interval of minimum 72h between them.

What are the benefits of shock wave therapy?

Extracorporeal Shock Wave Therapy (ESWT) is the application of Shock Waves in medicine. 

It is clinically proven that pressure waves, when applied to injured tissues, stimulate metabolic reactions:

  • Reduction of pain felt by nerve fibers
  • Increase of blood circulation in surrounding soft tissues
  • Beginning of healing process triggered by stem cells activation

The sound of healing with radial shock waves

How can shock wave therapy help in physical therapy?

 

  1. Compressed air accelerates a projectile which strikes a fixed applicator. 
  2. The kinetic energy is converted into a shock wave delivered to the target tissue through the skin.
  3. These shock waves are conveyed radially for broad treatment areas.
  4. A shock wave begins by a compression phase. The peak pressure creates shear stress in the tissues. 

  5. A tensile phase follows and generates cavitation bubbles. A high cavitation level is a result of a high amount of energy density delivered by the shock wave device. 

  6. This energy stimulates metabolic reactions to the applied tissues

How to be effective with shock wave therapy?

It`s easy: the more energy delivered into the tissue, the better the therapeutic outcome. For this, we know the following:

“A significant tissue effect is cavitation consequent to the negative phase of the wave propagation ” (Ogden et al., 2001)

“Both parameters (Compression phase and Cavitation) may have important consequences for therapeutic bioeffect” (Perez et al., 2014)

“The contribution of cavitation to the therapeutic effect of radial shock waves was recently shown in an advanced animal model ” (Angstman et al., 2015)

Radial shock waves visualization

The compression phase (P+) penetrates the skin
and weakens the tissue.

A tensile phase (P-) follows generating
cavitation bubbles.

These bubbles collapse causing secondary shock waves.

Which shock wave devices gives the most cavitation?

The pictures below represent the maximum level of cavitation (black dots) generated with different radial shock waves handpieces at maximum pressure settings at 15Hz.1

Cavitation of different shock wave devices

1 NikolausB. M. Császár et al., “Radial Shock Wave Devices Generate Cavitation”, 2015. 

Why is consistent energy delivery so important?

Shock Wave therapy is dose dependent. However, as you increase the frequency of shock waves generated, not all devices and handpieces can sustain the same energy delivery at higher frequencies.

Bench studies1 demonstrate that the DolorClast® Radial Shock Waves delivers up to 200% more energy density than competing devices at frequencies of 15 Hz and above and maximum pressure. 


1 Internal bench study comparison of energy density between the DolorClast Radial Shock Waves (EMS) and the best device among competition. 

Comparison of energy delivered at increasing frequencies:

Clinical researches1 show that therapeutic effects of RSWT® are linked to the level of cavitation produced in the treated tissues. 

And, a high cavitation level is a result of a high amount of energy density delivered by the devices’ handpieces.

 
The higher the total of the energy density is, the better the treatment outcomes will be.

1 Perez et al., 2014  / Angstman et al., 2015  / Ogden et al., 2001  / Maier et al., 2003 / Hausdorf et al., 2008.

How do radial shock waves work?

Red chili peppers contain capsaicin. At first this substance overwhelms the so-called C nerve fibers responsible for transmitting pain but then disables them for an extended period of time.
Everybody knows the feeling – first, the mouth is on fire, then it feels completely numb.  Research has indicated that shock wave therapy works the same way1

1 Maier et al., Clin Orthop Relat Res 2003; (406):237–245.

How are shock waves applied?

Pain therapy in 4 steps:

1. Palpate

Locate the area of pain through palpation and biofeedback.
 

2. Mark

Mark the area of pain.
 
3. Apply gel

Apply coupling gel to transmit shock waves to the tissue.
 
4. Apply shock waves

Deliver Radial or Focused Shock Waves to the area of pain while keeping the applicator firmly in place on the skin.

Guided DolorClast Therapy suggests a combination therapy approach:

Apply DolorClast® Radial Shock Waves:

  • 5 minutes after the end of DolorClast® High Power Laser treatment for excellent combined clinical outcomes, or
  • 1 hour after the end of DolorClast® High Power Laser treatment for excellent optimal clinical outcomes

Use DolorClast® Focused Shock Waves for: 

  • Deep indications
  • Sub-acute or chronic pathologies
  • Deep calcified lesions or myotendinous tears, nonunions fractures or enthesopathies located on the elbow and recalcitrant to heal. ​

What is DolorClast® Focused Shock Waves? 

 

Extracorporeal Shock Wave Therapy (ESWT) is the application of Shock Waves in medicine.

It is clinically proven that pressure waves, when applied to injured tissues, stimulate metabolic reactions:

  • Reduction of pain felt by nerve fibers
  • Increase of blood circulation in surrounding soft tissues
  • Beginning of healing process triggered by stem cells activation

Which shock waves are most effective?

The formula is simple: the more energy delivered into the tissue, the better the therapeutic outcome

The compression phase in focused ESWT is usually shorter than in radial ESWT.

The maximum pressure P+ in focused ESWT is usually higher than in radial ESWT.

Both focused and radial ESWT can reach an ED+ of 0.4 mJ/mm2, which has been clinically proven to be sufficient for almost all ESWT indications on the musculoskeletal system and the skin.

Focused shock wave visualization

1,000 pressure waves (P+ wave front) penetrate the skin and travel through the tissue focusing on a cigar-shaped volume (midpoint focus).

A depression phase (P-) follows, generating cavitation bubbles. These bubbles collapse causing secondary shock waves.

Guided DolorClast Therapy is based on the combination of different therapies aiming at relieving pain and healing musculoskeletal injuries. On top of the DolorClast® Laser & Shock Waves treatments, its strength lies as well in a rehabilitation program that speeds up and increases functions recovery. The rehabilitation program shall be set up at the discretion of each practitioner, depending on their habits and the material they own in their practice. 

GDT invites practitioners to involve patients in their treatment routine and be an actor of their recovery. Adding rehabilitation exercises to DolorClast® laser and shock-wave treatments will improve clinical outcomes.

Ultrasounds diathermy & TENS

"rSWT® combined with physical therpay enables better and faster pain reduction, grip strengh increase, functional improvement and tendon tear healing, than physical therapy alone."

Eccentric loading

The combination of rSWT® treatment and eccentric loading has a significantly better clinical outcome than eccentric loading alone. Combined treatment leads to a significant reduction in pain. 

Stretching exercises

24 months after treatment, pain decreased overall by almost 70% in patients who received GDT protocol.

Patient compliance to treatments that last over few weeks is tricky. GDT helps you keeping patients within your practice and improving your overall success. Here are some quick tricks to your patients:

Track treatment succes​

via outcome measurement tools (VAS score and ROM) to reassure your patients.

Schedule the next appointment​

Before patient leaves to establish a treatment pattern.

Don't forget!​

Patients are often your most passionate ambassadors. Their endorsement to the GDT will represent more than any paid campaign for your practice. So engage the discussion with your patients and make sure they FEEL GOOD about their treatment and results.

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