MALM

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What is shock wave therapyBrief information on the shock wave therapy and it history

Shock waves are acoustic waves transporting high energy transmitted through the skin surface

and radiated into the body, to the painful area.

Shock waves are characterized by a rapid change of pressure, high amplitude and non-periodic-

ity. The energy produced and transferred to tissue is much higher than ultrasound energy.

The body reacts by increasing the metabolic activity in the application area, thus making it easier

to minimize the inflammation caused by a pain-killing action induced by ant inflammatory local

reaction, thus stimulating and accelerating the recovery.

Shock wave therapy was first used in the 1980’s and was called lithotripsy (ESWT) for destruction

of kidney stones without surgery. It’s only recently that a new concept of shockwaves has been

developed (SWT)

There are now, two groups of technologies used for generating of shock waves:

 

Shock wave systems

FOCUSED SHOCK WAVE SYSTEMS

Deliver high energy in one small spot – this is very good for lithotripsy, but in orthopedics the

exact location of the pain can be difficult to locate. Diagnostic ultrasound is recommended.

High energy is very painful and local anaesthesia is required.

RADIAL SHOCK WAVE SYSTEMS

Shock waves are delivered in a radial or focused energy pattern depending on the transmitter

tip used. Treatments are not painful and precise targeting of the painful area is much easier.

From a medical viewpoint it is not important how the shockwave is created. The most impor-

tant factor is the total energy delivered to the painful spot.

Our MALM is a radial (ballistic) shock wave, in the sense that the shock wave is generated by

a special pistol-shaped probe equipped with a barrel which is plugged at one end by means

of a metal cap, where a steel bullet is shoot using compressed air (up to 5 bar pressure).

Thus a shock wave is generated which is radiated into the skin and into the first tissue layer

just below skin. Penetration depth may vary from 4 to 7 cm.

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Shock wave’s effectsMain medical effects of shock wave therapy

Analgesic effect - elimination of pain:

• Enhanced dispersion of substance P

• Decrease of muscle tension

• Inhibition of spasm and inhibition of nociceptive fibers

Acceleration of healing:

• Enhanced collagen production

• Improved metabolism and microcirculation

• Ligament neovascularization

• Stimulation of osteoblasts activity with increases in osteogenesis

Mobility restoration

• Enhances re-absorption of calcium deposits

• The shock wave method is the chosen treatment for chronic insertional tendinopathies

characterised by a poor vascularisation of the osteotendinous junction, where the

physiotherapy treatment (infiltrations and laser therapies) has been proven ineffective.

MAIN PATHOLOGIES THAT ARE SUITABLE FOR SHOCKWAVE APPLICATION:

• Elbow - Epicondylitis, epitrocleitis

• Shoulder - Insertional tendinopathies, impingement

• Knee - Patellar and “goose’s foot” tendinopathies

• Pubis - Adductor tendinopathies (pubalgy)

• Ankle - Achilles tendinopathies, calcaneal apophysis

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MALM

MALM is the latest technology with innovative features that position at the top of what the

market can offer.

The software specifically developed allows the access to a wide and comprehensive list of

stored protocols. The suggested parameters are a valuable tool, available to all those who

approach this kind of therapy for the first time making it simple to use, intuitive and complete.

The applicator supplied with the device is highly ergonomic and comfortable allows for dif-

ferent work methods. Moreover, it contains a anti-shock spring placed on the top of the appli-

cator to avoid any side effects to the operator.

The radial shock waves are ideal for a use in

dynamic mode. The therapeutic effect due to treat-

ment on the muscle groups around the point in

question allows the achievement of optimal and

fast results.

MALM, supplied with a trolley, delivers a maximum

of 5 bar pressure and reaches a frequency of 20

Hz .

MALM

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Treatment procedureApplication technique

MALM has in it’s software a dedicated part called Procedure where you will find all the indi-

cations step by step on how to deliver the therapy.

• PHASE I

The first phase to start the shock wave treatment consists in locating the area to be treated.

The operator, through a palpation of the aching area, strictly locates the area to be treated.

You may use X-rays (bone treatments) or ultrasound scan (treating soft tissues pathologies);

such controls may be carried out in-line or off-line,if available.

• PHASE II

MALM allows you to select the protocol to be used from a list of programs stored in the

machine memory.

• PHASE III

The parameters set for each protocol must be considered as indicative, since these may be

changed according to patient tolerance.

It is nevertheless advisable to start the session with a low frequency (15 Hz) and with a

power that should not exceed 3 Bar. Thus the area to be treated gets gradually used to the

therapy, with no trauma.

• PHASE IV

On the area to be treated, after having thoroughly cleaned the skin using a disinfectant solu-

tion, a handle-skin interface coupling gel is to be applied in order to convey the acoustic

waves through the skin, with no energy loss. Any gel for ultrasounds should be suitable.

• PHASE V

Now you can start the therapy. Just press start!

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Side effects and contraindications

MALM does have some limitation in use due to the power that it produces.

It can not be applied to target areas located above air filled tissue (lungs), nor to any

regions near large nerves, vessels, the spinal column or head.

Patients being treated with shock wave could have some irritation or swelling but it usu-

ally disappears within one week of treatment. About contraindications, it’s always advis-

able to have a consultation prior the treatment.

Contraindications include the following:

• Coagulation disorders and the use of

anticoagulants

• Cancer

• Pregnancy

• Application in certain tissues - eyes and

periorbital area, myocardium, spinal cord,

gonads, kidneys, liver)

• Application in an area of varicose veins

• Application directly above a nerve

• Polyneuropathy in case of diabetes mellitus

• No NSAIDS one week prior to treatment

• No cortisone six weeks prior to treatment

• No ice post treatment

• No anti inflammatory post treatment

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Our experienceTreatment results

Thanks to the studies carried out by our scientific consultant, we are now able to share with

you, some important information on the performance of our MALM on the patients:

A. Rotator cuff calcific tendinitis:

Calcific tendinitis is inflammation of a tendon triggered by calcium deposits. The rotator cuff

tendons of the shoulder are the most common location for this condition. Deposits may

occur in one or both shoulders.

30 cases were examined of people suffering from this pathology who have been treated with

our MALM. The parameters used by our doctors were the following:

• Pressure: 3 Bar

• Frequency: 10 Hz

• Shocks: 2.500

• Number of sessions done: 4 (weekly)

• The objective of the treatment was the elimination of calcific deposits. The study has

shown that for the 90% of treated patients the elimination of pain was total, while the

remaining 10% experienced a considerable decrease in pain.

 

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Our experience

B. Fascitis plantaris

Plantar fasciitis (more commonly called Heel pain) is commonly traced to an inflammation of

the base of the foot. People with vary flat feet or very high arches are also more prone to

plantar fasciitis. If you don’t treat plantar fasciitis, it may become a chronic condition.

Because plantar fasciitis changes the way you walk, you may develop symptoms of foot,

knee,hip and back problems. Pain is the main symptom of Plantar fasciitis.

This pain can be anywhere on the

underside of the heel. Commonly, one

spot is found as the main source of

pain. This is often about 4 cms forward

from the heel, and may be tender to

touch.

37 cases were examined of people suf-

fering from this pathology. The param-

eters used by our doctors were the fol-

lowing:

• Pressure: 2,5 Bar

• Frequency: 15 Hz

• Shots: 2.000

• Number of sessions done: 4 (weekly

• The study has shown that for the 73% of treated patients the result was considered to

be very good, for the 16% was considered with satisfactory results, and only 11% was

unsatisfactory

 

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Our experience

 

C. Epicondilite

Tennis elbow or lateral epicondylitis is an extremely common injury that originally got its

name because it is a frequent tennis injury, appearing in a large proportion of tennis players.

Nevertheless it commonly manifests in a vast proportion of people who do not play tennis at all.

25 cases were examined of people suffering from this pathology. The parameters used by

our doctors were the following:

• Pressure: 3 Bar

• Frequency: 10 Hz

• Shots: 3.000

• Number of sessions done: 3-4 (weekly)

• The study has shown that for the 75% of treated patients the result was considered to

be very good, for the 18% was considered with satisfactory results, and only 7% was

unsatisfactory.

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Main benefits of MALMThe strengths of our device

Main benefits of shock therapy

• Fast relief from pain – only 3–5 sessions needed

• Effective treatment –many patients feel less pain immediately after first treatment

• No anaesthesia needed –treatment with low energy shockwave therapy is well tolerated by

most patients

• No drugs needed – due to fast relief of pain

• Modern treatment modality that is recognized as leading edge by sportsmen and sports

medicine specialists

• Shock wave treatment is proven by many independent studies and has proven effective for

specific indications with success rates of 90%

• Short treatment time – only 15 minutes per session

• Treatment modality with wide range of applications

Main advantages of MALM

• Protocols: list of programmes with parameters suggested by our scientific consultant

• Help On line: all stored protocols are provided with information about how to use them and

trough the direct access to the therapy

• Selection by body area: by selecting the body area to be treated, access is guaranteed to a

list of localized protocols

• Selection by branches: by selecting the medical specialities (orthopedics/sport medicine/

aesthetic medicine), access is guaranteed to a list of specific protocols

• Low maintenance cost – fast return of investment

• Ergonomic suspended applicator - comfortable handling, light and ergonomic

• Interchangeable kit to be done easily by the operator, with no need to send the gun back to

the service dept.

• MP3: Therapy as a moment of relax. Relaxing songs can be listened to during the treatment,

with possibility to download your favourite music.

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Senator Medical CompanyStockholm, SWEDENScandiwave@senatormedical.se