Information for medical professionals 2018: Rehabilitation, part 5

Treatment and rehabilitation measures at Firda Physical Medicine Centre

We have a set of sub-goals to help us achieve our main objectives for a patient's condition.

  • To create a realistic relationship between his or her expectations and the likely effect of measures taken;
  • Discuss in depth the performed diagnostics, as well as diagnostic measures not as yet tried, for example:
    • Further CT and MRI 3T scans in positions that could be more usefully related to the patient's trauma, according to clinical testing;
    • Arterial venography with a contrast agent, in which we check the vascular system;
    • At these two examinations, do we position the patient's neck and head in the direction of the injury, as known from their case history and clinical testing?
  • Important: the time aspect - it can all take a long time. Many obstacles are likely to arise during the course of treatment and rehabilitation;
  • Sub-goals as against lesser findings from the clinic: how should we help the patient and what should he/she do herself? How much is it likely to cost? How can we plan the patient's time frame in relation to periods spent at the clinic, duration, content and frequency? Who can follow up on the patient when they are at home and training? We need to be in contact with the patient's local GP and ideally with any specialist health care, if this should become necessary. When a patient visits the clinic for the first time these subjects are raised several times.
  • What do we do if a home period has not met with our expectations? What occurred that caused the setback? Is there anything to be learned from measures that have not worked? What must we do to ensure better progress?

Methods of stimulating tissue regeneration

Focused shockwave treatment (fESWT) and laser therapy (Low-Level Laser Therapy - LLLT)

Focused shockwave treatment may be used both for the purposes of diagnosis, localizing areas of tissue damage and inflammation, as well stimulation of tissue regeneration. Focused shockwaves, or cell cavitation, changes cell permeability in a cell area with too high tissue acidity. Stimulation with shockwaves has also a direct impact on the nocireceptors (pain sensors), where it inhibits impulse activity. In addition, shockwaves stimulate the regeneration of peripheral nerves (ref. 1). Focused shockwaves increase angiogenesis related factors (endothel nitric oxide synthesis and vascular endothel growth factors, as well as increasing the synthesis of antigens in the cell core) (ref. 2,3). Focused shockwave treatment enhances tissue regeneration and clearly reduces pain (ref. 4,5). It has a mechanical influence on cells. Appropriate mechanical cell cavitation may help against mucoid substance production - part of the scar tissue attributed to micro trauma and processes of inflammation and which slows down the regeneration of tendons and ligaments (ref. 6). At Firda Physical Medicine Centre we always use ultrasound to direct our shock- wave treatment, thereby increasing precision and ensuring better results from the treatment (ref. 7).

We use low dosage focused shockwaves on the neck - laterally on the arch joints - and backwards towards spinos, but never over glands, large blood vessels or nerves/nerve networks. The strength of the neck treatment, side towards dorsal side, lies at max. 4 VAS.

Here at Firda we make use of Laser Class 4 treatment. The laser treatment has shown itself capable of reducing pain, it increases micro circulation in the tissue, reduces the level of inflammation and also reduces the oxidative stress level in the tissue (ref. 8).

Specific training therapy

Specific testing and training are important. We focus on posture, the function of joints and soft tissue, and the training of muscle strength with well-coordinated exercises. We test for fitness and make an individual fitness plan. We also make a plan for training at home, as well as following up patients by telephone and email.


1. Extracorporeal shock-wave therapy in the management of chronic soft-tissue conditions.
Speed CA. J Bone Joint Surg Br. 2004 Mar;86(2):165-71.
2. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits.
Wang CJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS, Yang LC. J Orthop Res. 2003 Nov;21(6):984-9.
3. Molecular basis for pain mediating properties of extracorporeal shock waves.
Hausdorf J, Schmitz C, Averbeck B, Maier M. Schmerz. 2004 Dec;18(6):492-7.
4. Upregulation of VEGF in subchondral bone of necrotic femoral heads in rabbits with use of extracorporeal shock waves.
Ma HZ1, Zeng BF, Li XL. Calcif Tissue Int. 2007 Aug;81(2):124-31.
5. Extracorporeal shockwave therapy in musculoskeletal disorders.
Wang CJ. J Orthop Surg Res. 2012 Mar 20;7:11.
6. The efficacy of shock wave therapy in patients with knee osteoarthritis and popliteal cyamella.
Chen TW1, Lin CW1, Lee CL2, Chen CH2, Chen YJ1, Lin TY1, Huang MH3. Kaohsiung J Med Sci. 2014 Jul;30(7):362-70.
7. The efficacy of ultrasound-guided extracorporeal shockwave therapy in patients with cervical spondylosis and nuchal ligament calcification.
Lin TY1, Chen JT1, Chen YY1, Chen TW1, Lee CL2, Chen CH3, Huang MH4. Kaohsiung J Med Sci. 2015 Jul;31(7):337-43.
8. Low-Level Laser Therapy (LLLT) in Dystrophin-Deficient Muscle Cells: Effects on Regeneration Capacity, Inflammation Response and Oxidative Stress.
Macedo AB1, Moraes LH1, Mizobuti DS1, Fogaça AR1, Moraes Fdos S1, Hermes Tde A1, Pertille A2, Minatel E1. PLoS One. 2015 Jun 17;10(6).


Please note: From Jan 1st 2018 we no longer accept credit cards. Only debit cards can be used.

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