Aims: To assess the efþcacy of repeated low-energy extracorporeal shock wave application (ESWA) for chronic plantar fasciitis in runners. Methods: 45 running athletes with intractable plantar heel pain were enrolled in a randomized single-blind trial with a parallel-group design and blinded independent observer, to evaluate the efþcacy of three applications of 2100 impulses of ESWA (Group I) compared with sham treatment (Group II). Follow-up examinations were done at six months, and at one year after ESWA. The primary efþcacy endpoint was reduction of subjectsñ self-assessment of pain on þrst walking in the morning on a visual analog scale (range, 0 Ð 10 points) at six months after shock wave application. Results: After six months self-assessment of pain on þrst walking in the morning as primary efþcacy endpoint showed a signiþcant reduction from an average 6.9 to 2.1 points in Group I, and from an average 6.9 to 4.7 points in Group II on the visual analog scale. The mean difference between both groups was 2.6 points (p= 0.0004; 95% CI: 1.3 Ð 3.9; power = 0.9). After twelve months pain on þrst walking in the morning showed a further reduction in both groups, to an average 1.5 points in Group I, and to 4.4 points in Group II (p < 0.0001). Conclusion: The current study showed that three treatments with 2100 impulses of low-energy ESWA were a safe and effective non-surgical method for treating chronic plantar fasciitis compared with sham therapy.

Aims: Primary aim of this study was to evaluate the inßuence of simultaneous local anesthesia on the clinical outcome after repetitive low-energy extracorpreal shock wave therapy (ESWT) for chronic tennis elbow. Methods: 51 patients were treated in a randomized single-blind international multicenter trial with a parallel-group design and blinded independent observer to evaluate low-energy ESWT with local anesthesia versus placebo ESWT with local anesthesia for patients with a chronic tennis elbow at three-month follow-up. 85% of patients of the verum group did not achieve good/ excellent results in the Roles & Maudsley score, they were offered once again application of the identical active treatment concept, this time without local anesthesia. 80% of the patients of the placebo group did not achieve good/excellent results, they were offered crossover therapy, i.e. identical active treatment with local anesthesia. Results: Reception of active therapy without local anesthesia resulted in excellent or good outcomes in 80% of patients of the original verum group at three-month follow-up, while application of active therapy with local anesthesia lead to good outcomes in 27% of the original placebo group (p= 0.0092, power= 0.8). Conclusions: Local anesthesia has a negative inßuence on the clinical outcome after repetitive low-energy ESWT for chronic tennis elbow.

Aims: To evaluate the inßuence of simultaneous local anesthesia (LA) on the clinical outcome after repetitive low-energy extracorporeal shock wave application (ESWT) for chronic plantar fasciitis. Methods: A prospective randomized observer-blinded pilot trial was performed in 48 painful heels (40 patients), having been resistant to various conservative treatment procedures for more than 6 months. 24 heels (20 patients) received 3 applications of 1500 impulses of 0.4 mJ/mm2 without LA (Group I)on 3 consecutive days with a conventional ultrasound-guided orthopaedic shock wave device (Sonocur plus, Siemens AG, Erlangen, Germany). 24 heels (20 patients) received 3 applications of 1500 impulses of 0.04 mJ/mm2 with LA on 3 consecutive days (Group II). Main outcome measure was the number of good or excellent outcomes needing no further therapy at three month follow-up. Secondary outcome measure was pain after weightbearing assessed on a visual analog scale (VAS; range, 0–10). Both groups did not differ signiþcantly before the start of the trial. Results: In Group I 16 of 24 (67%) heels reached a good or excellent result, in Group II 7 of 24 heels (29%) at three-month follow-up (p= 0.0199 for difference between groups; difference= 0.38; 95%CI= 0.09 to 0.66). Pain after weightbearing was 2.2±2.6 on a VAS in Group I, and 3.8±2.5 on a VAS in Group II (p= 0.0318 for difference between groups; mean difference= 0.16; 95%CI= 0.01 to 0.30). Conclusions: The simultaneous use of local anesthesia has a negative inßuence on repetitive low-energy shock wave therapy for chronic plantar fasciitis. Further prospective studies should be performed to evaluate more exactly the extent of this negative inßuence.

We have assessed the influence of somatisation on the outcome of treatment in 81 patients with chronic low back pain.

All, irrespective of whether treatment was surgical or conservative, had a significantly better (p < 0.001) health-related quality of life at follow-up on all but one scale of the SF-36. Lower health-related quality of life at follow-up correlated significantly with a higher tendency to somatise before treatment and at follow-up. A logistic regression analysis yielded two factors which predicted the outcome; somatisation (p < 0.001) and ‘doctor shopping’ (the number of physicians consulted before the present inpatient treatment, p < 0.001). These factors accurately distinguished between patients with good and those with poor outcomes in 82%. Patients with somatisation and ‘doctor shopping’ were at a higher risk for a poor outcome. The results show the relevance of somatisation in the outcome of treatment in patients with low back pain.