Kyiv, st. Raisa Okipnoy 10a Mon-Fri 9:00 - 19:00 Sat 9:00-17:00

Shock wave therapy. Comparison of treatment methods for heel spurs and osteochondrosis.

Shock wave therapy.

Comparison of treatment methods for heel spurs and osteochondrosis.

Diseases of the musculoskeletal system and peripheral nervous system are a very common problem today. Contrary to popular belief that these diseases are "age-related", they very often suffer from young people of working age. This pathology greatly impairs the patient's quality of life. After all, one of the most important functions of the body is disrupted - movement. The occurrence of these diseases is facilitated by such factors as sedentary work (in particular, working at a computer), poor training, the presence of injuries and overloads of the musculoskeletal system, psychoemotional stress.

Fortunately, many of these problems can be avoided by following healthy lifestyle guidelines. Sports and medical gymnastics, proper nutrition, proper selection of footwear, adherence to work and rest regimes will help maintain health and mobility for many years. However, what sounds good in theory is not always feasible in practice.

Chronic lack of time, overloading with work and household chores often does not leave the opportunity to engage in any kind of prevention. The scales "health-illness" are tilted in favor of the latter, and the patient is faced with quite understandable and logical questions:

There is no and cannot be an unambiguous answer to these questions. Everyone makes a decision based on many factors. In this review, we will focus on one, but very important aspect that influences the choice of treatment method - economic. Commercial trends in modern medicine cannot but affect the psychology of the doctor and the patient.

First of all, the modern patient is a client of a doctor and a consumer of medical services. Accordingly, he wants to achieve the fastest and highest efficiency of treatment for the most affordable payment. After all, today's realities are such that neither the state nor employers are interested in long-term treatment of sick workers. Therefore, patients with an attitude towards an active social and personal life are interested in a speedy recovery.

In this article, we will consider such common diseases as plantar fasciitis (commonly referred to as a heel spur) and osteochondrosis of the cervical spine, accompanied by pain. Despite the seeming "harmlessness" of these diseases, they cause a lot of trouble for doctors and patients. In turn, the costs of their treatment are also high.

Osteochondrosis - pain in the neck.

Treatment of osteochondrosis with shock wave therapy

For pain in the neck, conservative treatment is carried out mainly (without surgery). The most common causes are osteochondrosis and osteoarthritis of the cervical spine [11]. According to the clinical protocols of the Ministry of Health of Ukraine in the specialty "Neurology" (order of the Ministry of Health No. 487), the following treatment methods are used:

Medical therapy with non-steroidal anti-inflammatory drugs (NSAIDs) is used [1-3]. However, these funds have a number of side effects (see Table 1) and in some cases, in addition to them, drugs are prescribed that protect the mucous membrane of the gastrointestinal tract [1]. Also, the treatment regimen includes drugs that relax spasmodic back muscles (muscle relaxants) [4], B vitamins [5,6], therapeutic blockade, with the introduction of local anesthetics in combination with glucocorticoids [1,2,6], vascular drugs [1 , 6]. In the treatment of chronic pain syndrome, additional groups of drugs can be used, prescribed if necessary [1,2,4-7].

Among non-pharmacological techniques, manual therapy [12], reflexology (in particular, acupuncture) [8, 14, 22], therapeutic massage [14, 15], as well as various physiotherapeutic methods [14, 23] are actively used. Among them, we can mention laser and magnetic laser therapy [10], ultrasound, phonophoresis, amplipulse, myostimulation and vibration therapy [14, 17, 23], etc.

Unfortunately, not all of these physiotherapeutic methods are used to treat diseases of the musculoskeletal apparatus have the necessary scientific evidence base [9]. Special attention should be paid to the method of shock wave therapy, which has been used for over 20 years in European countries in various fields of medicine (sports, rehabilitation, etc.) and the effectiveness of which has been proven in scientific studies [9, 13, 16, 17, 19- 21].

Heel spur - heel pain.

пяточная шпора лечениеPlantar fasciitis. Heel spur.

As for the heel spur, its treatment has its own characteristics. This syndrome is often characterized by a persistent course [25]. One of the main methods is the appointment of various medications: local administration of glucocorticosteroids to the affected area, as well as the use of various forms of non-steroidal anti-inflammatory drugs (local, oral, parenteral) [24, 26]. Methods of conservative treatment using rest, orthotics, X-ray therapy and other physiotherapeutic techniques (in particular, laser therapy and rethngenotherapy [25, 27, 28]) are described.

One of the most effective methods in the treatment of heel spurs is the method of shock wave therapy (SWT), which avoids surgical intervention, shows pronounced clinical efficacy in various fields of application: sports medicine [18, 19, 29], in sanatorium and restorative treatment [17, 30]. Shock wave therapy can be used as an independent method of treatment (monotherapy) and in combination with other techniques, which enhances the clinical effect [30]. Thus, the scientific evidence base of shock wave therapy as an effective and promising method of treating various diseases of the orthopedic and neurological profile is very extensive today.

The main symptom that worries the patient with any disease is pain. However, the changes in the body that led to the onset of pain can be eliminated provided that causal factors such as sedentary work, wearing the wrong shoes, psycho-emotional stress, etc. are absent. Since these factors cannot be eliminated in most cases, the process becomes chronic.

We have to resort to repeated courses of treatment during exacerbations of diseases, and the side effects of medications tend to increase [3].

When choosing a treatment method, a significant nuance is a high safety profile and minimal harm to the body.

In this review, we did not consider the cost of treating side effects from different treatments. However, it is obvious that it is very significant and may even exceed the cost of treating the underlying disease.

Tables 1 and 2 include a comparative analysis of drug and non-drug treatments for cervical osteochondrosis and heel spurs.

The purpose of the analysis was to compare the time and cost of using each method to obtain a clinical effect, taking into account the risks to the patient.

The most commonly prescribed drugs by general practitioners and neurologists were included in the cost estimate of drug therapy. The average prices for pharmacies in Kiev were taken into account both for drugs from foreign manufacturers and for drugs of domestic analogues as of July 2015 (

The prices obtained from the Internet at randomly selected private clinics in Kiev were taken as the basis for assessing the cost of non-drug treatment methods. The peculiarities of the application of each technique are described taking into account the literature data and our own observations. In the case of the heel spur, we did not include the cost of orthopedic insoles in the table, since it is calculated individually in each specific case.

Cervical osteochondrosis


Drug treatment

Non-drug treatment


Drug courses

Blockade with local anesthetic and corticosteroids

Shockwave therapy



Manual therapy

Physiotherapy methods

Course duration 7-14 days for inpatient treatment, 1-1.5 months for outpatient treatment 3-5 days 1-1.5 months 10-12 days 10-14 days Several weeks to 2-3 months

10-15 days

Repetition frequency

2 times per year

With exacerbations (from 2 times a year)

No more than 1-2 times a year 2 times per year

2 times per year

From 1-2 courses per year to individual need

2-3 times a year

The severity of the effect Moderate to severe Moderate to severe Moderate to severe Moderate Mild to moderate Moderate Mild to pronounced
Duration of effect 3-4 months Individual From 6 months From several days to several months 2-3 months 4-6 months 3-4 months
Onset of effect During the course of treatment After 1-2 blockades After 1-2 sessions After 2-3 sessions After 4-5 sessions After 3-4 sessions After 1-3 sessions
Side effects Moderate to severe: pathology of the gastrointestinal tract (risk of gastritis, gastrointestinal bleeding and perforation, gastric ulcer and 12 duodenal ulcer), hematopoiesis disorders, increased blood pressure, toxic effect on the liver and kidneys, allergic reactions, etc. The effect of treatment may decrease over time Moderate: toxic and allergic reactions, punctures of the body cavities and the membranes of the spinal cord, damage to blood vessels and nerves with a needle, inflammatory local reactions, fluctuations in blood pressure, tachycardia Practically absent Rarely: infectious and inflammatory skin changes in the area of needle insertion, fracture or curvature of the needle with damage to adjacent tissues, very rarely: autonomic reactions (dizziness, sweating, nausea, fluctuations in vascular tone and fainting) with strong exposure Practically absent Uncommon: rupture of ligaments and muscles, blockage or displacement of the vertebrae, the development of hypermobility of the spine, infringement of the intervertebral hernia, fractures of the ribs, vertebral processes, ischemic stroke. The likelihood of side effects is highly dependent on the skill of the chiropractor. Practically absent
Patient risk Moderate Moderate Minimum Minimum Minimum Moderate Minimum
Time consuming Temporary incapacity for work in case of inpatient treatment (up to 14 days) For outpatient administration - the patient is able to work, up to 10 minutes per 1 block 15-20 minutes for 1 session once a week, the patient leads a normal life From 30 minutes to several hours depending on the specific method 20-30 minutes for 1 session daily or every other day 15-30 minutes with a break of 48 hours between sessions 10-15 minutes for 1 session for most techniques
Full course cost (approximate price range) 700-3000 UAH + additionally from UAH 1500 for a course of chondroprotectors and symptomatic therapy Price for 5 blockades: 250-500 UAH + 100-1000 UAH. and more for drugs 1000-2800 UAH 1000 – 2800 UAH 1200 – 2500 UAH 1500 – 4000 UAH 500 – 2000 UAH
Course cost (average) UAH 1850 (excluding chondroprotectors) 1000 UAH 1900 UAH 1900 UAH 1850 UAH 2750 UAH 1250 UAH
Average annual cost of treatment 3700 UAH (excluding chondroprotectors) UAH 2000 (in the treatment of exacerbations 2 times a year) 2800 UAH 3800 UAH 3700 UAH 4100 UAH 2500 UAH


Heel spur (plantar fasciitis)


Drug treatment

Drug-free treatment


Drug courses

Blockade with local anesthetic, lidase and corticosteroids

Shockwave therapy

Physiotherapy techniques


Course duration

7-14 days (for injections), several weeks (for tablets and gels) 3 weeks to 1.5 months 1-2 months 10 days 10-14 days

Repetition frequency

2 times a year or more 2 times a year or more No more than 1-2 times a year 1-2 times a year 2 times per year

The severity of the effect

Low Moderate Expressed Moderate Mild to moderate

Duration of effect

Short-term, up to several weeks Individual, high relapse rate From 6 months 3-4 months 2-3 months

Onset of effect

Individual, more often after 5-7 injections of NSAIDs After 2-4 injections After 1-2 sessions Individual, more often after 3-4 sessions After 4-5 sessions

Side effects

Moderate to severe: pathology of the gastrointestinal tract (risk of gastritis, gastrointestinal bleeding and perforation, gastric ulcer and 12 duodenal ulcer), hematopoiesis disorders, increased blood pressure, toxic effect on the liver and kidneys Severe: destruction of the calcaneus and soft tissues of the foot, GCS have a detrimental effect on the mucous membrane of the digestive tract Absent Practically absent Practically absent

Patient risk

Moderate Moderate Minimum Minimum Minimum

Time consuming

Temporary incapacity for work in case of inpatient treatment (up to 14-21 days) 3-5 injections with an interval of 1 time per week 10-15 minutes for 1 session, once a week 10-15 minutes for 1 session for most techniques 15-30 minutes for 1 session daily or every other day

Full course cost (approximate price range)

700-3000 UAH + about 1000 UAH for symptomatic therapy Price for 5 blockades: 250-500 UAH + 100-1000 UAH. and more for drugs 1000 – 2500 UAH 500 – 2000 UAH 500 – 1500 UAH

Course cost (average)

1850 UAH 1500 UAH 1750 UAH 1250 UAH 1000 UAH

Average annual cost of treatment

3700 UAH UAH 3000 (in the treatment of exacerbations 2 times a year) 2625 UAH 2500 UAH 2000 UAH

In conclusion, it should be noted that this review in no way pretends to comprehensively cover the specifics of the medical services market. The data in the tables are indicative only. We sincerely hope that by weighing the cost factors, as well as the safety, reliability and effectiveness of each method, both patients and doctors will be able to make the right choice.

The article is also intended for those patients who find it difficult to navigate in various medical approaches to the treatment of heel spurs and cervical osteochondrosis. It must be remembered that the main factors at the head of any method of treatment should be - efficiency and safety (no side effects).

Taking into account the transition of medicine to market conditions of existence, the economic feasibility of the patient's costs also matters. The Awatage Medical Center will continue to analyze methods of treating other diseases, not as advertising, but for the educational purpose of those who need it. The main argument in proof of our objective approach in presenting the material is the fact that the specialists of the Awatage Medical Center for Shock Wave Therapy always refer to authoritative scientific studies of both domestic and foreign doctors - at the end of each article there is a large list of used literature.

Read, think, analyze, make the right choice ... And be healthy.

Article author:

Kuts K.V.

doctor neurologist MC "Awatage"

Список литературы:

  1. Левин О. С. Диагностика и лечение вертеброгенной шейной радикулопатии / О.С. Левин // Неврология/ревматология (приложение Consilium Medicum). – 2010. - №1. – С. 59-63.
  2. Левин О. С. Диагностика и лечение боли в шее и верхних конечностях. / О.С. Левин // Рус. мед. журн. 2006; 9: 713–9.
  3.  Современные противоболевые средства в аптеке / Л. П. Ананьева, Е. В. Подчуфарова. - Москва : МЦФЭР, 2005. - 156, [2] с. : ил. ; 20 см. - (Приложение к журналу "Новая аптека" ; 3-2005) (Библиотека первостольника). - Библиогр.: с. 149-155.
  4. Хабиров Ф. А. Боли в шее и спине (диагностика, клиника и лечение) / Хабиров Ф. А.,                        Хабирова Ю. Ф // Практическая медицина. – 2012. -  №2 (57). -  С. 23-28.
  5. Котова О. В. Часто встречающиеся болевые синдромы в неврологической практике: причины, диагностика и лечение боли в спине и шее. / О. В. Котова // Русский медицинский журнал. – 2013. - №17. – С. 902-906.
  6. Исайкин А. И. Боли в шее: причины, диагностика, лечение. / А. И. Исайкин // Неврология, нейропсихиатрия, психосоматика. – 2011. - №4. – С. 94-98.
  7. Исайкин А. И. Боль в шейном отделе позвоночника. / А. И. Исайкин // Трудный пациент – 2012. - Т.10, №7. -  С. 36-44.
  8. Сафин Ш. М. Персонифицированный подход к немедикаментозному лечению шейных болевых синдромов. / Ш. М. Сафин, О. В. Миняева, А. Ю. Новиков // УДК 617.539:616.711.1-009.7-07-085.814.1
  9. Шарабчиев Ю. Т. Использование экстракорпоральной ударноволновой терапии в травматологии и ортопедии. / Ю. Т. Шарабчиев, Т. В. Дудина, О. Ю. Полянская // Международные обзоры: клиническая практика и здоровье. – 2013. - № 3. – С. 16-34.
  10. Малиновский Е. Л. Актуальные проблемы геронтологии и способы их решения с использованием лазерных терапевтических технологий. / Е. Л. Малиновский // Российский вестник фотобиологии и фотомедицины. – 2011. - №5. – С. 93-123.
  11. Пилипович А. А. Боль в шее: причины и подходы к лечению. / А. А. Пилипович, А. Б. Данилов, С. Г. Симонов // Русский медицинский журнал. – 2012. – Специальный выпуск. Болевой синдром. – С. 18-22.
  12. Фролов В. А. К вопросу о некоторых особенностях головных болей, важных с точки зрения мануальной терапии. / В. А. Фролов, И. Г. Лугова // Мануальная терапия. -  2007. - № 4(28). – С. 61-73.
  13. Лечение миофасциального синдрома трапециевидной мышци методом радиальной ударно-волновой терапии / Сикорская М.В., Ременюк Ю.К./
  14. Попелянский Я. Ю. Ортопедическая неврология (вертеброневрология) : руководство для врачей / Я. Ю. Попелянский. — 5-е изд. – М. : МЕДпресс-информ, 2011. – 672 с.: ил.
  15. Клебанович М. М. Классический лечебный массаж. Самоучитель (+ DVD с видеокурсом). – СПб.: Питер, 2010. – 224 с.: ил.
  16. Ивченко А. В. Использование экстракорпоральной ударно-волновой терапии в лечении хронического болевого синдрома. / А. В. Ивченко, В. Н. Коротнев, В. А. Родичкин, Т. С. Антонова, Б. С. Рудой // Спортивна медицина. – 2013. - №1. – С. 26-28.
  17. Мачула Г. Б. Радиальная ударно-волновая терапия в комплексном санаторном лечении заболеваний опорно-двигательного аппарата. / Г. Б. Мачула, О. В. Ульянина, П. Д. Копылов // Кремлевская медицина. Клинический вестник. – 2013. - № 4. – С. 63-65.
  18. Ульянов А. А. Пьезоэлектрическая дистанционная ударно-волновая терапия заболеваний опорно-двигательного аппарата в практике врача баскетбольного клуба. / А. А. Ульянов // Спортивная медицина: наука и практика. – 2013. -  №2. – С. 51-54.
  19. Шель Я., Лорер Г. Ударно-волновая терапия в травматологии и спортивной медицине. //
  20.  Marcus Gleitz. Myofascial syndrome & trigger points. Shock Wave Therapy in practice. / Level 10., 1st edition. – 2011.
  21. Heinz Lohrer & Ludger Gerdesmeyer. Multidisciplinary medical applications. Shock Wave Therapy in practice. / Level 10, 1st edition. – 2014.
  22. Мачерет Е. Л., Самосюк И. З. Руководство по рефлексотерапии. – 3-е изд., перераб. и доп. – К.: Выща шк., 1989. – 479 с.
  23. Гурленя А. М. Физиотерапия в неврологии / А. М. Гурленя, Г. Е. Бабель, В. Б. Смычек – М.: Мед. лит., 2008. – 296 с., ил.
  24. Шостак Н. А. Патология мягких тканей области голеностопного сустава и стопы – диагностика и лечение / Н. А. Шостак, А. А. Клименко // Русский медицинский журнал. Ревматология. – 2011. - №10. – С. 618-623.
  25. Павлов В. П. Консервативная ревмоортопедия: болезни мягких тканей (часть ІІІ) / В. П. Павлов // Современная ревматология. – 2009. - №3. – С. 11-18.
  26. Шутов Ю. М., М. З. Шутова, В. Н. Кокшарова. Оптимизация лечения пяточных фасциитов и ахиллитов.
  27. Качковский М. А. Лазеротерапия в комплексном санаторно-курортном лечении при профессиональных и экологически обусловленных заболеваниях /  М. А. Качковский, Н. Е. Чернова // Известия Самарского научного центра Российской академии наук. – 2010. – т. 12, № 1(7). – С. 1834-1837.
  28. Ананьева П. В. Лучевая терапия дегенеративно-дисторфического процесса пяточной кости (пяточный остеофит) / П. В. Ананьева, С. В. Полушкин, И. А. Костина // Bulletin of Medical Internet Conferences (ISSN 2224 - 6150). – 2014. – Volume 4. Issue 4.; 282.
  29. Семевский А. Е. Новейший опыт применения терапии ударными волнами в различных областях медицины // А. Е. Семевский, В. В. Чистов, Д. Д. Серов, М. С. Баранов // Доктор.Ру. – 2009. - №7(51). – С. 32-40.
  30. Петкевич Е. А., Родионов М. М. Ударно-волновая терапия как способ улучшения качества жизни при ортопедических заболеваниях. //