My latest X-ray report of the lumbosacral spine states the following:
“Sinistroconvex scoliosis of partially biconcave formed vertebral bodies of the lumbar spine segment. The L2 vertebral body is lower in height. According to Genant classification, it is grade 1. Intervertebral osteochondrosis. Reduced intervertebral space at L5-S1. Reduced joint spaces of the small joints from the L3 level downward. Sclerosis of the spinous processes. Reduced joint space of both SI joints with enthesopathy of the iliolumbar ligament.”
I noticed that your clinic has introduced a new device for piezoelectric focused shockwave therapy, which is extremely precise (focus 4×6 mm) and allows adaptation of penetration depth, so I assume that you may be able to offer appropriate therapy regarding my findings.
The X-ray findings of your spine indicate degenerative changes, also known as spondylosis. These changes result from a combination of three factors in varying proportions — genetic predisposition, age, and lifestyle. Since the first two components cannot be controlled or changed, the third remains available for intervention.
These interventions consist of two groups of procedures — learning proper sitting posture and lifting techniques, as well as regular exercise aimed at reducing stress on the damaged parts of the system during movement, thereby reducing or eliminating pain. All of this assumes that your primary issue is lower back pain, with or without radiation into the lower extremities. Additionally, during the recovery process, other methods from the arsenal of physiotherapy may also be used as supportive treatment.
Shockwave therapy is a powerful technology for the treatment of chronic tendon inflammation, tendon insertions, and other connective tissue injuries, along with several additional indications outside those described above. We also use it as a purely analgesic technique.
Around 20 years ago, studies were conducted on chronic lower back pain, and their results were not particularly good. Around the same time, we also attempted to apply shockwave therapy to chronic lower back pain in several of our patients, with ambivalent results. The treated area is rich in nerves, which do not respond well to this treatment method. Although we did not observe significant worsening in our clinical practice, the short-term improvements achieved did not justify the use of this method. As described earlier, there are better and more effective treatment protocols.
Additionally, the sound pulses of shockwave therapy cannot penetrate deeply enough to reach the intervertebral disc itself or its surrounding structures, which are the locations of most pathognomonic changes in spondylosis. On the other hand, the small joints of the spine are within reach of this therapy and often respond well to it. Therefore, in a smaller proportion of lower back pain cases caused partly or predominantly by pathology of the small spinal joints, this method may be considered as part of treatment, but not as the sole form of therapy.
