Pulse wave therapy contraindications. Shock wave therapy - cost and reviews

To treat diseases of the musculoskeletal system, doctors at the Edem Medical Center have been using medical technology - extracorporeal shock wave therapy - since 2008. We work on Swiss DolorClast machines, Switzerland. These devices are the gold standard in the field of shock wave medicine!

Our doctors

Tatarinov Oleg Petrovich- neurologist with more than 30 years of experience. Since 2008 professionally uses the method of shock wave therapy (SWT) for acute diseases of the central nervous system: spinal chondrosis, radiculitis, including disc herniation, post-traumatic neuritis, as well as diseases of the musculoskeletal system - arthrosis, arthritis, coxarthrosis, epicondylitis, sports injuries. This method is used for diabetic feet and trophic ulcers of various etiologies. Has a professional level of shock wave therapy treatment. Regularly participates in all-Russian and international seminars and conferences on diagnostics and treatment in neuralgic practice.

Beltikov Anton Alexandrovich- traumatologist-orthopedist, physiotherapist, rehabilitation specialist. Shock wave therapy specialist. Work experience 10 years. He has a specialization in “Medical rehabilitation after damage to the musculoskeletal system”, in “Traumatology and orthopedics in disaster medicine”. For more than 5 years he has been involved in the treatment and rehabilitation of patients with diseases of the musculoskeletal system. Proficient in all methods of conservative and surgical treatment. Performs all types of blockades, intra-articular injections, plasma lifting. He specializes in joint orthosis, kinesiotaping of joints and soft tissues. Performs selection and correction of individual orthopedic insoles.

Osipova Liliya Lvovna- traumatologist-orthopedist, surgeon, ultrasound diagnostics doctor. Shock wave therapy specialist. Work experience over 40 years. In 1979 she graduated from Leningrad medical school them. I.P. Pavlova. Engaged in the treatment and rehabilitation of patients with diseases of the musculoskeletal system. Proficient in all methods of conservative and surgical treatment. Performs all types of blockades, intra-articular injections, plasma lifting. Professionally engaged in treatment using shock wave therapy acute diseases central nervous system: spinal osteochondrosis, including disc herniation, and what about diseases of the musculoskeletal system, such as arthrosis, arthritis, coxarthrosis, epicondylitis.

Cost of shock wave therapy treatment

UVT service Swiss DolorClast® device, Electro Medical Systems S.A. (Switzerland)	Cost, rub.
Consultation with a doctor, specialist	for free
The first procedure in a course of shock wave therapy treatment of one anatomical zone, any tip according to indications (2000-2500 pulses)	500
SWT procedure (2500 pulses)	1200
SWT procedure for the treatment of heel spurs (2000 pulses)	1000
SWT procedure for the treatment of heel spurs "Power+" handpiece (2000 pulses)	1300
SWT procedure for more than three anatomical zones simultaneously (one zone 2500 pulses)	1100
UHT procedure "Power+" handpiece (2500 pulses)	1700
SWT procedure with "Power+" handpiece more than three anatomical zones simultaneously (one zone 2500 pulses)	1400
Handpiece "Power+" 1.5 anatomical zones simultaneously (one zone 2500 pulses)	2500
"Power+" handpiece for the treatment of prostatitis (2500 pulses)	2000

Using shock wave therapy we treat:

arthrosis of the joints
arthrosis of the foot
deforming arthrosis of the joints
arthritis of the joints
back pain
osteochodrosis
coxarthrosis
spinal disc herniation
heel spur
osteoarthritis
intervertebral hernia
epicondylitis (tennis elbow)
consequences of injuries

sports injury
spinal diseases
"bones" in the foot area
glenohumeral periarthritis
prostatitis
knee arthritis
false joints
diseases of tendons and ligaments
muscle pain
poor healing of fractures
shoulder pain
Dupuytren's contracture
salt deposits in joints, tendons and muscles

Shock wave therapy is a physiotherapeutic treatment method based on short-term exposure to a shock wave of a certain frequency on the affected area. As a result of exposure to high-energy wave vibration, pain, swelling and muscle spasm are relieved, and blood circulation at the site of exposure is improved. Loosening of salt deposits and fibrous foci occurs. In parallel with this, an active mechanism for renewing affected tissues is activated. Usually, positive result noticeable after the first procedure, not to mention a full course of treatment. These almost instantaneous results include:

increased metabolic rate;
local anesthesia during the procedure;
blood flow increases;
stimulation of regenerative processes;
restoration of elasticity and structure of ligaments;
pain relief;
restoration of blood supply to tissues;
improvement of microcirculation in tissues during and after the procedure;
microcrystals of calcium salts and fibrous areas are loosened.

The value of this technique is its simplicity and high effectiveness of treatment, reaching 95-98%!

Shock wave therapy is often an alternative to surgery and is much more effective than other conservative methods of treating musculoskeletal diseases. Over the past 30 years, shockwave therapy has been used in many countries, showing good results in terms of patient recovery.

The first sessions of shock wave therapy are usually accompanied by slight pain, which may continue to occur after the procedure is completed. However, pain decreases over time from one session to another. As a result, he disappears completely. In 95% of cases, a positive treatment result was recorded; as for complications, they do not arise. This indicates the excellent prospects of shock wave therapy for the treatment of diseases of the musculoskeletal system.

If you are tired of pain or limited in activity, we are happy to help you. Modern technologies and ours professional excellence will give you back fullness of movement and joy of life.

Live without pain!

With wishes for a safe recovery, the team of the EDEM Medical Center

We serve you by helping you restore your health.

Always happy to help!
We work from 9 to 21 hours, seven days a week.

UVT or shock wave therapy- relatively new technology treatment of chronic, painful pathologies of the musculoskeletal system. The essence of shock wave therapy is the impact on tissues of shock waves of supersonic frequency. These waves represent a powerful energy pulse that creates a pressure of 5-100 MPa over an ultra-short period of time - approximately 10 milliseconds.

Shock wave therapy is a relatively new technology for the treatment of chronic, painful pathologies of the musculoskeletal system.

Shock wave therapy is similar to lithotripsy, which uses acoustic shock waves to break up kidney stones without requiring surgery.

Lithotripsy has been known for several decades. In treating hundreds of thousands of patients, it was discovered that many who underwent the procedure also experienced relief from joint pain. Studies have shown that shock waves can have a healing effect on other types of tissue.

Firstly, the wave produces mechanical pressure and, as a result, stretches the cell membranes of the affected tissue. The permeability of cell membranes increases, thereby stimulating blood microcirculation and metabolism, which, in turn, activates regenerative (restorative) processes and promotes the subsequent dissolution of pathological calcific deposits.

Secondly, the pressure front of the shock wave creates so-called cavitation bubbles - small empty cavities. They tend to expand to maximum size, and then burst, creating a counterforce. In the tissues of the body, this force is enough to destroy the calcifications.

Third, bursting cavitation bubbles create smaller, secondary energy waves known as microjets. They complement and continue the destructive effect on pathological formations.

In addition, the shock wave affects neurons, interrupting the transmission of pain impulses, and provokes the production of endorphin, a hormone known for its ability to reduce pain and influence the emotional state.

For more information about the shock wave therapy method, watch the video.

In addition to the destruction of pathological calcifications, UVT stimulates osteoblasts - cells responsible for the healing of bone tissue, and fibroblasts, capable of regenerating connective tissue cells: tendons, ligaments.

Where is shock wave therapy performed?

Or wear and tear of the joints - a disease that leads to the destruction of articular cartilage due to various factors: acute inflammatory process, metabolic disorders, hormonal imbalance, old age, etc. Up to 80% of the world's population suffers from this disease to varying degrees of severity, so it is considered the third most common after cardiovascular diseases and oncology. Pain, crunching, decreased joint mobility are the most unpleasant symptoms of arthrosis.

Arthrosis or wear and tear of the joints is a disease that leads to the destruction of articular cartilage

Left unattended, arthrosis can lead to deformation, complete destruction of the joint, and as a result, disability.

Since the lower limbs most often suffer due to high load, shock wave therapy of knee joints– the most common procedure during treatment. It helps to visibly relieve pain and contribute to the launch of mechanisms for the regeneration of damaged tissue cells. Shock wave therapy of the knee is aimed not only at the breakdown of calcium salts, but also at areas of fibrosis that have arisen during the disease process.

Shock wave therapy for bunions is the next most popular treatment among patients. In addition to the fact that an ugly “bump” on the foot looks unsightly and makes it difficult to choose shoes, this pathology leads to severe pain when walking. In fact, this is not a growth, but a deviation towards the metatarsal bone that forms the foot, and a simultaneous deformation of the big toe outward. An incorrect angle between the bones causes the bone to protrude.

Shock wave therapy for the bunions in your feet will improve your foot condition in just a few sessions.

Several sessions of shock wave therapy will help break up the calcifications that cause the bones to deform and put the foot in order.
Shock wave therapy may have its own indications and contraindications.

What does shock wave therapy treat?

Shock wave therapy is widely used in orthopedics, physiotherapy, sports medicine, and urology.

Its main purpose is quick relief. pain syndrome, restoration of motor functions of joints.

This non-invasive (non-surgical) treatment method, which does not require pain relief, makes it an ideal therapy for accelerating recovery, treating various causes of acute or chronic pain.

Shock wave therapy is widely used in orthopedics, physiotherapy, sports medicine, urology

Indications for shock wave therapy:

chronic diseases caused by the destruction of connective tissue: arthrosis I and II degrees, plantar fasciitis, epicondylitis, tendonitis or tendinosis;
rehabilitation after injuries: pain in muscles, joints, areas of old fractures or;
osteocondritis of the spine;
valgus deformity of the toe (the so-called “bunion”);
emerging or already formed false joints;
avascular necrosis – death of some areas of the bone;
pain after or after installing plates on bones damaged due to fractures.

Contraindications for shock wave therapy:

malignant neoplasms (oncology);
pregnancy;
infectious and inflammatory processes in the acute stage;
blood clotting disorder;
implanted pacemaker.

In addition, shock wave therapy of joints is not performed on patients under 18 years of age, so as not to affect the developing young skeleton.

Also, procedures are contraindicated in areas bordering organs containing gases - lungs, intestines; shockwave therapy is not performed on the skull area.

As a mechanical method, shock wave therapy can cause side effects - swelling, redness, or slight bruising. Typically, these undesirable manifestations disappear after 7–10 days and are not an indication for interrupting the course of procedures.

Shock wave therapy techniques will be effective if the following conditions are met:

appropriate diagnosis when the patient's symptoms and causes of illness respond appropriately to shock wave therapy;
simpler, cheaper treatment options are ineffective;
as an alternative to surgery or other invasive methods;
There are no known contraindications to the procedure.

In medicine, there are many methods for treating pathological processes that affect the functions of the musculoskeletal system. But along with drug treatment, physiotherapy, surgical interventions and other techniques, a relatively new one has appeared - shock wave therapy or SWT.

The method of using shock wave therapy involves influencing inner fabrics the body with special shock waves that reach the target due to the special frequency of their reproduction.

Waves are energy pulses capable of creating pressures ranging from 5 to 100 megapascals (MPa) in less than 10 milliseconds. It has been proven that the use of shock wave therapy has a beneficial effect on joints in various parts of the human body. In addition, the technique has a positive effect on other types of tissue, that is, UVT is not only highly safe, but also has a positive effect on the course of all biological processes in the body.

The effect of shock waves on the body consists of several functions; to understand this, let us consider the mechanism of action of shock waves on tissue in more detail:

Shock wave high frequency passes freely through soft tissues and biological fluids of the human body. But due to the fact that the density of cartilage and bone tissue is higher, upon reaching them, the waves are not able to pass further, they are delayed and have a therapeutic effect.
The principle of action of high-frequency shock waves is similar to the action of lithotripsy, which is used to “break up” kidney stones. In the case of shock wave therapy, the so-called salt deposits (calcifications and ossifications), the formation of which is responsible for many pathologies of the motor system, are destroyed. This treatment method is based on crushing the mentioned deposits, which then resolve on their own.
In addition, in areas exposed to UVT, a beneficial effect is not only on the joints. After the procedures, doctors note a local acceleration of metabolic processes in tissues, an improvement in blood circulation, and regenerative abilities at the cellular level.

In other words, in response to the impact of low-frequency shock waves, nerve endings are irritated and “dormant” biological processes are stimulated. Thanks to this effect, neurons block pain impulses (an analgesic effect occurs), swelling and inflammation in damaged areas are also reduced, etc.

The effect of shock wave therapy is amazing; according to statistics, the result is observed almost after the first or second session of shock wave therapy, significant improvements are noted. Patients experience a decrease in pain and positive dynamics during various pathological processes.

In addition, theoretically, shockwave therapy has a positive effect not only on diseases of the joints and the musculoskeletal system as a whole, but also on other pathologies.

Indications and contraindications

Orthopedic doctors began using shockwave therapy in the 90s of the last century. During this time, it has found application in such areas of medicine as orthopedics, traumatology, urology and even cosmetology.

At the same time, orthopedic doctors have discovered that shock wave therapy has a number of indications and contraindications that you need to be aware of.

If we talk about pathological processes in which the use of the technique is indicated:

With progressive arthrosis of large articular joints, for example, the knee joint. In this case, treatment with shockwave therapy allows you to fight destructive-dystrophic lesions of the cartilage tissue of the joints, relieve pain and activate recovery processes.
With the development of osteochondrosis in all parts of the spine. Shock wave therapy stops the pathological process that initially affects intervertebral discs, and then bone tissue.
Treatment of heel spurs is also possible with shock wave therapy. The pathology is caused by injury to the fascia, which then becomes overgrown with osteophyte. SWT allows you to “break up” the growth and relieve the severe pain that occurs with this disease.
With a hernia of the spine - including with inward protrusion.
Shock wave therapy is prescribed for ankylosing spondylitis, which is accompanied by calcification of the articular ligaments.
The use of shockwave therapy is possible during rehabilitation and physiotherapy, which are carried out after physical injuries (bruises, punctures, fractures, etc.).
Among the pathologies affecting the spine and which can be cured by shock wave therapy, spondyloarthrosis, scoliosis, kyphosis, lordosis, and protrusions can also be identified.
There are also a number of yet unmentioned pathological processes that affect the joints of the body in general. We are talking about synovitis, epicondylitis, pseudarthrosis, glenohumeral periarthritis, etc.

UVT is used in most cases to relieve joint pain, as well as the need to restore back health.

There are few contraindications to shock wave therapy, however, ignorance of them can seriously harm the human body. Pathologies of the musculoskeletal system cannot be treated in the following cases:

If the patient is diagnosed with a bleeding disorder.
At oncological diseases accompanied by malignant neoplasms.
Wave treatment cannot be carried out if a person has acute infectious diseases.
Exposure to shock wave therapy is contraindicated during pregnancy and breastfeeding.
Procedures should not be carried out on those areas of the skin that are affected by purulent ulcerations.
If the patient has a pacemaker, therapy is also impossible.
In cases where the patient is diagnosed with hypertension or has a predisposition to hypertension, exposure to shock therapy is not possible.
According to scientists and orthopedists, shock wave therapy cannot be performed in areas of bone growth and areas bordering large blood vessels. First of all, we are talking about the head, ribs (at the level of the lungs) and abdominal cavity in close proximity to the intestines.

Even though the impact of UHT is local, the entire human body is involved in the process. For this reason, before starting a course of treatment, it is necessary to undergo a full examination to identify contraindications. Carrying out this physiotherapy is possible only in the absence of all the described contraindications.

How does the procedure work?

Despite the fact that the treatment must be carried out by a specialized specialist who knows how to properly influence certain joints, the shock wave therapy procedure is quite simple.

The physiotherapy procedure is carried out in different ways, but we are not talking about the principle (there are no differences in this regard), but about the settings of the UVT device and the duration of each procedure. It all depends on the nature, location and scale of the pathological process.

The procedure itself, which is carried out in an outpatient setting, will fit into just three points:

The patient removes clothing from the area of the body that will be exposed to shock impulses and takes a comfortable position on a couch or special chair.
The doctor sets the settings on the UVT device, treats the area of skin in which the procedure will be performed with a special gel (at this stage the process is similar to the ultrasound method).
The device’s sensor is pressed tightly against the affected area and the pulses begin to act. In this case, the patient feels minimal discomfort, and due to the low frequency of wave formation, there is even no sound.
As a rule, one session lasts from 5 to 30 minutes, the duration depends entirely on the type of disease, the degree of its progression and the joint being treated.

The course consists of 6–10 procedures; the length of the entire course, again, depends on the listed factors. Intervals between physical therapy last from 4 days to a week. However, after 1-2 sessions, most patients partially get rid of even chronic pain syndrome and feel noticeable improvements.

Due to the fact that shockwave therapy affects not only the joint, but also other tissues of the body, such as muscle, some people interrupt treatment. This is explained by the fact that when using shock wave therapy, patients experience muscle pain. However, this phase must be endured; it is due to the increased activity of biological processes in a certain area; with each subsequent procedure, muscle discomfort will go away. The appearance of such sensations does not pose a threat or harm to the body, but if you are concerned, it is better to talk about it with your doctor.

According to statistics, relief occurs after 2 procedures, and after 4–5 sessions, pain completely disappears in more than 80% of patients. In general, statistics confirm the stunning success of the use of new technologies. After completing the full course, 90–95% of patients with various forms of diseases of the musculoskeletal system are cured.

Modern medicine is developing at an accelerated pace, which allows us to constantly improve various physiotherapeutic techniques.

A striking example is shock wave therapy, which was tried to treat patients almost a century ago, but it was only later that it was possible to benefit from it. long years. The operating principle of shock wave therapy is based on the use of low frequency acoustic waves.

The main mechanisms of the technique are as follows:

Generated acoustic vibrations are able to pass through soft tissues and layers of the epidermis without problems, but at the same time they do not penetrate hard deposits in the kidneys, causing their destruction.
In the same way there is an impact on calcium deposits in the joint cavities, which leads to their destruction and slowing down the pathological processes observed in arthritis and some other diseases.
Passing waves stimulate the blood circulation process, so their targeted effect on areas with bone fractures accelerates regeneration and shortens the rehabilitation period. This effect is achieved due to the activation of the synthesis of cartilage and ligaments.
Stimulation of blood circulation also has a positive effect on the regeneration of soft tissues; for this reason, shockwave therapy is effective in the treatment of non-healing leg ulcers, which are often observed in the later stages of diabetes mellitus.
Waves passing through the heart muscle, stimulate the process of growth of new blood vessels, which allows many patients diagnosed with angina to avoid surgical operations.

The equipment for such a procedure may have a different appearance, but it is always designed in such a way that it is possible to target specific areas of the human body with waves.

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Shock wave therapy device

To carry out this physiotherapeutic procedure, special equipment is used.

Its appearance may vary depending on the purpose of the specific device and the set of functions included in it.

Most models are made in the form of an air gun equipped with an applicator or other element.

Such equipment allows you to influence individual problem areas of the body; it is actively used in sports and rehabilitation medicine, as well as in orthopedics.

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It has the following properties:

Relieves pain syndrome
Promotes regeneration of cartilage tissue
Effectively relieves muscle hypertonicity
Fights swelling and eliminates inflammation

Indications for the use of UVT

Specialists of various profiles can prescribe wave therapy; this usually occurs if the following indications are present:

The recovery period after sports injuries.
Recovery period after bone fractures.
The recovery period after implantation of implants into the joint.
Some forms of flat feet.
Osteoarthritis, which causes deformation in the hip or knee area.
The presence of calcium deposits on the bottom of the heel bone, which causes severe discomfort and is called a heel spur.
Plantar fasciitis.
Dystrophic disorders in the vertebral joints.
Lesions of the spinal nerve roots.
The presence of hernias in the intervertebral space.
Acute inflammatory processes affecting a joint or tendon.
Diabetic foot.
The presence of severe burns.
Trophic ulcers.
Changes in the structure of subcutaneous fat, formation of cellulite.
Painful sensations in chest resulting from angina pectoris.
Oxygen starvation of the heart muscle and coronary vessels.
Impotence.
Presence of hard deposits in the kidneys.

Therapeutic effects

Primary effects

Immediately after the start of shock wave therapy, the patient begins to experience the following primary therapeutic effects:

Reduction or complete disappearance of pain and physical discomfort.
Local improvement of blood circulation in areas affected by acoustic influence.

Secondary effects

Most of the therapeutic effects are secondary or delayed in nature, which appear some time after completing a course of physiotherapeutic procedures.

These include:

Increased mobility joint or injured part of the body.
Gradual resorption bone growths, calcium deposits, scars and other similar formations. Reduction in size leads to their complete disappearance.
Comprehensive strengthening and increasing the resistance of joints, ligaments and tendons to mechanical stress and physical stress.
Sprouting of new blood vessels occurring due to the systematic stimulation of the blood circulation process.
This has a positive effect on tissue nutrition, oxygen enrichment and functioning internal organs in a certain area.

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Duration of treatment

The duration of treatment is determined individually by the specialist who prescribed physiotherapy, since it depends on the diagnosis and the patient’s condition.

For diseases affecting musculoskeletal system, the following scheme usually works:

The patient undergoes shock wave therapy once a week.
Treatment lasts for 5-6 weeks, during which time the patient manages to undergo the same number of procedures.

Price

The cost of UVT depends on the region of residence, the pricing policy of a particular clinic, the equipment used and many other factors. The average cost of the procedure in Moscow varies from 1200 to 2000 rubles.

Contraindications

To minimize the risk of developing side effects And negative consequences Initially, you need to make sure that there are no contraindications for undergoing shock wave therapy.

They may be as follows:

Benign or malignant tumors located in close proximity to the impact area.
Blood diseases, negatively affecting its coagulability.
Pregnancy at any time.
Infectious diseases in the acute stage.
Availability installed pacemaker.
The presence of blood clots, especially when they are localized in the cardiac cavity.
Childhood, when the formation of the skeleton has not yet been completed.
Rehabilitation period and weakened state of the body after suffering serious illnesses.

Any diseases associated with significant overstrain of the musculoskeletal system of the human body are a rather acute problem in modern traumatology. Repetitive stereotyped or periodic explosive loads can often cause painful conditions in people professionally associated with constant physical activity. Also, people who have little training or have reached advanced age are susceptible to diseases of the musculoskeletal system. Mostly, residents of large industrial cities suffer from such diseases.

Quite often, physiotherapy, massage, expensive non-steroidal anti-inflammatory drugs, and special injections are used to treat existing problems. One of the newest methods of treating the above problems of residents of megacities is shock wave therapy. But before you begin treatment with this method of influence, you need to know the contraindications of shock wave therapy.

Shock wave therapy itself, as a method of treating diseases of the musculoskeletal system, was developed in Switzerland. It was the Swiss who first proposed the use of vibration to treat orthopedic diseases. At the same time, they achieved extremely rapid development of this medical technology. The proposed method of shock wave therapy is essentially based on the short-term application of high-energy vibration to the affected area, which effectively relieves pain, improves blood circulation in the affected area, loosens painful bone growths or osteophytes, fibrous dense foci in muscles and ligaments, followed by their rapid resorption .

The extremely positive effect of these procedures was used for a considerable time, until doctors noted some contraindications to shock wave therapy. First of all, such contraindications include effects on the bones of the skull, with the exception of the area of the temporomandibular joint. It is also not recommended to use this progressive method as effective treatment effects on large vessels and nerves. A contraindication is the effect of shock wave therapy on the intestines and lung tissue. In this case, the shock wave used in this method, located in the air environment of a hollow organ or vessel, may well lead to significant dangerous local expansion. In this case, there is a high probability of subsequent ruptures or thrombosis of the vessel, nerve paresis.

One of the most important contraindications to shock wave therapy can be called the presence oncological processes in the affected area. Indeed, with a certain increase in local blood flow with a significant dynamic effect in the area of the tumor process using shock wave therapy, conditions may well arise that provoke increased tumor growth, leading to metastasis.

It is also absolutely not recommended to use this progressive method of treatment for patients with bleeding disorders. During the shock wave therapy procedure, quite natural damage to small vessels and capillaries occurs, which, with a known dysfunction of blood clotting, can easily lead to the occurrence of extensive hematomas. During treatment, this procedure will subsequently lead to prolonged hemorrhages in the affected area.

It is imperative to remember that a completely natural contraindication to shock wave therapy is the use of the method directly over tissues filled with air. Moreover, this applies to the lungs or some large nerve nodes, blood collectors, and the spinal cord. Shock wave therapy is absolutely contraindicated for pregnant women.

If the patient has a pacemaker, it is also completely inappropriate to use a similar method of influence. In this case, the frequencies of the pacemaker, magnetic fields, and the shock wave therapy device are synchronized. This, with a significant degree of probability, can lead to the stopping of the artificial heart pacemaker. In this case, the use this method treatment will lead to the occurrence of uncorrectable arrhythmias and quite possible death.

Also a contraindication to shock wave therapy is the use of this method of treatment for children or adolescents who are in the growth zone, for people with acute infectious diseases. Progressive treatment methods must be used with extreme caution!

photo – shockwavetherapy.eu

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