Low back pain (chronic – more than 3 months duration) is ranked first among the causes of years lived with disability and sixth among the causes of disability-adjusted years of life (Vos et al. The Global Burden of Disease studies report). Lower back pain is a cause of significant disability and severe restriction of routine daily activities. Studies show that more than 84% of all adults experience low back pain in their lives (Chou et al. 2016, Kuijer et al. 2006, Wand and O’Connell 2008). Low back pain is also associated with physical disability and a reduced quality of life (Volinn 1997).
Karasel et al. (2020) Looked at the use of short wave both pulsed and continuous in low back pain patients. They used education and exercise along with a placebo or pulsed or continuous shortwave. In many metrics (including muscle strength) the pulsed and continuous shortwave groups showed no improvement over the placebo group. However they did find that general health, social function, and mental health scores, improved significantly in the shortwave groups (both pulsed and continuous) but there was no significant change in the placebo group.
So patients receiving shortwave felt ‘better’ both physically, socially and in their mental health. After 15 treatments patients still had improvements in symptoms 3 months later.
Of significance a group within the study did not respond to any treatment. This group described as ‘role limitation due to emotional problem’ found no benefit from any intervention. Based on this patients who are impacted at work with emotional factors are unlikely to respond to shortwave.
Recommendation:
- Single Head =
- Pulsed or continuous
- Stay between 4w and heating effect
- Frequency = daily down to 1x per week
- 20 mins
- For 3-6 weeks (aim for 6+ sessions)
- Combine with exercises for best results
In an earlier study looking at the effectiveness of shortwave on LBP Kerem and Yigiter (2002) looked at shortwave effects on disc degeneration and root irritation. They found that:
pain relief, increase in muscular strength and ROM were significantly higher in PSWD groups than in those who were treated by continuous diathermy. We concluded that all the interventions used in this study were effective in reducing low back pain but PSWD was found to be more effective than CSWD.
In 2013 Khan et al. did a comparative study of continuous short wave diathermy (15 mins, 3x wk, for 6 weeks) and exercise together vs. exercise alone in the management of chronic back pain. They found that although exercises alone offered some improvement in the pain symptoms it was too small to reach a satisfactory outcome for patients. They said:
Based on these results SWD and exercise should be the treatment of choice for chronic back pain rather than exercise alone.
In 2009 Ahmed looked at shortwave (3x wk, 15mins, for 6 weeks) they found significant improvement in symptoms at the end of first week. At the end of second week more improvements were observed. The trends of improvements were continued throughout the whole period of the six weeks of study. The significance of improvement in the group of patients who received shortwave diathermy was better than that of placebo group (p=0). They also found that the outcomes of treatment was unrelated to the initial severity or duration of pain.
Zaman (1992 disertation) reported partial or complete relief of pain was more in the patients who received shortwave diathermy than the exercise group or placebo group for LBP.
Gibson et al. (1985) found significant improvements after shortwave treatment were observed in 59% patients.
Chard and Dieppe 2001 said that shortwave diathermy in osteoarthritis is essential for good management.
Ullah (1998) showed that improvement was better in the patients who received shortwave diathermy than the patients who were not treated with shortwave diathermy.
Kerem and Yigiter (2002) studied 60 patients and showed significant improvements in measured parameters in the shortwave diathermy group after the treatment.
Debsarma (1999) in a study showed that deep heat is more effective than superficial heat in pain management in chronic low back pain patients.
Although often quoted in research papers as a negative review of shortwave – actually in 2017 Qaseem et al. (Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians) said there was insufficient evidence to assess the usefulness of shortwave for LBP (either acute or chronic).
Overall it would seem that shortwave both pulsed and continuous is a viable option for patients who have chronic low back pain (more than 3 months) even those with disk problems. Treatment with shortwave is an excellent adjunct to exercise therapy and offers better results than exercises alone.