Dr. Andrew Bruns Chiropractic

Dr. Andrew Bruns Chiropractic www.portlandhealthsupply.com

“Objectives: To evaluate the experience with rESWT in the management of nonunion and delayed bone healing.Specifically, ...
03/22/2026

“Objectives: To evaluate the experience with rESWT in the management of nonunion and delayed bone healing.
Specifically, to characterize patients according to demographic and clinical variables; to describe pain evolution using the visual analog scale (VAS); to compare radiological changes using the Montoya scale at one, three, and six months; and to determine patient functionality and satisfaction.

Methods: A descriptive, longitudinal, and prospective study was conducted in 15 patients treated at the Instituto Vivir
Mejor between January 2022 and January 2025. The protocol included rESWT (BTL 5000 SWT Power, 4 bar, 15 Hz,
4,000 impulses, five weekly sessions), nutritional supplementation, and physiotherapy. Variables analyzed included sociodemographic characteristics, pain (VAS), radiological consolidation (Montoya scale), functionality, and satisfaction.

Results: Sixty percent of patients were young adults (19–40 years), with a predominance of males (53.3%). The most
frequent diagnosis was delayed union (80%). Pain decreased significantly, from 33.3% with moderate pain at baseline
to 93.3% pain-free at six months (p < 0.001). Radiologically, 93.3% reached Montoya grade 4 at six months (p < 0.001).
Functionality improved progressively, with 100% of patients no longer requiring assistive devices and 93.3% reporting
being “very satisfied” at six months.
Conclusions: rESWT, combined with nutritional support and physiotherapy, appears to be a safe, effective, and
minimally invasive alternative in superficial nonunions and delayed consolidations. Its benefits include pain reduction,
accelerated bone healing, improved functionality, and high patient satisfaction. Controlled, multicenter studies are
recommended to confirm these findings and standardize clinical protocols.“

Radial Pressure Waves: The Invisible Frontier Between Bone
Healing and Nonunion
Mary S Chávez et al. SVOA Orthopaedics 2025 Oct.

https://sciencevolks.com/orthopaedics/pdf/SVOA-OR-05-018.pdf

Introduction: Greater trochanteric pain syndrome (GTPS) is a debilitating condition characterized by lateral hip pain lo...
03/19/2026

Introduction: Greater trochanteric pain syndrome (GTPS) is a debilitating condition characterized by lateral hip pain located at or around the greater trochanter.

Source of data: We performed a comprehensive search of Pubmed, Medline, Ovid, Google Scholar and Embase databases, from inception of the database to 20th of June 2011, using a variety of keywords. We identified 52 relevant abstracts of articles published in peer-reviewed journals. Fourteen studies reporting the outcomes of patients undergoing conservative and surgical management of GTPS were selected.

Areas of agreement: Significant pain relief and improved outcomes were observed after conservative and surgical management of GTPS. The modified Coleman methodology score averaged 44.7 (range from 14 to 82), evidencing an overall low-to-moderate quality of the studies. Repetitive low-energy radial shock wave therapy and home training approach provide beneficial effect over months, with almost 80% success rate at 15 months.

Management of the greater trochanteric pain syndrome: a systematic review
Angelo Del Buono et al. Br Med Bull. 2012 Jun.

https://pubmed.ncbi.nlm.nih.gov/21893483/

“All three systematic reviews concluded that there is no significant difference between the two treatments regarding sym...
03/06/2026

“All three systematic reviews concluded that there is no significant difference between the two treatments regarding symptom severity and functional status in the short term. Only one SR reported significantly better scores for symptom severity and functional status in the mid and long term (>1 month to >6 months). Two SRs measured electrodiagnostic parameters such as DML, SNAPA, CMAPA, and CMAPL which only changed inconsistently over the two SRs [132], [133],
[136]. Three SRs conducted a subgroup analysis to compare rESWT to fESWT [132], [134], [136].
Two SRs concluded that rESWT is more effective than fESWT in improving the VAS, BCTQS, and BCTQf score in the mid to long term (> 1 month to >6 months) [134], [136]. Kim et al. reported no significant difference between rESWT and fESWT [132].“

https://pmc.ncbi.nlm.nih.gov/articles/PMC12833726/

Radial extracorporeal shock wave therapy alters plantar pressure distribution in chronic plantar fasciitis: a biomechani...
03/06/2026

Radial extracorporeal shock wave therapy alters plantar pressure distribution in chronic plantar fasciitis: a biomechanical analysis

He Shang et al. Front Rehabil Sci. 2026.

Objective: This study aimed to investigate the impact of radial extracorporeal shockwave therapy (rESWT) on plantar pressure distribution in patients with chronic plantar fasciitis
(PF). While prior research has established rESWT’s clinical efficacy in pain relief, its specific biomechanical effects on plantar loading patterns remain less quantified. This study addresses that gap by providing objective pedobarographic evidence of rESWT-induced pressure redistribution.
Methods: A cohort of 42 patients with unilateral chronic PF was enrolled. Plantar pressure parameters-including total foot pressure, forefoot pressure, rearfoot pressure, peak pressure point, mean pressure, and contact area-were assessed using a plantar pressure measurement system before and after a standardized rESWT protocol. Evaluations compared the affected limb with the contralateral unaffected limb.

Results: Following rESWT, significant changes were observed:

on the affected side, forefoot pressure increased (p = 0.001)
and rearfoot pressure decreased (p = 0.001); on the
unaffected side, forefoot pressure also increased (p = 0.002)
and rearfoot pressure decreased (p = 0.003). Total foot
pressure decreased on the affected side (p = 0.032) but
increased on the unaffected side (p = 0.032). Contact area
increased significantly only on the unaffected side (p < 0.001).

No significant alterations were found in peak pressure point location or mean pressure (p > 0.05). Effect size analysis (Cohen’s d > 0.5) confirmed clinically meaningful improvements in forefoot and rearfoot pressure shifts.
Conclusion: rESWT effectively ameliorates abnormal plantar pressure distribution in PF patients, promoting a forward shift in the pressure center and improving gait symmetry. These findings provide a biomechanical rationale for its clinical use.
Future studies should incorporate patient-reported outcomes and longer follow-up to link these biomechanical changes to functional improvement.

https://pubmed.ncbi.nlm.nih.gov/41583729/

“No clear superiority of RSWT or FSWT was observed for pain or functional outcomes, owing to low or very low certainty o...
02/11/2026

“No clear superiority of RSWT or FSWT was observed for pain or functional outcomes, owing to low or very low certainty of evidence. Moderate-quality evidence indicated that RSWT significantly improved wrist extensor strength in patients with tennis elbow compared to FSWT”

Efficacy of radial and focused shockwave therapy for tendinopathy: a systematic review and meta-analysis

Magdalena Stania et al. Sci Rep. 2026.

https://pubmed.ncbi.nlm.nih.gov/41651897/

Methods: In this randomised, double blind, placebo-controlled study, we treated 34 patients with four sessions of RSWT (...
10/10/2025

Methods: In this randomised, double blind, placebo-controlled study, we treated 34 patients with four sessions of RSWT (once weekly) and treated 34 patients with placebo. Participants were assessed at baseline, 1 week after the first session, and 1 week and 4 weeks after the last session. We measured pain using the visual analogue scale for pain, while we assessed muscle tone using the modified Ashworth scale and evaluated spinal excitability using the H-reflex.

Results: After RSWT, muscle tone decreased 1 week after the last session and pain decreased at all the follow-up evaluations, while spinal excitability was unaffected. No significant changes were found after the placebo treatment.

Conclusions: RSWT can reduce pain and muscle tone in MS patients without adverse effects. The lack of RSWT effects on spinal excitability supports the idea that RSWT is likely to act on non-reflex hypertonia, for example reducing muscle fibrosis.

https://pubmed.ncbi.nlm.nih.gov/2525/616/

Participants:Thirty-two field and track runners (weekly mileage: 20–40 km) with chronic ITBS (15 females, 17 males; aged...
10/08/2025

Participants:
Thirty-two field and track runners (weekly mileage: 20–40 km) with chronic ITBS (15 females, 17 males; aged 18–35) were randomly assigned using block randomization to either an active RSWT group or a sham control group

Results:
Significant time × group interactions were found for pain (VAS), knee function (KOOS), and ITB tendon thickness. The SWT group showed greater improvements than the sham-group across all outcomes. Pain scores decreased substantially (F(2,60) = 126.83, p < .001, partial η² = 0.81), indicating a very large effect size. KOOS scores improved significantly (F(2,60) = 75.59, p < .001, partial η² = 0.76), also reflecting a very large effect. ITB thickness was reduced (F(2,60) = 54.39, p < .001, partial η² = 0.65), demonstrating a large effect size.

https://nata.kglmeridian.com/view/journals/attr/aop/article-10.4085-1062-6050-0463.25/article-10.4085-1062-6050-0463.25.xml

“Plantar heel pain, a chronic and disabling foot alignment, occurs in the adult population. Extracorporal shock wave the...
08/09/2025

“Plantar heel pain, a chronic and disabling foot alignment, occurs in the adult population. Extracorporal shock wave therapy (ESWT) offers a nonsurgical option in addition to stretching exercises, heel cups, NSAI, and corticosteroid injections. This study aimed to investigate the effects of ESWT on calcaneal bone spurs and the correlation between clinical outcomes and radiologic changes. The study involved 108 patients with heel pain and radiologically diagnosed heel spurs. All patients underwent ESWT once a week for 5 weeks at the clinic. Each patient received 2,000 impulses of shock waves, starting with 0.05 mJ/mm2 (1.8 bar) and increasing to 0.4 mJ/mm2 (4.0 bar). Standard radiographies of the affected heels were obtained before and after the therapy. Clinical results demonstrated excellent (no pain) in 66.7% of the cases, good (50% of pain reduced) in 15.7% of the cases, and unsatisfactory (no reduction in pain) in 17.6%. After five ESWT treatments, no patients who received shock wave applications had significant spur reductions, but 19 patients (17.6%) had a decrease in the angle of the spur, 23 patients (21.3%) had a decrease in the dimensions of the spur, and one patient had a broken spur. Therefore, results showed no correlation between clinical outcome and radiologic changes. The present study supports the finding that even with no radiologic change after ESWT therapy, the therapy produces significant effects in reducing patients’ complaints about heel spurs.”

https://pubmed.ncbi.nlm.nih.gov/21110027/

Material and methods: Twenty-one patients were included in the study (mean age 51.29 +/- 2.02 yrs, mean duration of symp...
06/28/2025

Material and methods: Twenty-one patients were included in the study (mean age 51.29 +/- 2.02 yrs, mean duration of symptoms 10.14 +/- 1.11 mos). Radial shock wave therapy was administered in five sessions. Total number of shocks per session was 2500 at a pressure of 2.5 bars. Visual analog scale (VAS) and a modification of the clinical rating system of the American Orthopedic Foot and Ankle Society (AOFAS) were used for outcome measurement. The patients were assessed before treatment and followed up 3, 6, and 12 months after end of treatment.

Results: Statistically significant improvement in pain and functional capacity was found after completion of treatment in comparison with baseline; the improvement was preserved throughout a one-year follow-up.

https://pubmed.ncbi.nlm.nih.gov/23905486/

Materials and Methods: In the experimental group (n = 30), the intensity of the shock wave was increased every two subse...
06/08/2025

Materials and Methods: In the experimental group (n = 30), the intensity of the shock wave was increased every two subsequent treatment sessions. In the control group (n = 32), the treatment parameters were not changed. In both groups, six treatments were performed, with two treatment sessions a week. In order to assess the biomechanical parameters of the plantar fascia, myotonometric measurements were performed. The pain intensity was assessed using the Visual Analog Scale (VAS).

Conclusions: The use of rESWT performed with an increasing intensity of impact during subsequent treatment procedures demonstrated greater effectiveness in improving the biomechanical parameters of the plantar fascia and was also more effective in reducing the pain ailments. Our results are encouraging. The dose escalation in the treatment cycle is worth considering.

https://pubmed.ncbi.nlm.nih.gov/38792948/

“Results: Fifty-five patients were followed up, 5 patients were lost to follow-up, two in the PRP group and three in the...
06/08/2025

“Results: Fifty-five patients were followed up, 5 patients were lost to follow-up, two in the PRP group and three in the PRP+ESW group, the follow-up time varied from 6 to 18 months, with an average of 12.7$5.2 months. At 8, 12, 16, 20, and 24 weeks following intervention, the callus score in the monotherapy group was significantly lower than in the combined treatment group (p

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About Dr. Bruns

Dr. Bruns specializes in gentle Chiropractic adjustments that are combined with neuromuscular massage techniques. Average visit times are 15 to 30 minutes to allow for stretching and deep tissue mobilizations. Treatments are effective for all joint conditions ranging from toes to elbows. Most insurances are excepted and same day appointments are welcomed.