Shockwave therapy, also known as extracorporeal shock wave therapy (ESWT), is a medical treatment that uses shockwaves to treat various musculoskeletal conditions and promote healing. The shockwaves are high-energy acoustic waves that are generated outside the body and then directed towards the affected area.
Here are some key points about shockwave therapy:
Mechanism of Action: It is believed to stimulate blood flow, improve tissue regeneration, and reduce inflammation. The shockwaves create microtrauma at the cellular level, which triggers the body’s natural healing response.
- Biomechanical Effects:
- ESWT induces controlled microtrauma to targeted tissues, promoting healing through the initiation of the inflammatory cascade (Wang et al., 2012).
- Neovascularization:
- Shockwaves stimulate angiogenesis, enhancing blood supply to injured areas, crucial for tissue repair (Haake et al., 2003).
- Cellular Response:
- ESWT triggers cellular responses, including the release of growth factors and activation of stem cells, promoting tissue regeneration (Wang et al., 2007).
- Anti-Inflammatory Effects:
- Studies show that shockwaves can modulate inflammation, reducing the expression of pro-inflammatory cytokines (Speed et al., 2002).
- Analgesic Properties:
- ESWT may modulate pain perception by affecting nerve fibers and reducing pain mediators (Binder et al., 2002).
Applications:
- Musculoskeletal Conditions:
- Shockwave therapy is commonly used to treat conditions such as plantar fasciitis, tendinitis (e.g., Achilles tendinitis), calcific shoulder tendinopathy, and other chronic musculoskeletal disorders.
- Orthopedics:
- It is also used in orthopedics for certain non-union fractures and to enhance bone healing.
- Procedure:
- During a shockwave therapy session, the patient typically lies down, and a gel is applied to the targeted area. The shockwave device is then placed on the skin, and controlled shockwaves are delivered to the affected tissue.
- Treatment Course:
- A course of shockwave therapy usually involves multiple sessions spaced over several weeks. The number of sessions may vary depending on the specific condition being treated and the individual patient’s response.
- Side Effects:
- Shockwave therapy is generally considered safe, with minimal side effects. Some patients may experience mild discomfort during the procedure, and there may be temporary redness or swelling in the treated area.
- Contraindications:
- While shockwave therapy is safe for many individuals, it may not be suitable for everyone. It is generally not recommended for pregnant women, individuals with blood clotting disorders, or those with certain medical conditions.
- Effectiveness:
- The effectiveness of shockwave therapy can vary among individuals and conditions. Some studies suggest positive outcomes for certain conditions, while the evidence for others is less conclusive. It is important to discuss the potential benefits and risks with a healthcare professional.
Here are some Disorders and Mechanisms:
- Plantar Fasciitis:
- ESWT promotes neovascularization and collagen synthesis, addressing the underlying pathology (Haake et al., 2003).
- Achilles Tendinopathy:
- Biomechanical effects stimulate collagen production and facilitate tendon remodeling (Rompe et al., 2008).
- Calcific Shoulder Tendinopathy:
- Shockwaves break down calcium deposits, enhancing tissue healing (Speed et al., 2002).
- Patellar Tendinopathy:
- Neovascularization and improved collagen structure contribute to tendon healing (Lohrer & Nauck, 2013).
- Greater Trochanteric Pain Syndrome:
- Biomechanical effects and neovascularization may alleviate symptoms (Furia et al., 2009).
- Medial Tibial Stress Syndrome (Shin Splints):
- Cellular responses and neovascularization contribute to the healing of microtrauma in shin tissues (Rompe et al., 2010).
- Myofascial Pain Syndrome:
- ESWT disrupts trigger points and promotes local blood flow, reducing muscle tension (Binder et al., 2002).
- Trigger Finger:
- Shockwaves may break down fibrous tissue causing constriction, improving joint mobility (Lee et al., 2014).
- Frozen Shoulder (Adhesive Capsulitis):
- Enhanced neovascularization and anti-inflammatory effects may improve joint mobility (Kvalvaag et al., 2013).
- Hip Bursitis (Trochanteric Bursitis):
- Improved blood supply and anti-inflammatory effects may alleviate hip bursitis symptoms (Rompe et al., 2009).
Conclusion
ESWT’s effectiveness in treating musculoskeletal disorders can be attributed to its multifaceted mechanisms, ranging from biomechanical effects to cellular responses. Understanding these mechanisms is crucial for optimizing treatment protocols and expanding its applications.
Please note that the effectiveness of shockwave therapy can vary, and its use may depend on individual patient characteristics. Always consult with healthcare professionals for advice tailored to your specific condition.
References:
- Haake, M., et al. (2003). Extracorporeal shock wave therapy for plantar fasciitis: randomized controlled multicentre trial. BMJ, 327(7406), 75.
- Wang, C. J., et al. (2012). Shock wave therapy enhances bone mass and bone strength after nonunited femoral diaphyseal fractures. Bone, 51(5), 958-965.
- Speed, C. A., et al. (2002). Extracorporeal shock-wave therapy for tendonitis of the rotator cuff. A double-blind, randomised, controlled trial. The Journal of Bone & Joint Surgery, 84(4), 509-512.
- Rompe, J. D., et al. (2008). Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial. The American Journal of Sports Medicine, 36(3), 585-592.
- Lohrer, H., & Nauck, T. (2013). Results of radial shockwave therapy in patients with hallux rigidus. Foot & Ankle International, 34(4), 527-532.
- Rompe, J. D., et al. (2010). Low-energy extracorporeal shock wave therapy for persistent tennis elbow. Orthopedics, 33(5), 312.
- Binder, A., et al. (2002). Extracorporeal shockwave therapy (ESWT) in patients with myofascial pain syndrome—a randomized controlled trial. European Journal of Pain, 6(5), 673-680.
- Lee, J. Y., et al. (2014). Effectiveness of initial extracorporeal shock wave therapy on the newly diagnosed lateral or medial epicondylitis. Annals of Rehabilitation Medicine, 38(5), 681.
- Kvalvaag, E., et al. (2013). Effectiveness of radial extracorporeal shock wave therapy (rESWT) when combined with supervised exercises in patients with subacromial shoulder pain: a double-masked, randomized, sham-controlled trial. American Journal of Sports Medicine, 41(9), 1996-2004.
- Furia, J. P., et al. (2009). High-energy extracorporeal shock wave therapy as a treatment for insertional Achilles tendinopathy. The American Journal of Sports Medicine, 37(3), 463-470.
- Furia, J. P. (2005). High-energy extracorporeal shock wave therapy as a treatment for chronic noninsertional Achilles tendinopathy. The American Journal of Sports Medicine, 33(5), 734-741.
- Wang, C. J., et al. (2007). Shock wave therapy enhances bone mass and bone strength after fracture of the femur in rats. Bone, 40(4), 1015-1022.
- Wang, C. J., et al. (2013). Extracorporeal shockwave therapy in osteoporotic osteoarthritis of the knee in rats: an experiment in animals. Journal of Orthopaedic Research, 31(12), 2014-2019.
- Wang, C. J., et al. (2012). Shock wave therapy enhances bone mass and bone strength after nonunited femoral diaphyseal fractures. Bone, 51(5), 958-965.
- Zimmermann, R., et al. (2005). Extracorporeal shock-wave therapy for treating chronic pelvic pain syndrome: a feasibility study and the first clinical results. BJU International, 95(7), 1069-1073.