Home » Shock Wave Therapy Expanding Treatment Protocols
- August 09, 2023
Extracorporeal shock wave therapy (ESWT) is the transcutaneous application of high energy acoustic waves to promote healing and repair. First used in the early 1980’s, this therapy emerged as a noninvasive treatment to eliminate kidney stones. Patients were placed into a water bath and a focused acoustic wave was applied to the stones to break them apart.
Years after the successful use of these sounds waves in urology, researchers began to examine other potential clinical applications and radial ESWT was invented. In contrast to the focused ESWT, radial ESWT are transmitted in a more diffuse pattern. Soon after, studies were conducted worldwide and found many clinical applications for this therapeutic tool.
ESWT was found to be a significant tool to reduce pain and promote healing in damaged tissues. It was also found to reduce spasticity caused by neurologic disorders. Studies published in 2005 found patients with refractory lateral epicondylitis who were treated with radial ESWT, experienced a decrease in pain and functional impairment after one treatment.
Further studies in 2017, demonstrated encouraging results in patients with spasticity related to a stroke. This was also found to be the case in treating multiple sclerosis with spasticity.
Treatment has now been expanded into orthopedics, cardiology, dermatology, neurology and urology to treat many different diseases.
Urology
A. Kidney stones
B. Erectile dysfunction
C. Overactive bladder
D. Prostatitis and pelvic pain syndromes
Cardiology
A. Severe calcified lesions
B. Left ventricular ejection fraction.
C. Reducing ischemia
Dermatology
A. Foot ulcers
B. Wound care
C. Treatment of burn scarring
Neurology
A. Post stroke spasticity
B. Peripheral neuropathy
C. Chronic low back pain and Spinal cord injuries
D. Post herpetic neuralgia.
Orthopedics
A. Tissue regeneration
B. Lateral epicondylitis
C. Shoulder tendinopathy and rotator cuff injuries
D. Hamstring injuries
E. Patellar tendinopathy
F. Achilles tendinopathy
G. Plantar fasciitis
H. Knee osteoarthritis
I. Nonunion of fractures
Side effects of ESWT
The side effects are generally mild and short in duration, they include,
A. Transient discomfort
B. Skin erythema
C. Localized swelling
Focused ESWT has caused Achilles tendon rupture, humeral head osteonecrosis and stress type fracture of the calcaneus. These side effects have not been reported with non-focused radial shock wave therapy.
Contradications
A. Pregnancy
B. Presence of tumor locally or infection
C. Recent corticosteroid injection (Usually less than 6 weeks since treatment)
D. Age under 18 with few exceptions
E. Treatment in areas of pre-ruptured tendons
F. Blood clotting disorders
The Difference Between High Energy and Low Energy Shock Waves
High energy are true shock waves. These high energy pulses are focused directly through the effective tissue and result in several effects,
A. Mechanical pressure and tension on the tissue increases cell permeability and therefore increases microcirculation and metabolism. This promotes healing.
B. The shock wave created and located behind it, a cavitation bubble. When it collapses the resultant force helps to break down calcific tissue.
C. Shockwaves stimulate osteoblasts responsible for bone growth and formation.
D. Shockwaves stimulate fibroblasts responsible for building connective tissue such as tendons.
E. Pain reduction through hyperstimulation of the nerves and this overwhelming action results in pain reduction.
F. Pain mechanisms that fire abnormally in chronic pain syndromes are recalibrated and results in long term pain modulation.
Low energy shockwave is really a pressure wave.
A. Low energy shockwaves travel at slower speeds and a true shockwave is not produced.
B. Low energy shockwaves are longer, slower and less intense.
C. Pressure waves diverge from the source unlike high energy that converge on the target, this results in less energy applied to the target tissue when compared to high energy shockwaves.
Significant research has been done in the field of orthopedics using shock wave therapy.
In a recent review and meta-analysis by Avendano-Coy et al, the authors appraised the latest evidence as to whether therapy results in improvement in the function and reduction of pain in patients with knee osteoarthritis. Based on the pooled data extracted from 14 randomized clinical trials involving 877 knees in 782 patients, the authors reported that the ESWT reduces pain and moderately improves the movement and function of the knee.
Many other clinical trials have proven the effectiveness. The exact mechanism of action needs further investigation. One postulated therapeutic mechanism is the modification of the immune response by shifting macrophage phenotype from M1 to M2. The M1 population of macrophages is responsible for the pro inflammatory response and play a direct role in host defense against pathogens by the secretion of pro inflammatory cytokines and anti-microbial molecules. The group of M2 macrophages limits the immune response and intensifies anti inflammatory properties. This M2 response is involved directly in the regenerative process. Data from animal models, confirm an increase in the M2 molecules after shock wave therapy. This promotes angiogenesis and release of regenerative growth factors and cytokines.
ESWT accelerates the healing of tendon pathologies by not only modulating the immune response and increasing vascular proliferation but also on direct stimulation of the tenocytes. In patients with tendinopathy, there was a higher level of metalloproteinases. ESWT reduced the level of MMP and reversed an unfavorable level of MMP and IL-6.
Pain relief is also an important part of therapy in these cases. ESWT has analgesic actions. ESWT induces changes in concentrations of substance P and prostaglandin E2. Both substances are involved in acute and chronic pain.
Study
Zhongguo Xiu Fu Chong 2019 Dec 15;33(12): 1527-1531 PMID 31823552
Objective: To investigate the effectiveness of extracorporeal shock wave therapy combined with platelet rich plasma injection in the treatment of knee osteoarthritis by prospective clinical study
Methods: 180 patients met the inclusion and were assigned to group of PRP treated, ESWT treated and PRP/ESWT groups
Conclusion: The extracorporeal shock wave therapy combined with PRP can relieve the pain synergistically for knee osteoarthritis
Biomed Res Int 2020; Mar 18:1907821 PMID 32309424
Background: Extracorporeal shockwave therapy has shown an effect on osteoarthritis in both animal and clinical studies but there was no systematic review to confirm the value of shockwave therapy in the treatment of all types of osteoarthritis and compare it with other traditional therapies.
Conclusion: Extracorporeal shockwave therapy could be recommended in the treatment of osteoarthritis as a non-invasive therapy with safety and effectiveness.
Note- This study demonstrated a difference in shockwave therapy and platelet rich plasma in initial pain reduction but not in overall functional improvement.
Int J Surg; 2020 Oct; 82:64-75 PMID 32798759
Objective: To examine the safety and effectiveness of extracorporeal shockwave therapy for reducing pain and improving functionality in people with knee osteoarthritis
Conclusion: ESWT is an effective treatment for improving pain and functionality in patients with KOA in the short term with few minor side effects. Further clinical trials should include longer follow up periods.
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our kits have been scientifically manufactured to provide a consistent platelet concentrate, devoid of red blood cells with a minimum number of leukocytes, critical to the regenerative process.
Juventix Regenerative Medical offers a patent pending LED Activator to activate the platelets and begin the regenerative process. This activation is a critical step in the release of cytokines, growth factors and bioactive proteins and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen.
Juventix Regenerative Medical is proud to announce our collaboration with SoftWave Tissue Regeneration Technologies.
SoftWave is a leader in the shock wave therapy field. Their unfocused/parallel shockwave device is unmatched in this field. The SoftWave low intensity, unfocused energy is delivered via a patented parabolic reflector applicator. It is the only one of its type in the world. This technology does not cause the microtrauma that can occur with the use of other shock wave energy devices. The SoftWave unfocused applicator design makes it possible to spread the shock wave energy to a large area of both superficial and deep tissue.
The Soft Wave device is the only one with FDA clearance for activation of connective tissue, treatment of diabetic foot ulcers, cleared to improve blood supply, treatment of pain and treatment of second-degree burns. It is FDA inspected.
SoftWave is another member of the ever-expanding Juventix family of regenerative products and services.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
