Shockwave therapy rESWT

shock wave generally

SHOCK WAVE / ESWT

Shock wave or ESWT stands for Extra Corporeal Shock Wave Therapy.

Introduction

Therapeutic shock wave was introduced some 20 years ago. First it was used as a medical treatment for eliminating kidney stones without causing skin damage. As early as 1994 began, however, in orthopedics to treat epicondylitis using shock wave that since 1995, treating Achilles tendinitis and Plantar. 1999, also the first generation of radial shock wave, which is frequently used today in the treatment of various diagnoses of the locomotor apparatus.

Shock wave and shock waves

What then is the shock wave may ask? A shock wave is a type of surge / wave propagating. This wave carries energy and can continue to propagate through the body tissue. Libra is in itself a sound wave, it has a very large oscillation range and built up quickly in frequency. The theory is that the sound wave and the energy elicited creates biological reactions when in contact with the tissue.

Radial or focused shock wave

There are two variations of the shock wave; radial and focused. Radial are pressure waves and pulses generated by compressed air by a compressor. The compressed air drives a projectile inside a cylinder on the stötvågstransmittorn ( “Gun”). This energy generated by the projectile is converted to sound energy when the projectile hits stötvågstransmittorn. Sound pulses are then transmitted to the tissue. Regardless of the power, depth and variation so the skin will proportionally take up the most energy. It is believed that the shock wave is generally affect the local metabolism, which will be able to promote healing. It is also believed that the increased local metabolism promotes healing by the results.

    • Increased neurotoxin angiogenesis (growth of nerves and blood vessels)
    • Effects on cellular metabolism
    • Defense system is activated and enhanced diffusion of cytokines (group proteins carrying chemical signals regulating immune and inflammatory processes) which promotes healing senors.
    • Reduces C fibers (burning pain, heat, itching, sensual touch) which are not myelinated and reduces the release of CGRP (Calcitonin gene-related peptide) and substance P.
  • Enables stem cells (primarily focused shock wave)
  • Cell adhesion, proliferation of fibroblasts, collage organization, increase of capillaries and thickening of epitendon (observed in the healing tendon).
  • Increases blood circulation in the treated tissue. Increasing the level of oxygen and the concentration of carbon dioxide in the tissue. This is believed to stimulate the healing process.
  • Reduces muscle tension and muscle shortening
  • Enables interneurons pain and irritation by increasing the release of GABA in the dorsal horn. The pressure and the vibrations from the shock waves so also increases lymphatic drainage.

Differences between fokuserad- and radial shock wave

radial shock wave

Radial shock wave is more like what the therapist can get out with your hands, which is affecting the soft tissue. 

  • Type: Blast
  • Pressure: 0-10 bar
  • Pulse: about 1 microsecond
  • Distribution: Spread / radial
  • Depth: Superficial (3-5cm)
  • Power: Soft tissue

focused shock wave

Focused go more in depth in the tissue and may have effects on the cellular level, where it is believed that it may increase metabolism and activate stem cells.

  • Type: shock wave
  • Pressure: 100-1000 bar
  • Pulse: 300 nanoseconds
  • Distribution: Focused
  • Depth: Deep
  • Power: Cell Level

Shock wave and pain

Studies have shown that some of the effect of the shock wave will disappear if you stun before treatment. It is thought that this may be a key process that leads to healing, making the need for pain signals from the area to heal for the brain to know where the “help” is needed.

Indications for the shock wave (muscle-tendon)

  • Akillestendinos
  • Plantarfascialgi
  • Jumper
  • Epicondyalgi
  • Axeltendinopati
  • Greater trochanter pain syndrome
  • runner’s knee
  • medial traktionsperiostalgi
  • Morton metatarsalgi
  • Mb Dupuytren, Quervain’s (tendonitis of the finger)
  • Stress fracture / pseudoarthrosis
  • Carpal Tunnel Syndrome
  • osteitis pubis
  • Muscle cramps / spasticity
  • Cervical brachial neuralgia
  • Frozen Shoulder (Adhesives capsulitis)
  • piriformis syndrome
  • lime Shaft
  • Breaks down calcifications

Indications for the shock wave (not the muscle-tendon)

  • Impotence, prostatitis
  • angina pectoris
  • Gall and kidney stones
  • Parkinson’s, depression
  • Wound healing

Contraindications

  • 6 weeks after cortisone injection
  • Blood-thinning (Coumadin, Fragmin, coagulation disorders)
  • vascular diseases
  • Do not treat the large vessels
  • Acute inflammation symptoms
  • Cancer / malignancy
  • pregnant
  • polyneuropathy
  • neurological diseases
  • large nerves
  • Over spinal cord
  • Prosthesis, metal
  • Neck and Face
  • Pacemaker and ICD
  • Over growth zones

Side effects

  • Redness
  • Swelling
  • Pain
  • hematoma
  • Petechial (red dots)
  • Skin lesions after previous cortisone treatment

General advice for radial extracorporeal shockwave therapy

  • Patients should rest in a relaxed position during treatment
  • Locate pain points and optimizing muscle and tendon length
  • Wash hesitate skin surface with alcohol (no fat or massage oil over the area where the treatment will take place)
  • Apply the gel over the treatment area after cleaning
  • Customize transmitter tower for deep and purpose of the treatment
  • Inform about sound and this treatment can be experienced painful