- Mechanism of Action
- Medical Effects
- Therapy Sequence
Shockwave therapy is a multidisciplinary device used in orthopedics, physiotherapy, sports medicine, urology and veterinary medicine. Its main assets are fast pain relief and mobility restoration. Together with being a non-surgical therapy with no need for painkillers makes it an ideal therapy to speed up recovery and cure various indications causing acute or chronic pain.
MECHANISM OF ACTION
Shockwave is an acoustic wave which carries high energy to painful spots and myoskeletal tissues with subacute, subchronic and chronic conditions. The energy promotes regeneration and reparative processes of the bones, tendons and other soft tissues.
Shockwaves are characterized by jump change in pressure, high amplitude and non-periodicity.
The kinetic energy of the projectile, created by compressed air, is transferred to the transmitter at the end of the applicator and further into the tissue.
Acoustic waves with high energy peak used in Shockwave therapy interact with tissue causing overall medical effects of accelerated tissue repair and cell growth, analgesia and mobility restoration. All the processes mentioned in this section are typically employed simultaneously and are used to treat chronic, sub-acute and acute (advanced users only) conditions.
New Blood Vessel Formation
Nutrient blood flow is necessary to start and maintain the repair processes of damaged tissue. The application of acoustic waves creates capillary microruptures in tendon and bone.
Nutrient blood flow is necessary to start and maintain the repair processes of damaged tissue structure. The application of acoustic waves creates capillary microruptures in tendon and bone. Due to microruptures the expression of growth factors such as eNOS, VEGF, PCNS and BMP is significantly increased.
As a result of these processes arterioles are remodeled, stimulated to grow and new ones are formed. The new blood vessels improve blood supply and oxygenation of the treated area and support faster healing of both the tendon and the bone.
Reversal of Chronic Inflammation
Mast cells are one of the key components of the inflammatory process. Their activity may be increased by using pervasive acoustic waves.
Chronic inflammation occurs when the inflammatory response is not completely halted. It can damage healthy tissue and results in chronic pain. Mast cells are one of the key components of the inflammatory process. Their activity may be increased by using pervasive acoustic waves.
Mast cell activation is followed by the production of chemokines and cytokines. These pro-inflammatory compounds first enhance the inflammatory process and in the next step help restore normal healing and regenerative processes.
Stimulation of Collagen Production
The production of a sufficient amount of collagen is a necessary precondition for the repair processes of the damaged myoskeletal and ligamentous structures. Shockwave therapy accelerates procollagen synthesis.
The production of a sufficient amount of collagen is a necessary precondition for the repair processes of the damaged myoskeletal and ligamentous structures. Shockwave therapy accelerates procollagen synthesis. The therapy forces the newly created collagen fibers into a longitudinal structure which makes the newly formed tendon fibers more dense and stiff and creates a firmer structure.
Dissolution of Calcified Fibroblasts
Calcium build-up is most often a result of micro-tears or other trauma to a tendon. Acoustic waves break up the existing calcifications. Shockwave therapy starts the biochemical decalcification of the calcium build-up of a toothpaste-like consistency and treats the tendon. The granular particles of calcium are then removed by the lymphatic system.
Dispersion of Pain Mediator “Substance P”
Substance P is a neurotransmitter that mediates pain information through C-fibers. This neuropeptide is generally associated with intense, persistent and chronic pain. It relays pain messages to the central nervous system. Lowering the concentration of Substance P reduces the stimulation of afferent nociceptive fibers and thus reduces the pain. Decreasing Substance P, histamines and other nociceptive metabolites also helps inhibit development of inflammatory edema. Acoustic waves generated by Shockwave therapy lower the Substance P concentration and trigger pain relief.
Release of Trigger Points
Trigger points are the principal cause of pain in the back, neck, shoulder and limbs. They are associated with palpable nodules in taut bands of muscle fibers and have extremely contracted sarcomeres. The dysfunctional sarcomeres contract so tightly that they begin to cut off their own blood supply. This causes the waste products to build up. Waste product build-up irritates the sensory nerve endings which then causes even more contraction. This vicious cycle is referred to as “metabolic crisis”. The assumed mechanism of action is that the delivered acoustic energy unblocks the calcium pump and thus reverses the metabolic crisis in the myofilaments and releases the trigger points.
- Jumper’s Knee
- Plantar Fasiitis
- Painful Shoulder / Frozen Shoulder
- Tennis Elbow
- Heel Spur
- Insertional Pain
- Chronic Tendinopathy
- Medial Tibial Stress Syndrome
- Hip Pain
- Knee Pain
- Back Pain
- Neck Pain
Shockwave therapy is a non-invasive treatment. The application is simple and easy. Initiate therapy in 3 steps:1st
Location of the area to be treated
The area to be treated is located using palpation in order to deliver the therapy precisely.2nd
Sufficient amount of gel is applied to the area located in step 1. Use of gel is necessary to transfer the acoustic waves efficiently and smoothly.3rd
The Shockwave applicator is slightly pushed against the area to be treated and the start button is pressed.
There may be a slight feeling of discomfort during the treatment, depending on the level of pain the patient is already experiencing in the area. However, since the treatment lasts only about five minutes, most patients are able to tolerate this discomfort. Additionally, the intensity of the treatment can be adjusted throughout the session.
The number of treatments varies depending on the indication and tissue response. The effect of the treatment is cumulative, so you will typically need more than one (3–5) treatment. Very often though, you will experience relief right after the first treatment.
Most indications require 3–5 treatments which are done 3–10 days apart, depending on the patient’s tolerance and their tissue response.
Most patients will experience an immediate pain relief following the treatment. However, within 2–4 hours after the treatment, they may experience some soreness in the treated area. This soreness has been reported as tolerable and not limiting.
It is recommended that patients refrain from physical activity, especially one that would involve the treated region, for about 48 hours following each treatment session.