Extracorporeal Shock Wave Therapy

Focused shock wave therapy uses a cylindrical coil to generate electromagnetic waves. It penetrates deeper tissues, causing tissue membranes to vibrate and create pressure waves in their surrounding fluids without losing energy. Focused shock wave is used to target a smaller focal area. Ultrasonography is often used in conjunction with focused shock wave therapy to accurately visualize deep tissues.

Focused shock waves are most often used for:

• Acute athletic injuries

• Bone fractures

• Shin splints

• Groin pain

• Achilles tendon pain

• Medial and posterior tibial pain

• Ankle sprains

• Wound healing

Radial shock wave therapy is the most commonly used form of ESWT. It is used for a larger treatment area at a more superficial level. It transmits kinetic energy to targeted tissues, creating a radial wave. Radial shock waves emit their greatest energy at the skin’s surface, and lose power as their energy penetrates deeper tissues.

Radial shock waves are most often used for

• Superficial tendinopathy

• Superficial trigger points

• Myofascial pain

• Plantar Fasciitis

• Fascial adhesions

Radial shock wave therapy is also effective for managing spasticity in conditions such as stroke, cerebral palsy, multiple sclerosis, dystonia and writer’s cramp.

While it may seem counterintuitive, a small amount of damage needs to be done to the body to prompt it to repair itself. Shock wave therapy creates tiny ruptures in the capillaries that feed injured tissues. This prompts the body to start producing new blood vessels to replace the damaged ones. The tiny new blood vessels increase the blood supply to the injured area, increasing the flow of oxygen and nutrients necessary for healing.

Increased nutrient-dense blood flow is necessary for neovascularization to occur, to start and maintain the repair process of damaged tissue. The application of acoustic waves creates capillary micro-ruptures in tendon and bone and significantly increases the expression of growth indicators such as the eNOS, VEGF, PCNA and BMP. These processes stimulate the growth and remodeling of new arterioles. The new blood vessels enhance the tissue’s blood supply and oxygenation, resulting in accelerated healing of muscles, tendons and bones.

Sufficient amounts of collagen are also necessary for tissue repair. Shockwave therapy hastens procollagen synthesis. The newly created collagen fibers are forced into a longitudinal structure, making tendon fibers denser and stiffer.

Trigger points are the principal cause of pain in the back, neck, shoulder and limbs. They are palpable nodules in taut bands of muscle fibers that have extremely contracted sarcomeres. The dysfunctional sarcomeres contract so tightly that they begin to cut off their own blood supply. This causes the build-up of waste products which in turn, irritates the sensory nerve endings, causing even more contraction. This vicious cycle is referred to as a metabolic crisis. Although the precise medical effects of acoustic wave therapy are still unclear, it can be assumed that the delivered acoustic energy unblocks the calcium pump, thus reversing the metabolic crisis and releasing the trigger points.