Shock Wave Therapy
RADIAL EXTRACORPOREAL SHOCK WAVE TREATMENT (rESWT)
Radial shock waves are generated ballistically by accelerating a bullet (metal cylinder) to hit an applicator, which transforms the kinetic energy into radially expanding acoustic shockwave or pressure wave. In front of the wave is an increase in pressure and behind the wave is a decrease in pressure. It is this pressure gradient that elicits many of the beneficial physiological effects. Reported effects include increase in nitric oxide to
enhance blood flow, protein synthesis, cell proliferation, nerve and cartilage growth, stimulation of angiogenesis/neovascularization (new blood vessel growth), growth factor (TGFb1, IGF-I, VEGF) release and modulation of pain.
ESWT was first used in the 1980 to disintegrate kidney stones. It was only natural, then, to apply the technology to calcified tendon injuries like rotator cuff and heel spurs and then to plantar fasciitis which is a chronic tendinosis. The dissolution of calcific tendonitis on X-Ray helped to further its application to other soft tissues. Although no such studies exist for dissolving the heel spur ESWT?s ability to alleviate heel and plantar fasciitis pain was reported to be 81% which is superior to other conservative or operative treatments.
Shockwave has been studied on virtually every musculoskeletal tendonitis or injury, including golfer?s and tennis elbow formally known and medial and lateral epicondylitis, rotator cuff tendinopathies, Achilles tenonitis. Additionally, its use has been expanded to include erectile dysfunction, although this application should be reserved for a urology center specializing in this area.
Wang C. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res. 2012;7(1):11. Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles Ligaments Tendons J. 2012;2(1): 33e37.
Simplicio C, Extracorporeal shock wave therapy mechanisms in musculoskeleltal regenerative medicine. J Clin Orthop Trauma. 2020 May; 11(Suppl 3): S309-S318