Physiotherapy – What is Extracorporeal Shock Wave Therapy (ESWT)?

History of extracorporeal shock wave therapy

Extracorporeal shock wave therapy (ESWT), also known as shock wave therapy, was first introduced into clinical practice in 1982 for the treatment of urinary conditions. The success of this technology for treating urolithiasis quickly made it a non-invasive and effective method.

Later, ESWT was studied in the field of orthopedics and physical therapy. Furthermore, animal studies conducted in the 1980s showed that ESWT can enhance the osteogenic response and improve fracture healing. Shockwave therapy has been shown to be beneficial in fracture healing, with most orthopedic research focusing on upper and lower extremity tendon disorders, plantar fasciitis, and soft tissue conditions. .

See more: Review of shock wave therapy machine Modus Basic IMET800

ESWT . physiology

Shock waves are sound waves with specific physical properties, including nonlinearity, high peak pressure, followed by low tensile amplitude, short duration (10 ms). They have a single pulse, wide frequency range (0-20 MHz) and high pressure amplitude (0-120 MPa).

These characteristics produce a positive phase with direct mechanical force, while the negative phase creates voids and air bubbles that explode at high speed, creating a second shock wave.

Compared with ultrasonic waves, the peak pressure of the shock wave is about 1000 times greater than the peak pressure of the ultrasonic wave.

The mechanism of action of the shock machine

Proposed mechanisms of action for ESWT include the following: promotion of repair at the tendon-bone junction, stimulation of cylindrical cell proliferation and osteoblast differentiation, increased leukocyte infiltration, amplification growth and protein synthesis to stimulate collagen synthesis, tissue regeneration.

Principle of shock wave

Shock waves are pressure disturbances that propagate rapidly in three dimensions. They are associated with a sudden rise from ambient pressure to their maximum pressure. Significant tissue effects include cavitation, which is a result of the negative phase of wave propagation.

Direct shock waves and indirect effects induce hematoma formation and localized cell death, which then stimulates the formation of new bone or tissue.

Contraindications to ESWT in Physiotherapy

  • Pregnancy
  • On major blood vessels and nerves
  • Pacemakers or other implantable devices
  • Open wound
  • Joint replacement
  • Epiphysis
  • Coagulation disorders including thrombosis
  • infection
  • Cancerous tissues
  • The patient’s mental status is compromised and/or inability to cooperate.

What is the difference between ESWT and Ultrasound Therapy?

Therapeutic ultrasound uses high frequency sound waves, while ESWT uses lower frequency waves.

Ultrasound can produce thermal or non-thermal effects in tissues, while ESWT produces no heating effect.

Similarities Between Therapeutic Ultrasound and ESWT

  • Both modalities use sound waves to create treatment.
  • Both use coupling media to deliver sound waves to the tissues being treated.
  • Both are non-invasive forms of treatment.

Evidence of the benefits of shock waves

According to a study conducted by Rompe and colleagues, stretching exercises combined with radial shock wave therapy were more effective in treating chronic symptoms of plantar fasciitis than plantar fascia therapy. merely repetitive radial pressure waves. The patients underwent three treatment sessions with each session 2000 radial pressure pulses (EFD = 0.16 mJ/mm 2) at weekly intervals, Study using a shock machine using a bullet mechanism steam (compressor pressure 4 bar; speed 8 Hz).

Another study investigating the clinical outcome of ESWT in osteophytes of 108 patients and its correlation with radiographic changes was reported by Yalcin et al. All patients received radial shockwave therapy once weekly for 5 weeks (2000 pressure waves starting at EFD of 0.05 mJ/mm2 and increasing to 0.4 mJ/mm2). After treatment, about 67% of patients reported a marked improvement in pain sensation.

Source: Editors

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