Extracorporeal shockwave therapy (ESWT) is considered to be the leading evidence-based safe and effective non-invasive treatment for subacute and chronic muscle-joint disorders and sports injuries, particularly those that present resistant to the conventional treatment. Noteworthy, recent studies have shown that ESWT produce significant beneficial effects in acute muscle-joint disorders and sports injuries.
What is Shockwave Therapy?
How does Shockwave theapy work? Summary & Intro
The physical ESWT shockwave impulses delivered produce the acquired energy in musculoskeletal and neural tissues to induce and raise the respective mechanotransduction pathways that convert the acoustic waves into biological signals and lead to a cascade of beneficial biological responses at a cellular level with the resultant desired physiological and therapeutic effects of improved tissue homeostasis and metabolism accompanied by enhancement of the tissue’s self-healing abilities. Studies have confirmed that ESWT can support and promote proliferation and differentiation of mesenchymal stem cells and reduce and inhibit apoptosis (cell death).
What can ESWT do for you, and by what mechanisms?
Angiogenesis : the ingrowth of new blood vessels into the injured tissue to markedly improve blood supply and thereby promote and enhance tissue regeneration and healing, by way of including the up-regulation of the pivotal angiogenic growth factors, and the significant phosphorylation of vascular endothelial growth factor receptor 2. In addition to the sprouting of existing vessels, namely angiogenesis, ESWT has been shown to induce the recruitment of endothelial progenitor cells for de novo vessel formation or known as vasculogenesis.
ESWT has been effectively used in the treatment of: avascular necrosis,bone death due to compromised and/ or lack of blood supply; anterior cruciate ligament reconstruction healing, the functional outcome of ligament reconstruction relies on restoration of adequate blood supply and firm healing of the tendon to the bone; shoulder rotator cuff tendinopathy, the inability of the supraspinatus rotator cuff tendon to fully heal and recover after injury can be attributed to its poor anatomical vascular supply and muscle ischaemia, decreased and inadequate blood flow to muscle tissue due to several mechanisms including muscle spasms.
Exciting new research has shown that ESWT is a novel treatment for peripheral nerve injury and can produce a neuroprotective effect and accelerate neural tissue healing. Injured and damaged neural tissue recovers very slowly and is often incomplete. Recent studies have shown that angiogenesis plays a critical role in neural tissue healing and recovery. ESWT can be used as a safe and effective treatment for relieving pain and disability in patients with carpal tunnel syndrome, the most common peripheral nerve entrapment. Despite the ubiquitous nature of peripheral entrapment neuropathies, they are underdiagnosed, underreported and sometimes not properly managed, especially in developing countries.
Pain relief and anti-inflammatory: modulate the respective inflammatory signalling pathways by significantly supressing the pro-inflammatory profile and promoting the acquisition of an anti-inflammatory profile with subsequent decreased pain and enhanced tissue regeneration and repair. In addition, they modulate endogenous nitric oxide production contents to the desired physiological level, stimulating a shift in the macrophage phenotype from M1 to M2, and desensitizing sensitized soft tissue. Also, substantial pain relief can be achieved by way of the gate theory of pain and descending pain modulation mechanisms.
ESWT has been effectively used in the treatment of chronic plantar fasciitis and heel spur and chronic Achilles tendinopathy, that is the most common running injuries, pain under the heel and foot, and athlete performance hindrances. ESWT has been shown to be significantly more effective in reducing pain versus the conventional treatment of including nonsteroidal anti-inflammatory drugs, orthotics and local cortisone injections.
ESWT can produce pain relief and beneficial functional outcomes and improvements in the treatment of frozen shoulder, a common 2 to 5 year self-limiting disabling pain disorder, often causing severe shoulder pain and disability and resistant to the ambiguous conventional treatment. Also, ESWT has been effectively used in the treatment of chronic tennis elbow, a common overuse injury in sport and significant athlete performance hindrance. ESWT has been shown to be greatly more effective in reducing pain and increasing grip strength with more long-lasting results versus ultrasound therapy in the treatment of these musculoskeletal disorders.
ESWT has been effectively used in the management of myofascial pain syndrome and fibromyalgia, the leading causes for chronic pain and working days lost. ESWT has been shown to be markedly more effective versus trigger point injection and versus ultrasound therapy in the treatment of these pain disorders.
Chondrogenesis: promote and enhance the formation of new cartilage in joints, and healing and repair of injured cartilage tissue by way of inducing angiogenesis in the surrounding vascularized articular tissues and promoting chondrocyte proliferation, migration and regeneration
ESWT has been shown to significantly relief pain, improve spinal range of motion and decrease disability in individuals suffering from degeneration or arthritis of the spine, an unavoidable consequence of aging of the human body, and a common cause of neck, back, and referred arm and leg pain. ESWT has been shown to be greatly more effective versus articular corticosteroid injection in the treatment of osteoarthritis of the knee in reducing pain and increasing movement and function. Osteoarthritis of the knee has doubled in the last decade due to recent exponential increases in life expectancy, obesity and sedentary life style, and can be considered the most common joint disease and leading causes of disability.
Osteogenesis: promote and enhance the formation of new bone and enhance healing and repair of injured bone tissue, by wat of inducing angiogenesis in the bone tissues, promoting osteoblast proliferation, migration and regeneration, and in addition by inducing mechanical reactions of the bone lacunae-canalicular network to tensile, shear and compression forces.
ESWT has been effectively used in the treatment of non-union fractures and stress fractures that respond poorly to the conventional treatment. Stress fractures are commonly misdiagnosed in the active individual and athlete, and can be debilitating to the athlete’s treatment recovery time, training and sport performance.
Recent studies have shown that ESWT can increase bone mineral density, normalize bone turnover or remodelling in individuals suffering from osteopenia and osteoporosis, as well as significantly promote and enhance healing of osteoporotic fractures. Osteoporosis is the most common bone disease affecting human beings with an alarming exponential increasing incidence of osteoporosis-related symptomatic fractures and consequential major physical, social and financial burden. Physical therapy may be challenging and problematic, due to the risk to induce insufficiency fracture.
Promote and enhance the formation of new tendon and ligament cells and skeletal muscle cells. ESWT has been shown to promote and enhance healing and repair of injured tendon and ligament tissues with subsequent decrease in aberrant scar tissue formation, by way of promoting tenocyte proliferation, migration and regeneration, and mechanically stimulating collagen synthesis and fibroblast synthesis.
ESWT has been proven to decrease pain and improve functional outcomes in the treatment of shoulder impingement syndrome, a combination of ligament, tendon and bony pathologies of the shoulder. Shoulder impingement syndrome is the most common cause of shoulder pain and loss of shoulder function in the active individual and athlete who participate in repetitive upper limb work and throwing activities.
ESWT has been effectively used in enhancing recovery and reducing excessive scar tissue formation of damaged ankle ligaments after an ankle sprain. Despite the high prevalence, disability and severity of lifestyle-limiting symptoms that follow ankle sprains, they are often misinterpreted as benign injuries that will resolve quickly with limited treatment. ESWT has been effectively used to reduce painful excessive scarring after hand surgery. Detrimental and excessive scar tissue formation after musculoskeletal injury can significantly hinder treatment recovery time and rehabilitation, and prevent the active individual and athlete from participating sooner in their sports activity.
ESWT has been proven to accelerate regeneration and healing of damage skeletal myocytes after acute muscle injury or strain as well as in the chronic muscle injury. This allows the athlete to return sooner to sport after a muscle strain. Muscle injuries are the most common injury in sport, of which hamstring strains are the most prevalent. Strains account for almost half of all sports injuries and are responsible for about a quarter of days of absence away from training and competition. Studies have confirmed that muscle tightness and decreased muscle flexibility significantly increase the risk for a muscle strain. Notable to the athlete, ESWT has shown to markedly decrease hamstring muscle tightness and increase hamstring muscle flexibility as well as decrease muscle spasticity. Furthermore, the repetitive application of ESWT to the inured and uninjured muscle has been proven to extend the beneficial effect of increased microcirculation in the muscle tissue resulting in the enhancement of the functional output of the muscle.