Shockwaves are mechanical pressure waves that work on the tissue. Shockwave therapy is widely used to treat musculoskeletal problems.
Originally indicated for the non-invasive disintegration of kidney stones, shockwave therapy has since also been used successfully in orthopaedics. Its efficacy has been described and confirmed in numerous international studies and reports.
Indications & Applications
RSWT (radial shockwave therapy) indications are corroborated by a sound study base. The technique is generally used to treat:
- Myofascial trigger points
- Calcific tendonitis of the shoulder
- Radial and ulnar epicondylitis
- Plantar fasciitis / heel spurs
- Deep back pain / lumbago
- Trochanteric bursitis
- Achillodynia
Users
- Orthopaedic consultants / sports doctors
- Physiotherapists
- Osteopaths
- Emergency surgeons
- Pain doctors
- Physiotherapists / masseurs
Objectives
- Pain relief
- Elimination of the cause of the pain
- Effect on muscle tone
- Stimulation of cell metabolism
- Activation of regeneration processes
- Improvement of muscle trophic level
- Stimulation of vascular renewal
Radial Shockwave Therapy (RSWT)
With RSWT, the rise time of the pressure pulse is longer than with ESWT. The maximum pressure is around 15 MPa. The waves are transmitted to the tissue via applicators of various diameters and geometry.
During this process, the shockwaves propagate radially from the transmission point into the tissue. They penetrate approximately 35-40 mm. At 40 cm, the wavelength of the shockwaves is much longer than the diameter of the applicator heads as the pressure shock source, resulting in divergent, non-focused wave propagation.
The amount of energy in the shockwaves is controlled with different acceleration of the projectile.
The effective amount of energy in the tissue is influenced considerably by additional factors, such as contact area and contact pressure, etc.
Mechanism of action of RWST
Radial shockwaves release numerous substances which, as messenger substances, trigger various pain-inhibiting and stimulating reactions in the body.
This results in a reduction in pain, expansion of blood vessels, and, as a result, improved blood flow and tissue healing.
- Inhibition of the COX II enzyme (cyclooxygenase) – Inflammatory mediators such as COX II can be inhibited by radial shockwaves. This attenuates inflammatory processes (anti-inflammatory effect).
- Activation of cellular defenses – Radial shockwaves trigger the release of free
radicals. Hence this strengthens the body’s cellular defense mechanisms.
Treatment with RSWT
RSWT has been used successfully for more than 10 years for patients with a wide variety of disorders.
According to studies, a positive reaction (pain relief / improved function) has been recorded in over 80% of patients in the treatment of painful plantar fasciitis, for instance. The therapeutic outcome was even deemed to be good to very good in 70% of cases.
In this context it is interesting to note that the highest incidence of positive findings were recorded at low to moderate energy levels (2–3 bar, equivalent to an enPuls Version 2.0 shock energy of 90 and 120 mJ) and frequencies of around 10 Hz.
Advantages of RWST
Radial shockwave therapy is gaining increasing significance for the treatment of superficial orthopedic conditions. This is essentially due to:
- Virtually the same therapeutic outcome as with ESWT
- RSWT treatment costs less than ESWT (purchase price / wear and tear).