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Extracorporeal Shock Wave Therapy – ESWT Explained

Extracorporeal shock wave therapy (ESWT) is a non-invasive medical procedure that uses high-energy sound waves applied from outside the body to relieve pain and stimulate healing.

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Things worth knowing about "Extracorporeal Shock Wave"

Extracorporeal shock wave therapy (ESWT) is a non-invasive medical procedure that uses high-energy sound waves applied from outside the body to relieve pain and stimulate healing.

What is Extracorporeal Shock Wave Therapy?

Extracorporeal shock wave therapy (ESWT) is a non-invasive medical procedure in which high-energy sound waves – known as shock waves – are generated outside the body and directed through the skin into the affected tissue. The term extracorporeal literally means outside the body, referring to the external generation of these waves before they are precisely targeted at the treatment area. ESWT is primarily used in orthopedics, physiotherapy, and sports medicine and is considered a well-established alternative to surgery for certain musculoskeletal conditions.

Mechanism of Action

Shock waves are short, intense pressure pulses that transmit mechanical energy to biological tissue. This stimulus triggers several important biological responses in the body:

Improved blood circulation: Blood flow to the treated area is stimulated, enhancing the supply of oxygen and nutrients to the tissue.
Dissolution of calcifications: Calcium deposits, such as those found in calcific tendinitis of the shoulder, are loosened and broken down by the mechanical impulses.
Pain reduction: Shock waves inhibit the transmission of pain signals through nerve fibers, leading to noticeable relief of chronic pain.
Tissue regeneration: The mechanical stimulation promotes the release of growth factors and encourages the formation of new blood vessels (neoangiogenesis) as well as cellular regeneration.

Types of Shock Wave Therapy

Focused Shock Wave

Focused shock wave therapy concentrates the energy on a precisely defined point deep within the tissue. This approach is particularly suitable for deeper structures such as bone or deep tendon insertions.

Radial Shock Wave

Radial shock wave therapy distributes energy more broadly over a larger area. It is less penetrating in depth but more versatile in application and is commonly used for more superficial conditions such as muscle tension or plantar fasciitis.

Indications

Extracorporeal shock wave therapy is used for a wide range of orthopedic and musculoskeletal conditions, including:

Plantar fasciitis (heel spur): Pain in the sole of the foot caused by inflammation of the plantar fascia
Calcific tendinitis of the shoulder: Calcium deposits within the rotator cuff tendons
Tennis elbow (lateral epicondylitis): Chronic irritation of the tendon insertion at the elbow
Patellar tendinopathy (jumper's knee): Pain affecting the patellar tendon below the kneecap
Achilles tendinopathy: Chronic pain and degeneration of the Achilles tendon
Myofascial trigger points: Painful nodules within muscle tissue
Non-union fractures (pseudarthrosis): Failure of bone healing following fractures

How the Treatment is Performed

Shock wave therapy is performed on an outpatient basis and typically takes between 10 and 20 minutes per session. The treating physician or therapist first applies a coupling gel to the skin to ensure optimal transmission of the shock waves. The applicator head is then placed against the affected area, and the shock waves are delivered in a targeted manner. Depending on the condition and its severity, 3 to 5 treatment sessions spaced approximately one week apart are usually required.

Side Effects and Risks

Extracorporeal shock wave therapy is considered a very safe procedure with a low risk profile. Potential side effects are generally mild and temporary:

Mild pain or tenderness during or after the treatment
Redness, swelling, or bruising in the treated area
Temporary worsening of symptoms in the first few days following treatment

Serious complications are rare. However, there are certain contraindications for which shock wave therapy should not be used, including blood clotting disorders, pregnancy, malignant tumors in the treatment area, and the presence of a pacemaker.

Scientific Evidence

The effectiveness of extracorporeal shock wave therapy has been supported by clinical studies for several indications. The therapeutic benefit is particularly well documented for the treatment of plantar fasciitis, calcific tendinitis of the shoulder, and tennis elbow. International professional bodies such as the International Society for Medical Shockwave Treatment (ISMST) and national orthopedic associations have published guidelines for the clinical use of ESWT.

References

Schmitz C. et al. - Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PubMed database. British Medical Bulletin, 2015.
International Society for Medical Shockwave Treatment (ISMST) - Consensus Statement on ESWT Indications and Contraindications. www.ismst.com, 2016.
van der Worp H. et al. - Extracorporeal shockwave therapy in tendinopathies: a systematic review. British Journal of Sports Medicine, 2013.

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