Extracorporeal Shock Wave Therapy

In Extracorporeal Shock Wave Therapy, a cylindrical wave is generated underwater inside the headpiece. The wave is focused through the reflector and transmitted into the tissue. Focused Shock Wave produces a high pressure peak in a very short amount of time and is converted into biochemical energy in the cell and extracellular matrix. The physiological effects of Shock Wave on the tissue includes enhanced neo-vascularity, accelerated growth factor release, inhibition of molecules that have a role in inflammation, and stimulation of cellular processes that contribute to tissue healing and regeneration.

Physiological Effects

• Increased blood flow/Neovascularization
• Regulate inflammation/reboot the healing process in stalled, chronic conditions
• Tendon tissue regeneration, remodeling, Facilitate tendon gliding
• Fibrotic tissue and scar remodeling/ Resorption
• Stimulation of osteo-regenerative processes, influence osteoblast and osteoclast activity
• Influence transmission of pain signals/ Release of pain mediators
• Reduce hypertonia in spastic muscle

This shoulder MRI shows the amazing results after only (3) Focused Shock Wave & (5) Laser Therapy treatments

Chronic, stalled conditions are brought back into the acute phase to re-activate the body’s natural healing state. The energy delivered into the tissue by Shock Wave creates microscopic injuries: this controlled acute trauma stimulates the development of new blood vessels in the area.

Tendinitis, plantar facilities, carpal tunnel syndrome

Treatment Principles

• Dependent on-indication and tissue response
• 1-4 treatment sessions
• 5-10 days between sessions
• Recommended Laser therapy after the Shock Wave therapy and between sessions

What might happens after the Shock Wave therapy

• Redness of the skin, possible local discomfort, Bruising
• Swelling, reddening, hematomas – Petechiae – Pain. These side effects generally occur between 5 to 10 days.

Importance: Avoid physical activities 48 hours post treatment

Contraindication and Precautions

• Pregnancy
• Coagulation disorder
• Malignancy
• Thrombosis
• Corticosteroid injection (6 weeks)
• Over growth plate (not for under 18 years old)
• Over nerve roots and spinal cord
• Acute inflammation, lower and upper ankle
• History of rheumatic diseases
• History of hyperthyroidism
• Paget disease or calcaneal fat pad atrophy 6) Osteomyelitis (acute, sub-acute, chronic)
• Poly-neuralgia
• Infection in the area to be treated – Patient has a coagulation disorder or taking anti-coagulant medications
• Patient has a prosthetic device in the area to be treated – Over ischemic tissue in individuals with vascular disease effects (e.g. foot ulcers, venous stasis, etc.)
• Fracture of the Calcaneus
• Immunosuppressive therapy
• Long-term (≥ 6 months duration) treatment with any corticosteroid
• Insulin-dependent diabetes mellitus, severe cardiac or respiratory disease
• Bilateral painful heel, if both feet need medical treatment
• Previous surgery of the painful heel syndrome
• Previous unsuccessful treatment of the painful heel with a similar shockwave devices
• History of allergy or hypersensitivity to bupivacaine or local anesthetic sprays
• Significant abnormalities in hepatic function
• Poor physical condition
•  History or documented evidence of peripheral neuropathy such as nerve entrapment, tarsal tunnel syndrome, etc.
• History or documented evidence of systemic inflammatory disease such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, aseptic bone necrosis, Reiter‘s syndrome, etc.
• Implanted pacemakers, insulin pumps, defibrillators and/or neuro-stimulators
• Open wounds or skin rashes
• Tendon rupture, neurological or vascular insufficiencies of the painful heel, as assessed using the Semmes-Weinstein Monofilament test and the Ankle Brachial Index