Simply stated, frequency determines how deeply shock waves penetrate tissue and also affects how energy spreads throughout the body.
Shockwave therapy has long been utilized as an alternative treatment option, often to lithotripsy for kidney stones or to increase blood flow to treat erectile dysfunction. Shockwave therapy offers patients who are seeking alternatives to surgery a powerful form of therapy when other conservative measures have failed.
1. Focused Shockwaves
Shockwave therapy is an innovative noninvasive solution to bone conditions that uses sound waves to stimulate the body’s natural healing processes and reduce calcification, promote new blood flow and increase overall flexibility of bones and joints. Shockwave therapy has also been proven to relieve muscle pain associated with tendinopathies such as tennis elbow, as well as chronic plantar fasciitis due to tight muscles in feet and ankles.
Focused shockwaves differ from therapeutic ultrasound by possessing enough frequency and amplitude to deform tissue and break down adhesion, thus initiating mechanotransduction, which involves mechanical stimuli stimulating production of specialist cells necessary for healing and repair (Roche et al, 2020).
Physical methods employed for creating shockwaves vary between focused and unfocused shockwaves, with focused ones converging more closely on the point of injury to provide energy in a concentrated zone, making them effective at treating localized injuries such as calcific tendonitis or fractures more quickly than their unfocused counterparts, like radial shockwaves which spread their energy more widely, making them suitable for superficial soft tissue management treatments such as soft tissue management. Focused shockwaves can be produced using electrohydraulic, electromagnetic, or piezoelectric generators available from therapists specialized in musculoskeletal health care providers.
When the acoustic pulses from fESWT reach injured bones, they produce rapid pressure fluctuations that trigger cellular responses and trigger inflammation responses in your body resulting in new blood vessel growth and tissue repair. Furthermore, fESWT stimulates production of both transforming growth factor (TGF) and vascular endothelial growth factor (VEGF), both essential for remodelling and healing (Roche et al 2020).
Conservative approaches for treating bone injuries like stress fractures involve passive recovery methods (like resting your bone, restricting weight-bearing, and wearing braces), but focused shockwaves offer an active solution which encourages the bone itself to heal itself faster, more efficiently, and effectively than its usual course. The result? A quicker healing process!
2. Radial Shockwaves
Radial shockwaves differ from focused shockwaves by dispersing their energy over a larger area, treating conditions such as tendonitis, bursitis, plantar fasciitis, and other musculoskeletal disorders over a wider area. Radial shockwaves not only provide pain relief but also stimulate new blood vessel growth and collagen formation to increase range of motion for greater range of motion that helps decrease swelling and inflammation.
Radial shockwaves work similarly to focused shockwaves by way of momentum transfer – they both generate vibrations which are then absorbed by tissue and transmitted as mechanical pressure waves to exert force against it and stimulate healing within it. Radial shockwaves also can produce vibrations similar to focused shockwaves when they come into contact with tissue, producing vibrations which cause tissues to vibrate which then converts to mechanical pressure waves which exert pressure against tissue which then stimulate cytokine production which ultimately stimulate healing within this tissue.
Radial shockwaves also stimulate the creation of new blood vessels and collagen, helping reduce inflammation and speed the healing process. Extracorporeal shockwave therapy is a noninvasive, low-risk procedure typically utilized alongside traditional treatments like physical therapy or injections.
Shockwave devices come in various varieties, and each offers its own set of benefits. Shockwave frequency can depend on the condition being treated and can affect penetration depth and energy distribution as well as patient pain tolerance levels.
Higher frequencies tend to have greater surface impacts than lower ones, and can alter shockwave intensities, potentially impacting patient responses during therapy.
Radial shockwaves offer many advantages, including being suitable for use on any part of the body. However, focused shockwaves may be more suitable in certain instances.
Adjusting the frequency of shockwaves is one way to increase their effectiveness, as frequency determines their depth of penetration and effect at target sites. Furthermore, amplitude can influence how much force is applied by each shockwave to their target tissues.
3. Combination Shockwaves
Shock waves have many uses in medicine and may be employed in different ways. Shockwave therapy was first utilized within human bodies in 1980 for fragmenting kidney stones; since then it has expanded in application. Shock waves can stimulate bone growth, promote connective tissue healing cells known as fibroblasts, inhibit pain receptors, as well as facilitate bone remodeling. When combined with other forms of treatment such as massage therapy or medication.
Shockwave therapy can be applied at low to moderate intensities and is generally well-tolerated by most patients. Treatment intensity can be adjusted during treatment based on individual patient comfort levels and increased or decreased accordingly.
Shockwaves apply mechanical pressure to tissue, increasing cell membrane permeability. This enables nutrients, hormones, and chemicals to move freely within cells promoting cell growth, healing, breaking down calcium deposits in damaged tissues as well as stimulating osteoblasts for new bone formation and fibroblasts for healing connective tissues such as tendons. The shockwaves also stimulate osteoblasts that create new bone while also stimulating fibroblasts for tissue healing purposes such as tendon repair.
Acoustic waves also promote collagen production in the treated area, strengthening surrounding tissue while relieving pain and inflammation. Acoustic waves also disrupt calcium buildup in injured tendons which the body then expel naturally, helping reduce spasticity by decreasing muscle tone and cutting pain signals from reaching your brain that cause spasms.
Researchers believe ESWT may improve musculoskeletal conditions and assist in healing damaged tissue due to its ability to induce mechanotransduction – the process by which mechanical stimuli trigger cell responses like proliferation, differentiation or apoptosis – within cells.
Shockwave therapy can offer immediate results; however, several sessions are often required for long-term relief and substantial relief. Most patients require multiple sessions weekly initially before their frequency gradually decreases as conditions heal. It’s essential to discuss expectations with a specialist, as each situation and injury requires unique considerations regarding frequency of shockwave therapy treatments.
4. High-Intensity Shockwaves
Shock waves are transient short-term sonic pulses with extremely high peak pressures (up to 100 MPa) and extremely rapid rise times, usually less than 1 micro second. Shock waves are used as medical therapy treatments for conditions affecting the musculoskeletal system such as chronic plantar fasciitis and Achilles tendinitis.
ESWT differs from many other treatments in that its course does not entail medication or injections; rather, shockwaves stimulate healing by inducing local inflammation which triggers your body’s natural healing response and leads to new collagen fiber formation that strengthens and supports the tendon. Furthermore, blood flow and lymphatic drainage increase to further boost recovery.
ESWT works through cellular mechanotransduction. This theory describes how shockwaves act like mechanical stimuli to produce biological responses such as migration, proliferation, differentiation or apoptosis in cells. ESWT may also help decrease pain modulation by disrupting cell membranes to increase cell permeability thereby decreasing neurotransmitters responsible for pain signaling and decreasing pain modulation by decreasing pain modulation through disrupting neurotransmitter release.
ESWT stands out as an invaluable treatment option because it does not require anesthesia or sedation for use, which means it can be performed safely even on patients who cannot tolerate being sedated; those with bleeding disorders and anticoagulant use; pacemakers; other implanted devices etc. It may cause skin reddening, swelling and pain during and post treatment sessions as well as occasionally returning after multiple sessions have concluded. Common side effects may include reddening and swelling; pain during or post session use as well as occasional recurrence after multiple sessions has taken place.
Radial wave treatments are usually effective at treating most conditions; however, sometimes more targeted solutions may be required. Focused shockwave therapy (FSWT), in contrast with its radial counterpart, offers higher maximum intensities and adjustable depth of focal zone than its radial counterpart; making FSWT the superior choice when applied directly to problem areas like pelvic or hip regions.
Though fESWT may still be relatively new, several randomized control trials have demonstrated its efficacy for treating spasticity. Multiple studies have revealed its ability to reduce spasticity significantly while improving mobility and decreasing pain for those suffering from cerebral palsy or stroke causing upper or lower limb spasticity.
