Extracorporeal Shock Wave Therapy (ESWT) for Pain Relief

ESWT was first introduced in 1982 as a way to dissolve urinary stones, so they could pass less painfully. However, as medical studies progressed, ESWT was found to be an effective treatment for tendonitis and other soft-tissue conditions. ESWT treatment promotes collagen synthesis and tissue modeling, among other benefits, which improve the chances for a complete recovery for musculoskeletal pain conditions without the need for surgery.

Extracorporeal shockwave therapy (ESWT) is a treatment mostly used to treat kidney stones and in physical therapy and orthopedics.

ESWT is used in physical therapy for pain reduction, increase in metabolism at cellular level, revascularisation, and recovering normal muscle tone following various disorders. The use of ESWT was demonstrated in patients with frozen shoulders compared to therapeutic ultrasound with exercises.

It uses acoustic pressure waves to safely increase metabolism and blood flow, stimulating or enhancing healing of the injury.  The microtrauma induced, triggers a cascade of inflammatory factors such as cytokines and chemokines that help regenerate the damaged tissue.  These inflammatory factors are essential for healing and are present at high levels in acute injuries, but diminish or cease to exist over time in chronic injuries.

More about ESWT

Extracorporeal shock wave therapy gets its name, because shock waves, a type of sound wave, are delivered to the injured tissue “extracorporeally,” which means above the skin. The shock wave device delivers impulses to the affected area, which stimulate blood flow, relax muscles in spasm, and stimulate tissue repair. Immediate pain relief is achieved upon the 1st treatment in most cases, while 6-10 treatments are usually required for complete recovery.

ESWT is commonly used in the treatment of a wide variety of musculoskeletal conditions. If you suffer from chronic pain in the Achilles tendon, elbow, knee, plantar fascia, shoulder, or other parts of your body, you might be a candidate for ESWT.

Indications that ESWT can HELP:

Myofascial trigger-point muscular back painRadial and Ulnar epicondylitis
Trochanteric Hip BursitisTendinitis of the shoulder
Periostitis or shin splintsCalcific Tendinopathy of the shoulder
Dupuytren’s diseaseStatus post muscular injury
Thumb basal joint arthritis or rhizarthritisPatellar tendinitis
Muscular pain quadratus lumborum or gluteusPatellar Tendinopathy
Muscular pain tibialis posterior, soleus or gastrocnemiusAchilles Tendinopathy
Muscular pain quadricepsPlantar Fasciitis or Fasciopathy
Muscular ImbalanceHeel spurs
Low Back PainMyofascial trigger-point neck therapy

CLINICAL RESEARCH

Physical treatment options with impact on bone healing

A comparative study of the efficacy of ultrasonics and extracorporeal shock wave in the treatment of tennis elbow: a meta-analysis of randomized controlled trials.

Hyaluronic Acid (HA), Platelet-Rich Plasm and Extracorporeal Shock Wave Therapy (ESWT) promote human chondrocyte regeneration in vitro and ESWT-mediated increase of CD44 expression enhances their susceptibility to HA treatment

Extracorporeal Shockwave Therapy in Pillar Pain after Carpal Tunnel Release: A Prospective Randomized Controlled Trial

“A positive effect for bony healing could be seen in 70-71% of ESWT patients but also in 73% of the surgically treated group. ““…indicated that ESWT offers more effective therapy for lateral epicondylitis than US therapy.”“…ESW-induced CD44 overexpression enhances the in vitro cell susceptibility of human chondrocytes to HA, presumably favouring the repair of degenerated cartilage.”“After ESWT, hand function and pain score in patients with pillar pain improved faster compared to control patients. Hence, ESWT can be used as a safe and effective noninvasive technique in patients with pillar pain after carpal tunnel release.”

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Shock-wave therapy versus corticosteroid injection on lateral epicondylitis: a meta-analysis of randomized controlled trials

Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial

The Effectiveness Of Radial Extracorporeal Shock Wave Therapy In Patients With Chronic Low Back Pain: A Prospective, Randomized, Single-Blinded Pilot Study

Extracorporeal shock wave therapy for patients suffering from recalcitrant Osgood-Schlatter disease

“In light of the better improvement in the terms of VAS and grip strength with follow-up more than 12 weeks, we assume that SW may be a superior alternative for the treatment of LE.”“…topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis.”“The rESWT combined with stabilization training is particularly effective in the long-term and achieves a stable beneficial effect for patients with LBP. ““This pilot study demonstrates that radial ESWT is a safe and promising treatment for adolescent athletes with recalcitrant Osgood-Schlatter disease.”

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Rehabilitation treatment of spastic cerebral palsy with radial extracorporeal shock wave therapy and rehabilitation therapy

Comparison Between Extracorporeal Shock Wave Therapy and Intra-articular Hyaluronic Acid Injections in the Treatment of First Carpometacarpal Joint Osteoarthritis

Effectiveness and Safety of Shockwave Therapy in Tendinopathies

The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders

“The rESWT combined with rehabilitation can quickly and effectively relieve paralysis of lower extremities, reduce the tension of hamstrings and calf muscles, relieve muscle spasm, and rapidly improve limb function in children with spastic cerebral palsy.”“The use of ESWT in patients with first CMC joint osteoarthritis leads to a reduction in pain, an improvement in pinch test performance that persists for at least 6 months, and a decrease in hand disability up to the 6-month follow-up visit.”“Shockwave therapy significantly reduced the pain that accompanies tendinopathies and improves functionality and quality of life. It might be first choice because of its effectiveness and safety.”“Increasing evidence suggests that extracorporeal shockwave treatment (ESWT) is safe and effective for treating several musculoskeletal disorders…”

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Electromagnetic transduction therapy and shockwave therapy in 86 patients with rotator cuff tendinopathy: A prospective randomized controlled trial

Comparison the Effect of Extra Corporeal Shockwave Therapy with Low Dosage Versus High Dosage in Treatment of the Patients with Lateral Epicondylitis

Shockwave treatment for medial tibial stress syndrome in military cadets: A single-blind randomized controlled trial

Extracorporeal shock waves alone or combined with raloxifene promote bone formation and suppress resorption in ovariectomized rats

“In patients with RC tendinopathy, electromagnetic transduction therapy combined with extracorporeal shock wave therapy significantly improves pain and function compared to ESWT with sham-EMTT.““Extra corporeal shockwave therapy can be effective in treating lateral epicondylitis, but its effects usually appear in after 2 or 3 months and using the low dose of this treating method has more desirable therapeutic effects.”“ESWT patients were able to run longer…”“SW therapy is considered a non-invasive therapeutic modality with effectiveness, convenience, and safety; also replacing surgery with no surgical risks in many orthopedic disorders and it may represent an innovative strategy to limit the progression of osteoporosis.”

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Extracorporeal Shock Wave Therapy Accelerates Regeneration After Acute Skeletal Muscle Injury

Extracorporeal Shockwave Therapy Improves Functional Outcomes of Adhesive Capsulitis of the Shoulder in Patients With Diabetes

Radial Soundwave for Sesamoidopathy in Athletes: A Pilot Study

Radial extracorporeal shockwave therapy for the treatment of finger tenosynovitis (trigger digit)

“ESWT stimulates regeneration of skeletal muscle tissue and accelerates repair processes.”“Results indicate that ESWT may be effective, feasible, and well tolerated and can therefore represent a valid alternative to steroids for ACS treatment in patients with diabetes.”“An overall improvement was seen in reported pain after RSW. ““This study provides initial evidence that rESWT is an effective treatment for trigger digit…”

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Repetitive shock wave therapy improves muscular microcirculation

Success and Recurrence Rate after Radial Extracorporeal Shock Wave Therapy for Plantar Fasciopathy: A Retrospective Study

Two emerging technologies for Achilles tendinopathy and plantar fasciopathy

Extracorporeal shockwave therapy for avascular necrosis of femoral head

“Extracorporeal shock wave therapy (ESWT) is mainly applied in tendon as well as bone problems based on stem-cell activation and healing acceleration. ““Individualised rESWT protocol constitutes a suitable treatment for patients undergoing rESWT for plantar fasciitis.”“The use of acoustic energy in the form of unique sets of “high-energy” acoustic pressure waves or sound waves to treat musculoskeletal injuries has been around for approximately 30 years..”“ESWT is an effective and non-invasive method in the treatment of ONFH. ESWT is equally effective for ONFH in SLE patients.”

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Mechanical Stimulation (Pulsed Electromagnetic Fields “PEMF” and Extracorporeal Shock Wave Therapy “ESWT”) and Tendon Regeneration: A Possible Alternative

Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study

Extracorporeal shock wave therapy vs cryoultrasound therapy in the treatment of chronic lateral epicondylitis. One year follow up study

Mechano-transduction effect of shockwaves in the treatment of lumbar facet joint pain: comparative effectiveness evaluation of shockwave therapy, steroid injections and radiofrequency medial branch neurotomy

“ESWT is reported to be an effective treatment in different chronic tendon pathologies. ““…there was a significant difference (p = 0.0027, one-sided) in the reduction of heel pain in the extracorporeal shock wave therapy group (69.2%) compared with the placebo therapy group (34.5%).”“ESWT has better clinical therapeutic results at 6- and 12-month follow-up as compared to Cryo-US therapy.”“Shockwave therapy had shown better longterm results compared to FJ injections group and little inferior efficacy compared to RMBN. “

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Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial

Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study

Triggerpunkte – Diagnose und Behandlungskonzepte unter besonderer Berücksichtigung extrakorporaler Stoßwellen

Ultrasonographic evaluation of low energy extracorporeal pulse activated therapy (EPAT) for chronic plantar fasciitis

” At the final follow-up, significant improvement in the total CMS score and most of the CMS subscales was observed in the ESWT group when compared to the baseline values.”“The time to full recovery was significantly faster in the ESWT group compared with the patients who only performed a graded running programme…”“Insgesamt stellt die Stoßwellentherapie am Muskel eine Bestätigung und Erweiterung der bestehenden Triggerpunkttherapie dar.”“For patients with a greater than 12-month history of heel pain, EPAT can effectively decrease plantar fascia thickness as demonstrated objectively by ultrasound evaluation and reduce patient-reported pain.“

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High-energy focussed extracorporeal shockwave therapy reduces pain in plantar fibromatosis (Ledderhose’s disease)

Extracorporeal shock wave therapy improves the walking ability of patients with peripheral artery disease and intermittent claudication

Extra-corporeal pulsed-activated therapy (“EPAT” sound wave) for Achilles tendinopathy: a prospective study

Calcific tendinitis of the shoulder

“Pain was 6±2 at baseline, 2±1 after 14 days and 1±1 after 3 months. Softening of the nodules was noted by all patients. No adverse effects were noted.”“Non-invasive SW therapy improves the walking ability of PAD patients.”“…we believe that shockwave therapy serves as a safe, viable, and effective option for the treatment of Achilles tendinopathy.”“Nonoperative management including rest, nonsteroidal anti-inflammatory drugs, subacromial corticosteroid injections, and shock wave therapy is still the treatment of choice. “

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Extracorporeal shock wave therapy in pillar pain after carpal tunnel release: a preliminary study

Extracorporeal shockwaves versus surgery in the treatment of pseudoarthrosis of the carpal scaphoid

Shock waves in the treatment of stress fractures

“We treated 40 consecutive patients with ESWT who had pillar pain for at least six months after carpal tunnel release surgery…”“Recently, extracorporeal shockwaves therapy (ESWT) has yielded encouraging results in the treatment of pseudoarthrosis of various bone segments. ““Extracorporeal shock wave therapy (ESWT) has been used successfully on fracture complications, such as delayed union and nonunion. “

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