Claude Dornier was a German aeronautical engineer and industrialist whose company later pioneered extracorporeal shock wave lithotripsy (ESWL), the original form of extracorporeal shock wave therapy for breaking kidney stones non-invasively.
ESWL subsequently expanded from urology into orthopedics and other fields once its biological effects on bone healing were recognized. The application of shockwaves in orthopedics (orthotripsy) became simply known as ESWT or extracorporeal shock wave therapy.
Clinical reports in the late 1980s and 1990s extended ESWT from fracture healing to chronic soft-tissue problems. It was increasingly used for conditions such as plantar fasciitis, lateral epicondylitis (tennis elbow), calcific shoulder tendinitis, and other tendinopathies and fasciopathies that often failed conservative care.
In the early 2000s, devices featuring ballistic pressure waves were introduced into the Extracorporeal Shock Wave Therapy (ESWT) market. These waves are produced mechanically by a compressed air driven projectile which hits the applicator. This technology is since named radial ESWT (rESWT). The clinical effect of rESWT could soon be demonstrated and today rESWT is a widely accepted method with comparable results specifically for superficial musculoskeletal disorders
Figure 1: Initiation of the ESWT technology to treat Olympic athletes during the 1996 Olympic Games in Atlanta.
The essential principle behind this technique revolves around the action of shockwaves, which are rapid but short duration acoustic waves that carry energy and can propagate through tissues. In contrast to ESWL, the application of shockwaves in orthopedics (orthotripsy) can be beneficial due to their ability to cause interstitial and extracellular responses which lead to tissue regeneration.
Acting as a mechanical stimulus, it is believed that ESWT promotes healing via mechanotransduction. Reportedly, biological responses include tissue regeneration, pain modulation, anti-inflammatory, angiogenesis and calcific deposit disruption. Additionally, it may also alleviate pain by means of hyperstimulation analgesia via the gate control theory, endorphin release and central biasing mechanism.
Multiple clinical trials and meta-analyses on ESWT regarding various musculoskeletal conditions have shown beneficial results. The following is a selection of the key studies that highlight its effectiveness in reducing pain and improving function.
Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo- controlled multicenter study.
Conclusion: Radial extracorporeal shock wave therapy significantly improves pain, function, and quality of life compared with placebo in patients with recalcitrant plantar fasciitis.
A comparison of the effectiveness of radial extracorporeal shock wave therapy and ultrasound therapy in the treatment of chronic plantar fasciitis: a randomized controlled trial
Conclusion: In chronic plantar fasciitis treatment, both rESWT and US were found to be effective in reducing pain and increasing mobility; however, statistical analysis showed that rESWT is significantly more effective than US.
Extracorporeal shock wave therapy without local anesthesia for chronic lateral epicondylitis
Conclusions: These results demonstrate that low-dose shock wave therapy without anestheticis a safe and effective treatment for chronic lateral epicondylitis.
Efficacy of Extracorporeal Shock Wave Therapy for Lateral Epicondylitis: A Systematic Review and Meta-Analysis
Conclusion: Based on the existing clinical evidence, extracorporeal shock wave therapy can effectively relieve the pain and functional impairment (loss of grip strength) caused by tennis elbow, with better overall safety than several other methods.
Effectiveness and Safety of Shockwave Therapy in Tendinopathies
Conclusions: 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.
Does Radial Extracorporeal Shockwave Therapy Applied to the Achilles Tendon Influence Ankle Functionality?
Conclusion: The results revealed that rESWT led to significant improvements in single-leg vertical jump, indicating enhanced power generation and ankle functionality that were not observed in the control group. Additionally, the therapy resulted in increased ankle mobility, as observed by improvements in plantar flexion and heel-rise tests. This study highlights rESWT as a promising tool for rehabilitation, particularly following Achilles tendon injuries.
Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single- blind, randomized clinical study
Discussion and conclusion: The results suggest that the use of RSWT for the management of calcific tendinitis of the shoulder is safe and effective, leading to a significant reduction in pain and improvement of shoulder function after 4 weeks, without adverse effects.
No difference in effectiveness between focused and radial shockwave therapy for treating patellar tendinopathy: a randomized controlled trial
Conclusion: There were no statistically significant differences in effectiveness between FSWT and RSWT. It is therefore not possible to recommend one treatment over the other on grounds of outcome. Both groups improved significantly.
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