ESWs have an impact on bone tissue and cause minor damage to the treated bone (focal point) without damaging adjacent soft tissues. The osteogenic promoting effect of extracorporeal shock waves occurs at the interface between the cortical and reticular parts of the bone, and these treatments cause micro-injuries to stimulate and reactivate bone healing capacity in fractures that do not heal (1). ESWT can cause microfractures in old calluses by mechanical conduction, forming a subperiosteal hematoma, promoting the release of bioactive factors and inducing the expression of several angiogenic and osteogenic growth factors, significantly increasing the number of new blood vessels in the tissue, and thus accelerating the healing of the lack of bone attachment (20). Osteoblasts convert mechanical signals into biochemical signals for osteoblasts and osteoclasts, which in turn affect bone tissue reconstruction.
ESW of the right intensity can agglutinate and activate osteoblasts, thus promoting osteogenesis and the healing of fractures. Osteoarthritis can involve degenerative changes in bone and cartilage, as well as inflammation or synovitis. The studies summarized in this review article show that shock wave therapy can improve bone, cartilage, and inflammation at the cellular level and appears to stimulate the regenerative abilities of these tissues. Therefore, the use of shock waves alone or in combination with other treatments may be a good option for patients with pain affecting degenerative joints and bones.
Initially used for the treatment of urinary, kidney and salivary stones, extracorporeal shock wave therapy has been increasingly used as a non-invasive treatment modality for people who have no attachment and delayed unions, 8-10 In fact, initial basic scientific work using unbonded dog and rabbit models evaluated the efficacy of extracorporeal shockwave therapy in obtaining bonding. This work has suggested that shock wave therapy promotes callus formation, as well as dose-dependent osteogenesis, 11-16 In addition, the callus produced appears to undergo adequate remodeling to become laminar bone. More recently, bone treated with shock wave therapy has been shown to be associated with neovascularization and increased expression of angiogenic growth factors, suggesting that increased vascularization may play a role in osteogenesis, 15 In fact, Maier et al. In a rabbit femur model that found an alteration of blood flow to bone treated with shock wave therapy in a dose-dependent manner, 16 Other molecular data suggest that there is a direct stimulating effect of shock wave therapy on the differentiation and proliferation of cultured osteoblasts.17 In addition, the regulation of genes involved in osteoblast proliferation and differentiation (such as the BMP-inducible kinase receptor E2 and prostaglandin, for example) has been observed after extracorporeal shock wave treatment, 17. The number of shocks due to calcification treatment varies between 1000 and 1500 shocks. The chance of bone damage is low. To damage the bone structure, it is necessary to use stronger and more frequent shock waves.
An example of this is the treatment of fractures not related to the joint, which requires 5000 shocks at a much higher pressure to stimulate bone tissue growth without destroying the integrity of the bone structure. Research has also shown that pressure waves generated by muscular electrodystrophy can exert mechanical force on body tissues and promote healing by stimulating blood flow and metabolism. Increased blood flow can be especially beneficial in tendons, which don't receive enough blood supply and heal slowly. Shockwaves can mimic the forces experienced during trauma and promote tissue and bone regeneration and healing.
Extracorporeal shock wave therapy is increasingly being used as adjunctive therapy to treat lack of attachment, delayed attachment and, more recently, recent fractures. The International Society for Medical Shock Wave Treatment approves the use of focused shock waves for the treatment of stress fractures. More research is needed in this area, in the form of large scale randomized trials, to better answer the question about the efficacy of extracorporeal shock wave therapy on binding rates, both in the case of acute fractures as if not related to the joint. The extracorporeal shock wave (ESW) is a special form of mechanical waves that are released rapidly over a very short period of time.
Focused shockwave is a safe, evidence-based treatment option for treating a wide variety of bone injuries. The list of ways that patients describe extracorporeal shock wave therapy (ESWT) is almost as long as the list of conditions that this advanced treatment can help cure. The focused shock wave can provide a simple and effective non-surgical treatment option for stress fractures that don't heal or for facilitate the healing process. The shock waves are directed to the bone through a soft, cone-shaped handset that is placed on the gel, over the lesion.
To improve bone healing, a focused shock wave cycle is required, consisting of between 3 and 8 sessions with an interval of one week. This is incredibly important, and yet it must be respected when embarking on a focused shock wave cycle. There is a large volume of research supporting the use of the focused shock wave to stimulate a healing response in bone injuries, and basic scientific data on how shock waves work support its use in stress fractures. Extracorporeal shock wave therapy has been increasingly used in the treatment of fractures and, specifically, in its role as a non-surgical treatment strategy for non-union or delayed unions.