The promising developments in the newest medical fields are based on long experience with shock waves – effective and minimal risk of side effects. For 30 years, extracorporeal shock wave treatment has been applied successfully for disintegrating urinary tract concrements, whereby primarily the mechanical energy of the shock wave is used. Shock waves pass through soft tissue without damaging it. At the kidney stone energies are set free which cause it to disintegrate. The remnant is secreted via the urinary tract.
From Kidney Stone Disintegration to Bone Treatment
The concept of treating bone and tendon pathologies arose from observations of shock wave treatments of deeper positioned stones in the ureter and bladder. In order to disintegrate these concrements, shock waves must pass through the ala of the ileum (pelvic bone). Monitoring radiography showed that a thickening of the treated patients’ pelvic bone occurred, and this definitive growth-enhancing effect of shock waves on bony tissue soon attracted the attention of orthopedic and trauma surgeons.
After appropriate clinical studies and animal experiments, use of shock wave therapy increased worldwide in cases of delayed fracture healing and non-unions as well as tendon pathologies (tennis elbow, heel spurs). All observations indicated that shock waves not only enhanced the growth in bony tissue, but also in other tissues (skin, blood vessels).
Shock Wave Treatment successfully used over more than 15 years for orthopedic conditions
Extarcorporeal shockwave treatment expanded worldwide for the "classical" orthopedic indications:
1. Tendinopathy of the shoulder (with and without calcification)
2. Fasciitis plantaris (heel spur)
3. Epicondylitis of the elbow (tennis elbow)
4. Pseudarthrosis (non-union/non healing fractures)
Due to extensive basic research and increased knowledge of the regenerative working mechanism of this technology the indication spectrum grew quickly over the past years including achillodynia, patella tendonitis (jumper´s knee), greater trochanteric pain syndrome (GTPS), adductor syndrome and many more chronic tendinopathies. Especially for physically active people and high profile athletes ESWT offered a non-invasive complication free treatment option.
"Positive" side-effects lead to new fields of application
By documenting "positive" side-effects like faster wound healing after shock wave treatment, this technology expanded quickly into completely new medical fields. ESWT gets more and more importance in the treatment of acute and chronic skin lesions such as: bedsores, chronic diabetic, arterial and venous ulcers, burn injuries, post traumatic post surgical healing disorders etc. Animal trials and first clinical studies could also prove a regenerative effect on damaged heart muscle tissue. Recent studies even showed accelerate recovery of peripheral nerve lesions after shock wave application in animal trials.
Mechanisms of Shock Waves
Originally, a "mechanistic" model of the shock wave was adopted whereby shock waves, having passed through the soft tissue without damaging it, cause micro-lesions in the target area thereby triggering the healing impulse in the bone. But recent findings in basic research prove the assumption of a mechanical effect to be mistaken.
From the Mechanistic Model to the "Body’s Innate Bioengineering"
Several groups of researchers all over the world performed basic research in shock wave therapy demonstrating that shock waves trigger a "biological response" in treated tissue. Under the influence of shock waves, genes in the nucleus of treated cells are activated starting the production of various proteins responsible for healing processes (so called "growth factors"). This causes an increased integration of newly formed blood vessels as well as new growth of tissue, thereby triggering the healing process – better circulation of the myocardial muscle, new bone formation or the formation of new skin on lesions. Very recent studies could also prove that tissue preconditioned with ESWT influences the migration of body own stem cells (attracts stem cells). Even differentiation of stem cells (forming original tissue/avoiding scar formation) seems to be influenced positively by shock waves.
Thus, it was demonstrated that under the influence of shock waves a "body’s innate bioengineering" and the process of self-healing are initiated.
Effective Initiation of Self-Healing – Relevant in Many Medical Fields
For physicians, this active principle provides scores of new possibilities. Instead of applying biologically active substances, which are produced in laboratories at high cost and with high risks, shock waves can be applied to activate the body’s innate system to create these substances naturally. This new hypothesis of the micro-biological mechanism of shock waves has been confirmed in various animal experiments and has attracted the interest of other medical fields. It has also been corroborated by the first successful clinical applications of shock wave treatment in cases of circulation problems of the myocardial muscle as well of chronic and acute skin lesions.
These findings pave the way for shock wave therapy to be utilized in other medical disciplines.