Iuamoto LR. et al., 2025: Penetration Depth and Tissue Interaction of Focused Extracorporeal Shock Waves: An In-vitro Investigation.
Leandro R Iuamoto 1, Wu T Hsing 1
1Acupuncture Center, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, BRA.
Abstract
Introduction: Extracorporeal shock wave therapy (ESWT) is a non-invasive therapeutic approach with minimal consequences, extensively utilized for the management of musculoskeletal problems. Focused ESWT (f-ESWT) is known to have regenerative effects on muscle and bone tissues; however, little is known about its penetration and propagation in different tissues.
Objective: To assess the reach of f-ESWT in soft tissues and bone tissues.
Methods: An in-vitro observational study was conducted. A piezoelectric shock wave device was used to evaluate the penetration and visual propagation of shock waves in an aquarium with water in muscle tissues (ham) of different thicknesses, and bone tissues (scapula and femur). High-resolution images and videos were captured to observe the penetration of mechanical waves into the different tissues.
Results: Light beams and air bubbles were observed, consistent with the propagation of f-ESWT through different tissues. The f-ESWT was able to penetrate wide bones such as the femur and thin bones such as the scapula.
Conclusion: F-ESWT is capable of penetrating soft tissues and bone tissues depending on the depth. This is an important study for the safe application of f-ESWT by a healthcare professional with prior anatomical knowledge.
Cureus. 2025 Mar 7;17(3):e80205. doi: 10.7759/cureus.80205. PMID: 40196067;
PMCID: PMC11973608 FREE PAPER
Comments 1
Introduction: The article discusses the characteristics and applications of focused extracorporeal shock wave therapy (f-ESWT), originally developed for kidney stone treatment but now utilized for various musculoskeletal disorders, such as calcific tendinopathy and chronic heel pain. This non-invasive therapy employs shock waves to stimulate biological responses, including tissue regeneration and pain modulation, though the penetration depth and effectiveness across different tissue types remain inadequately understood.
Objectives: The study aims to evaluate the penetration depth of f-ESWT in soft and bone tissues, analyzing wave propagation through various biological tissues and gel pads to ensure safe clinical applications.
Introduction: The article discusses the characteristics and applications of focused extracorporeal shock wave therapy (f-ESWT), originally developed for kidney stone treatment but now utilized for various musculoskeletal disorders, such as calcific tendinopathy and chronic heel pain. This non-invasive therapy employs shock waves to stimulate biological responses, including tissue regeneration and pain modulation, though the penetration depth and effectiveness across different tissue types remain inadequately understood.
Objectives: The study aims to evaluate the penetration depth of f-ESWT in soft and bone tissues, analyzing wave propagation through various biological tissues and gel pads to ensure safe clinical applications.
Discussion: The study outlines how mechanical wave properties affect biological tissues, noting that shock wave efficacy is influenced by tissue density and the type of shock wave generator used. The findings advocate for a nuanced understanding of shock wave interaction across different tissues to optimize therapeutic outcomes and highlight potential risks, including impacts on vital organs during treatment. Unfortunately, the article does not give an answer, how the used shock wave energy / intensity has an impact on shock wave propagation and interaction.
Limitations: The reliance on visual observations as indirect indicators of penetration depth poses limitations, and the study suggests future research incorporate quantitative measurements to assess energy transmission and depth accurately. It also notes the impact of using cadaver bones, which may not fully represent living conditions.
Conclusions: The study concludes that f-ESWT effectively penetrates both soft and bone tissues, with penetration depth varying by tissue type and shock wave intensity. It emphasizes the necessity for proper coupling mediums like gel and underscores the importance of anatomical knowledge in clinical application. Future research should refine measurement techniques to improve understanding and effectiveness of shock wave therapy.
Overall, this study contributes valuable insights regarding the dynamics of shock wave interactions with biological tissues, advocating further research to enhance treatment protocols and patient outcomes in the field of musculoskeletal therapy.
Jens Rassweiler