{"id":2104,"date":"2020-05-01T14:31:03","date_gmt":"2020-05-01T12:31:03","guid":{"rendered":"https:\/\/pes-luxembourg.lu\/bascharage\/?page_id=2104"},"modified":"2024-01-24T18:15:35","modified_gmt":"2024-01-24T17:15:35","slug":"shock-wave-physiotherapy","status":"publish","type":"page","link":"https:\/\/pes-luxembourg.lu\/bascharage\/en\/shock-wave-physiotherapy\/","title":{"rendered":"Shock waves Kinesitherapy"},"content":{"rendered":"
Shock waves are acoustic waves with extremely high energy peaks, such as those produced in the atmosphere by explosive phenomena like lightning strikes or sonic explosions. A shock wave differs from ultrasound in its extremely wide pressure amplitude. What’s more, ultrasound usually consists of a periodic oscillation, whereas a shockwave is a single pulse.<\/p>\n
Extracorporeal shockwave therapy (ESWT) is the application of shockwaves in medicine.<\/p>\n
When applied to damaged tissue, pressure waves stimulate metabolic reactions. It’s clinically proven:<\/p>\n
Evolution of shockwave therapy<\/p><\/h2><\/div>
The term “shockwave therapy” refers to mechanical pressure impulses that spread like a wave through the human body. In 1980, the shock wave method was first used to disintegrate stones in a patient’s kidneys(Journal of Urology<\/em>, 1982).<\/p>\n<\/div> Therapeutic effect of shockwaves<\/p><\/h2><\/div> Extracorporeal acoustic wave therapy (unlike lithotripsy) is not used to disintegrate tissue, but to induce microscopic extracellular and interstitial biological effects, including tissue regeneration. In modern pain therapy, acoustic wave energy is conducted from the point of origin, which is the acoustic wave generator (via a coupling gel), to the areas of the body experiencing pain. Here, its curative capacity is applied.<\/p>\n After 4 or 5 sessions, over 80% of patients report no more pain or a very marked reduction in pain.<\/p>\n The 2 types of shockwave<\/p><\/h1><\/span> Radial shockwaves have been used for many years to treat tendinopathies. Your physiotherapy practice in Bascharage also uses focal shockwaves, which are much more precise and effective for many pathologies. What’s more, not all radial shockwaves are created equal, and this can be one of the reasons for the success or failure of a treatment.<\/p>\n<\/div> Radial shock waves<\/p><\/h2><\/div> Compressed air accelerates a projectile, which strikes a fixed applicator at high speed (up to 90 km\/h). The kinetic energy <\/strong>is converted into a shockwave that is released <\/strong>through the skin into the targeted tissue. These shockwaves propagate radially across large treatment areas.<\/strong><\/p>\n <\/p>\n <\/p>\n The energy flux density (ED or EFD) is represented by the square area below the pressure curve.<\/p>\n <\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div> Focal shock waves<\/p><\/h2><\/div> A high voltage is applied to 1,000 piezoceramic crystals, generating pressure waves<\/strong>. They penetrate the skin and pass through the tissue, concentrating on a<\/strong> cigar-shaped volume<\/strong>.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n <\/p>\n Focused ESWT and radial ESWT can both achieve an ED+ of 0.4 mJ\/mm2, a value that has been proven for almost all ESWT indications on the musculoskeletal system and skin.<\/p>\n <\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div> The 2 major impacts of shockwave therapy<\/p><\/h1><\/span> Tissue repair and cell growth<\/p><\/h2><\/div> The blood flow of nutrients is necessary to start and maintain the repair processes of the damaged tissue structure. The application of acoustic waves creates capillary microruptures in tendon and bone and significantly increases the expression of growth indicators such as eNOS, VEGF, PCNA<\/em> and BMP<\/em>.<\/p>\n <\/p>\n<\/div>\n Both processes stimulate the growth and remodelling of new arterioles. The new blood vessels will improve blood supply and oxygenation, resulting in faster healing of tendon and bone.<\/p>\n Chronic inflammation occurs when the inflammation reaction is not completely stopped. It can damage healthy parts of the body and lead to chronic pain. The activity of mast cells, involved in the inflammatory process, can be enhanced by insinuating acoustic waves. Mast cell activation can be followed by the synthesis of chemokines and cytokines. Unblocking pro-inflammatory mixtures, if necessary, can help restore normal healing and regenerative processes.<\/p>\n The production of sufficient quantities of collagen is a necessary precondition for the tissue repair process. Shockwave therapy accelerates procollagen synthesis. The newly created collagen fibers are imposed in a longitudinal structure. These newly-formed tendon fibers are denser and harder.<\/p>\n <\/p>\n Analgesia and mobility rehabilitation<\/p><\/h2><\/div> Substance P is a neurotransmitter that mediates pain information via C-fibres. This neuropeptide is generally associated with chronic, persistent and intense pain. It is used to relay pain messages to the central nervous system. Reducing the concentration of substance P reduces the stimulation of afferent nociceptive fibers, thereby reducing pain. Reduced substance P, histamines and other nociceptive metabolites also help inhibit the development of inflammatory edema.<\/p>\n Calcium deposits are most often the result of micro-tears or other tendon trauma. Acoustic waves break up existing calcifications. Acoustic wave therapy initiates biochemical decalcification of the toothpaste-like calcium deposit and treats the tendon. Calcium granules are removed by the lymphatic system.<\/p>\n Trigger points are the main cause of pain in the back, neck, shoulders and extremities. They are associated with palpable nodules in taut groups of muscle fibers, and their sarcomeres are extremely contracted. Dysfunctional sarcomeres contract so hard that they begin to cut off their own blood supply. This causes a deposit of waste products which in turn irritates the sensory nerve endings, causing even more contractions. This vicious circle is referred to as a “metabolic crisis”. Although the precise medical effects of the acoustic wave are still unclear, it can be argued that the acoustic energy supplied unlocks the “calcium pump”. This reverses the metabolic crisis into myofilaments and relieves these trigger points.<\/p>\n <\/p>\n Acoustic waves relieve extremely contracted sarcomeres in trigger points.<\/p>\n<\/div> Shockwave applications<\/p><\/h1><\/span> Extracorporeal shockwave therapy is most frequently used in physiotherapy<\/strong>, orthopedics<\/strong> and sports medicine<\/strong>.<\/p>\n Shockwave therapy is the perfect treatment method for all complex chronic and musculoskeletal conditions.<\/p>\n<\/div>\n<\/div>\n<\/div> New indications for shockwave treatment in sports medicine<\/p><\/h2><\/div> This therapy can be used for chronic and acute soft-tissue disorders in sports medicine. The latest results prove the effectiveness of shockwaves in healing muscular tension, reducing recovery times and enabling a return to full sporting endurance.<\/p>\n Sports medicine indications for shock waves are :<\/p>\n In the case of acute muscle injury, shockwave therapy is part of my standard therapeutic procedure. I’ve managed to use them for all my patients, including some of the world’s best tennis players, including Tomas Berdych (2010 Wimbledon finalist) and other members of the Czech Davis Cup team.<\/p>\n<\/div><\/div><\/span><\/blockquote>Benefits for the patient:<\/h3>\n
\n
Ballistic shockwave generation<\/strong><\/h3>\n
Pressure characteristics of radial shock waves<\/strong><\/h3>\n
\n
Visualization of radial shock waves<\/strong><\/h3>\n
Piezoceramic shockwave generation<\/strong><\/h3>\n
Pressure characteristics of radial shock waves<\/strong><\/h3>\n
\n
Visualization of focal shock waves<\/strong><\/h3>\n
Inward growth of neovascularization :<\/strong><\/h3>\n
Reversing chronic inflammation:<\/strong><\/h3>\n
Collagen stimulation :<\/strong><\/h3>\n
Dispersion of pain mediator Substance P :<\/strong><\/h3>\n<\/div>\n
Dissolution of calcified fibroblasts :<\/strong><\/h3>\n
Pre-treatment x-ray images.<\/h5>\n
X-ray images after 3 shockwave sessions<\/h5>\n
Trigger point relief:<\/strong><\/h3>\n
\n
\n
\n
\n