Shockwave Therapy in faster recovery.pptx

Shockwave therapy for faster recovery

1. EXTRACORPOREAL SHOCKWAVE THERAPY R. Rakesh prabu MPT 1 st Year Government cuddalore medical college hospital

2. History  Extracorporeal Shockwave Therapy (ESWT) otherwise referred to as shockwave therapy, was first introduced into clinical practice in 1982 for the management of urologic conditions. The success of this technology for the treatment of urinary stones quickly made it a first-line, non-invasive, and effective method  Subsequently, ESWT was studied in orthopaedics where it was identified that it could loosen the cement in total hip arthroplasty revisions. Further , animal studies conducted in the 1980s revealed that ESWT could augment the bone-cement interface, enhance osteogenic response and improve fracture healing.   While shockwave therapy has been shown to be beneficial in  fracture healing , most orthopedic research has focused on upper and lower extremity tendinopathies , fasciopathies , and soft tissue conditions.

3. Physics of ESWT Shockwaves are sound waves that have specific physical characteristics, including nonlinearity, high peak pressure followed by low tensile amplitude, short rise time, and short duration (10 ms ). They have a single pulse, a wide frequency range (0-20 MHz), and a high pressure amplitude (0-120 MPa) These characteristics produce a positive and negative phase of shockwave. The positive phase produces direct mechanical forces , whereas the negative phase generates cavitation and gas bubbles that subsequently implode at high speeds, generating a second wave of shockwaves . In comparison to ultrasound waves, the shockwave peak pressure is approximately 1000 times greater than the peak pressure of an ultrasound wave .

4. Extracorporeal shockwave therapy works in two ways Focused shockwaves Radial pressure waves. The focused shockwave method uses a very focused impulse to target affected areas through an extracorporeal shockwave therapy machine . There is no need for anaesthesia since the shockwave used is low energy . The doctor applies a special gel to the affected area, which helps deliver the impulses deeper into the skin .

5. The main difference between radial shockwaves and focused shockwaves is That radial shockwaves dissipate once they have been discharged and have contacted the skin, While focused shockwaves are a little higher in energy and therefore don’t dissipate when it reaches the skin.

6. Focused Radial

7. Focused Radial

8. Radial Pressure Wave / Radial shockwave (soft shock) Larger treatment area of superficial indications Superficial 3-4 cm treatment depth Spreads to treat larger areas Slow impulse Low energy density Focused shockwaves (hard shock) Smaller focal point for greater accuracy and greater treatment depth . Deep reach up to 12cm dependent on the attachments used Precise energy delivery to the exact area Fast impulse High energy density

9. B iological effects of focused shockwave and radial pressure waves Focused shockwave AND radial pressure waves: Increase of cell wall permeability Stimulation of Microcirculation (Blood, Lymph) Release of Substance P Neurotransmitter responsible for pain modulation. It is a powerful vasodilator, causing considerable hypotension Focused shockwaves ONLY: Cavitation Release of nitric oxide (increased cell metabolism, neoangogenesis, anti-inflammatory effect) Stimulation of growth factors

10. Mechanism of Action T he proposed mechanisms of action for ESWT include the following: Promote neovascularization at the tendon-bone junction, Stimulate proliferation of tenocytes  and osteoprogenitor differentiation , Increase leukocyte infiltration , And amplify growth factor and protein synthesis to stimulate collagen synthesis and tissue remodeling  

11. Principles of Shockwave Therapy Shockwaves are transient pressure disturbances that propagate rapidly in three-dimensional space. They are associated with a sudden rise from ambient pressure to their maximum pressure. Significant tissue effects include cavitation, which are consequent to the negative phase of the wave propagation . Direct shockwave and indirect cavitation effects cause hematoma formation and focal cell death, which then stimulate new bone or tissue formation.

12. Indications for Shockwave Therapy Shockwave therapy is primarily used in the treatment of common musculoskeletal conditions. These include : Upper and lower extremity  tendinopathies Greater trochanteric pain syndrome Medial tibial stress syndrome Patellar tendinopathy Plantar fasciopathy . Adhesive capsulitis Non-union of long bone fracture Avascular necrosis of femoral head Osteoarthritis of the knee

13. C ontraindications to ESWT in Physiotherapy Pregnancy Over major blood vessels and nerves Pacemakers or other implanted devices Open wounds Joint replacements Epiphysis Blood clotting disorders including thrombosis Infection Cancerous tissues A compromised mental status /or the inability to cooperate .

14. Differences between ESWT and UST Therapeutic ultrasound utilises high frequency sound waves, W hile ESWT utilises lower frequency waves. Ultrasound may produce either thermal or non-thermal effects in tissues, While ESWT does not result in heating effects.

15. Similarities between Therapeutic US and ESWT Both modalities employ acoustic waves to produce  therapeutic  benefits. They both make use of a coupling medium to transmit sound waves to the tissues being treated. They are both non-invasive forms of treatment.

16. What can patients expect during a session? During first treatment, the therapist locates the spot that needs treatment and applies ultrasound gel on the contact area to aid the shockwave device. Then a hand held probe delivers controlled acoustic waves for approximately 5-10 minutes for each injured area. The treatment might feel like pressing on a bruise , but the therapist can adjust the intensity if needed. Post-treatment, most patients can usually resume normal activities immediately. But it is advised to avoid strenuous activities for 48 hours. Some may experience mild temporary soreness, tenderness, or swelling which is normal. Pain medications or ice therapy are not recommended as they might interfere with the healing process​​​​.

17. How Many Treatments and Expected Outcomes The best results from shockwave therapy usually show up 8 to 12 weeks after treatment, with outcomes lasting long-term. Some patients feel better after their session. The number of treatments needed for the best results can vary depending on the problem being treated and how severe it is. Relief often comes right after the first session. For the best results, sessions are set 3-10 days apart, with a total of 3 to 6 sessions needed, and may be scheduled annually or bi-annually. Patients with chronic conditions may require ongoing treatment at weekly intervals to experience lasting results. About  91% of patients in clinical studies say shockwave therapy worked  for them, reducing chronic pain and improving movement.

18. Potential Side Effects of Shockwave Therapy While shockwave therapy is generally safe, it may induce temporary side effects like Pain, Tenderness, Bruising, Swelling, and Numbness at the treatment area.

19. What are the benefits of Shockwave Therapy Overall, shock wave therapy enhances recovery by Effectively breaks down calcific deposits in tendons Promotes collagen synthesis and repair of injured tissues Decreases the levels of  Substance P , contributing to a significant reduction in intense and chronic pain. Repairing musculoskeletal damage Alleviating chronic pain Improving the quality of life.

20. But the benefits of shockwave therapy don’t stop there. The therapy is also observed to: Aid bone healing after fractures Reduce severity in early-stage knee osteoarthritis Significantly lower pain in cases like calcified tendinopathy of the shoulder. While corticosteroid injections offer short-term pain relief in conditions such as plantar fasciitis, shockwave therapy provides more durable with virtually no side effects with benefits lasting beyond 6 months. Also, shockwave therapy avoids risks like heel damage or plantar fascia tear, which can happen with corticosteroid shots.

21. Treatment Application

22. Evidence-based According to a study performed by Rompe and coworkers [ , stretching exercises in combination with radial shock wave therapy is more efficient for the treatment of chronic symptoms of proximal plantar fasciopathy than repetitive radial pressure wave therapy alone. Patients were subjected to three sessions of 2000 radial pressure pulses (EFD = 0.16 mJ /mm 2) in weekly intervals, generated with a ballistic device (air compressor pressure 4 bar; rate 8 Hz) manufactured by Electro Medical Systems.

23. A study to investigate the clinical outcomes of ESWT on calcaneal spurs of 108 patients and its correlation with radiologic changes were reported by Yalcin et al. All the patients underwent radial pressure wave therapy once a week for 5 weeks (2000 pressure waves starting at an EFD of 0.05 mJ /mm 2 and increasing up to 0.4 mJ /mm 2). After the therapy, approximately 67 % of the patients reported no pain; however, there was no correlation between clinical outcome and radiologic changes. The authors concluded that even without radiologic change.

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