القائمة الرئيسية

الصفحات

تعديل المشاركة

Extracorporeal Shock wave Therapy (ESWT)

Physical Therapy
(0)

 


Image Rights

What is Shockwave Therapy


 Extracorporeal = outside body​
Shockwave = intense, short energy wave travelling faster than speed of sound​
Well-controlled mechanical insult to tissue​

ESWT was established based on the principles of lithotripsy​

Technology that uses acoustic sound waves to break up kidney stones​

Heel spur ​


Background of Extracorporeal Shock wave Therapy 


Therapeutic shockwaves were introduced as a medical treatment for eliminating kidney stones in 1980
One of the side effects discovered during treatment, was the effect on​ bone healing (bone density 
increase), as well as accelerated tissue healing in the area

More than 10 years later, shock waves were successfully utilized for the​ treatment of several
 musculoskeletal diseases​

Shock waves are mechanical waves passing through the surface of a body without causing injury ​

In nature, shock waves are caused by a high energy wave. This wave has an extremely short build up time and high amplitude, similar to an explosion



What are shock waves

Shock waves appear in the atmosphere when explosive events occur, such as when explosive material detonates, when lightning strokes occur or when airplanes break the sound barrier

Shock waves are acoustic (sound) waves that are characterized by high pressure amplitudes and a steep increase in pressure​

Ultrasound vs shock waves​



Despite their relationship to ultrasound, shock waves basically differ by having especially large pressure amplitudes

In addition, ultrasound usually consists of periodic oscillations with limited bandwidth, whereas shock waves are represented by a single, mainly positive pressure pulse that is followed by comparatively small tensile wave components​



Principles of Production​

​There are basically four different way to produce the 'shock wave', which are 

spark discharge

 piezoelectric

electromagnetic and​

pneumatic (or electrohydrualic). ​

​

 In therapy the most commonly employed generation method is based on the pneumatic system​


So…generally they are 2 main types

​

 Focused Shockwave: Can be Electromagnetically generated, high energy, deep penetration, and precise focus on a very small area

 Radial Shockwave: Radial shockwaves are often referred to as Radial Pressure Waves (RPW)​



  





Focused Shockwave

Based on the physical principle of electromagnetic induction, as used for example in loudspeakers

The arrangement of coils and membranes is optimized to generate powerful and short acoustic pulses

The cylindrical arrangement of the coil primarily generates a divergent cylindrical wave, which is transformed into a convergent spherical wave using a special rotation parabolic​


Radial Pressure Waves​


Radial shockwaves are often referred to as radial pressure waves, which is the correct definition in physical terms

       



Radial vs focused principle​

  Radial

 Designed for superficial treatment​

 Clinically focused​

 No anesthesia, no analgesics​

 Higher comfort of the therapy​

Low costs of the unit = faster reimbursement​

        ​

          Focused​

 Developed to reach internal organs​

 X-ray or ultrasound guided​

 Anesthesia necessary​

 Costs per unit, treatment




Characteristics​

​
The characteristics of a shock wave are (typically)


Peak pressure - typically 50-80 MPa (according to Ogden et al, 2001) and 35 - 120 MPa (according to Speed, 2004)​

Fast pressure rise (usually less than 10 ns (nanoseconds)​

Short duration (usually about 10 microseconds)​

Narrow effective beam (2-8mm diameter)​



Shockwaves are divided in terms of their energy content and although there is some controversy, it is generally accepted that the following groups would be reasonable (after Rompe et al, 1998)

LOW (up to 0.08mJ/mm2)​

MEDIUM (up to 0.28mJ/mm2 - though some authorities elect for a higher value)​

HIGH (over 0.6mJ/mm2)​




Mechanics​
​
Radial wave pulses are produced by compressed air in the cylinder of the hand piece ​

A projectile in the hand piece generates kinetic energy​ This kinetic energy is transferred into acoustic energy which is sent into nearby tissues​ Depth of energy penetration is​ approximately 0-6 cm​


​






Conditions treatable with ESWT​

​​ Plantar fasciitis​

 Achillodynia​

 Shin splint​

 Muscle sprain​

 Jumpers knee​

 Runners knee​

 Trigger point therapy​

 Trochanteric insertion tendonitis​

 Piriformis syndrome​

 Low back/thoracic pain​


Calcified shoulder tendonitis​

 Frozen Shoulder​

 Cervicobrachial neuralgia​

 Trapezius tension​

 Radial/medial epicondylitis​

 Finger tendonitis​

 Muscular cramps/spasm​

 Cellulite treatment​

 Massage, vibration therapy​

Myositis ossificatns​

Heterotopic ossification​

CONTRAINDICATIONS​

Skin defects – relative, some studies show improvement i.e. in DM ulcer​

TBC​

Tumor diseases​

Fever, flu or other infectious disease​

Application in the area of varicose veins​

Application just above the nerve​

Application on certain tissues (eyes and periorbital area,​

myocardium, spinal cord, kidneys, liver)​

​Application of therapeutic X - rays within last 6 weeks​

Pharmacotherapy by corticosteroids within last 6 weeks​

Sensational deficit in the treated area​

Disc hernia or protrusion​

CONTRAINDICATIONS​
ABSOLUTE​

Blood coagulation disorders, anticoagulation treatment​

Pregnancy​

Abdominal or frontal pelvic application


Possible Temporary Side Effects​

Temporary hyper/hypo- sensitivity​

Erythema​

Haematoma​

Oedema​

​

Most of the patients never experience any of these side effects​

Can be maximally reduced in combination with other therapies e.g. Lasertherapy, magnetotherapy​


Physical effects​

Pain reduction: The patient experiences a reduction of pain, explained by the Gate Control Theory Intensive pulses from the transmitter into​ the tissues create a strong nociceptor activation of the A-β fibers, which affect interneurons that inhibit the transmission of the pain signals.​

 Increased metabolism: Shockwaves influence the tissues on a cellular level. The chemical environment of the cells is affected by free radicals​ promoting the release of pain and inflammatory inhibiting substances

 Revascularization: Repeated shockwaves to the affected area create a revascularization effect, with the new blood flow in the area promoting​ tissue healing and regeneration

Reduced muscle tone: The “vicious circle”, as well as the strong pathological association between pain and muscle tone, will be broken and​ lead to restoring a normalized muscular tone










أنت الان في اول موضوع

أخر المواضيع من قسم : العلاج الكهربائي

تعليقات

إرسال تعليق

اكتب لفريق العمل تعليق هل أستفدت من هذه المقالة ؟