Effects of shock waves
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Shock waves can have various biological effects depending on their energy level. Low-energy shock waves are used for cell regeneration and wound healing, while high-energy shock waves are used for lithotripsy and breaking bone non-unions. Shock waves can stimulate microcirculation, cell metabolism, and release of substances like nitric oxide and substance P. They may also have analgesic, antibacterial and anti-inflammatory effects through stimulation of growth factors and stem cells. Focused shock waves are used in urology for conditions like Peyronie's disease and erectile dysfunction, while radial shock waves target areas like tendinopathies and trigger points. Treatment involves multiple sessions with focused or radial shock waves at varying energy levels
Effects of shock waves
- 1. Effects of shock waves
- 2. 0.2 0.4 0.6 0.8 1.0 low-energy high-energy Energy flux density (mJ/mm2) Cell regeneration (R-SW/F-SW) Lithotripsy Non-unions (F-SW) 2.0 3.0 4.0 Pain Therapy (R-SW/F-SW) Wound healing (F-SW) ESWL From ESWT to ESWL ¨C All about the right energy
- 3. ? Stimulation of microcirculation (blood, lymph) and metabolism (nitrous oxide, vasodilation, reduction of oxidative stress) ? Mechanotransduction ¨C cell matrix stimulation ? Increase of cell wall permeability (Cell metabolism) ? Release of substance P ? Antibacterial and anti-inflammatory effect ? Stimulation of growth factors (neogenesis of vessels, bone, collagen) ? Stimulation of stem cells (cell proliferation, transport and differentiation, skin rejuvenation) ? Analgesia effect (inhibition of nociceptive fibres ¨C gate mechanism, endorfines and serotonine release, acceleration of substance P washout) Biological effects of shock waves
- 4. Apply ESWT ¨C Pain is NOT perceived ? Large myelinated A-delta fiber: carries quick, intense-pain messages ? Small, unmyelinated C fiber: transmits throbbing, chronic pain ? Non-nociceptive A-beta fiber: does not transmit pain stimuli Gate open Gate closed Pain Management: Gate-Control Theory ¨C Ronald Melzack (1960s) Pain is perceived ? The gate control theory asserts that signals transmitted by the A-delta and C pain fibers can be thwarted by the stimulation with SHOCK WAVES of the non- nociceptive A-beta fibers and thus inhibit an individual's perception of pain
- 5. Focused and radial application and transmitters F-SW R-SW
- 6. Use of the focused handpiece (F-SW) with different stand-offs
- 7. 2013 ¨C Radial shock transmitter portfolio
- 8. ? Muscle and connective tissue relaxation, elimination of adhesions ? Improved microcirculation ? Improved neuromuscular performance ? Revitalisation ? Pneumatic generated vibration pulses Vibration heads of V-ACTOR? handpiece Mechanism of action of vibration therapy with the V-ACTOR?
- 9. ESWT ¨C Orthopedics Combined/radial treatment ?Achillodynia ?Plantar fasciitis ?Metatarsalgia ?Tibial stress syndrome ?Patellar tendinitis ?Trochanteric tendinopathy ?Calcific tendinitis ?Radial/ulnar epicondylitis ?Trigger points AWT? ¨C Aesthetics Combined/radial treatment ?Anti-cellulite treatment ?Body shaping ?Tissue tightening ?Scar and wrinkle smoothing ?Skin elasticity improvement ?Connective tissue tightening ?Treatment of pregnancy stretch marks ?Treatment of skin irregularity after liposuction ESWT ¨C Dermatology Focused treatment ?Non-healing wounds ?Diabetic gangrene ?Ulcera (diabetic) ?Ulcera (non-diabetic) ?Skin burns ESWT ¨C Urology Focused treatment ?IPP (Induratio penis plastica) ?Peyronie¡¯s disease? ?CPPS (Chronic pelvic pain syndrome) ?ED (Erectile dysfunction) Shock wave ¨C Indications
- 10. Step 1: F-SW Stand-off: 0, I or II Parameters: 1 ¨C 8 Hz; 0.01 ¨C 0.35 mJ/mm? Number of shocks: 500 ¨C 200 Step 2: R-SW Transmitter: D20-S, D20-T Parameters: 15 ¨C 21 Hz; 1.0 ¨C 3.5 bar Number of shocks: 2000 ¨C 4000 Step 3: V-ACTOR? Parameters: 25 ¨C 35 Hz; 2.0 ¨C 3.0 bar Number of shocks: 5000 ¨C 10000 ESWT/Orthopaedics ¨C Treatment steps of combined therapy
- 11. ESWT/Orthopaedics ¨C Treatment steps of radial shock wave therapy Step 1: R-SW Transmitter: F15, R15, DI15, C15 Parameters: 8 ¨C 15 Hz; 1.0 ¨C 3.5 bar Number of shocks: 1500 ¨C 3500 Step 2: R-SW Transmitter: D20-S, D20-T Parameters: 15 ¨C 21 Hz; 1.0 ¨C 3.5 bar Number of shocks: 2000 ¨C 4000 Step 3: V-ACTOR? Parameters: 25 ¨C 35 Hz; 2.0 ¨C 3.0 bar Number of shocks: 5000 ¨C 10000
- 12. AWT?/Aesthetics ¨C Treatment steps of combined therapy Step 1: C-ACTOR? Stand-off: I or II Parameters: 1 ¨C 8 Hz; 0.56 ¨C 1.02 mJ/mm? Number of shocks: 500 ¨C 3000 Step 2: D-ACTOR? Transmitter: D20-S, D20-T Parameters: 15 ¨C 21 Hz; 1.5 ¨C 4.0 bar Number of shocks: 3000 ¨C 4000 Step 3: V-ACTOR? Parameters: 25 ¨C 35 Hz; 2.0 ¨C 3.0 bar Number of shocks: 5000 ¨C 10000
- 13. AWT?/Aesthetics ¨C Treatment steps of radial shock wave therapy Step 1: D-ACTOR ? Transmitter:C15, DI15 Parameters: 15¨C21 Hz; 1.5 ¨C 4.0 bar Number of shocks: 1500 ¨C 3500 Step 2: D-ACTOR ? Transmitter: D20-S, D20-T Parameters: 15 ¨C 21 Hz; 1.0 ¨C 3.5 bar Number of shocks: 2000 ¨C 4000 Step 3: V-ACTOR? Parameters: 25 ¨C 35 Hz; 2.0 ¨C 3.0 bar Number of shocks: 5000 ¨C 10000
- 14. C-ACTOR? Stand-off: I Parameters: 6 Hz; 0.25 mJ/mm? Number of shocks: 400 + 20/cm? Dermatology ¨C Treatment of focused shock wave therapy
- 15. CPPS ED IPP Urology ¨C Treatment steps of focused shock wave therapy F-SW Stand-off: none, II or II ?anatomical? Parameters: 6 Hz; 0.2 ¨C 0.3 mJ/mm? Number of shocks: 3000
- 16. ? Coagulation disorders (haemophilia) ? Use of anticoagulants, especially Marcumar ? Thrombosis ? Tumour diseases, carcinoma patients ? Pregnancy ? Children in growth (growth plates) ? Cortisone therapy up to 6 weeks before first ESWT treatment ? Swelling ? Reddening ? Haematomas ? Petechiae ? Pain ? Skin lesions in case of previous cortisone therapy ESWT ¨C Contraindications ESWT ¨C Side effects
- 17. Thank you!
Editor's Notes
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