What parameters determine success and failure in shockwave therapy?

The success of shockwave therapy depends crucially on the quality of the device used. However, correct application as well as the therapist's experience, empathy, and communication skills also play a decisive role. In this blog post, we would like to briefly list the most important points.

Key factors that determine the success of ESWT therapy

1. HIGH ENERGY per stroke is crucial

• Recent clinical studies show that a high amount of energy (energy density) per individual shock wave is essential for effective treatment.^.1
• In terms of treatment efficiency, lower energy levels per pulse cannot be compensated for by emitting a greater number of pulses.¹

2. CAVITATION is the key to success

• Cavitation plays a particularly important role in the success of extracorporeal shock wave therapy.²
• Without cavitation, certain important biological reactions do not occur in the treated tissues.^2-11

Radial or focused shockwave? That is not the central question!

Rather, it depends on the quality of the device: In other words, is the energy flux density sufficiently high, and does the energy output remain constant throughout the entire treatment period? Studies show that, when using the same treatment protocol, comparable results are achieved with radial (e.g., DolorClast) and focused shock waves (e.g., Storz).

The second point in this line of reasoning is: Does the energy reach the right place? A wave is a wave, regardless of whether it is generated by a focused or a radial device. What is much more important is that enough energy reaches exactly where it is needed inside the cell.¹²

Therefore, the question of whether to use radial or focused shock waves is not really relevant to energy delivery. There is no “better” or “worse” option here.¹² The selection of the appropriate type of shock wave depends on the type and localization of the condition, as well as the patient's medical history and response.

The Game-Changers at a Glance

However, successful treatment with shock waves does not depend on whether a radial or focused technique is used. Various other parameters play an important role:

Energy Flux Density & Energy Output

That nowWe just discussed that high-quality devices with high energy density and consistent energy output deliver successful and long-term treatment results.

Device quality

90 of the % studies published in the PEDro database that used DolorClast devices were conducted with an energy flux density > 0.1 mJ/mm². However, since not all devices have the same performance parameters, these published settings cannot be applied directly to other devices. It is important to know the exact performance specifications of your own device.

Exclusion of contraindications

• Treatment over air-filled tissue (lung, intestine).
• Treatment of torn tendons.
• Treatment of pregnant women.
• Treatment of persons under 18 years of age (exception: Osgood-Schlatter disease).
• Treatment of patients with blood coagulation disorders (including local thrombosis).
• Persons treated with oral anticoagulants.
• Treatment of tissue with local tumors or local bacterial or viral infections.
• Individuals who have received local corticosteroid treatment (minimum interval between shock wave therapy and the last cortisone injection: six weeks).

patient's pain sensitivity

Patients with a higher sensitivity to pain might refuse the shockwave therapy. It is important to inform the customer precisely in advance about the effects and side effects of the therapy.

Follow-up Treatment

Combining shockwave therapy with further rehabilitation measures, such as performing complementary exercises to improve functionality and effective follow-up care, can further enhance the treatment success achieved with the shockwave.

Knowledge is power: Secure your advantage!

This blog only briefly summarized the important parameters for successful shockwave therapy, but it does not replace in-depth further training on this topic.

To further optimize your own shockwave therapy or, even better, to understand what really matters when purchasing a shockwave device, we cordially invite you to our next shockwave seminar. Our full-day seminars are aimed at therapists who want to deepen their expertise and expand their practical skills. Practice owners who are planning to purchase a radial or focused shockwave therapy device will also benefit enormously from the knowledge of our speakers.

Our seminars are each led by top speakers who work with shockwaves on a daily basis or are active in the field of shockwave therapy research. First-hand knowledge is therefore guaranteed.

Sign up now and improve your treatment outcomes for the long term!

References

1. KENMOKU et al., J Orthop Sci. 2021;26(4):698-703.
2. CSASUAR et al., Plos one. 2015;10:E0140541.
3. HOCHSTRASSER et al., Sci Rep. 2016;6:30637.
4. WAUGH et al., Eur Cell Mater. 2015;29:269-280.
5. ZHANG et al., Cell Tissue Res. 2011; 346:255-262.
6. ZHANG et al., Stem Cell Res Ther. 2018; 9:54.
7. WANG et al., Arch Orthop Trauma Surg. 2008: 128(8):879-84.
8. WANG et al., Nitric Oxide. 2009;20(4):298-303.
9. GOLLWITZER et al., Ultrasound Med Biol. 2013;39:126-133.
10. HOFMANN et al., J Trauma. 2008:65:1402-1420
11. TISCHER et al., Eur Surg Res. 2008:41:44-53
12. WUERFEL et al., Biomedicines. 2022; 10(5):1084.

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