SHOCKWAVE THERAPY

(Tap or click to scroll to section)
What Is Extracorporeal Shockwave Therapy ESWT?
How Acoustic Shockwaves Work
Why Shockwave Therapy Does Not Harm Healthy Tissue

What Is Extracorporeal Shockwave Therapy ESWT?

Extracorporeal Shockwave therapy is the therapeutic use of unique acoustic (sound) waves to break apart extremely painful calcifications and myofascial adhesions in the soft tissues and joints of the body, responsible for most chronic pain situations.

Shockwaves are used in modern medicine as an alternative to surgery to break apart kidney stones in a process termed lithotripsy. In this, its use has the capability to break apart large, hardened stones into smaller fragments that can then pass out of the body in the urine.

Shockwaves are used therapeutically to break apart unwanted, extremely painful calcium deposits from finger and toe joints (bunions, arthritic spurs), calcium deposits in damaged tendons (calcific tendonitis), calcium deposits in damaged muscles, and to completely dismantle the fibrotic twisted/tangled fibres in myofascial adhesions which develop in muscles/tendons/ligaments, responsible for most chronic pain conditions. These myofascial adhesions along with tendinopathies, heel spurs, pinched nerves, general muscle fibre damage, ligament sprains, chronic inflammation, and pinched nerves are all examples of how widespread pain can manifest itself in knees, hips, low back, neck, arms, and legs. Shockwave therapy is the only technology able to break apart the core dysfunctions responsible for most chronic pain conditions.

The Basics of Shockwave Therapy

Shockwaves are a unique type of pressure waves, abruptly alternating from a high- pressure to a low pressure, faster than the speed of sound. They are created within the soft tissues of the body, by the application of extremely powerful acoustic waves from an acoustic wave generator.

Shockwaves are not at all electrical as their name may imply. They are also not to be confused with other technologies such as Ultrasound, TENS, IFC, or muscle stimulators. The term “Shock” wave got its name in physics due to the high speed (faster than the speed of sound) and extremely powerful nature of their acoustic waves.

The sonic boom of a fighter jet travelling faster than the speed of sound is an example of a shockwave being generated by the speed and energy of the jet travelling through the air. The impeller in all pumps and boat motors generate shockwaves all the while they are running.

Brief History:

Shockwaves were first discovered during the second world war when the U.S. military was testing depth charges used to sink enemy submarines. Swimmers at a nearby beach noticed odd sensations on their body but couldn’t identify what they were experiencing. They were experiencing shockwaves created when the depth charges exploded deep underwater, propagating through the water from many miles away.
It wasn’t until the 1980s when the Technology was perfected in Germany for use in breaking apart kidney stones and in the hands of therapists in Canada by the early 2000’s.

Types of Shockwaves: Radial vs. Focused

Focused shockwaves

Do not disperse, but rather remain in a narrow beam pattern. Focused shockwaves are ideal for small, extremely dense dysfunctions such as chronic tendonitis and heel spurs. These shockwaves require extreme skill from the therapist as an incorrect application angle of the shockwave beam could miss the targeted tissues, resulting in a totally ineffective treatment. Both have their advantages and disadvantages in treating conditions, to be chosen by the therapist based on the condition being treated.

How Acoustic Shockwaves Work

Each acoustic wave has a leading-edge called a “wavefront,” where its energy (ability to do work) is located. This potential energy comes from both the pressure used to create the acoustic wave and from the speed of transmission in the applicator that disperses them. The most powerful shockwaves available to therapists in the world are generated at 90 pounds per square inch (PSI). EMS (Germany) is the original developers of the technology, and with their patent protection are still the only company in the world today producing the most powerful, most effective version of the technology.

The ability for acoustic waves to enter the body, and accomplish therapeutic work, directly come from this high energy wavefront. The more energy a shockwave possesses, the more capable it’s wavefronts will be in penetrating dysfunctions. There are times when some basic shockwave units do not possess sufficient power to get the job done, but the higher power offered by professional units can, but make treatments more expensive.

Here’s how the process works:

1.  Acoustic waves begin entering the body when the gun-like applicator is depressed against the skin, moistened by a special anti-bacterial gel allowing for its impulse penetration.
2. The high-speed acoustic waves traveling faster than 760 miles per hour, cause gas molecules within blood and lymphatic fluids to rapidly expand to many times their size.
3. These rapidly expanding gas molecules cause a sudden (shock) and violent stretch pressure on the twisted/tangled/glued fibres within the adhesions, creating cavities or hollow voids in muscles, tendons, and ligaments, in a process termed “cavitation.”
4. Voids are like a vacuum and have no pressure within them, so violently collapse on themselves (implode) far more rapidly then when they expanded, thus generating an implosion wave (shockwave) of force on the tissue. Think of the process as stretching out an elastic (creating the void), then releasing it (implosion). This enormously high-speed expansion/implosion wave is the starting point to the creation of a shockwave.
5. Billions of these expanding/imploding cavitational voids create a rapidly moving wave through the tissues which is finally the creation of a shockwave.
6. These shockwaves are sufficiently disruptive to cause myofascial adhesions and small non-ossified calcium deposits to break apart.

Shockwave devices can be thought of as the acoustic wave generators which cause the cavitational process to occur, not as a device which specifically delivers shockwaves into the body.

Healthy muscles, tendons, ligaments, and nerves are not affected by shockwaves as they can easily absorb the cavitational and thus shockwave forces. The acoustic waves simply bounce off bones and hyaline cartilage having no affect positive or negative on them.

Affects of Shockwave Therapy include:

Flush out chronic inflammation and edema from within damaged tissue and joints by the high energy wave front action causing higher pressure in the tissue and joint than the pressure outside it.

Why Shockwave Therapy Does Not Harm Healthy Tissue

The acoustic waves of a shockwave applicator cause the gas molecules (oxygen/carbon dioxide/nitrogen…) in blood and lymphatic fluid to expand to many times their normal size. This expansion of gases creates increased internal pressure in the tissues being treated, disintegrating the notorious, cross-bridged collagen bonds common to myofascial adhesions, some forms of scar tissue, and unwanted calcifications.

There is a unique and remarkable relationship between the concentration of gas molecules in the blood and lymphatic fluid in the soft tissues of the body, and the degree of elasticity these tissues possess. The higher concentration of gases, the higher elasticity the tissue has. The lower the concentration of gases, the lower elasticity the tissue has.

Muscles

Muscles and their fascial tissue component possess the highest degree of elasticity of all the body’s soft tissues. They equally possess the highest concentration of blood and lymphatic fluid, because of their high demands for oxygen to provide essential energy to stretch and contract.

When acoustic waves reach the billions of microscopic gas molecules in blood and lymphatic fluid, the molecules explode in size, causing an extremely high internal pressure to develop in the muscle’s fibres. This internal pressure is sufficient to stretch the fibres enough to break apart the cross-bridged collagen bonds in the adhesion, but not enough to tear the muscle’s fibres.

There are simply not enough gas molecules per square centimeter in the blood or lymphatic fluids to tear these elastic muscle fibres.

Tendons and Ligaments

Tendons and ligaments have no blood in their fibres, only small amounts of lymphatic fluid. The amount of this lymphatic fluid per square centimeter is far less than in muscles because tendons and ligaments are extremely hardened structures that can expand only 3% of their original size, with a limited amount of lymphatic fluid able to flow through their densely packed fibers.

The good news is that shockwave’s acoustic waves simply cannot cause enough expansion in the small amount of lymphatic fluid present, to stretch the fibres more than 3%. There is simply not enough concentration of gas molecules per square centimeter to do so.

However, the expansion pressure is sufficient to break apart the collagen bonds in adhesions and unwanted calcifications that may develop.

Internal Organs

The internal organs in the body have varying degrees of elasticity based on their diverse composition of elastic muscle and less elastic structural connective tissue (tendon/ligament) matrix.

An essential aspect for all organs to function correctly is to be able to stretch as they fasciculate in a unique rhythm set by the blood flow through their tissue fibres.

As the shockwave’s acoustic waves reach organ tissue, the amount of tissue stretch caused by the expanding gas molecules is directly proportional to the concentration of each tissue type comprising that organ.

Tissue comprised of 100% muscle tissue like blood vessels, stomach, and heart for example, will stretch, while tissue comprised of 50% muscle, and 50% denser connective tissue fibres such as the colon will stretch less.

When acoustic waves of shockwave therapy reach any organ, they will cause each tissue type to safely expand within their specific limits as mentioned above, sufficient to disintegrate myofascial adhesions but not enough to tear organ tissue fibers.

Abdominal Adhesions

Finally, we get to those infamous myofascial adhesions that can ruin a person’s life.

Every organ in the abdomen has the same physiology with respect to varying degrees of tissue types, elasticity, and blood and lymphatic fluid concentrations, as described above.

Shockwave therapy into the abdomen targets myofascial adhesions in the abdominal muscles and their inner lining tissue, connective tissues holding all organs in their correct position, omentum, ligaments, and the organ’s outer connective tissue matrix adhering it to adjacent organs.

The shockwave’s acoustic waves physiologically cannot harm any organs or tissues in the abdomen due to the ratio of gas molecule concentration versus tissue elasticity.

This ratio of gas molecule expansion versus tissue elasticity is the genius research conducted by EMS Technologies, the German company who invented shockwave therapy over 40 years ago, and is the version of the technology we exclusively use in our clinic in Canada every day to break apart myofascial adhesions, scar tissue, and calcifications wherever they reside.

Note!
EMS Shockwave therapy is used daily to break apart kidney stones for a good reason. Their acoustic waves are easily absorbed by the high/medium/low elastic tissues comprising the kidney and see their gas molecules expand in the ratio of concentration versus the elasticity factor but have no adverse effect on healthy tissues in the kidney.

However, the acoustic waves do possess enough energy to vibrate the stone to fracture it into smaller pieces.

Shockwave therapy physiologically cannot harm healthy tissue, no matter where in the body their acoustic waves are applied.