Application Of Extracorporeal Shock Wave Therapy Research Articles

Can extracorporeal shock wave therapy be effective in temporomandibular joint disorder?: A pilot study.

This study aimed to compare extracorporeal shock wave therapy (ESWT) with the use of stabilization splint in nonsurgical temporomandibular disorders treatments, and to evaluate the effects. In this study, individuals, who are diagnosed with disc displacements with reduction according to the diagnostic criteria for temporomandibular disorder examination criteria. The patients in the first control group (n = 36) were applied a medical treatment + stabilization splint. The second group (n = 25) was applied the ESWT (2 days a week for 4 weeks) + medical treatment + stabilization splint. Visual Analog Scale scores, painless maximum painless mouth opening, and passive-forced mouth opening measurements were recorded for the first and second weeks. The ESWT application significantly contributed to pain-reducing (Visual Analog Scale) in patients at short notice (P = .030) in the second group. There were statistically significant differences between the groups in painless maximum active mouth opening (P = .009) and passive forced measurements (P = .004) in the second week. This pilot study showed that short-term ESWT addition to stabilization splint and medical treatment may yield satisfactory outcomes.

Is Shock Wave Application Effective on Various Chronic Wounds in the Geriatric Population? Preliminary Clinical Study.

Extracorporeal shock wave therapy (ESWT) is a beneficial adjunct modality for chronic wounds. Limited research has been conducted on pressure ulcers (PUs), while the majority of studies have focused on diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs). This study aimed to evaluate the short-term effects of radial ESWT in older adults with chronic wounds. This study involved a total of 31 wounds: PUs (n=22), VLUs (n=7), and DFUs (n=2). A single radial ESWT was performed with 300 + 100 shocks per cm2, pressure of 2.5 bar, energy of 0.15 mJ/mm2, and frequency of 5 Hz. Assessments using digital planimetry and clinical methods, utilizing the Wound Bed Score (WBS) and the Bates-Jansen Wound Assessment Tool (BWAT) were performed before the radial ESWT application (M0) and one week after (M1). A significant wound decrease in planimetry was noted (pre-ESWT vs post-ESWT), with wound area from 9.4 cm2 to 6.2 cm2, length from 6.4 cm to 3.9 cm, and width from 2.8 cm to 2.1 cm (p<0.001). Additionally, a substantial clinical improvement was noted in both the WBS with a 31.25% increase and the BWAT with a 20.00% increase (p<0.001). It was also found a significant correlation between the planimetric and clinical outcomes for both tools: WBS (r=-0.446, p=0.012) and BWAT (r=0.327, p=0.073). The ESWT application yields substantial immediate clinical effects that support the healing of chronic wounds in older adults. Even a single ESWT session can prove to be clinically effective and beneficial in the management of chronic wounds.

Effects of Adding Extracorporeal Shockwave Therapy (ESWT) to Platelet-Rich Plasma (PRP) among Patients with Rotator Cuff Partial Tear: A Prospective Randomized Comparative Study.

A rotator cuff tear is a prevalent ailment affecting the shoulder joint. The clinical efficacy of combined therapy remains uncertain for partial rotator cuff tears. In this study, we integrated extracorporeal shockwave therapy (ESWT) with platelet-rich plasma (PRP) injection, juxtaposed with PRP in isolation. Both cohorts exhibited significant improvements in visual analogue scale (VAS), Constant-Murley score (CMS), degrees of forward flexion, abduction, internal rotation, and external rotation, and the sum of range of motion (SROM) over the six-month assessment period. The application of ESWT in conjunction with PRP exhibited notable additional enhancements in both forward flexion (p = 0.033) and abduction (p = 0.015) after one month. Furthermore, a substantial augmentation in the range of shoulder motion (SROM) (p < 0.001) was observed after six months. We employed isobaric tag for relative and absolute quantitation (iTRAQ) to analyze the differential plasma protein expression in serum samples procured from the two groups after one month. The concentrations of S100A8 (p = 0.042) and S100A9 (p = 0.034), known to modulate local inflammation, were both lower in the ESWT + PRP cohort. These findings not only underscore the advantages of combined therapy but also illuminate the associated molecular changes.

Efeito agudo da terapia por ondas de choque na pressão plantar e equilíbrio de indivíduos hemiparéticos

Abstract Introduction: Cerebral vascular accident (CVA) is the second leading cause of death and is one of the diseases that most generate disability Hemiparesis is the most common motor deficit, and one of its characteristics is asymmetry in weight bearing and in the plantar sup-port area, leading to balance deficits. extracorporeal shock-wave therapy (ESWT) has been shown to be effective in reducing post-stroke spasticity. Objective: To evaluate the effect of a ESWT session on the distribution of plantar pressure and on the static and dynamic balance of hemiparetic individuals after stroke. Methods: Twelve individuals with hemiparesis as a result of stroke in the chronic stage participated in the study. Data collection was divided into two days. On the first day, anamnesis and tests were performed: timed up and go (TUG), four square step test (FSST), and short physical performance battery (SPPB). After carrying out the tests, the distribution of plantar pressure was evaluated using baropodometry. Also on the first day, participants received ESWT in the muscle belly of the gastrocnemius muscle on the hemiparetic side. At the end of the ESWT session and after 7 days, the individuals were reassessed. Results: The results referring to the static and dynamic balance and baropodometry evaluations performed before, immediately after and one week after the application of ESWT did not show a significant difference between the three evaluations in any of the tests and in any of the moments performed. Conclusion: One ESWT session did not affect plantar pressure distribution and static and dynamic balance of hemiparetic individuals after stroke.

Effects of extracorporeal shock wave therapy on spasticity, walking and quality of life in poststroke lower limb spasticity: a systematic review and meta-analysis

Objective To determine the effects of extracorporeal shock wave therapy (ESWT) on lower limb function, walking, and quality of life in patients with lower limb poststroke spasticity. Data Sources A comprehensive and systematic electronic database search of PubMed, Web of Science, ProQuest thesis Dissertation checks, Google Scholar was conducted from January 2010 to March 2022. Review Method Initially, the bibliography was screened to identify randomized and nonrandomized controlled trials evaluating the effects of ESWT on lower limb spasticity and functional outcomes in stroke patients. Two reviewers independently screened the title and abstract, full-text articles, extracted data, and assessed the quality of the selected studies. The primary evaluation outcome was spasticity assessed by Modified Ashworth Scale (MAS), and the secondary outcomes were walking performance and quality of life measured on different scales. Data Synthesis Out of the total of 483 records, 15 studies (389 participants) were finally found eligible for inclusion. A meta-analysis was performed and beneficial effects of ESWT were observed in the experimental group compared with the control group on spasticity. MAS: Standard mean difference (SMD = 0.626), (95%CI = −0.133, 1.119), (p < 0.01), ROM: (SMD = 0.573), (95%CI = 0.074, 1.072), (p < 0.02). The result for before and after ESWT application on TUG: (SMD = 0.174), (95%CI=-0.151, 0.499), (p = 0.29). The results for walking performance were not significant and inconclusive which may be due to the heterogeneity of the studies included. Conclusion Evidence suggests that ESWT has promising effects in reducing spasticity and improving lower limb motor function. However, uncertainty exists regarding its effectiveness in walking performance.

Adhesive Capsulitis of the Ankle (Frozen Ankle): An Infrequent Syndrome.

Adhesive capsulitis, characterized by progressive fibrosis, causes a gradual, painful loss of both active and passive articular motion, leading to the final contracture of the joint capsule. The condition commonly referred to as "frozen ankle" (FA), which Goldman was the first to use, relates to the ankle joint and is challenging to both diagnose and treat. Data acquired from people who suffer from this type of damage in other joints such as the shoulder, hip, and wrist also exists. Despite the fact that a well-defined model for the medical management of FA does not exist, a wide spectrum of local treatments, both surgical and non-surgical, exist. This review gives an overview of the current scientific position of the frozen ankle in terms of evolutionary factors, etiology, the different mechanisms of action involved, current treatment options, and other possible interventions based on recent discoveries of pathophysiological mechanisms. The application of extracorporeal shockwave therapy, stretching exercises, and corticosteroid injections combined with physical therapy modalities that enhance pain management, range of motion, and functional capacity is highly advisable for the treatment of adhesive capsulitis, commonly known as "frozen joints". Furthermore, the addition of interventions both impacting and analyzing chronic hypoxia, low-grade inflammation, and sedentary life is proposed.

Case Study : The Application of Extracorporeal Shockwave Therapy (ESWT), Transverse Friction Massage and Hold Relax Exercise On Movement and Function of Ankle Joint Due to Calcaneus Spur Dextra

Background : Calcaneal spurs are a common cause of heel pain. Calcaneus Spur is an abnormal bony protrusion condition. It can occur anywhere along the calcaneal tuberosity. It is caused by pressure in the region of the plantar aponeurosis attachment to the calcaneal bone. This causes heel pain, the pain will be more severe when waking up in the morning. Objective: This case study was aimed to determine the effect of Extracorporeal Shockwave Therapy (ESWT), transverse friction massage and hold relax exercise on movement and function ankle joint disorders caused by calcaneus spur dextra. Methods: This case studies were carried out 6 times for 2 weeks on one patient, female 44 years old with calcaneus spur dextra condition by evaluating the degree of pain by using the Visual Analogue Scale (VAS), Joint Range of Motion (RoM) by using a goniometer and functional activity ability of the foot by using Foot Function Index (FFI) questionnaire. Results: There was a decrease of unmotion pain degree from VAS 2 to VAS 0, motion pain degree from VAS 3 to VAS 2, while tenderness pain degree decreased from VAS 7 to VAS 4. There was an increase on movement of plantar flexi ankle joint dextra from (S) 300-00-200 to (S) 400-00-200, and the FFI value decreased from 95% to 61% at the end of therapy. Conclusion: The application of intervention Extracorporeal Shockwave Therapy (ESWT), transverse friction massage and hold relax exercise can significantly reduce the motion pain on movement of plantar flexi dextra, tenderness pain around calcaneus, increase the RoM plantar flexi ankle joint dextra, and functional activity ability of the foot as well on calcaneus spur dextra condition.&#x0D;

Case Study: The Application of Extracorporeal Shockwave Therapy (ESWT) and Active Finger Blocking Exercise on Movement and Function of Fingers Disorders Caused by Trigger the 4th Finger Dextra

Background: Trigger finger also referred to as stenosing tenosynovitis. It is a traumatic condition that involves the formation of nodules in the tendons of flexor digitorium muscle due to a combination of repetitive finger movements or local trauma and impaired healing, as a result of which the affected finger is locked in either a flexed or extended position thereby impeding movement. Objective: This case study was aimed to determine the effect of extracorporeal shockwave therapy, and active finger blocking exercise in one women patient, aged 47 years old with diagnosed of trigger the 4th finger dextra. Methods: This case studies have been carried out 6 times for 2 weeks in one women patient, by evaluating the degree of pain by using the Visual Analogue Scale (VAS), Joint Range of Motion (RoM) by using a goniometer and functional activity ability hands with the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Results: There was a decrease in the motion pain degree from VAS 7 to VAS 4, and the degree of tenderness pain from VAS 5 to VAS 2. There was an increase active flexion-extension movement of the 4th finger dextra from (S)=25°-0°-50° to (S)=40°-0°-75°, while passive movement from (S)=30°-0 °-60° to (S)=40°-0°-75°. There was a decrease in the value of hand disabilities based on the results of the DASH questionnaire from 24% to 21%. Conclusion: The application of extracorporeal shockwave therapy and active finger blocking exercise can reduce the pain, increase the range of motion and functional abilities patient diagnosed Trigger the 4th Finger condition.

Early application of extracorporeal shock wave therapy improves pain control and functional scores in patients undergoing total knee arthroplasty: a randomized controlled trial.

The use of biophysical stimuli produced by extracorporeal shock wave therapy (ESWT) can improve the rehabilitation treatment of patients undergoing total knee arthroplasty (TKA). The aim of our study is to evaluate the short-term efficacy of early postoperative ESWT in combination with physiotherapy in terms of pain reduction and motor function recovery of patients undergoing TKA and compare it with conventional physiotherapy treatment. Fifty-six patients undergoing TKA were enrolled in the study from January 2019 to February 2020. Patients received two sessions of physiotherapy daily, with (experimental group) or without (control group) four sessions of ESWT within sevendays after surgery. Patients were prospectively evaluated at baseline and at post-operative day two and seven. Assessment included active knee range of motion (aROM), timed up and go (TUG)test, visual analogue scale (VAS) for pain, and Borg scale. Fifty patients completed the study. Both treatments proved to be effective in reducing pain and improving the knee range of motion and functional scores at sevendays after surgery: the aROM in the ESWT group was 36.8 ± 11.0 grades (p < 0.001), while in control group was 19.8 ± 7.8 grades (p < 0.001). TUG, VAS, and BORG scores showed a similar trend. Comparative analysis revealed superior clinical results for the experimental group in all the outcomes, in particular aROM (96.0 ± 5.40 vs. 81.20 ± 11.01, p < 0.001) and TUG test (17.4 ± 5.61 vs. 21.24 ± 5.88, p < 0.001), at day seven after surgery. Early application of ESWT in addition to physiotherapy can positively influence the rehabilitation process after TKA. The treatment proved to be well tolerated and safe. Preliminary results demonstrated better pain control and functional scores compared to physiotherapy alone.

Global trends in research on extracorporeal shock wave therapy (ESWT) from 2000 to 2021

BackgroundThis study intended to analyze the application of extracorporeal shock wave therapy in medicine and to evaluate the quality of related literature.MethodsAll publications were extracted from 2000 to 2021 from the Web of Science Core Collection (WoSCC). The literature characteristics were depicted by VOSviewer (version 1.6.15) and the online bibliometric website (http://bibliometric.com/). The future trends and hotspots were conducted by Bibliographic Item Co-occurrence Matrix Builder (version 2.0) and gCLUTO software.ResultsWe analyzed 1774 articles corresponding to the criteria for ESWT publications from 2000 to 2021. Most studies were conducted within the United States and China which besides have the most cooperation. The most published research institutions are Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, and Kaohsiung Medical University. Six research hotspots were identified by keyword clustering analysis: Cluster0: The effects of ESWT on muscle spasticity; Cluster1: The application of ESWT in osteoarthritis (OA); Cluster2: Therapeutic effect of ESWT on tendon diseases; Cluster3: Early application of ESWT/ESWL in urolithiasis; Cluster4: The Role of angiogenesis in ESWT and the efficiency of ESWT for penile disease; Cluster5: The Special value of radial extracorporeal shock wave therapy (rESWT).ConclusionsA comprehensive and systematic bibliometric analysis of ESWT was conducted in our study. We identified six ESWT-related research hotspots and predicted future research trends. With the gradual increase of research on ESWT, we find that ESWT is used more and more extensively, such in musculoskeletal disease, bone delay union, neurological injury, andrology disorders, lymphedema, and so on. In addition, the mechanism is not destructive damage, as initially thought, but a restorative treatment. Furthermore, delayed union, cellulite, burn, and diabetic foot ulcers may be the future direction of scientific study.

The effect of shock waves on mineralization and regeneration of distraction zone in osteoporotic rabbits

Objective Osteoporotic individuals suffer from various complications such as spontaneous bone fractures due to decreased bone strength and failure in bone healing as a result of decreased bone mineral density and deterioration of bone microstructure. In this study, the effects of Extracorporeal Shock Wave Therapy (ESWT) in a distraction osteogenesis model in osteoporotic rabbits were investigated to prevent these failures and improve bone microstructure. Material and Methods A total of 28 female New Zealand rabbits underwent mandibular distraction osteogenesis and were divided into four groups: non-ovariectomized control (Cont), ovariectomized control (O-Cont), ovariectomized ESWT1 (O-ESWT1) and ovariectomized ESWT2 (O-ESWT2). ESWT was only applied to the ESWT2 group before the osteotomy, and to both the ESWT1 and ESWT2 groups after the osteotomy. Dual-energy x-ray absorptiometry was used to determine bone mineral density on both the 7th and 28th day of the consolidation. Stereological methods were used to identify new bone formation, connective tissue and neoangiogenesis volume. Results According to the dual-energy x-ray absorptiometry examination both at the 7th and 28th day of the consolidation, lower bone mineral density was seen in the ESWT groups. However, the stereological examination showed that shock wave therapy significantly increased new bone formation both ESWT1 and ESWT2 compared with O-Cont, significantly increased neoangiogenesis in O-ESWT1 compared with O-Cont. Conclusions The application of ESWT in these parameters after osteotomy was beneficial for bone regeneration in mandibular distraction in osteoporotics. However, ESWT has been shown to be ineffective in improving bone mineral density. KEY MESSAGES The osteoporotic model can be successfully established in rabbits and the subjects can tolerate the distraction procedures. Stereology is a useful analysis method that can determine the volume of the new bone formation and neoangiogenesis. Extracorporeal shock wave therapy has biostimulatory effects on bone tissue.

Application of extracorporeal shockwave therapy to improve microcirculation in diabetic foot ulcers: A prospective study.

Extracorporeal shockwave therapy (ESWT) can induce wound healing by increasing tissue microcirculation. However, studies on the effect of ESWT on enhancing tissue microcirculation in diabetic foot ulcer (DFU), particularly on when the microcirculation increases after ESWT application, are still lacking. Therefore, we aimed to examine the effectiveness of ESWT in promoting microcirculation in DFU patients in a time-dependent manner. We included 50 feet of 25 patients with type 2 diabetes mellitus and Wagner grade I to II DFU in this study. The affected feet were used as the ESWT group and the unaffected contralateral feet were used as the control group. ESWT was performed in 3 sessions per week for a total of 3 weeks. Transcutaneous partial oxygen pressure (TcPO2) was used to evaluate the tissue microcirculation. The TcPO2 level (>43 mm Hg) in the ESWT group was recovered by the 2nd week of treatment, and statistical significance (P < .05) was demonstrated at the same time. From the 2nd week of ESWT, a significant increase in TcPO2 was observed in Wagner grade I and II DFU. These findings imply that the ESWT may improve microcirculation in patients with Wagner grades I to II DFU. However, this impact requires at least 2 weeks or more than 6 sessions. For better comparison, further studies with larger clinical groups and extended period are needed.

Lateral Epikondilitli Hastalarda Farklı Tedavi Yöntemlerinin Klinik Sonuçlarının Karşılaştırılması

Aim: In our study, the effectiveness of steroid injection therapy, extracorporeal shock wave therapy (ESWT) and splint use in the treatment of lateral epicondylitis, were compared.Methods: A total of 97 patients (28 males, 57 females, mean age: 47 years) with a clinical diagnosis of lateral epicondylitis were included in the study. The patients were divided into three treatment groups. Steroid injection was applied to 30 patients, ESWT treatment to 28 patients, and bandage treatment to 29 patients. Patients were evaluated with Visual analog scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores before and after treatment.Results: A decrease in VAS and DASH scores and clinical improvement compared to pre-treatment were observed in all three groups. Although positive results were obtained with all three treatment methods, we found that the most statistically significant treatment method was steroid injection. Better results were obtained in the group that received steroid injection with the peppering technique. (p&amp;lt;0.05).Conclusion: The results of this study showed that local steroid injection, ESWT application and bandage treatment may be beneficial in the short term in the treatment of patients with lateral epicondylitis. However, it was evaluated that the best improvement in scores was obtained with local steroid injection with the peppering technique, whereas the least improvement was obtained with bandage treatment.

Application of extracorporeal shock wave therapy in nervous system diseases: A review.

Neurological disorders are one of the leading causes of morbidity and mortality worldwide, and their therapeutic options remain limited. Recent animal and clinical studies have shown the potential of extracorporeal shock wave therapy (ESWT) as an innovative, safe, and cost-effective option to treat neurological disorders. Moreover, the cellular and molecular mechanism of ESWT has been proposed to better understand the regeneration and repairment of neurological disorders by ESWT. In this review, we discuss the principles of ESWT, the animal and clinical studies involving the use of ESWT to treat central and peripheral nervous system diseases, and the proposed cellular and molecular mechanism of ESWT. We also discuss the challenges encountered when applying ESWT to the human brain and spinal cord and the new potential applications of ESWT in treating neurological disorders.

ESWT Diminishes Axonal Regeneration following Repair of the Rat Median Nerve with Muscle-In-Vein Conduits but Not after Autologous Nerve Grafting.

Investigations reporting positive effects of extracorporeal shockwave therapy (ESWT) on nerve regeneration are limited to the rat sciatic nerve model. The effects of ESWT on muscle-in-vein conduits (MVCs) have also not been investigated yet. This study aimed to evaluate the effects of ESWT after repair of the rat median nerve with either autografts (ANGs) or MVCs. In male Lewis rats, a 7 mm segment of the right median nerve was reconstructed either with an ANG or an MVC. For each reconstructive technique, one group of animals received one application of ESWT while the other rats served as controls. The animals were observed for 12 weeks, and nerve regeneration was assessed using computerized gait analysis, the grasping test, electrophysiological evaluations and histological quantification of axons, blood vessels and lymphatic vasculature. Here, we provide for the first time a comprehensive analysis of ESWT effects on nerve regeneration in a rat model of median nerve injury. Furthermore, this study is among the first reporting the quantification of lymphatic vessels following peripheral nerve injury and reconstruction in vivo. While we found no significant direct positive effects of ESWT on peripheral nerve regeneration, results following nerve repair with MVCs were significantly inferior to those after ANG repair.

Molecular Mechanisms Underlying the Pain-Relieving Effects of Extracorporeal Shock Wave Therapy: A Focus on Fascia Nociceptors.

In recent years, extracorporeal shock wave therapy (ESWT) has received increasing attention for its potential beneficial effects on various bone and soft-tissue pathologies, yielding promising outcomes for pain relief and functional recovery. In fact, ESWT has emerged as an alternative, non-invasive, and safe treatment for the management of numerous musculoskeletal disorders, including myofascial pain syndrome (MPS). In particular, MPS is a common chronic painful condition, accounting for the largest proportion of patients affected by musculoskeletal problems. Remarkably, sensory innervation and nociceptors of the fascial system are emerging to play a pivotal role as pain generators in MPS. At the same time, increasing evidence demonstrates that application of ESWT results in selective loss of sensory unmyelinated nerve fibers, thereby inducing long-lasting analgesia. The findings discussed in the present review are supposed to add novel viewpoints that may further enrich our knowledge on the complex interactions occurring between disorders of the deep fascia including changes in innervation, sensitization of fascial nociceptors, the pathophysiology of chronic musculoskeletal pain of MPS, and EWST-induced analgesia. Moreover, gaining mechanistic insights into the molecular mechanisms of pain-alleviating effects of ESWT may broaden the fields of shock waves clinical practice far beyond the musculoskeletal system or its original application for lithotripsy.

Observation of curative effect on meridian theory-based extracorporeal shock wave therapy for non-specific low back pain: study protocol for a randomized controlled trial

BackgroundNon-specific low back pain (NLBP) is a major global socioeconomic burden, and the prevalence of NLBP is still on the rise. At present, there is no ideal drug to cure this disease. This may be the reason why patients often use complementary therapies. Among them, extracorporeal shock wave therapy (ESWT) has gradually received more attention and has become the main treatment method for NLBP. The purpose of this study is to provide scientific evidence for the effect and safety of meridian theory-based ESWT on NLBP.ObjectiveThis study aims to evaluate the effect and safety of meridian theory-based ESWT on NLBP. This study will also provide more high-quality experimental evidence for the clinical application of meridian theory-based ESWT for the treatment of NLBP in future.MethodsThe study design is a single-blind, multi-center, randomized controlled trial. 66 patients with NLBP, aged 18 to 60 years, will be randomly divided into two groups: the experimental group (N = 33), which will receive meridian theory-based ESWT application, and the control group (N = 33) which will receive conventional ESWT treatment. These two applications will be carried out twice a week for two weeks. The primary outcome will be the Visual Analog Scale (VAS), and the secondary outcomes will be Oswestry Disability Index (ODI), Surface Electromyography (sEMG), and Patient Health Questionnaire-15 (PHQ-15). All outcomes will be evaluated at baseline and after the intervention (7 days, 14 days).DiscussionResults of this trial will contribute to providing rigorous clinical evidence for the efficacy and security of meridian theory-based ESWT for NLBP.Trial registration: Chinese Clinical Trial Registry, ChiCTR2100051049. Registered on 10 September 2021, http://www.chictr.org.cn/showproj.aspx?proj=46316.

IS THE REITERATION OF EXTRACORPOREAL SHOCK WAVE THERAPY BENEFICIAL TO ENHANCE THE BONE INTEGRITY IN TYPE 1 DIABETIC RATS?

Objective: Type 1 Diabetes Mellitus is an important endocrine disease that causes disorders in the musculoskeletal system. Extracorporeal shock wave therapy (ESWT) may be effective in the improvement of these disorders due to its reported anabolic effects. Material and Methods: The effects of unfocused shock waves on the mandible in healthy and diabetic rats were investigated. 36 wistar albino rats were used and randomly divided into 4 groups: non-diabetic control (n-cont), non-diabetic eswt (n-eswt), diabetic control (d-cont), diabetic eswt (d-eswt). Geometric structure, bone mineral density (BMD) and biomechanical properties of the mandibles were analyzed. Datas were statistically analyzed by one-way variance analysis and Tukey post-hoc test. Results: According to the results, BMD was lower in the diabetic groups. There was no significant increase in ESWT groups. The surface area of the mandible was significantly lower in the diabetic groups than in the n-cont group. However, it was significantly higher in the d-eswt group than in the d-cont group. Ultimate load values were found to be significantly lower in the d-eswt group than in the d-cont group. While there was no significant difference between the groups in terms of stiffness, ultimate strain and young modulus, lower ultimate stress values were observed in the d-eswt group compared to the d-cont group. Conclusions: As a result, type 1 Diabetes Mellitus caused a decrease in bone dimensions and bone mineral density, but did not affect the biomechanical properties. Interestingly, ESWT application caused the bone to be more fragile in diabetics

Orthodontic force and extracorporeal shock wave therapy: Assessment of orthodontic tooth movement and bone morphometry in a rat model

ObjectiveThe objective was to investigate the effect of extracorporeal shock wave therapy (ESWT) on the magnitude of orthodontic tooth movement, in a rat model, based on a previously established treatment protocol. DesignIn conjunction with orthodontic force commencement, rats underwent ESWT. The amount of tooth movement along with different microarchitectural parameters were measured after three weeks by means of microcomputed tomography. In addition, the percentage of cells expressing vascular endothelial growth factor, the number of tartrate-resistant acid phosphatase (TRAP) positive cells/area and blood vessel density were evaluated both for the pressure and tension sides. ResultsThe addition of ESWT to the orthodontic force after three weeks more than doubled the average tooth movement. The addition of ESWT on the pressure side induced a significant decrease in volumetric bone mineral density. Blood vessel density and the number of TRAP positive cells were higher after the application of ESWT. ConclusionThe induction of ESWT during orthodontic tooth movement in a rat model increases the rate of tooth movement by accelerating bone resorption on the pressure side and possibly enhances bone formation on the tension side.

Extracorporeal Shockwave Therapy for Treating Chronic Low Back Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Objective To assess the effectiveness and safety of extracorporeal shockwave therapy (ESWT) for the treatment of chronic low back pain (CLBP). Methods This was a systematic review and meta-analysis of randomized controlled trials (RCTs) designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement standard. We identified relevant studies by searching multiple electronic databases, trial registries, and websites up to April 30, 2021, and examining reference lists. We selected RCTs that compared ESWT, in unimodal or multimodal therapeutic approaches, with sham ESWT or other active therapies. Two investigators independently extracted data and assessed the risk of bias and quality of the evidence. The main outcomes were pain intensity and disability status, examined as standardized mean differences (SMD) with 95% confidence intervals (CI). The risk of bias was assessed by using Cochrane Back and Neck (CBN) Group risk of bias tool and Jadad score, and GRADE was applied to determine the confidence in effect estimates. Heterogeneity was explored using sensitivity analysis and meta-regression. Results Ten RCTs, including a total of 455 young to middle-aged individuals (29.2–55.8 years), were identified. Compared with control, the ESWT group showed lower pain intensity at month 1 (SMD = −0.81, 95% CI −1.21 to −0.42), as well as lower disability score at month 1 (SMD = −1.45, 95% CI −2.68 to −0.22) and at month 3 (SMD = −0.69, 95% CI −1.08 to −0.31). No serious shockwave-related adverse events were reported. Conclusion The use of ESWT in CLBP patients results in significant and quantifiable reductions in pain and disability in the short term. However, further well-conducted RCTs are necessary for building high-quality evidence and promoting the application of ESWT in clinical practice.